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National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

Reeves, Aaron, Steele, Sarah, Stuckler, David, McKee, Martin, Amato-Gauci, Andrew and Semenza, Jan, C. (2017) National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries. The Lancet HIV. ISSN 2352-3018

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Identification Number: 10.1016/S2352-3018(16)30217-X


Background: Sex workers are disproportionately affected by HIV and other STIs compared with the general population. To date, most studies of HIV risk among sex workers focus on individual-level risk factors, with few studies evaluating potential structural determinants of HIV risk. In this paper we examine whether criminal laws around sex work are associated with HIV prevalence among sex workers. Method: To test our hypothesis, we estimate cross-sectional, ecological regression models using data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation on U.S. State Department’s Country Reports on Human Rights Practices; the Rule of Law and GDP per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injection drug use among sex workers. Findings: We found that countries which have legalised some aspects of sex work (n = 10) have significantly lower HIV prevalence among sex workers than those which have not (n = 17) (β = -2.09, 95% CI: -0.80 to -3.37, p = 0.003), even after controlling for the level of economic development and the proportion of sex workers who are injecting drug users. We observe that the relationship between sex work policy and HIV among sex workers may be partially moderated by the effectiveness and fairness of enforcement, suggesting legalization of some aspects of sex work may reduce HIV among sex workers to the greatest extent in countries where the enforcement is fair and effective. Interpretation: Our findings suggest that legalizing some aspects of sex work may help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair.

Item Type: Article
Official URL:
Additional Information: © 2017 Elsevier
Divisions: International Inequalities Institute
Subjects: H Social Sciences > HV Social pathology. Social and public welfare. Criminology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 14 Nov 2016 10:51
Last Modified: 20 Oct 2021 02:28
Funders: European Centre for Disease Prevention and Control

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