Mandating Tests for Sex Workers Doesn't Get a Passing Grade

Often when I engage in conversations with folks about sex work and public policy, I'm asked how I feel about mandatory testing of sex workers for sexually transmitted infections (STIs). And, when I answer that I don't support such measures, they're frequently astonished. "I thought you said that you support harm reduction methods! So why not this? Wouldn't requiring sex workers to be regularly tested reduce the spread of HIV and other STIs?"

No. Testing doesn't "prevent" anything. It provides information towards that end, and only if it's done right.

Let's take the argument for mandatory testing to its logical extreme. Sex workers are a relatively small segment of the total number of sexually active people out there, and according to the best studies out there, contribute very little to STIs overall, and virtually none of HIV transmissions. So if we were to mandate STI testing, then it makes sense to do that for all sexually active adults and adolescents, not just sex workers. Of course, it's reasonable to assume that a significant number of people would lie about being sexually active, in order to avoid being tested. The answer then would be to test everyone from the age of thirteen up.

This would, of course, be met with a number of objections, from cost to loss of freedom to invasions of privacy. And yet, some would still argue that, since STIs constitute an "occupational hazard" for sex workers, then mandatory testing therefore qualifies as an occupational health and safety measure.

But again, this doesn't make sense when applied to comparable circumstances. Hospital workers, for example, are exposed to far more diseases, some of them far more dangerous, and far more often. Yet hospitals do not regularly test every employee for every disease they might have been exposed to. Instead, they find it more effective to implement preventative measures, much as full-service sex workers use condoms and other safer sex measures to reduce the risk of contracting HIV or other infections.

There's also the question of how such measures are best mandated and enforced. More often, they are mandated as a condition of employment rather than by legal regulation; even when laws or government regulations are put in place, it is usually left to employers to maintain and enforce, with government agencies making spot checks or responding to employee complaints. Also, the most effective systems are when lawmakers institute a general mandate to assure health and safety, while leaving specifics to another body which may adapt more quickly to changes in evidence as to the best means of assuring this.

An example of which I'm personally aware is cardiopulmonary resuscitation (CPR). I've been trained and recertified many times over the years, and have noticed how the protocols change as new evidence comes in, most significantly the use of an automated external defibrillator (AED). While there are laws determining who may train and certify people, those laws do not specify the protocols for performing CPR; instead, the groups that train and certify pay attention to new scientific data, and update protocols accordingly.

Compare that system to how Nevada mandates STI testing for sex workers in their legal brothels. The Centers for Disease Control and Prevention recommend that people with multiple sexual partners should be screened every three to six months, based on the best available medical studies; more frequent tests do not produce more reliable results. Nevada's legal requirements, relatively unchanged since 1937, are that women working in brothels are required to weekly medical exams, and at their own expense. With consistent condom usage, and STI rates reported at zero, where is the sense in having sex workers required to be tested at thirteen times the rate recommended by public health officials?

There is no good reason to impose such a requirement on sex workers when other people in similar circumstances are not similarly required. To impose such a burden is nothing more than discrimination, rooted in stigma and unnecessarily perpetuating it. Sex workers have long known how to minimize these risks, as proven by empirical studies. They need neither bureaucrats nor moralists to require anything further. If anything, the rest of us would benefit from listening to their collective experience.

The Question Anti-Prostitution Zealots Refuse to Answer

Like any well-organized endeavor, the movement seeking to do away with commercial sex has worked hard to come up with responses to various questions. When asked about people who say they do sex work willingly and happily, they will either accuse them of being brainwashed or dismiss them as "not representative". When called to account for distorting or fabricating evidence, they insist there's a "greater truth" that needs to be heard.

But there's one question I've never heard any prohibitionist address, even when they've been asked directly: What about the repeated abuse of sex workers by police?

As much as these so-called "abolitionists" keep trying to pin the blame on clients and people inside the industry, sex workers will tell you that they have more to fear from law enforcement – not just being arrested, but systematic harassment, assault, and exploitation. Elizabeth Nolan Brown of Reason magazine published a summary of almost forty cases of police sexual misconduct in the course of 2014 and 2015. Brown's report is just the tip of the iceberg. There's also this Associated Press analysis that almost one thousand law enforcement officers nationwide lost their badges over a five-year period over sexual misconduct, with one-third of those involving people under eighteen. From Oakland to Baltimore, various public and private sources confirm what sex workers have been saying for years about cops robbing, raping and even pimping them out. And it's not just in the United States. This report from Great Britain shows that police in England and Wales have been sexually assaulting prostitutes and other vulnerable women there as well.

Police in Sweden and Norway – so admired by prohibitionists for their efforts to "crush the sex trade" by "ending demand" – have chosen a different tactic. They bully the sex workers' landlords, threatening to arrest them for pimping or brothel-keeping, unless they evict the women. Amnesty International's report shared this particularly disturbing story from Mercy, a Nigerian-born sex worker living and working in Oslo:

A little guy came to the house with a knife. I answered the door. There were nine of us in the house. He threatened us with a knife and robbed our money and phones… He forced us to have sex with him. The police took two or three hours to come. They took us all to hospital and got us a hotel for two nights. Later, we went back to the house and, two days later, the landlord threw us out ... The police put pressure on the landlord. She gave us half a day to get out ... I had to wander around Oslo for hours with my bags until I found somewhere to stay.

It's not just that prohibitionists fail to check their facts. They are failing to check their privilege. White and affluent Americans tend to view police as public servants dedicated to keeping their communities safe, with abuses dismissed as individual aberrations. But among marginalized communities, police are seen as an occupying army sent to impose social control, not just with guns and handcuffs, but a variety of weapons and tools, both legal and extra-legal. Now, take a look at the list of major prohibitionist leaders – overwhelmingly white and wealthy. Privilege lays the foundation for denial, and the interdependence of the movement with law enforcement continue to pile upon it.

History, however, shows that such piles of denial inevitably collapse. That happened almost a century ago, when the American experiment with banning alcohol was abandoned as a failure. Despite repeated claims by advocates that it would lead to significant reductions in crime, the Prohibition Era actually saw criminal activity increase – including rampant bribery and corruption of police and public officials. The temperance movement, now dwindled to irrelevance, has paid the price for their denial. And I have no doubt that this prohibitionist movement will encounter the same fate as more people become aware of the facts.

Sex, Science, and Fiction

This past weekend, I watched a TV movie from 1994 called "Island City" – a post-apocalyptic science fiction tale where an eternal youth drug had worked for some humans, while mutating many others into immensely strong and violent primal brutes. Many of the former live in a protected city, sending patrols to find other "normal" living among the brutish "recessives" in the "badlands" beyond. To avoid giving birth to more potential recessives, every adult inhabitant of the city has a special colored crystal implanted on their chest, and is only allowed to have sex with someone with the same color.

Forget how simplistic and gimmicky it seems, or that we're now beginning to understand the complexity of human genetics. Such a "solution" ignores the realities of human psychology. Did the writers of this story really think that everyone would just say: "Well, I like you, but I'm a green and you're a blue, so no dice"? Yeah, right.

It reminds me of a similar shortcoming in the Star Trek: Enterprise episode "Cogenitor" – an alien species treats members of its third sex as mere means to the end of procreation, depriving them of choices and education and even personal names. Imagine being the parent of such a child, wondering why they shouldn’t be able to make more of a contribution than simply being "assigned" to one couple after another. And as the series Alien Nation demonstrated in its storyline, it's not impossible to conceptualize a more respected social role for cogenitors.

As Isaac Asimov pointed out, a good science fiction writer must know science, and I would contend that this includes the so-called "soft" social and behavioral sciences. Human beings ultimately questions rules and find ways to work around the diverse barriers put in front of them. That is especially true when it comes to sexuality and intimacy. We may seek to find and create some rational and orderly way of choosing mates and expressing affection, but ultimately such decisions are impelled by passion and desire, even to the point of affecting what we perceive to be "rational and orderly".

There is no better real-life example than the disagreement over the hypothesized invention of "sexbots" for erotic release. Proponents see the potential for custom-made sexual partners, perhaps even doing away with sex trafficking and prostitution. Those opposed to this hitherto nonexistent technology, such as British academic Kathleen Richardson, speculate that the "unequal power relationship" between humans and robots would somehow bleed over into relationships between humans as well. Both extremes are to be congratulated for pushing the envelope of imagination, yet they do so by blithely ignoring the realities of technology, materials science, economics, and sexual psychology. Assuming that sexbots were to become a reality, it follows that they would be incredibly expensive, prohibitively so for most mere mortals. And while things like transportation and cleaning are made more efficient with cars and washing machines, erotic satiation and fulfillment demand a complexity and nuance which no artifice has come close to meeting.

Sex, like much of human and animal nature, is chaotic. That may not sound very scientific, and yet science has its own definition of chaos: sensitivity to initial conditions. Each individual is indeed sensitive to the conditions surrounding us, from birth to death, and no more so than when we interact with those around us. We may develop social and cultural structures to help us navigate, and science may provide data and insight, but in the end the course we take is our own choice to make.