Recently, the World Health Organization (hereafter, the WHO) released guidelines for helping to prevent the spread of HIV in several *key* populations. The WHO, who also monitors the whole world for epidemic outbreaks, says we need to decriminalize sex work and drugs if we want to stop (or at least slow) the spread of HIV.

This makes perfect sense to me.

HIV can be controlled with medications and safer sex. But outside privileged portions of the “developed” world, the virus continues to be a hugely significant issue. Following recommendations from many epidemiologists, the WHO hopes to shutter the spread of HIV by decriminalizing, and thus partially destigmatizing, certain sex work- and drug use-related behaviors. Ideally, less fear, etc would help connect high risk groups with preventative information and programs and/or treatment, thus blocking a (the?) main avenue the virus uses to get into the general population.


A reporter from Someplace That Shall Remain Nameless recently asked me a few questions about The WHO’s recommendations. Unfortunately, STSRN decided after the fact not to run the story (the story that they had originally requested), but I thought the whole discussion was too interesting not to share.

Soooo… here’s what was asked/said:

STSRN: 1) Has the WHO published guidelines like this before? What’s the precedent for these kinds of recommendations?

CT: I have to admit I don’t know, though I’d expect not. I doubt these recommendations would be getting so much attention if the WHO had offered up similar suggestions previously. Like many international organizations, they probably have to err on the side of caution in order to appease as many people and countries as possible.

STSRN: 2) What would sex work look like under the [new] WHO guidelines? 

CT: That would completely depend on the culture of each specific environment. In other words, decriminalized sex work would look very different in the U.S. vs China or in San Francisco, CA vs Louisville, KY (all arbitrary examples). I would hope that, at minimum, the WHO’s guidelines would result in some degree of improved sexual health and better daily working conditions for all sex workers.

STSRN: 3) I know that there are varying levels of criminalization around the world (from full-legalization in the Netherlands to decriminalization for sex workers in Sweden). What type of system do you think would work best?

CT: Again, this would vary from population to population. In the U.S., though elaborate and certainly not without problems, the system in place regulating legal brothel prostitutes in Nevada seems effective – to my knowledge, there has been no reported cases of workplace HIV transmission between workers and clients… ever (read: since the system’s inception). So though I do not think the Nevada system could be applied directly and/or uncritically to any other population, evidence of the effectiveness emerging from a balance of population-specific regulation in conjunction with decriminalization is encouraging.

I think the next logical step to tackle (in the Nevada example specifically, but also in general) would be working towards destigmatization – because the stigma levied by so many different populations against sex work and sex workers is only partially based in illegality. It’s also situated in wider cultural discomforts with sex.

STSRN: 4) What would drug use look like under the WHO guidelines? Would it be like Amsterdam all around the world?

CT: I think this would also depend on the country and/or culture. An environment comparable to Amsterdam (e.g. already decently socially liberal, with a lot of comparably minded social wellness programs already in place, etc) could likely expect similar outcomes from similar programs. A country or culture, however, wherein drug use was heavily stigmatized, etc may not expect the same results. The WHO’s guidelines, though universally applicable, would have to be carried out in a manner that’s tailored for each particular social environment. There’s no such thing as a “one size fits all” protocol.

STSRN: 5) What, in your mind, are the greatest barriers in implementing these guidelines? I imagine that here in America, there’s simply too much political stigma to take decriminalization of either sex work or drug use seriously. What do you think?

CT: Well, in terms of social sentimentality, the U.S. is so widely varied. Consequently, in some parts of the country, I wouldn’t expect there to be too many barriers. In other places and spaces, however, I imagine the push back against even the idea of decriminalization would be huge. Sadly, the places where the barriers would be the most significant are likely also the spaces where these types of changes would have the greatest benefit.

And there was this one follow-up question and response:

STSRN: The WHO guidelines don’t specify how to legalize sex work, just that it should be legal so that it can be regulated (unless I missed something in the report, and please correct me if I’m wrong!). What, in your opinion, is the best way to legalize sex work? A laissez faire system like the Netherlands? A semi-legal system like Sweden? A small, tightly regulated system like Nevada? What’s the most “feminist” way to legalize sex work?

CT: I hate to continue with the same academic-ese, but it completely depends on the particularities of the specific population. I would say that the most “feminist” way to legalize sex work would involve public health workers’ open-minded, informed, and judgment free exploration of a specific community – things like how the population works, norms, conventions, and general practices must be understood before any sort of regulation, etc can be beneficial. Then, appropriate programs, policies, and services could be developed and implemented.

I do not think legalizing sex work uncritically across the board and then walking away would be effective at all – some sex work populations are so marginalized, so stigmatized, and so lacking in services that such a thing might cause more harm than good. If the WHO is truly interested in public health, then every instance of legalization will also work to understand the needs of specific populations – because even the most marginalized and stigmatized workers know how to do their jobs. The most feminist way to legalize sex work is not to tell people how to do live their lives, but to make sure sex workers have the information and resources they may need to keep themselves healthy and safe.

The idea of decriminalizing sex work and drug use is interesting. On a grand scale, I completely agree with it; but on a practical and feminist/social justice level, I worry about effective, informed, and respectful execution.

It will be interesting to see what comes from all this.

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