Meeting People Where They Are: A Harm Reduction-Based Approach to Services for Sex Workers
written with Zooey Zara
What Is “Harm Reduction?”
Harm reduction originally referred to an approach for substance use treatment. According to the Harm Reduction Coalition (n.d.), harm reduction seeks to reduce the negative consequences associated with a practice such as drug use. Harm reduction neither condones nor condemns any behavior, is non-judgmental, gives the individual agency, and recognizes social inequalities, like those stemming from poverty, racism, and gender-based discrimination. The National Health Care for the Homeless Council (2010, April) gives six principles of harm reduction:
1. “Individual’s decision… is accepted” (p. 1)
2. “Individual is treated with dignity” (p. 1)
3. “The individual is expected to take responsibility for [their] own behavior” (p. 1)
4. “Individuals have a voice” (p. 1)
5. “Reducing harm…” (p. 1).
6. “No pre-defined outcomes” (p. 1)
In terms of sex work, harm reduction can be contrasted to abolition, which seeks to do away with the sex trade. In contrast to harm reduction, abolitionism makes value judgements about behaviors and does not recognize social inequities. Furthermore, abolitionism often conflates consensual sex work with sex trafficking by assuming force, fraud, or coercion.
Abolitionist Laws and Decriminalization: The United States, Sweden, and New Zealand
Comparing prostitution policies is challenging as researchers do not share an understanding of what constitutes a particular model or which general policy models exist. In a European Commission Policy Brief, “Preventing Exploitation and Trafficking within the Sex Work Sector,” Petra Östergren (2017) proposes a prostitution policy typology. The three general prostitution policy models she presents are: repressive, restrictive and integrative (Östergren, 2017).
An abolitionist approach to sex work falls within a repressive policy regime, which understands sex work to be a negative social phenomenon. Repressive policy regimes intend to eliminate sex work through criminalization and criminal law. This is the current policy approach within the United States and the dominant policy rationale is based on religious morality and moral harm. Sweden also operates through a repressive regime by making the purchasing of sex illegal, though the dominant policy rationale there is based on feminist ideology equating prostitution as violence against women. A repressive policy regime, however, does not eliminate obstacles to detecting, reporting, and preventing crimes. In actuality, it creates them. Although it is vital for sex workers to be able to turn to law enforcement, their relationship is defined by a lack of trust. Without access to ordinary legal means, sex workers are limited in reducing vulnerability, discouraging inappropriate client request, or combatting exploitation by employers or third parties. Furthermore, sex workers have limited to no access to labor rights, social security, medical assistance, self-organization, or community (Östergren, 2017).
A restrictive policy regime also views sex work as negative in itself, however, it uses a more pragmatic approach than the repressive regime. A restrictive regimen aims to regulate the conditions in which sex work takes place by using criminal and administrative law. The dominant policy rationale for a restrictive policy is also based on religious or moral harm (Östergren, 2017).
As opposed to repressive and restrictive policy regimes which have abolitionist intentions, an integrative policy regime aligns most closely with a harm reduction approach to sex work. An integrative regime recognizes sex work as a “multifaceted phenomenon containing negative elements;” sex workers as service providers subject to stigma; and the need to integrate sex work into existing social and legal structures (Östergren, 2017, p. 2). This is a human rights-based policy rationale. This policy aims to protect those selling sex from harm through labor, commercial, and administrative law regulating employment rights, as well as through legislation against exploitation. Furthermore, it seeks to implement directives and ‘codes of conduct’ for authorities and business owners; and campaigns to combat stigma and improve working conditions. Similar to the harm reduction model, an integrative regime believes sex workers are in the best position to make decisions about their own lives and livelihood (Ostergren, 2017).
This is the current model within New Zealand which decriminalized sex work with the Prostitution Reform Act in June 2003 (Bellamy, July 10, 2012). New Zealand takes measures to protect sex workers from violence and exploitation, and emphasizes collaboration between sex service organizations and law enforcement to prevent crime (Östergren, 2017). While Östergren (2017) explicitly avoids recommending a policy type to adopt, the advantages of an integrative regime and decriminalization are vast. International human and labor rights organizations, such as Amnesty International (2016), advocate for the decriminalization of sex work. However, these advantages cannot be realized without first addressing the vulnerabilities sex workers face and redistributing resources away from abolitionist and anti-trafficking efforts and legislation (Östergren, 2017).
A Harm Reduction-Based Approach to Services: Thailand, India, and the United States
The Sex Workers’ Outreach Project (SWOP) Los Angeles is a local chapter of SWOP USA, a national sex workers’ rights organization, that seeks to decriminalize and destigmatize sex work through outreach, education, and advocacy. SWOP LA’s Services Committee provides direct services to sex workers according to a harm reduction, rather than an abolitionist, model. Abolitionist approaches, particularly in the United States, often attempt to “rescue” workers from sex work without providing them with another source of income. In their newsletter, SWOP Behind Bars (personal communication, September 16, 2018) reports that more than 18,000 women, 91% of them Asian, have gone through prostitution diversion programs in New York City in the last few years. They are court mandated to take part in services such as yoga classes, shamed-based counseling, and immigration services, but they are not provided with housing, jobs, or money. As Melissa Gira Grant (2014) writes of these diversion programs, “Even for those who wish to leave the sex trade, their demands to seek an alternative income would hardly be met by the elimination of their current one” (pp. 99–100).
In Europe, the situation is much the same. According to Giulia Garofalo (2010), the forced “rescue” associated with “anti-trafficking” efforts targets migrant women and frequently results in their criminalization and deportation. Sometimes in Europe, if a woman “admits” to being a victim of trafficking she will be allowed to allowed to stay in the country to take part on a “rehabilitation” program, but she will be banned from working and encouraged if not forced to give evidence against her “traffickers” during this time. After this, she will be deported and travel restrictions may be applied to her passport.
In contrast to an abolitionist approach, a harm reduction-based approach does not try to prevent workers from doing sex work, but tries to make the conditions under which they work safer. The harm reduction model assumes that people are in the best position to make decisions about their own lives and livelihood. For example, in Thailand sex worker activist organization EMPOWER has a bar owned and run by sex workers in Chiang Mai, the Can Do Bar, that has safe working conditions, fair labor practices, and makes safer sex supplies freely available to both staff and customers, and in Kolkata, India the Durbar Mahila Samanwaya Committee, a West Bengali sex worker collective, runs the Sonagachi Project, named after the city’s red light district, to reduce the incidence of HIV among workers (EMPOWER Foundation, n.d.; Durbar Mahalia Samanwaya Committee, n.d.). The Sonagachi Project has reduced the the HIV prevalence rate among sex workers to 5%, as compared to 60% in Mumbai (Mukerjee, 2006, April 1). Like these other sex worker led organizations, SWOP LA utilizes the harm reduction model to improve the physical and mental health of workers though it’s outreach to outdoor sex workers and its health-related education and trainings.
SWOP LA has participated in the Asian Pacific AIDS Intervention Team’s Midnight Stroll, a monthly street outreach program for homeless LGBT youth in Hollywood. The Midnight Stroll distributes food and hygiene supplies to the homeless, but it also provides safer sex supplies to trans street workers on Santa Monica Boulevard. SWOP LA also partners with LA County Department of Public Health as a member of their condom distribution program. We have developed our own monthly street outreach program offering safer sex and hygiene supplies to street workers in South Central Los Angeles, and we are currently the only non-church group doing street outreach in this area, despite the fact that it is the largest stroll in LA. Soon we will be adding an additional outreach location in East Hollywood/Echo Park to provide safer sex and hygiene supplies to trans street workers in this area. We are presently attempting to coordinate with the Los Angeles Police Department (LAPD) so that we can continue this important work without putting ourselves or other workers at risk of arrest. Although the three condom rule has been illegal in California since 2014, the LAPD regularly uses more than two condoms as evidence of prostitution, even including a space to include number of condoms on routine prostitution arrest forms.
Through our street outreach efforts, SWOP LA hopes to build trust with less-privileged sex workers, such as trans-workers and workers of color, and get them involved with the organization so that we can center their needs and perspectives. As a step toward this goal, SWOP LA has starting a peer-support group for sex workers, particularly survival workers, led by a social worker who is also a sex worker. Moreover, in the future we plan on partnering with Homeless Health Care LA to provide needle exchange services to trans street workers in Hollywood and possibly also Skid Row.
Furthermore, SWOP LA uses a harm-reduction based approach in its health-related education and training efforts. In August, SWOP LA took part in a two part, eight-hour HIV Promotoras training led by one of our members at the East Los Angeles Women’s Center, where seven additional members became certified as HIV peer educators. As a final qualification for certification, each member was asked to provide HIV training to at least ten other people in their communities. When SWOP LA tabled at the University of Southern California’s Student Assembly for Gender Empowerment Feminist Involvement Fair later that month, we provided HIV education to students visiting our table. Finally, SWOP LA took part in a drug overdose prevention training hosted by Community Health Project LA, in which members received a free Narcan nasal spray and learned how to administer it.
Policy Recommendations after SESTA/FOSTA
Within the US, the conflation of sex trafficking and consensual adult sex work is a platform for political grandstanding and law enforcement funding. In April 2018, the US Congress and President Trump passed the Stop Enabling Sex Traffickers Act (SESTA) and the Allow States and Victims to Fight Online Sex Trafficking Act (FOSTA), bills seeking to abolish sex trafficking by holding websites accountable for third-party content, targeting websites with ads for prostitution. This bill package makes no distinction between sex trafficking and consensual adult sex work, and within two weeks of passing, more than twenty popular websites sex workers utilized for advertising and screening were shut down. Members of Congress received letters of opposition regarding SESTA and FOSTA from the Department of Justice; the American Civil Liberties Union; the National Center for Transgender Equality; and the Freedom Network, the largest network of anti-trafficking organizations in the US; and its negative impact has been immediate (COYOTE-RI, 2018)
Call Off Your Old Tired Ethics (COYOTE) Rhode Island (2018) reported on collected data from a SESTA/FOSTA Impact Survey conducted during April and May of 2018. Their results found that sex workers experienced a decrease in safety and an increase in danger as a direct result of SESTA/FOSTA. Sex workers surveyed saw a decrease in income, available clients, screening practices, and bargaining power while experiencing an increase of risk taking, contact from ‘pimps’, predators preying on desperation, and demands for cheaper services. 60% of sex workers surveyed reported taking on less safe clients to make ends meet. 65% reported being threatened, exploited, or propositioned for ‘freebies’ recently. Before FOSTA, 90% reported screening their clients, and after FOSTA, only 63% said they still screened (COYOTE-RI, 2018). Furthermore, SESTA and FOSTA have prevented anti-sex trafficking advocates from finding real trafficking victims (Q, 25 May 2018). Abolitionist laws and repressive policy regimes do not work.
In “Preventing Exploitation and Trafficking within the Sex Work Sector,” Östergren (2017) offers counterbalance measures and recommendations for policy-makers supporting repressive regimes to consider:
● “Ensure that sex workers can access health and safety services that are non-conditional and non-discriminatory” (p. 7).
● “Implement amnesty practices” when reporting a crime (p. 7).
● “[S]uppress the name and occupation of” sex workers, clients, or third parties who “appear as witnesses” (p. 7).
● Change laws “assisting in sex workers’ safety measures” (p. 7).
● “Create ‘police-liaisons’ to whom migrant and domestic sex workers can turn” (p. 7).
SWOP LA supports such counter-balance measures as they align with harm reduction principles, and recognize the need for implementation, especially in the wake of SESTA/FOSTA.
Amnesty International (2016, May 26). Amnesty International report on state obligations to respect, protect and fulfill the human rights of sex workers. Retrieved from https://www.amnesty.org/download/Documents/POL3040622016ENGLISH.PDF
Bellamy, P. (2012, July 10). Prostitution law reform in New Zealand. Retrieved from https://www.parliament.nz/en/pb/research-papers/document/00PLSocRP12051/prostitution-law-reform-in-new-zealand
COYOTE-RI. (2018). After FOSTA slide show [Google Presentations Slides]. Retrieved from https://docs.google.com/presentation/d/1KBsVBQh7EsRexAyZacaf_fUvvsVb2MR1Q3_gV7Jegc/edit#slide=id.p
Durbar Mahalia Samanwaya Committee (n.d.). Health care. Retrieved from https://durbar.org/html/health_care.html
EMPOWER Foundation (n.d.) Can do! Retrieved from http://www.empowerfoundation.org/barcando_en.html
Garofalo, G. (2010). Sex workers’ rights activism in Europe: Orientations from Brussels. In M. H. Ditmore, A. Levy, & A. Willman (Eds.), Sex Work Matters: Exploring Money, Power, and Intimacy in the Sex Industry (pp. 221–238). London: Zed Books.
Grant, M. G. (2014), Playing the Whore: The Work of Sex Work, London: Verso.
Harm Reduction Coalition (n.d.). Principles of harm reduction. Retrieved from https://harmreduction.org/about-us/principles-of-harm-reduction/
Mukerji, M. (2006, April, 1). The prostitute’s union. Scientific American. Retrieved from https://www.scientificamerican.com/article/the-prostitutes-union/
National Health Care for the Homeless Council (2010, April). Harm reduction: Preparing people for change. Retrieved from https://www.nhchc.org/wpcontent/uploads/2011/09/harmreductionFS_Apr10.pdf
Östergren (2017, June). Preventing exploitation and trafficking in the sex work sector. Retrieved from http://demandat.eu/sites/default/files/DemandAT_PolicyBrief_Preventing%20 Vulnerability.pdf
Q, S. (2018, May 25). Anti-sex trafficking advocates say new law cripples efforts to save victims. Rolling Stone. Retrieved from https://www.rollingstone.com/culture/culture- features/anti-sex-trafficking-advocates-say-new-law-cripples-efforts-to-save-victims- 629081/