Even though people often relate prostitution to women who acquire financial benefits by offering clients with sexual services, in actuality, the concept of prostitution is quite broad which involves both female and male gender, only the latter was not quite popular (at least in Malaysia). Even though the traditional concept laid out in prostitution involves two consenting adults which were having sexual intercourse in return for paying the prostitute some money, if we disregard the financial rewards, sexual intercourse would never have been consented by the provider, pointing out some sort of technical errors (the consent was motivated by acquiring financial benefit) in the concept of prostitution. Nevertheless, if we did some risk assessments on the consumers, traditionally, it is the product that was being subscribed/purchased/used that might pose a greater risk to the consumer; a cigarette is one of the products which can be a great example to this concept.
People who were smoking cigarettes were exposed to various kind of health complications and problems including lung diseases and numerous form of cancers. Every year, the financial records documented by tobacco's companies related to the damage potentially caused by cigarettes towards the general well-being of its consumer's increase (close to a trillion dollars). Usually, it is the product which has been causing damage to the consumers, not the other way around but in prostitution, the greater risk might have been shouldered by the "product" instead. Of course, people who subscribed to the service provided by a prostitute are prone to become affected by sexual-transmitted diseases but so do the prostitutes themselves. In addition to that point, the prostitute might have been willing to be abused by their client for the sake of making an extra income (masochism, devoid from the use of condoms) making them bore the greatest risk among the two (or three, if you include trafficker as well).
Prostitution has been an important part of various cultures although it doesn't bode well with what is considered an accepted form of behaviour among numerous societies. It is known that sometimes, people called prostitution as the oldest profession in the world although the validity of such statement is kinda debatable. They have been involved with various sectors and often were treated as some kind of bribe to be given to other people to earn a necessary political (or other forms of collaboration) advantage over the other. If we want to analyse prostitution from the perspective of a prostitute, we can say (well not quite clearly) that prostitution can be a form survival strategy which is assumed by the prostitute by exposing themselves to numerous health-related risks while expecting money which is considered as an important tool that enable us to survive in this world.
People who have been involved in prostitution usually came from a poor family background, homeless, have problems with drugs or they were separated from their own families due to personal issues. In United State, 1% out of the total of American citizens were prostitutes and around 75% of them came from a poor family background. The statistic was merely an estimation and the source of such information is unknown but if it was, in fact, true, it's quite a significant number won't you say? People have been throwing the luxury of living healthily under the bus for the sake of living a good life. According to a study conducted by Ward and Day in 2006 which involved 130 out of 354 women from a prior cohort study has found that prostitutes were 93% prone to contract sexually transmitted diseases which include gonorrhoea, herpes, pelvic inflammatory diseases and sure, AIDS (Ward and Day, 2006).
Decriminalisation Of Prostitution
Dealing with issues related to prostitution such as infidelity, sexually transmitted diseases and abuse can be very difficult. The majority of religions (if not all) in the world, view prostitution as a form of taboo and often, indirectly, stigmatise those who currently or used to be involved with such institution even with all of the ethical principles which have been taught in their respective religions to never treated someone else for their past sins; we are humans after all, eh? There were numerous attempts in the past in various countries to decriminalise the institution related to prostitution in order to establish a law which can be used to protect women or those who were involved. In New Zealand (2003), there were a few organisations which have come together with notions to legalise prostitution industry and demanded people that owned brothels, pimps and anyone who has been dealing with clients to be called as businessmen instead. Almost as high as 95% of the 772 sex workers who have been interviewed felt safe and secure by the law which has been upheld for them after decriminalisation of prostitution in New Zealand.
In medical perspective, legalisation of prostitution would allow a better coverage of health promotion program among prostitutes. This would include practising safe sex, getting a proper sexual education, starting treatments for sexually transmitted diseases etc. I'm not saying governments should legalise prostitution per say, but as a medical doctor who is interested in preventative medicine, I believe that if we can't seem to forbid something, we should educate and treat people to minimise risk or damage. A paper which was published in the Review of Economic Studies regarding prostitution has found a significant decrease (more than 40%) of the incidence of gonorrhoea among women who were involved in prostitution (Source). However, it would be a problem if people who manage prostitutes do not want to register or getting a license for their brothel which makes the operation they were doing, illegal, thus denying their sex workers the medical benefit of being a prostitute. This situation was illustrated by most of the illegal brothel in Melbourne through a study which was published in the Australian and New Zealand Journal of Public Health in 2010 (Source).
Stigma In Regards To Prostitution
Now let's talk about stigma. If you are quite familiar with this word, you should know that stigma existed in many conditions and it is usually understood as an act of social discrimination to people who were having a specific trait which is viewed by the society as undesirable. Down syndrome, chronic diseases, permanent disabilities and HIV; all of them are some of the well-known reasons for stigmatisation within a society. Prostitution, even after they have been decriminalised, can be undesirable for certain societies thus stigmatisation is imminent. Why did I use the word "can be undesirable"? This is because there were numerous factors which can contribute to stigmatisation and mainly, it will be affected by the society imagination regarding prostitution. People have been treating prostitutes as the lowest scum within a society when most of them preached how valuable every single soul which have been living on the earth are.
Let's take the murder case of Tracy Connelly in 2013 as an example. Connelly is one of the sex workers who has been showing her support towards a global campaign which has been raising awareness regarding sexual abuse (violence) towards sex workers. One day after the demonstration, she was murdered brutally in her van but the media seems reluctant to report such news to the public. Even if the news was reported, the term "prostitute" that will surely be used by the media to describe Connelly would have a distancing effect, meaning the population of women who were not prostitutes would feel relief by the fact that the one who has been murdered is a prostitute. If for the sake of argument, a normal woman was murdered instead, I'm sure the whole country (or world) would become chaotic and all of the women (yes, all of them) would feel insecure and threatened by such news. Describing someone in the news as a prostitute is irrelevant in my opinion, but due to stigma, it suddenly becomes a relevant factor that the public should know about to access the level of danger in regards to the crime being committed.
Even if we can't see it directly, stigma among sex workers, even if they were decriminalised by law, can bring a significant damage to the society. Obviously, we can't (or it is bloody difficult) stop people from subscribing to the service provided by prostitution so it would depend on the prostitutes themselves whether they have the courage to seek medical treatment, sexual education or to refuse any kind of unusual request from their clients (sex without protection for example). Whether or not they feel motivated to seek or learn will depend largely on the perception of the surrounding communities. Without proper education on safe sexual intercourse, the probability for either the client or the prostitute to be affected by sexually transmitted diseases and sexual abuse will increase. Aside from getting good opportunities for education and medical treatment, sex workers often been denied the luxury of having their own accommodation, any shot at other job opportunities and they might seem less valuable, legally speaking.
Now let's talk about social support. Do you think it is easy for a sex worker to find someone who accepts them for who they really are? Honestly speaking, I am a wee bit uncomfortable last week, when I was treating a sex worker in the clinic but after awhile, I've realised that most of them were quite nice. They knew how to mingle (maybe it's like a pre-requisite for their career) but it doesn't erase the fact that most of them were having some problem when it comes to social support. There were no other people (be it relatives or parents) that would listen to them if they were in trouble and if we consider the fact that they were often ostracised by the society due to the nature of what they were doing on a daily basis, then they would have a limited list of options when it comes to solving whatever they were facing. Without any encouragement and the opportunity to express their emotion, the problem can turn psychological which can make it worse for them. Frankly speaking, they (sex workers) were prone to depression and depression can affect an individual immune system which will make them prone to get be infected.
Healthcare For Sex Workers
Nowadays, there were many volunteer programs which are organised to help homeless people and people who were less fortunate. People have been going from a place to another, giving out free foods, providing free medical checkups and all but how many volunteer programs that you have ever heard off designed specifically to cater for sex workers? Maybe a few or none at all. Sex workers are one of the most under-screened or under-treated population even though we know the fact that they were exposed to all kind of infections most of the time of their life. Speaking about sex workers, they can be divided into two groups which are the street sex workers and the parlour sex workers (classification based on their place of operation). According to a study conducted by Jeal and Salisbury in 2007, sex workers who work in a parlour are more likely to get medical checkups and treatment for any sexually transmitted diseases compared to street sex workers. This can be due to some policies that they have to satisfy while people who were working on the street are mostly freelancers.
People who were leaving on the street were usually associated with low level of knowledge especially when it comes to recognising the signs and symptoms of infections or any chronic diseases. They were unable to get their hands on good foods, medical insurance and transportations which might have been the other factors that determine the state of their general health. According to a study conducted by Potterat et al in 2004, the commonest cause of death among sex workers in the United States was homicides followed by drug and alcohol abuse and last but not least, HIV infection. It's quite difficult to organise a volunteer program which could cater for sex workers due to some forms of stigma and the fact that prostitution is illegal in most countries but if we could encourage and educate them on matters related to safe sexual intercourse, it would help the community a lot.
Sources
- Risks of Prostitution: When the Person Is the Product
- What happens to women who sell sex? Report of a unique occupational cohort
- Women in Street Prostitution: The Result of Poverty and the Brunt of Inequity
- The decriminalisation of prostitution is associated with better coverage of health promotion programs for sex workers
- This is what really happens when prostitution is decriminalised
- The stigma of sex work comes with a high cost
- Decriminalising sex work is the only way to protect women – and New Zealand has proved that it works
- Decriminalising prostitution could 'dramatically' reduce sexual violence and STI transmission, finds study
- The Failure of Governments to Protect Sex Workers from Discrimination
- Dehumanising sex workers: what’s ‘prostitute’ got to do with it?
- Access to healthcare for long-term conditions in women involved in street-based prostitution: a qualitative study
- Health needs and service use of parlour-based prostitutes compared with street-based prostitutes: a cross-sectional survey.
- Mortality in a long-term open cohort of prostitute women.
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