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Legalisation of sex work associated with lower prevalence of HIV in sex workers
Roger Pebody, 2017-02-07 07:30:00

Countries that have legalised some aspects of sex work have fewer sex workers living with HIV than countries that criminalise all aspects of sex work, according to an ecological analysis of 27 European countries published online ahead of print in the Lancet HIV.

The association remained statistically significant after adjustment for countries’ economic development, HIV prevalence, antiretroviral therapy coverage and proportion of sex workers who inject drugs.

“Our findings suggest that the legalisation of some aspects of sex work might help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair,” say Aaron Reeves and colleagues.

Although the prevalence of HIV tends to be higher in sex workers than in the general population, prevalence varies between European countries, suggesting that structural factors might play a part.

Structural determinants of HIV risk include sex work policy, particularly laws that criminalise buying, selling, or procuring sex. They may increase HIV risk through recurrent police harassment, violence, and arrests or fear of arrests of female sex workers or clients, which can perpetuate unsafe working conditions, drug use risks, and physical or sexual violence against sex workers without recourse. Such insecurity can make it more difficult for sex workers to negotiate condom use, especially if condoms can be used as evidence in judicial proceedings.