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

[Originally posted December 20, 2016]

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 have 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.


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