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AMSTERDAM -- "End demand" laws regarding prostitution, which criminalize clients and sex-work advertising -- but which excuse the sex workers themselves -- failed to benefit sex workers' healthcare access and, in some cases, made things worse, researchers said here.

Research conducted in Canada and France, which implemented the so-called for such laws, found that sex workers had reduced access to healthcare and support services and a decrease in safe sex practices.

Indeed, some panel members at a press conference at the (IAC) outright called for full decriminalization of sex work, similar to the situation with laws seen in New Zealand and parts of Australia.

Elena Argento, MPH, of the University of British Colombia in Vancouver, shared the results of her longitudinal study that examined a cohort of sex workers both before and after Canada's "end demand" legislation, the Protection of Communities and Exploited Persons Act (PCEPA).

She found that following implementation of this law, sex workers had significantly reduced access to health services and sex worker-led support, such as outreach, drop-in centers, and peer support. The post-PCEPA time period (2015-2017) was associated with 41% reduced access to health services, and 23% reduced access to sex worker-led support services, Argento said. Moreover, there were no changes to access to HIV treatment and care for sex workers living with HIV following the implementation of these laws.

"These findings demonstrate that 'end demand' models continue to replicate and exacerbate harms to sex workers and are a barrier to accessing HIV health and community health services," Argento said.

France recently passed similar "end demand" legislation in 2016. Hélène Lebail, PhD, of Centre National de la Rechere Scientifique (CNRS), a scientific research firm in France, said she discovered that contrary to helping sex workers, these laws resulted in "an acute increase in their socioeconomic vulnerability."

Lebail also said her research found decreased condom use and increased difficulty for sex workers to negotiate safe sex practices and difficulty in accessing treatment for HIV-positive sex workers.

"Violence is increasing, working conditions are more dangerous, autonomy is decreasing ... but all of these elements are described as 'collateral damages,'" she said. "Is it morally acceptable to consider this impact as just collateral damages? [The laws don't] change anything in terms of stigma."

Lebail speculated that the reason sex workers may be unable to find healthcare services following the "end demand" laws is because they are forced to move to less visible areas, because their clients don't want to be arrested by the police. But once they move to a different city, they don't know where to go for health services, she said.

Linda-Gail Bekker, MBChB, PhD, of the Desmond Tutu HIV Centre in Cape Town, South Africa, who moderated the panel but was not involved with the research, told 番茄社区app that clinicians treating this population should provide "welcoming, affirming" services, and that it may be necessary to work around laws because "public health demand is so compelling."

"My message to providers is do it anyway, do it with love and compassion, do it expertly and excellently," said Bekker, who also is president of the International AIDS Society, which sponsors the biennial conference. "I think our voice matters to policy-makers, and I think if we say this makes good public health and individual health sense, that's a powerful lobbying tool."

Stigma and Discrimination

The panel also featured several women who had been involved with advocacy for sex workers' rights, discussing the stigma and discrimination they face. Loveness Bowa Gunda, a drop-in center manager in Malawi, detailed examples of how sex workers are treated by the healthcare establishment in her country, where sex work is not allowed.

"One sex worker [with HIV] went to a healthcare facility [for antiretroviral therapy] and the healthcare provider said, 'I cannot assist you because you contracted the virus deliberately,'" Gunda said. "Another one was beaten up by police, and they said 'you're a sex worker -- you deserve it.'"

But the most impassioned voice came from Duduzile Dlamini, of Sex Workers Education and Advocacy Task Force in South Africa, who called for the full decriminalization of sex workers in her country and for countries to allow sex workers to "exercise full rights as human beings."

"We are tired of people coming in with their moralities ... to develop policies that say sex workers are bad people. We choose to be -- we are not victims. Sex workers are mothers. Sex workers are sisters. Policymakers, lawmakers -- they must recognize us. The fact is we are human beings," Dlamini said.