Sex Worker Health Outcomes in High-Income Countries of Varied Regulatory Environments: A Systematic Review

There is significant debate regarding the regulation of the sex industry, with a complex range of cultural, political and social factors influencing regulatory models which vary considerably between and within countries. This systematic review examined the available evidence on the relationship between different approaches to sex industry regulation in high-income countries, and associated effects on sex worker health status. Objectives included identification of sex worker health outcomes, including sexual health, substance use and experience of stigma and violence. A search was performed electronically in eight scholarly databases which yielded 95 articles which met the criteria for inclusion. Findings suggested that sex workers in legalised and decriminalized countries demonstrated greater health outcomes, including awareness of health conditions and risk factors.

IDU and unprotected sex associated with high level of depressive symptoms. 70% had high levels of depressive symptoms. SWs with depressive symptoms more likely to report risk behaviours for HIV. Lee et al. (2010).

South Korea.
To evaluate condom use and prevalence of chlamydia Condom use was low and corresponded to high prevalence of chlamydia.

USA, California, San Francisco.
To assess psychosocial correlates of condom use within this population Cross---sectional Purposive n=190 31.5 years Transgender Yes Condom use, health history and sexual practices via self---report questionnaire.

USA, California.
To characterise demographics, sexual and drug using behaviours and prevalence of HIV, STI, and HAV, HBV, and HCV in low--income women with/without a history of SW Women with a history of SW more likely to have positive results for syphilis, HSV---2 and HCV.

USA, New York City, Harlem.
To determine the relationship between sex trading and psychological distress Jones et al. (1998).

USA.
To examine prevalence of sexual risk behaviours and HIV and STI Cross---sectional Convenience n=419 Age not specified

Female, Male
Not specified STI and HIV testing. Assessment of sexual risk behaviours by questionnaire.
25% of participants infected with HIV, 37.5% with syphilis. Illicit drug using SWs had higher prevalence of risky sexual behaviours. Morse et al. (1991).

USA, Louisiana, New Orleans.
To determine HIV prevalence and transmission Prevalence Convenience n=211

RR=97%
Age not specified Male Not specified STI testing. SW characteristics and risk behaviours via questionnaire.
HIV seroprevalence higher compared to FSW data from the CDC. MSW serve as a vector for HIV transmission. Rosenblum et al. (1992).

USA.
To determine prevalence of HBV and evaluate transmission of HBV Prevalence of past or present HBV infection was 56%. Surratt et al. (2014).

USA, Miami.
To determine use of a behavioural intervention to reduce HIV risk in drug---using FSW

Argentina.
To determine the association of socio---demographic characteristics with syphilis and HIV infection.

Argentina.
To determine socio---demographics, sexual practices, drug use behaviours, and prevalence of HIV, syphilis, HBV, HCV, HTLV---1 and 2 in migrant and non---migrant female SWs NGO influence and client support were positively related to negotiation self---efficacy. Manager and client pressure were negatively related to negotiation self---efficacy and condom use. SWs with high condom---use self--efficacy were 24 times more likely to use condom in the previous six months than counterparts.

Hong Kong.
To assess effect of SW on women's environmental health and safety Prevalence of chlamydia, gonorrhoea and syphilis decreased significantly between 1990---1993 which may be related to increased condom use.

Japan.
To determine prevalence of chlamydia HIV infection rates not as prevalent as thought based on media reports (2---5% of samples).

To assess efficacy of a HIV/STI prevention program on improving condom usage
Quasi---experimental FSWs had higher incidence and persistence of HR---HPV than WGP. Pineda et al. (1992).

Spain, Andalusia.
To assess prevalence of and risk factors for HIV---1 among non---IV drug using SWs Prevalence of HIV---1 low. Risk increased with higher rates of sexual exposure.

Spain.
To assess impacts of violence and drug use on loneliness

Australia, Melbourne (VIC).
To estimate number of unlicensed brothels and assess sexual health of women working in unlicensed brothels.
Cross---sectional Convenience n=22 Age not specified Female Yes Tampon specimen collection for STI testing. Sexual health status via questionnaire.
Number of unlicensed brothels less than expected. SWs in unlicensed brothels had lower rates of STI testing than licensed brothels. Unregulated SW industry made it difficult to promote sexual health and STI control.

Australia, Melbourne (VIC).
To evaluate the impact of reducing STI testing from monthly to 3 monthly Cross---sectional Convenience n=6146 (monthly consults), n=3453 (3 monthly consults) Age not specified

Australia, Victoria.
To examine characteristics and work attitudes/approach of SWs

Australia, Queensland.
To describe self---reported physical and mental health of SWs Cross---sectional Convenience n=247 RR=98% (brothels), RR=93% (street work) 32 years, Female Yes Self---report data on status of physical and mental health via questionnaire Illegal SWs, particularly street based SWs, were four times more likely to report poor mental health outcomes than SWs working in licensed brothels. Tang et al. (2013).

Australia, Melbourne (VIC).
To determine prevalence of STIs from low prevalence and high prevalence countries Krumrei---Mancuso (2017) The Netherlands.
To examine depression and PTSD in SWs in relation to characteristics of the job   Proportion of gonorrhoea diagnoses for Adelaide SWs was higher than data from Melbourne for same time period. Sydney SWs had significantly less gonorrhoea diagnoses. Minichiello et al. (2000).

Australia, Sydney (NSW) Melbourne (VIC) and Brisbane (QLD).
To examine self---reported patterns of drug and alcohol use