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Drug Alcohol Depend. Non-injection use of any Prostitutes Remedios last month. Quote [In a case where a participant reported being attacked by a client and the case going to court.

Studies that Prostitutes Remedios associations with registration at the municipal health department were also synthesised separately, since this policy was less comparable with all others that involved direct police action. All analyses were conducted using the metafor package in R version 3. For qualitative studies, data were synthesised inductively, Prostitutes Remedios, and thematically.

Among the body of papers that had a limited focus on the topic, we then purposively sampled studies that reported on an under-represented population, setting, legislative model, or health issue of interest in this review [ 52 ] until no new themes emerged Prostitutes Remedios saturation.

For the data-rich papers, we reviewed and Prostitutes Remedios summaries of the results and discussion sections, inductively and iteratively drawing out author- and reviewer-identified themes and sub-themes.

Correlates of Injection Drug Use among Female Sex Workers in Two Mexico-U.S. Border Cities

We then linked sub-themes and themes to 4 core categories, informed by concepts of structural, symbolic, and everyday violence that argue that mistreatment, stigma, exclusion, and ill health often result from intersecting inequalities that become institutionalised and normalised through policies, practices, and social norms Prostitutes Remedios 53 ].

Prostitutes Remedios paid careful attention to the different levels and forms of environmental influence within risk environments [ 18 ]. Finally, we reviewed the less Prostitutes Remedios papers relative to our research questions against these emerging categories until they required no further refining. We summarise the core categories narratively with illustrative quotes Box 1drawing out findings that help to unpack the quantitative Prostitutes Remedios and their causal pathways.

Within each category, we pay close attention to patterns by legislative model. From 9, papers identified, studies met the inclusion criteria, resulting in 40 papers included in the quantitative synthesis, of which 20 were included in the meta-analysis and 20 in the narrative synthesis. A total Prostitutes Remedios 94 met the inclusion criteria for the qualitative synthesis, of which 46 were included in the thematic analysis, 3 were excluded following quality assessment, and 45 were excluded when thematic saturation had been reached Fig 1.

SWs, sex workers. We identified 40 studies that measured the association between an aspect of police repression of sex workers or Prostitutes Remedios clients and our outcomes of interest.

The majority of the studies were cross-sectional 28 or serial cross-sectional 2 ; there were 9 prospective cohorts [ 27 Prostitutes Remedios, 54 — 61 ] and baseline data from 1 randomised control trial Prostitutes Remedios 62 ]. Studies were conducted in a variety of countries representing some but not all of the main sex work legislative models Table 1.

Tijuana and Cd.

Full criminalisation was Prostitutes Remedios in 3 studies in Uganda, 2 studies in China, and 1 each in Iran, Rwanda, and South Korea. Regulation models were represented by 8 studies in Mexico. No quantitative studies examined the effects of the criminalisation of sex purchase in isolation, or the effects of decriminalisation. Two studies focused on the association between criminalisation and social and criminal justice factors including further extortion by the police or history of arrest [ 63 ], any contact with the criminal justice system, being a migrant, and unstable housing [ 60 ].

Location of sex work was diverse across street and off-street settings. All studies reported an association between lawful or unlawful repressive police actions towards sex workers and outcomes, of which 21 adjusted for confounders.

We synthesised 4 studies that reported an effect estimate associated with a mandatory registration separately [ 79818990 ] but considered lawful and unlawful repressive police activities within the regulatory system as part of the pooled analysis [ 637291 ]. Three studies presented effect estimates associated with a policy change, STIs, and rushing negotiation with clients, and were also considered separately [ 577792 ].

Characteristics of all studies are summarised in Table 2. RE, random effects; STI, sexually transmitted infection. We pooled data from 9 studies that measured the association between repressive policing activities and experience of physical or sexual violence against sex workers by a range of perpetrators, including clients, intimate sex partners, and police. Random effects meta-analysis of 9 independent multivariable estimates showed that, overall, repressive policing was associated with substantially higher odds of any kind of violence 5, participants, OR 2.

Shannon, refers to [ 58 ]. RE, random effects. This overall association between police repression and violence increased slightly, but was still associated with substantially higher odds of violence, when all unadjusted estimates were pooled Prostitutes Remedios 6 studies OR 3.

Odds of experiencing physical or sexual violence by other Prostitutes Remedios defined as anyone other than Prostitutes Remedios clients, including the police was higher for those who had experienced any type of repressive police activity compared to those who had not OR 3. Similarly, physical or sexual Prostitutes Remedios from clients was higher among those who had been exposed to repressive police activity compared to those who had not OR 2.

Five studies Prostitutes Remedios the association between repressive policing activities and condom use with both paying and non-paying partners. Meta-analysis of 4 independent multivariable estimates 9, participants suggested that on average these practices were associated with increased odds of Prostitutes Remedios using a condom OR 1.

The overall association between repressive policing activities and condom use increased Prostitutes Remedios pooling unadjusted estimates from 2 studies Prostitutes Remedios 1.

Sub-group analysis suggested that the odds of condomless sex with clients was higher following policing exposure OR 1. There was no difference in the odds of condomless sex with non-paying partners Prostitutes Remedios police exposure OR 1.

Five studies looked at the Prostitutes Remedios between repressive policing activities and access to health and social care services. One study in India found that arrest in the last year was associated with increased odds of attendance at an Prostitutes Remedios clinic OR 1.

In Canada, fear of police and police harassment, including arrests, was associated with avoiding healthcare services among street-based cis women [ 85 ] and cis and trans women [ 61 ]. Geospatial analyses among the same population showed that a higher density of police enforcement practices including displacement, legal restrictions of sex work areas, and police harassment was associated with disrupted HIV treatment [ 56 ].

In Uganda, rushed negotiations with Prostitutes Remedios due to police presence was associated with less frequent dual contraceptive use OR 0. In a study in China, where HIV testing is mandatory following detention, history of arrest was associated with increased Prostitutes Remedios of having an HIV test or taking up HIV prevention interventions, but fear Prostitutes Remedios arrest was associated with decreased odds of both HIV testing OR 0.

Three studies looked at indicators of emotional ill health. In India, cis female sex workers mostly working on the street who had been arrested had increased odds of major depression defined through Patient Health Questionnaire—2 OR 1. Prostitutes Remedios Canada, recent incarceration was associated with poor emotional health outcomes among both cis and trans female sex workers in a univariable analysis OR 1. Among the same population, individuals who reported that the police had affected where they worked had increased work stress compared to those who did not report this [ 55 ].

Five studies examined the association between repressive policing practices and drug use including injecting drug use [ 606686 Prostitutes Remedios, 87 ], the use of non-prescription opioids [ 27 ], and Prostitutes Remedios alcohol drinking [ 6066 ]. Recent history of incarceration was associated with use of crystal Prostitutes Remedios among cis female sex workers in Iran [ 86 ].

Four studies reported associations between mandatory registration at a city health service in Tijuana, Mexico and health outcomes [ 79818990 ]. One study suggested that registered Prostitutes Remedios workers had reduced odds of working in a sex work venue with high prevalence of HIV or syphilis and testing positive for HIV or an STI syphilis, gonorrhoea, or chlamydia univariably.

These associations became insignificant Prostitutes Remedios adjusting for injecting risk behaviours, age, and time in sex work [ 79 ]. Of note, sex workers who test positive for HIV in this system have their registration revoked, and sex workers already living with HIV cannot work in the regulated sector; therefore, sex workers who know or suspect they Prostitutes Remedios living with HIV are unlikely to register.

Registered sex workers had reduced odds of ever injecting drugs and higher odds of being tested for HIV [ 81 ]. A final study suggested that lack of registration was associated with increased odds of unprotected sex OR 2.

Two studies in Canada evaluated a new policing guideline Prostitutes Remedios prioritised enforcement of laws against clients and third parties over arrest of sex workers introduced in Vancouver in These studies found that there was no decrease in physical and sexual violence OR 1. The introduction of an anti-trafficking policy in South Korea, accompanied by brothel closures, in was associated with a decrease in prevalence of gonorrhoea and antibodies to Treponema pallidum indicating current or past infectionbut also changes in the demographic profile of sex workers.

Sex workers Prostitutes Remedios younger in surveys conducted after the act compared to Prostitutes Remedios, which may contribute to the lower prevalence of infection, although sex workers reported receiving more clients [ 77 ]. From the 94 eligible papers including Prostitutes Remedios data, we generated 4 core analytical categories over Prostitutes Remedios unique analyses papers in different legislative frameworks and geographical settings, refining these through the inclusion of a further 9 purposively sampled papers S3 Text.

Partial criminalisation models were represented in analyses from 5 papers in Canada and 1 paper each in Hong Kong, India, Nigeria, Thailand, and the UK. Five papers focused on Canada following the introduction of criminalisation of clients, and 1 on Sweden, where that model is in place. Four papers related to New Zealand, where sex work has been decriminalised. In total, interviews with 2, sex workers were analysed, representing a range of sex work locations including street settings, truck stops, Prostitutes Remedios, massage parlours, bars, night clubs, hotels, lodges, and homes and means of meeting clients including organised in person, via phone or online, independently, and via third parties.

Just 2 papers focused exclusively on the experiences of trans sex workers, and 1 on male sex workers. Characteristics of included studies data-rich and purposively sampled [ 222634 — 364993 — ] are summarised in Table 3indicating which papers were purposively selected. A list of the other papers that were identified but not included is available S3 Text. Core analytical categories identified include disrupted workspaces and safety Prostitutes Remedios institutionalised violence, coercion, and extortion, and restricted access to justice; reproduction Prostitutes Remedios multiple stigmas and inequalities; and restricted access to health and social care and support S4 Text.

Illustrative quotes from the core categories are summarised in Box 1. For sex workers operating indoors, these laws impeded direct negotiations with clients and communication between peers about safety and sexual health [ ].

This pattern persisted in contexts where clients were criminalised. In Canada, cis and trans female sex workers continued to be displaced by police in areas undergoing gentrification, and, even when they were not targeted, some still experienced police presence as harassment [ 26]. Across diverse contexts, experience of possession of condoms being used as evidence of sex work, and experience of police raids where condoms had been confiscated, led to sex workers not carrying, using, or accessing condoms consistently [ 93Prostitutes Remedios, ] and venues restricting or not providing them [ 9398, ].

In South Australia, sex workers attributed the latter to increased raids, closures, and Prostitutes Remedios recent arrest of a venue owner [ 98 Prostitutes Remedios.

A lack Prostitutes Remedios legal protection left sex workers vulnerable to exploitation by venue managers who could restrict access to information on their working and legal rights []. In Guatemala, some venue managers warned sex workers about raids, but, in common with experiences in Sri Lanka [ Prostitutes Remedios, others encouraged them to provide officers free sexual services to avoid their prosecution Prostitutes Remedios ].

In India, some brothel owners paid police to avoid raids, or allowed pre-selected sex workers to be arrested Prostitutes Remedios 99 ]. Conversely, where certain indoor work places were informally approved by police in a wider landscape of criminalisation, as occurred in low-barrier housing Prostitutes Remedios women in Canada, the removed threat of Prostitutes Remedios penalties fostered venue-level safety strategies, in which sex workers could refuse unprotected sex or call the police in the event of a client Prostitutes Remedios violent Quote 7 [ ].

Similarly, in the context of decriminalisation in New Zealand, cis female sex workers working on the street reported greater police presence contributing to their protection as well as increased time for screening clients Quotes 8 Prostitutes Remedios 9 Prostitutes Remedios 3694 — 96 ].

Sex workers across sectors reported being able to negotiate services more directly and refuse clients [ 36 ]. Police became more focused on sharing information with Prostitutes Remedios about violent incidents or individuals, and when their presence Prostitutes Remedios off-putting to clients, women could request that they left [ 96 ]. Sex workers working outdoors no longer needed to move to isolated areas [ 94 ], although they continued to experience verbal and physical abuse by passers-by [ 95 ].

Although sex worker organisations objected to mandatory condom use within this model, some sex workers felt that it helped them Prostitutes Remedios on condom use [ 36 ]. In contexts of regulation in Australia, Mexico, and the US, venue-level systems Prostitutes Remedios as alarms, Prostitutes Remedios prices, intercoms, and condom use [], as well as being able to work in close proximity with other sex workers and third parties [ 35,], improved control and sense of safety for those able to work in regulated venues.

In Canada, the cost of business licenses and the ineligibility of those with criminal records restricted access to and mobility between regulated venues [ 93]. In Mexico, only well-networked, resident, HIV-negative, cis female sex workers gained access to tolerance zones and regulated venues, which offered fewer physical risks than unregulated indoor and outdoor settings but were often overcrowded, making income less stable [ 35].

In Australia, Guatemala, and Mexico, the ineligibility of minors to work in regulated venues meant that they had to work on the street [ 35, ].

A Comparison of Registered and Unregistered Female Sex Workers in Tijuana, Mexico

In Australia and Sri Lanka, sex workers operating in Prostitutes Remedios venues had less control over negotiations with clients, and some owners encouraged women to provide sex without a condom []. Studies Prostitutes Remedios that policing practices in contexts of criminalisation and regulation institutionalised violence against sex workers, both directly Prostitutes Remedios police inflicting physical or sexual violence or demanding fines in lieu of arrest, and indirectly by restricting access to justice and thus creating an environment of impunity for perpetrators of violence [ 97, Prostitutes Remedios ].

Violence and abuses of power by Prostitutes Remedios were reported across all genders and diverse political and economic contexts, including Cambodia, Canada, the Democratic Republic of the Congo, India, Kenya, Nepal, Nigeria, Pakistan, Serbia, South Africa, Sri Lanka, Thailand, Uganda, the US, and Zimbabwe [ 499799,,, ].

This took the form of arbitrary arrest and detention, verbal harassment, intimidation, humiliating and derogatory treatment, extortion, forcible displacement, physical violence, gang rape, and other forms of sexual Prostitutes Remedios during raids and in police custody [ 49Prostitutes Remedios99,,].

In Nepal, cis female sex workers, including those hired as peer educators, reported being arrested, beaten, and robbed by police upon being found in possession Prostitutes Remedios condoms [ ]. Sex workers were reluctant to report violence and theft to the police [ 98] for fear of the following: arrest for prostitution-related activities, unrelated petty offences, or non-payment of previous fines [ 9798, ]; being accused of crimes they had not committed [ 49]; harsh Prostitutes Remedios or moral judgement [ 97]; further extortion or violence [ 35, ]; disclosure in court [ 97 ]; prohibitive costs [ ]; or because no action would be taken to address the crime [ 97, ].

Long-standing discrimination, and the sense that police viewed them as criminals, made sex workers doubt the police would take complaints seriously [, ]. Cis Prostitutes Remedios trans women in Canada and the US reported police questioning whether it is possible for a sex worker to be raped [ 97]. Quote This produces an environment of impunity, where further violence, extortion, and theft from police and others operate unchecked [ 98,], perceived to be a major contributor in normalising violence against Prostitutes Remedios workers [ 26].

Reluctance to report violence occurred even in contexts where the purchase but not the sale of sex was criminalised, due to fears that information about where sex work takes place could be used to target clients and harass sex Prostitutes Remedios Quote 15 [ 34]. In contexts of regulation, registered sex workers in Guatemala viewed their health cards recording compliance with mandatory testing as protective against police and immigration harassment [], and registered sex workers in Mexico had better access to police protection but rarely reported violence [ 35 ].

In Senegal, registered workers still experienced being disbelieved when reporting physical or economic violence to police and so were reluctant to report it as a result Quote 16 [ ]. Concerns about being exposed to family and friends were paramount [ 35Prostitutes Remedios and deterred some from registering [ ]. Those Prostitutes Remedios were not registered were afraid they would be sent to jail or fined for Prostitutes Remedios illegally, or for active drug use [ Prostitutes Remedios ], and were more heavily targeted Prostitutes Remedios police for fines, arrest, Prostitutes Remedios, extortion, and sometimes sexual violence [ 35, ].

Subst Use Misuse.

In India, marked reductions in police raids and violence were achieved through a peer-based intervention that facilitated access to justice and challenged power relations between sex workers and police, although some officers cited lengthy procedures to dissuade reporting [ Prostitutes Remedios ].

Since decriminalisation in Prostitutes Remedios Zealand, sex workers describe having better relationships with the police, and greater access to justice which—despite some prevailing mistrust in police—makes them feel safer and more confident with clients [ 369596 ] and more deserving of respect Quote 18 [ 36 ]. The removal of threat of arrest—which reduced police power and afforded sex workers rights—gave sex workers, and particularly young people [ 95 ], greater confidence to report violent incidents, exploitation by managers, Prostitutes Remedios disputes with clients [ 3696 ].

Prostitutes Remedios, some officers treated disputes with clients as breaches of contract rather than crimes [ 96 ]. While there were Prostitutes Remedios some reports of abuses of police power, there were also examples of offending officers being prosecuted as a result, helping to challenge environments of impunity [ 369496 ].

Findings show that repressive police Prostitutes Remedios reinforced inequalities and entrenched marginalisation of sex workers, as well as creating disparities within sex-working communities, with police targeting specific settings or populations. In the context of full criminalisation in Sri Lanka, sex workers reported experiencing harsher punishment than their clients Prostitutes Remedios managers: both sex workers and clients might be fined, Prostitutes Remedios clients were not arrested Prostitutes Remedios charged in the way that Prostitutes Remedios workers were [ 49 ], nor were managers of flats arrested during police raids [ Prostitutes Remedios.

Across settings, arrests, fines, extortion, and theft by police particularly targeted street-based sex workers [,], resulting in loss of income and increased economic vulnerabilities Quote 19 [ 4999,Prostitutes Remedios, ]. Findings from Canada, Sri Lanka, and the US also show how criminalisation and police enforcement restricted freedom of movement, as sex workers were targeted arbitrarily by police during and outside of sex work hours and environments [ 4997,], and outed as sex workers by officers [ 97 ].

Studies showed how police targeting and mistreatment of sex workers, and inaccessibility to justice, reproduced inequalities and discrimination against sexual and gender minorities [ 26Prostitutes Remedios,], people who use drugs [ 22,], women, people of colour, and migrants [ 26349798,].

In Sri Lanka, where both sex work and homosexuality are criminalised, trans sex workers were less likely to be charged than cis women but they experienced extensive extortion, humiliation, false accusations of crime, and verbal, physical, and sexual violence by Prostitutes Remedios targeting their gender expression Quote 22 [ 49]. Similar experiences were reported among feminine-presenting male and trans sex workers in Pakistan and among trans women and sex workers of colour in Canada and the Prostitutes Remedios [ 26, ].

In criminalised and regulated settings, the precarious legal status Prostitutes Remedios undocumented or unregistered migrant sex workers was used by clients [ ] and venue owners [ ] to refuse payment, and by landlords to charge inflated Prostitutes Remedios for substandard rooms [ ]. Migrant sex workers did not report violence and other crimes to the police due to fear of deportation [ Prostitutes Remedios, ] or language barriers [ 98 ].

In Sweden, immigration legislation and anti-trafficking policies have been used to deport migrant sex workers, despite their characterisation in national prostitution law as victims of violence, as a way of reducing sex work [ 34 ]. In Cambodia and various sub-Saharan African countries, crackdowns on brothels have Prostitutes Remedios access to health services by disrupting peer networks and displacing sex workers from usual places of work, making it difficult for outreach services to find people, and hindering collective organisation Quote 24 [].

In China, sex workers were reluctant to accept condoms from health services after police crackdowns, for fear of their use as evidence [ ]. Based on ethnographic observations, authors noted multiple difficulties experienced by sex workers as a result of laws against renting property used Prostitutes Remedios sex work, including problems with eviction as well as with immigration, child custody, Prostitutes Remedios tax authorities [ 34 ].

In Canada, some sex workers had received referrals from supportive police to health, counselling, and legal aid services [ 97 ], but indoor venue managers remained reluctant to allow outreach visits for fear of prosecution, restricting access to sexual and broader healthcare—particularly disadvantaging migrant sex workers Prostitutes Remedios relied on outreach [ 93 ].

Trans sex workers in Canada [ ] and sex workers of all genders in South Australia [ 98 ] were fearful of accessing clinics [ ], sex-worker-led outreach services, and peer information and resources [ 98 ], for fear of being reported to the police. Studies showed how registration and mandatory testing necessitated more frequent contact with healthcare systems [,] and were viewed positively by authors in Nevada, US, as a way of maintaining a low level of STIs [ ] and by some sex workers as Prostitutes Remedios form of self-responsibility for health [].

However, in Guatemala the decision to comply with testing requirements was mostly motivated by Prostitutes Remedios of police harassment and detention rather than health considerations [].

In Turkey, unregistered Prostitutes Remedios sex workers were forcibly tested upon arrest [ ], and in Australia, some sex workers experienced judgement and were refused testing by health professionals [ ]. In Nevada, sex workers who test HIV positive can face up to 10 years in prison Prostitutes Remedios they are found Prostitutes Remedios sex in a licensed or an unlicensed environment [ ]. The negotiation has to take place afterwards, which is always so much scarier. And I just hopped in cause I was cold and tired of standing out there.

And you know, he put something to my throat. And I had to do it for nothing. You have to just hurry up before the cops come. To avoid police they wanna move to Prostitutes Remedios different area.

Because of the legal situation you have to be very, very careful. But now [since police crackdowns] we cannot know where they take us to. Such as taking us to Prek Ho [a village 15 km from Prostitutes Remedios Penh] and hurt us. There is no one to control us. So it is not safe for us. He was a visitor in the house, and he came in as a date, and they called the police, and he got arrested.

But when it got legalised the police were Prostitutes Remedios. They afterwards demanded sex from me. One of them threatened to stab me if I refused.

I ended up having sex with all of them and the experience was so painful. I sold my body. I worked. The man, for instance, Prostitutes Remedios me, fucked me and everything, for the money. And they take the money. Today,tomorrow Why the law does not limit…the charges for this amount? I feel like the charges just depend on their [police] mood.

A Comparison of Registered and Unregistered Female Sex Workers in Tijuana, Mexico. Nicole Sirotin, MD,a,b Steffanie A. Strathdee, PhD,a Remedios Lozada. nataliebaviles.com work is regulated in Tijuana, Mexico, but only half of the city's female sex workers (FSWs) are registered with the municipal health.

Quote [In a case where a participant reported being attacked by a Prostitutes Remedios and the case going to court. The next day she recognised him in the bar and told the bar owner who told her to Prostitutes Remedios to the police.

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They let the girls go. They just pick us up, and go to the woods, and go wild on us…First, they beat us in the woods, and then they take us to the station. It got thrown out of court…. In the past, women live in one place at the brothel. We are sleepless, so we Prostitutes Remedios at day time, so I am lazy to go to check Prostitutes Remedios health. I have no feeling to go.

It has to be every three months at least. You have to go Prostitutes Remedios a sexual health clinic and wait all day to see a doctor.

Pair arrested for prostitution in a parked van in Fort Myers

I did that for a couple of weeks to see what it was like. The amount of controls and the lack of freedom was horrendous. Yeah, I think decriminalization gives us the most freedom. We estimate that, collectively, lawful or unlawful repressive policing practices linked to sex work criminalisation partial or Prostitutes Remedios are associated with increased risk of infection with HIV or STIs, Prostitutes Remedios or physical violence from clients or intimate partners, and condomless sex.

The qualitative synthesis clearly shows pathways through which these policing practices Prostitutes Remedios health risks are associated: enacted or feared police enforcement—targeting sex workers, clients, or third parties organising sex work—displaces sex workers into isolated and dangerous work locations and disrupts risk reduction strategies, such as screening and negotiating with clients, carrying condoms, and working with others.

Repressive police practices frequently constitute basic violations of human rights, including unlawful arrest and detention, extortion, physical and sexual violence by law enforcement, lack of recourse to justice, and forced HIV testing—violations inextricably linked to increased unprotected sex, Prostitutes Remedios of HIV and STIs, increased violence from all actors, and poorer access to health services [ 329].

The qualitative synthesis shows how violence and Prostitutes Remedios against sex workers are institutionalised, legitimised, and rendered invisible [ 2635 ] in contexts of any criminalisation and regulation [ 2635 ], as sex workers across settings consistently report Prostitutes Remedios further criminalised, blamed, or ignored when they report crimes against them.

This Prostitutes Remedios, symbolic, and everyday violence fosters climates of impunity and under-reporting, and failure to recognise sex workers as citizens deserving protection, care, and support [ 26 ]. Targeting and exclusion of the most marginalised sex workers reinforces and obscures the injustices they face. They do so by showing Prostitutes Remedios these Prostitutes Remedios interplay with criminalisation to further marginalise sex workers and deprive them of civil, labour, and social rights [ — ].

Fear of prosecution and moral judgement, due to laws against homosexuality and transgenderism [ ] and drug use [ ], and, in the case of migrant workers [ ], fear of deportation, further reduce willingness to report violence and exploitation to the Prostitutes Remedios.

Despite including search terms relating to broader health outcomes, the majority of epidemiological literature focused on sexual health outcomes and, in more recent evidence, violence. We found few studies that focused on emotional health, but these show detrimental associations with repressive policing and criminalisation.

Qualitative Prostitutes Remedios quantitative studies demonstrate that police enforcement and its threat is a major source of anxiety [], whereas working in indoor, decriminalised environments is associated with improved mental health outcomes [ 32]. Only 1 quantitative study reported on the associations between Prostitutes Remedios and violence from intimate or other partners, and further research Prostitutes Remedios needed to understand the mechanisms of this relationship [ 58 ].

Successful sex-worker-led approaches to improving access to justice and challenging institutional stigma in South India offer important examples of what can be achieved with sustained funding and support [ 99 ]. Findings clearly show that criminally enforced regulatory models create major disparities within sex worker communities, possibly enabling access to safer conditions for some but excluding the large majority who remain under a Prostitutes Remedios of criminalisation, including trans Prostitutes Remedios, cis men, people who use drugs, migrant populations, and Prostitutes Remedios sex workers operating in outdoor environments, who are at increased risk of HIV in many settings [ 8190].

In contexts of mandatory HIV testing following arrest, fear of enforcement can hinder voluntary uptake of HIV testing and interventions [ 7180 ], showing how this punitive approach to public health ultimately reduces access to health services. More recent research from Senegal has shown that while registration was associated with better physical health, the stigma attached to being registered has a detrimental effect Prostitutes Remedios well-being; only a minority of sex workers are registered, and those who test HIV positive are excluded [ ].

As Prostitutes Remedios qualitative synthesis demonstrates, in New Zealand, Prostitutes Remedios decriminalisation, sex workers reported being better able to refuse clients and insist on condom use, amid improved relationships with police and managers [ 36, ]. This concords with existing modelling data that suggest a positive effect of decriminalisation on incidence of HIV [ 2 ].

We were unable to examine the effects of different legislative models in the quantitative synthesis Prostitutes Remedios to limited data, particularly for the models of decriminalisation and the criminalisation of the purchase of sex. Evidence included in our qualitative synthesis clearly shows that criminalisation of clients does not facilitate access to services, nor minimise violence.

This is supported by the epidemiological evidence from Vancouver that showed that sex workers who were stopped, searched, or arrested were at increased Prostitutes Remedios of client violence despite the introduction of more severe laws against the purchase of sex introduced in alongside fewer sanctions for sex workers working together and modelled on the Swedish law [ 57 ].

In addition, the practice of rushing negotiations due to police presence increased and was associated with increased client-perpetrated violence [ 92 ]. Findings from our qualitative synthesis suggest that enforcement strategies that seek to reduce the numbers of sex workers [ ] or clients [ ] are unlikely Prostitutes Remedios achieve these Prostitutes Remedios, since the economic needs of sex workers remain unchanged, resulting in sex workers having to work longer hours, accept greater risks, and deprioritise health.

There is no reliable evidence from Sweden that the numbers of sex workers have decreased since the law changed in [ 34 ]. There are a number of limitations to this review. Findings Prostitutes Remedios our pooled meta-analyses examining condom use and violence were limited by high heterogeneity, although effect estimates remained consistent across sensitivity analyses, suggesting we can be confident in their robustness. By limiting the search to literature written in English, Russian, and Spanish, we may have missed key studies.

There was a lack of comparable quantitative data on outcomes such as access to services, drug-related harms, and emotional ill health, which precluded the use of meta-analysis. Similarly, few qualitative studies explored the emotional health effects of criminalisation and enforcement, and its effects on access to health and broader services received less attention relative to safety and health risks, within the rich body of evidence reviewed.

Methodologically, some Prostitutes Remedios did not provide sufficient detail on sampling and analysis methods, and few included reflexive discussions on the position of the researcher. Although a growing number involve sex workers as researchers or advisors, few included discussion of the challenges and benefits of participatory approaches. We found few eligible studies that included trans female or cis male sex workers, who experience particular inequalities in relation to HIV, access to services, and—as the qualitative synthesis Prostitutes Remedios targeting Prostitutes Remedios violence, limiting our ability to generalise findings to these populations.

It is also possible that some studies may not have differentiated between trans women and cis men [ ], or between cis and trans participants within samples of female and male sex Prostitutes Remedios, and Prostitutes Remedios disaggregated experiences or outcomes by gender.

Sex workers can face multiple interdependent health risks [ 1 , 2 ].

This is an important area of future research given the specific vulnerabilities experienced by these populations, in contexts where gender and sexual minorities are criminalised, inadequately protected against hate crimes, and, in the case of trans people, not legally recognised. Our review focuses on the implementation of enforcement practices linked to 5 broad legislative models.

We report on recent and past history of arrest or prison based on the information available to us, but few studies reported whether the arrest was related to Prostitutes Remedios work, was related to another offence, or had to do with social, gender, or racial profiling.

Assessing the extent to which the enforcement practice was lawful or unlawful is beyond the scope of this review, but in some cases unlawful activities are clearly evidenced e. This limits our ability to assess the specific contribution of sex work penalties to the health and Prostitutes Remedios of sex workers, relative to the use Prostitutes Remedios other Prostitutes Remedios and abuses of police powers against sex workers in contexts of Prostitutes Remedios.

Lack of clarity on the lawfulness of police enforcement practices also reflects the difficulties in measuring stigma and its interaction with criminalisation, and the need for mixed-methods approaches to unpack these complexities in context. We found few data on the interplay between criminalisation, collective organisation, and health outcomes. Evidence from India has shown how tackling social injustice and mistreatment by the police as part of a Prostitutes Remedios HIV prevention intervention Prostitutes Remedios resulted in fewer arrests, more explanation of reasons for arrest, and fairer treatment by the police, Prostitutes Remedios well as decreased violence against sex workers [ 8499 ].

However, most evaluations of community-led health interventions have been limited to HIV prevention and have been implemented in India, Prostitutes Remedios Republic, and Brazil []. Although there are numerous examples of active Prostitutes Remedios worker organisations Prostitutes Remedios for sex worker rights Prostitutes Remedios evidence-based policy internationally, as well as developing guidelines for rights-based HIV programming with, for, and by sex workers [ ], the voices of sex workers Prostitutes Remedios to be dismissed and silenced in policy debates in many settings as well as in the design and evaluation of public health interventions.

The public health evidence clearly shows the harms associated with all forms of sex work criminalisation, including regulatory systems, which effectively leave the most marginalised, and typically the majority of, sex workers outside of the law. Prostitutes Remedios evidence available suggests that decriminalisation can improve relationships between sex workers and the police, increasing ability to report incidences Prostitutes Remedios violence and facilitate access to services [ 369596 ].

Considering these findings within a human rights framework, they highlight the urgency of reforming policies and laws shown to increase health harms and act as barriers to the realisation of health, removing laws Prostitutes Remedios enforcement against sex workers and clients, and building in health and safety protections [ ]. It is clear that while legislative change is key, it is not enough on its own. Law reform needs to be accompanied by policies and political commitment to reducing structural inequalities, stigma, and exclusion—including introducing anti-discrimination and hate crime laws that protect sex workers and sexual, gender, racial, and ethnic minorities.

Mixed-methods, interdisciplinary, and participatory research is needed to document the context-specific ways in which criminalisation or decriminalisation interacts with other structural factors and policies related to stigma, poverty, migration, housing, and sex worker collective organising, to inform locally relevant interventions alongside legal reform.

This research must go alongside efforts to examine concerns surrounding decriminalisation of sex work within Prostitutes Remedios and communities, which influence policy and practice, and sex workers must be involved in decision-making over any such research and reforms []. The recognition of sex work as an occupation is an important step towards conferring social, labour, and civil rights on all sex workers, and this must be accompanied by concerted efforts to challenge and redress cultures of discrimination and Prostitutes Remedios against people who sell sex.

While such reforms and related institutional shifts are likely to be achieved only in the long term, immediate interventions are needed to support sex workers, including the funding and scale-up of specialist and sex-worker-led services that can address the multiple and linked health and social care needs that sex workers may face.

Abstract Background Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. Methods and findings We searched bibliographic databases between 1 January and 9 May for qualitative and quantitative research involving sex workers of Prostitutes Remedios genders and terms relating to legislation, police, and health.

Conclusions Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation.

Author summary Why was this study done? This evidence is critical to informing evidenced-based policy-making, and timely given the growing interest in models of decriminalisation of sex work or criminalising the purchase of sex the latter recently introduced in Canada, France, Northern Ireland, Republic of Ireland, and Serbia.

What did the researchers do and find? We searched bibliographic databases for qualitative and quantitative research, Prostitutes Remedios lawful and unlawful police repression, including criminal and administrative penalties within different legislative models.

Repressive policing of sex workers was associated with increased risk of condomless sex across 9, participants from 4 studies. What Prostitutes Remedios these findings mean?

The quantitative evidence clearly shows the association between repressive policing Prostitutes Remedios frameworks of full or Prostitutes Remedios sex work criminalisation—including the criminalisation Prostitutes Remedios clients and the Prostitutes Remedios of sex work—and adverse health outcomes.

More research is needed in order to document how criminalisation and decriminalisation interact with other structural factors, policies, and realities e. Introduction Sex workers can face multiple interdependent health risks [ 1Prostitutes Remedios ]. Download: PPT. Definitions We included Prostitutes Remedios with sex workers of all genders who currently or have ever exchanged sexual services for money, drugs, or other material goods.

Inclusion criteria We included quantitative, qualitative, and mixed-methods studies published in English, Russian, or Spanish, and included data specific to the experiences Prostitutes Remedios sex workers. Results Prostitutes Remedios 9, papers identified, studies met the inclusion criteria, resulting in 40 papers included in the quantitative synthesis, of which 20 were included in Prostitutes Remedios meta-analysis and 20 in the narrative synthesis. Fig 1. Flow chart of included qualitative and quantitative studies.

Quantitative synthesis Included quantitative studies. Table 2. Fig 2. Meta-analyses summarising associations between repressive policing actions Prostitutes Remedios HIV and sexually transmitted infections.

Fig 3. Condom use. Fig 4. Meta-analyses summarising the association between Prostitutes Remedios policing actions and condomless sex with clients and intimate partners. Access to services and mandatory testing.

Emotional ill health. Drug and alcohol use. Registration at a municipal health service. Prostitutes Remedios of sex work policies. Qualitative synthesis Included qualitative studies. Table 3. Summary of qualitative study characteristics included in the thematic analysis including legislative context and methods. Core category 1: Disrupted workspaces and Prostitutes Remedios strategies.

Core category 2: Institutionalised violence, coercion, and extortion, and restricted access to justice. Core category 3: Reproduction of multiple stigmas and inequalities. Core category 4: Restricted access to health and social care and support. Box 1. Discussion We estimate that, collectively, lawful or unlawful repressive policing practices linked to sex work criminalisation partial or full are associated with increased risk of infection with Prostitutes Remedios or STIs, sexual or physical violence from clients or intimate partners, and condomless sex.

Limitations There are a Prostitutes Remedios of limitations to this review. Conclusion The public health evidence clearly shows the harms associated with all forms of sex Prostitutes Remedios criminalisation, including regulatory systems, which effectively leave the most marginalised, and typically the majority of, sex workers outside of the law.

Supporting information.

Exploring the context and implementation of public health regulations governing sex work: a qualitative study with migrant sex workers in Guatemala.

S1 Moose Checklist. S1 Fig. S2 Fig. S3 Fig. Sensitivity analysis of unadjusted and adjusted estimates of condomless sex stratified by police exposure. S4 Fig. Sensitivity analysis of outcome misclassification.

S1 Table. Quality assessment of quantitative studies. S2 Table. Data used in R for meta-analysis. S1 Text. Systematic review protocol. S2 Text. Prostitutes Remedios of CERQual assessment. S3 Text. Category themes and sub-themes. S4 Text.

All references reviewed as part of qualitative synthesis. References 1. Rekart ML. Sex-work Prostitutes Remedios reduction. Global epidemiology of HIV among female sex workers: influence of structural determinants. A systematic review of the correlates of violence against sex workers. Am J Public Health. Prostitutes Remedios business: health and safety in the sex industry over a 9 year period. Sex Transm Prostitutes Remedios.

Mortality in a long-term open cohort of prostitute women. Am J Epidemiol. Factors associated with premature mortality among young injection drug users in Vancouver.

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Prostitutes Remedios, Phone numbers of Whores in Remedios (CU): Findings from Canada, Sri Lanka, and the US also show how criminalisation and police enforcement restricted freedom of movement, as sex workers were targeted arbitrarily by police during and outside of sex work hours and environments [ 49 , 97 , , , ], and outed as sex workers by officers [ 97 ]. Strathdee , 1 Morgan M.

First	City	State	Code	Escort	Easy sex	Handjob massage
Prostitutes Remedios	Remedios	Villa Clara	CU	7344	no	no
23.07.2001	63	61	27	RYSU	18	23
17.10.2013	no	90	no	RYSU	yes	50

1. Introduction

Sexually transmitted infection control with sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. Prostitutes Remedios are. S4 Fig. Effects of government registration on unprotected sex amongst female sex workers in Tijuana; Mexico. Miller Prostitutes Remedios. Harm Reduct J. Mexican male bisexuality.

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Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses Prostitutes Remedios others, as well as variable sample size and study quality. While here reforms and related institutional shifts are likely to be achieved only in the long term, immediate interventions are needed to support sex workers, including the funding Prostitutes Remedios scale-up of specialist and sex-worker-led services that can address the multiple and linked health and social care needs that sex workers may face. Condom use among female commercial sex workers in Nevada's legal brothels.

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