Prostitution - Medical Situation

Medical Situation

In some places, prostitution may be associated with the spread of sexually transmitted diseases (STDs). Lack of condom use among prostitutes and their clients has been cited as a factor in the spread of HIV in Asia: "One of the main reasons for the rapid spread of HIV in Asian countries is the massive transmission among sex workers and clients". As a result, prevention campaigns aimed at increasing condom use by sex workers have been attributed to play a major role in restricting the spread of HIV.

One of the sources for the spread of HIV in Africa is prostitution, with one study finding that encounters with prostitutes produced 84% of new HIV infections in adult males in Accra, Ghana. The spread of HIV from urban settings to rural areas in Africa has been attributed to the mobility of farmers who visit sex workers in cities, for example in Ethiopia. Some studies of prostitution in urban settings in developing countries, such as Kenya, have stated that prostitution acts as a reservoir of STDs within the general population.

Typical responses to the problem are:

• banning prostitution completely
• introducing a system of registration for prostitutes that mandates health checks and other public health measures
• educating prostitutes and their clients to encourage the use of barrier contraception and greater interaction with health care

Some think that the first two measures are counter-productive. Banning prostitution tends to drive it underground, making safe sex promotion, treatment and monitoring more difficult. Registering prostitutes makes the state complicit in prostitution and does not address the health risks of unregistered prostitutes. Both of the last two measures can be viewed as harm reduction policies.

In countries and areas where safer sex precautions are either unavailable or not practiced for cultural reasons, prostitution is an active disease vector for all STDs, including HIV/AIDS, but the encouragement of safer sex practices, combined with regular testing for sexually transmitted diseases, has been very successful when applied consistently. As an example, Thailand's condom program has been largely responsible for the country's progress against the HIV epidemic. It has been estimated that successful implementation of safe sex practices in India "would drive the epidemic to extinction" while similar measures could achieve a 50% reduction in Botswana. In 2009, UN Secretary-General Ban Ki-moon urged all countries remove bans on prostitution and homosexual sex, because "such laws constitute major barriers to reaching key populations with HIV services". In 2012, the Global Commission on HIV and the Law, which was convened by Ban Ki-moon, and which is an independent body, established at the request of the UNAIDS, and supported by a Secretariat based at the UNDP, reached the same conclusions, also recommending decriminalization of brothels and procuring. Nevertheless, the report states that:"The content, analysis, opinions and policy recommendations contained in this publication do not necessarily reflect the views of the United Nations Development Programme."