Basic research to support prevention in the sex trade

An estimated 13 000 to 20 000 people work as prostitutes in Switzerland. Social marginalisation, financial insecurity and absence of a residence permit make sex workers a particularly vulnerable group that requires prevention measures geared to their specific needs. In 2007, the Federal Office of Public Health (FOPH) commissioned the University of Geneva’s Sociological Institute to carry out a broadly based study of the sex trade in Switzerland. The main objective of the study is to provide politicians, organisations and researchers with a knowledge base from which to draw up effective measures that will improve sex workers’ health.

HIV, violence, mental health problems
The first part of the study takes stock of sex workers’ principal health problems. Overall, the prevalence of HIV in sex workers is no higher than in the general population. However, migrant sex workers or those who are intravenous drug users are at greater risk of contracting HIV. Moreover, because many of them are illegal migrants, they are particularly difficult for health services to reach, and are thus all the more vulnerable. Lastly, the higher prevalence of sexually transmitted diseases (STDs) among sex workers also puts them at greater risk of HIV infection. Most authors of the literature investigated regard sex workers’ negotiating skills and independence in the practice of their occupation as factors that help protect them against HIV and other STDs.
The violence that is widespread in this setting is also an important health factor. It has an impact on sex workers’ mental health, which already comes under great strain as a result of their way of life and the social stigma to which they are exposed. Various studies have identified factors that aggravate the risk of physical assault. These factors include ignorance of the risks associated with prostitution and lack of experience when it comes to choosing clients.

Prostitution laws are conducive to health
The second part of the study is an overview of the legal situation of the sex trade in Switzerland. Prostitution in Switzerland has the status of a legally authorised, private, self-employed activity. The advantage of this status is that it makes it possible to develop appropriate health promotion and prevention measures in collaboration with the authorities. In legal terms, sex work is regulated by the Swiss Criminal Code, which includes an article on the exploit­ation of sexual relations or on human trafficking for the purpose of prostitution. Compared with countries whose legislation is aimed at abolition, Switz­erland’s regulatory approach ensures better access to healthcare services and better dissemination of information for sex workers. The regulations vary considerably from canton to canton. Generally speaking, however, the existence of a cantonal law on prostitution is conducive to sex workers’ health because it often goes hand in hand with measures such as the distribution of free condoms or easier access to healthcare services for people who have no medical insurance.

«Empowerment» is the key to success
As the analysis of existing projects and best practices in Switzerland has shown, empowerment, or helping people to help themselves, is the key to improving the health situation of sex workers. There is a particular need here for outreach prevention work by trained mediators in order to improve sex workers’ access to such measures.
With regard to physical problems, the authors recommend the provision of rapid tests in specialised centres, the creation of a list of physicians with whom sex workers can develop a relationship of trust, and continuation and strengthening of prevention efforts targeting clients.
At the psycho-social level, the following approaches should be promoted: self-help groups (to launch empowerment pro­cesses), information aimed at specific settings (problem complexes/language groups), warning systems to protect sex workers against violent clients, and promotion of the provision of support on legal issues from lawyers who are familiar with the sex trade.
On the basis of these findings, the FOPH has drawn up a vision for the sex trade that largely reflects the above recommendations. In particular, the FOPH will be supporting all initiatives that promote the independence, self-help efforts and empowerment of sex workers.