Thread by @WilsonKM2

Sex work study live-tweet starting now.

Tonight: A 2018 study by Wong at al published in BMC Public Health - ncbi.nlm.nih.gov/m/pubmed/29587…

The topic: What happens when you shut down brothels?

In 2001, Cambodia embarked on a campaign to encourage 100% condom use among sex workers (although the program focused primarily on brothels, presumably because of their fixed location).

This took the form of providing free STI screening and treatment to brothel-based workers...

...trsining for brothel manager's to better support condom use, and venue monitoring in the form of penalties (e.g. temporary closure) in the event of an outbreak of STIs.

And (whatever you think of those measures)... it seemed to have some positive effects.

National surveillance studies showed marked declines in STIs and increased condom use.

In 2008, Cambodia implemented a Law on Supression of Human Trafficking and Sexual Exploitation. The main effect of this law was to bam brothel bases sex work.

This study looks at the effects

To evaluated the impact of the policy shift towards criminalization, the authors analyzed data from an ongoing surveillance study that, each year from 2003 to 2012, drew random samples of heterosexual men and female sex workers attending the Mondol Moi Health Centre.

This technique allowed the researchers to track changes in safe sex behaviour from before to after the onset of brothel criminalization.

Over the course of the study, a total of 976 make sex work clients were surveyed (757 before and 219 after).

The age of clients tended to decrease from before to after the law change (median if 29 to 26 years).

Marital status shifted towards clients being less likely to be married (50.1% vs 38.7%).

The annual income of clients was typically higher after the law (59.9% made less than $100USD before the law per year, versus 28.4% after).

Alcohol consumption increased.

As one would expect, the venue in which clients saw sex workers changed dramatically after criminalization was implemented.

Before, criminalization, 77.1% of clients had only seen brithel-based workers. After, it was 52.4%

Before criminalization, 62.6% reported consistent condom use with sex workers in the past six months, compared to 36.1% after criminalization.

Before criminalization, 90.6% of those that used a condom received it from the sexual worker, compared to just 35.3% afterwards.

After criminalization of brothels, the frequency of unprotected sex went up.

And probably the biggest shift in behaviour: sex workers ability to refuse unprotected sex plummeted after criminalization.

Moreover, the total number of times clients saw sex workers wasn't affected by criminalization (about once per week before and after), but the number of unprotected visits did increase aftex criminalization (nearly doubling).

So, in summary: criminalizing brothels did not affect how often clients visited sex workers, but merely shifted the market underground and lead to an increase in unprotected sex (making the entire situation worse).

And that's tonight's study. As always, thanks for the interactions.

If you have a sex work study you'd like covered, get in touch.

See you next Sunday!