Perspectives on public health and sex work in New Zealand
Sex workers’ health and safety are significant aspects of the 2003 Prostitution Reform Act but what do health and safety actually entail from a public health perspective?
by Fraser Crichton
The Ministry of Health (New Zealand)’s Information Technology department has the unusual responsibility for relaxing rather than enforcing filters for online adult content. Under New Zealand’s Prostitution Reform Act 2003 (PRA) regional health authorities are responsible for proactively locating and approaching commercial sex operators to ensure they comply with their responsibility for promoting safer sex practices. With no register of operators or sex workers allowed under the PRA, the Ministry use the internet, the yellow pages and newspaper ads to locate commercial operators.
New Zealand is one of the few countries in the world where sex work is fully decriminalised. Under Section 8 of the PRA workers and clients, “must take all reasonable steps to ensure commercial sex services are not provided without using a condom or other appropriate barrier,” including vaginal, anal or oral sex, or any other activity that may lead to the transmission of STIs, HIV or hepatitis. Under the legislation workers and clients can be fined up to $2 000 and operators $10 000 for not taking all reasonable steps to use a condom and clients have been fined for removing condoms. Operators of businesses must also adopt and promote safer sex practices, including appropriate health information signage.
Dr Annette Nesdale, as a Medical Officer of Health, is tasked with ensuring compliance and has the power to inspect commercial businesses and to appoint health protection officers as inspectors.
The Ministry provides formal health promotion information in the form of Health and Safety Information for Sex Workers and Health and Safety Information for Operators of Businesses of Prostitution.
Whilst the Ministry has the formal role of ensuring compliance the Occupational Safety and Health Service (OSH) of the New Zealand Department of Labour’s A Guide to Occupational Health and Safety in the New Zealand Sex Industry sets out the practical expectations around roles, responsibilities, health, workplace amenities, security and safety for workers in the New Zealand sex industry.
It’s important to note that under the OSH guidelines workers can refuse clients or withdraw consent at any time. This serves all workers including outdoor workers who reference the PRA legislation as strengthening their ability to negotiate with clients. Behind all this regulation is a commitment to health promotion as a central strategy for public health in New Zealand.
According to the World Health Organisation, health promotion enables people through knowledge, skills and information to make healthy choices for themselves. Paternalistic approaches to sex worker health — for instance, formal registers of workers and mandatory testing — are not part of the New Zealand approach. Under the PRA, OSH recommends workers have regular health checks twice a year but it is the responsibility of workers to decide in practice when that should be. Along with health promotion the Ministry favour harm reduction strategies to all aspects of public health (New Zealand was one of the first countries to adopt needle exchanges in 1987).
In regard to sex work policy, decriminalisation is considered a harm reduction approach because it addresses the harms that come with the criminalisation and stigma associated with sex work. In countries like Scotland, which does not have a decriminalised system, the police have used condoms as evidence of sex work to prosecute workers or their employers with obvious health risks for workers.
Dr Nesdale stresses that harm reduction also applies to the mental health of workers. “How can someone’s work be outside the law and also conducive to health? If you think about health in the broader sense of your physical health, your mental health, your confidence, your well being I just can’t imagine spending my working life outside the law and being able to maintain a strong sense of self.”
Why is there no register of sex workers?
Mandatory registration of sex workers is controversial for a number of reasons. Catherine Healy, the New Zealand Prostitutes’ Collective (NZPC)’s National Coordinator explains why registers were abolished under decriminalisation saying, “A register stigmatises sex workers and it is usually held by a governmental authority. It means the name of the sex worker is forever tagged to sex work, and can later surface beyond the sex worker’s control in other contexts and create problems. For example, there are occupations that may require deep security checks or countries which will not allow sex workers to visit that may discover via such a registration system that someone is or has been a sex worker.”
“People fall out of registration schemes and are then pushed to the margins and excluded from being able to either work or access support services.” - Catherine Healy, NZPC
Healy believes registers are an unnecessary intrusion into the life of workers and goes on to say that a register, “usually appeals to authorities, brothel operators and clients who usually want to sort out ‘good’ sex workers from the rest. It is is an illogical way to support sex workers who need support. People fall out of registration schemes and are then pushed to the margins and excluded from being able to either work or access support services.” Dr Nesdale agrees that a register would have worked against the intention of better health outcomes saying, “If there had been a list then our visits would have had a different tone.”
Why has mandatory testing not been adopted?
NZPC identify two issues with mandatory testing, “It sets up an expectation that all sex workers have been checked and clients can relax about safe sex. This can place pressure on sex workers to have unprotected sex. It also places pressure on sex workers to organise a check up at a time that may not suit them or be of use to maintain good health,” says Healy.
Mandatory testing frameworks like that in Victoria, Australia can also expose workers to stigma and direct discrimination from health care professionals. Helping workers avoid stigma is one reason why NZPC provides free, confidential sexual health services through on-site clinics and dedicated health professionals.
The role of the New Zealand Prostitutes’ Collective
NZPC - as a peer-led sex worker organisation - plays a vital role in health promotion according to Dr Nesdale. NZPC receives funding from the Ministry to provide confidential sexual health services and free sex worker packs containing health promotion material, condoms, lube and dental dams.
“This is not about the health police coming down.”- Dr Annette Nesdale
NZPC also work closely with inspectors from the Ministry. Dr Nesdale says they have a crucial bridging role in ensure commercial operators understand, “this is not about the health police coming down.” NZPC have also worked with commercial operators recently on a voluntary Sex Workers’ Safety Accord — All Business Code of Conduct that further strengthens the rights of workers.
New Zealand’s OSH guide to health and safety is a unique document. It sets out genuine rights for workers in New Zealand’s sex industry. It’s a document that exists because of direct input from workers in one of the few countries in the world where legislators listen to sex workers and treat their concerns seriously.
Fraser Crichton is a Scottish documentary photographer and writer currently based in Melbourne. He works on long term personal documentary projects in a variety of media including writing, photography and video. His current longterm project Faces Behind the Voices explores and supports sex worker’s rights.