frc home > issue analysis

The Medical Arguments Against Legalizing Prostitution

The Medical Arguments Against Legalizing Prostitution

by Reginald Finger, MD, MPH and Jeff Barrows, DO, MA (Ethics)

Over the last two decades, many have argued that legalizing the practice of prostitution could benefit society. First, it is alleged that bringing it into a regulated indoor environment, and giving those involved the legitimate protection of law enforcement against violence, would solve many of the problems that surround street prostitution (1). Second, some have reasoned that there is no compelling justification to criminalize sexual activity between consenting adults just because they have chosen to turn it into an economic transaction (2). However, in the midst of the debate, very little attention has been given to the medical data dealing with prostitution and whether this would argue for or against its legalization.

In 2003, Dr. Janice G. Raymond, a professor of ethics and women's studies, published a compelling series of arguments against legalization (3). Evidence has begun to accumulate from the Netherlands and Australia that legalization has resulted in more crime rather than less. Dr. Raymond and others have shown that a legally-sanctioned sex industry simply increases demand and attracts traffickers. In the meantime, violence against prostitutes continues and law enforcement often does little to stop it--the perception being that these women "bring it on themselves."

From our backgrounds in infectious disease epidemiology and obstetrics and gynecology respectively, we also believe legalization is a very unwise approach. Another of the frequently heard arguments for legalization is that by facilitating regular screening and treatment of prostitutes for sexually-transmitted infection, prostitution can be rendered safe from a health perspective (4). This line of reasoning is obviously flawed when one considers that to make a living for herself, or more usually for her pimp or trafficker, a prostitute has to have sex with several dozen customers a week at least. There is no way that screening could be carried out frequently enough in that context to avoid passing on a variety of infections from one customer to the next. Furthermore, it would be impractical to test and treat the male customers in order to protect the prostitutes (3). Gonorrhea, syphilis, chlamydia, human papillomavirus, trichomonas, and herpes are commonly encountered among sexually-active populations and would continue to be endemic among prostitutes and their customers despite a screening and treatment protocol.

A tempting option for control of bacterial STIs might be to simply keep prostitutes on antibiotics more or less continuously. However, this approach would only lead quickly to the development of resistant strains of bacteria, and in the meantime, viral STIs would only continue to circulate unchecked. Additionally, HIV infection could be acquired by a prostitute and passed on to customers for several weeks before a screening test would turn positive (5).

The answer given by many to this infectious disease dilemma is to promote the use of condoms among prostitutes. Unfortunately, even in areas where prostitutes are given complete autonomy over their work conditions, they often choose to forego condom use for the extra money the customer is willing to pay for sex without a condom. In fact, one study showed that only 5.8 percent of prostitutes used condoms consistently over the previous 2 weeks. (6) Prostitutes, moreover, often do not have the privilege of working independently and controlling their own working conditions. On every continent, the demand for purchased sex is so great that large sums of money can be made by prostitutes for those who control their services. Therefore, enslavement of women and children for the purpose of sexual services occurs frequently and has become the single most common manifestation of human trafficking (7-9). Some have been brought into the U.S. for this purpose, and others are citizens or residents of this country who have been lured or coerced into the control of traffickers from the homes, streets and shopping malls of our cities and towns.

Once trafficked into the sex industry, women and children suffer all kinds of serious health consequences. In addition to sexually transmitted infections, these include injuries, coercion to take alcohol and drugs, violence (10-12), post-traumatic stress disorder (10,12), infertility (13), and premature death (14). More detail about these health effects can be found in another of our publications (15).

The consequences to the health of the men who buy sex, as well as to the health of the prostitutes themselves, are serious, especially those related to sexually transmitted infections. The motivations for men who buy sex have not been studied adequately and are poorly understood. However, two or three courses of preventive action seem obvious. First, it would certainly help us as a society to throttle back on the constant stream of sexual stimulation coming from the entertainment industry, particularly pornography. Child pornographers and those who violate the law by distributing porn by mail and internet need to be prosecuted aggressively. Men need to hold each other accountable in the workplace and in the context of their personal relationships to avoid pornographic internet sites, magazines, and attendance at strip clubs.

From a law enforcement standpoint, we believe a better approach to controlling street prostitution would be to arrest and fine the customers rather than the prostitutes. Given that so many prostitutes, particularly those who are underage, have been forced into service and do not really want to be there, it would seem more helpful to provide avenues out of the profession for them, places to live, and educational opportunities--perhaps supervised jointly by the social services and the law enforcement systems. Meanwhile, the customers could be fined, jailed for short terms in case of repeat offenses, and their names published. More serious punishment could be reserved for the pimps and traffickers. This approach is being tried in Sweden, with some success (3).

The woman or child who has been trafficked into prostitution usually has one other source of contact with those who could help other than law enforcement--that being the health care system. Unfortunately, health professionals are ill-trained to recognize and respond adequately to trafficked victims when they are seen (16). So, the health consequences of trafficking--infections, injuries, violence, undernutrition, and psychological damage (10)--continue to occur.

Sex trafficking is clearly a thorny, multi-layered societal problem that will take many years of efforts from all sides to successfully combat. As the efforts to eradicate sex trafficking and prostitution continue, we should not forget the often devastating health consequences of purchased sex. We owe it to ourselves to invest aggressively in approaches that are likely to make a positive difference, and avoid steps in the wrong direction such as legalization of prostitution.


1) Brents BG, Hausbeck K. Violence and Legalized Brothel Prostitution in Nevada: Examining Safety, Risk, and Prostitution Policy. Journal of Interpersonal Violence. 2005 Mar;20(3):270-95
2) Decriminalize Private Adult Sexwork Coalition; http://www.sexwork.com/coalition/index.html
3) Raymond JG. Ten Reasons for Not Legalizing Prostitution and a Legal Response to the Demand for Prostitution. In Farley M (ed), (2003). Prostitution, Trafficking, and Traumatic Stress. New York: The Haworth Press, pp. 33-74
4) Morton AN, Tabrizi SN, Garland SM, Lee PJ, Reid PE, Fairley CK. Will the Legalisation of Street Sex Work Improve Health? Sexually Transmitted Infections. 2002;78:309
5) Information on HIV Testing from CDC: http://www.cdc.gov/hiv/topics/testing/resources/qa/be_tested.htm#wait
6) Basuki E., Wolffers, I., Deville W., et. al. "Reasons for not using condoms among female sex workers in Indonesia." AIDS Education Preview. 2002 Apr;14(2):102-16.
7) International Labour Office. A Global Alliance Against Forced Labour. Geneva, 2005. http://www.ilo.org/dyn/declaris/DECLARATIONWEB.DOWNLOAD_BLOB?Var_DocumentID=5059
8) Victims of Trafficking and Violence Protection Act of 2000. Public Law 106-386, October 28, 2000
9) Stewart DE, Gajic-Veljanoski O. Trafficking in Women: the Canadian Perspective. CMAJ 2005; 173(1):25-26.
10) Farley M, et al. Prostitution and Trafficking in Nine Countries: an Update on Violence and Posttraumatic Stress Disorder. In Farley M (ed), (2003). Prostitution, Trafficking, and Traumatic Stress. New York: The Haworth Press, pp. 33-74
11) Silbert MH, Pines AM. Victimization of Street Prostitutes. Victimology 1982; 7:122-133
12) Farley MF, Baral I, Kiremire M, Sezgin U. Prostitution in Five Countries: Violence and Post-traumatic Stress Disorder. Feminism and Psychology. 1998;8:405-26
13) Ward H, Day S. What Happens to Women Who Sell Sex? Report of a Unique Occupational Cohort. Sexually Transmitted Infections. 2006;82:413-17
14) Potterat JJ, Brewer DD, Muth SQ, Rothenberg RB, Woodhouse DE, Muth JB, et al. Mortality in a Long-term Open Cohort of Prostitute Women. American Journal of Epidemiology. 2004 Apr 15;159(8):778-85.
15) Finger R, Barrows J. Estimating the Health Effects of Human Trafficking in the United States -- a Daunting Challenge. In preparation.
16) Chisolm-Straker M, Richardson L. Assessment of Emergency Provider Knowledge About Human Trafficking Victims in the ED. Academic Emerging Medicine. 2007; 14(5):Supp 1: 134

frc home > issue analysis