HEALTH AND HUMAN RIGHTS

Prostitution, public health, and human-rights law

In a 1998 International Labour Office (ILO) study on prostitution in southeast Asia investigators noted that safety law is applied to prostitutes in he Optional Protocol to the for adults it was possible to distinguish lawful brothels but not to their counConvention on the Elimination between forced and voluntary prostiterparts on the street. of All Forms of Discrimination tution. But, they asserted, It is outVulnerability to contracting HIV Against Women (CEDAW), created side the purview of the ILO to take a has been characterised as exercising in September, 1981, is now open for position on whether prostitution little or no control over ones risk of signing and ratification by nations. should be legalized. The question of acquiring HIV infectionvulnerabilShould the protocol come into force, legalization is thorny because the ity is magnified by societal factors women will be given the right to comhuman rights concerns are difficult to such as marginalisation or discriminaplain to the United Nations (UN) disentangle from concerns over moraltion. This account encapsulates the about breaches of the Convention ity, criminality and public health situation of most prostitutes. In this and, in particular, discrimination in threats. the provision of health Many prostitutes services. For women Rights were not granted to include this image would not find it diffiwho are prostitutes, cult to disentangle the however, and whose in electronic media. Please refer to the printed human-rights issues. legal status is uncertain, journal. Social history explains it is unlikely that the the legal emphasis on Convention will be of trafficking and rehabilisubstantial benefit. tation, and constructed Prostitutes are entisimilarities to slavery. tled to enjoy universal But this is no longer a human rights. Because sufficient explanation. their legal status is comPerhaps the prohibition plex, and compounded of exploitation of prosby international titution is a protective human-rights law, prosmeasure necessary titutes are rarely in a sitwhen prostitution is uation where health illegal, but substitutes protection or promopoorly for labour tional activity could be Prostitutes are yet to enjoy universal human rights rights. This is not a expected to succeed. basis upon which to carry out a health context rights-based objections to The view that linking health policy programme for prostitutes. No interindividual programmes such as with respect for human rights will national treaties promote the rights of compulsory testing, for example, result in a better health outcome is willing workers. The failure to recoghave some, but limited, worth. A gaining acceptance. But when nise the distinction between forced failure to acknowledge a background human-rights instruments are applied and unforced prostitution allows the of general deprivation of rights uncritically, in ignorance of the larger claims of prostitutes rights groups to undermines the impact of these social picture, measurements of be ignored. This expression of interobjections. improved health outcomes may be national law undermines efforts to International law that deals with less certain. Rights-based questions reduce the incidence of HIV and AIDS prostitution targets trafficking in about public health should be asked women for the purpose of prostituand failings in rights instruments must and discriminates against prostitution tion, and counterpoises prostitution be confronted. on the basis of occupation. Anti-Slavery with human dignity. The 1949 Prostitutes overwhelmingly work International and the Network of Sex Convention for the Suppression of outside the law. This has implications Work Projects argue that the redefiniTraffic in Persons prohibits the for their health that are hard to quantion of prostitution as work is vital if exploitation of prostitution of a pertify. In one Australian study carried prostitutes are to enjoy equal human son even with the consent of that perout in 1998, the prevalence of sexually rights, in particular, their rights as son. CEDAW asks States to suppress transmitted bacterial infections was workers. trafficking in women and exploitation 80 times greater in 63 illegal street If it is possible to conceive that a of prostitution. Nowhere is trafficking prostitutes than in 753 of their legal person can enter prostitution volundefined. brothel counterparts. All the illegal tarily as the best of available options, In May this year the Council of street prostitutes with infections were then it is evident that there is a probEurope adopted a recommendation in the group who had not been lem in international law. This probwhich stated that trafficking in human screened for infections in the past 3 lem contributes to the vulnerability of beings for the purpose of sexual months, whereas none of those prostitutes to disease. It is therefore exploitation includes the procurement screened in the last 3 months were within the remit of health practitionof individuals, even with their coninfected. In legal brothels women are ers to advocate for a critical review of sent. Prominence is given to the rehagiven a strong legal incentive to be human-rights law. Rights instruments bilitation of the prostitute and screened monthly, and the use of conshould not contribute to the vulnerapunishment of those responsible. doms is compulsory. Legally sancbility of populations to disease, This is despite the comment in tioned encouragement of prostitutes they should aim to diminish this February this year from Radhika to use condoms or access screening vulnerability. Coomaraswamy, the UN Special services, both major determinants of *Bebe Loff, Beth Gaze, Christopher Fairley Rapporteur on violence against the prevalence of sexually transmitted *Department of Epidemiology and Preventive women, that lack of consent should be diseases, is impossible because of their Medicine; and Faculty of Law, Monash an element of trafficking. illegal status. Occupational health and University, Melbourne, Australia
Panos Pictures

1764

THE LANCET Vol 356 November 18, 2000

For personal use only. Not to be reproduced without permission of The Lancet.