N° 46
SÉNAT SESSION ORDINAIRE DE 2013-2014
Enregistré à la Présidence du Sénat le 8 octobre 2013
RAPPORT D´INFORMATION
FAIT au nom de la commission des affaires sociales (1) sur la situation sanitaire et sociale des personnes prostituées,
Par M. Jean-Pierre GODEFROY et Mme Chantal JOUANNO,
Sénateurs.
(1) Cette commission est composée de : Mme Annie David, présidente ; M. Yves Daudigny, rapporteur général ; M. Jacky Le Menn, Mme Catherine Génisson, MM. Jean-Pierre Godefroy, Claude Jeannerot, Alain Milon, Mme Isabelle Debré, MM. Jean-Marie Vanlerenberghe, Gilbert Barbier, Mme Catherine Deroche, vice-présidents ; Mmes Claire-Lise Campion, Aline Archimbaud, MM. Marc Laménie, Jean-Noël Cardoux, Mme Chantal Jouanno, secrétaires ; Mme Jacqueline Alquier, M. Jean-Paul Amoudry, Mmes Françoise Boog, Natacha Bouchart, Marie-Thérèse Bruguière, Caroline Cayeux, M. Bernard Cazeau, Mmes Karine Claireaux, Laurence Cohen, Christiane Demontès, MM. Gérard Dériot, Jean Desessard, Mme Muguette Dini, M. Claude Domeizel, Mme Anne Emery-Dumas, MM. Guy Fischer, Michel Fontaine, Bruno Gilles, Mmes Colette Giudicelli, Christiane Hummel, M. Jean-François Husson, Mme Christiane Kammermann, MM. Ronan Kerdraon, Georges Labazée, Jean-Claude Leroy, Gérard Longuet, Hervé Marseille, Mmes Michelle Meunier, Isabelle Pasquet, MM. Louis Pinton, Hervé Poher, Mmes Gisèle Printz, Catherine Procaccia, MM. Henri de Raincourt, Gérard Roche, René-Paul Savary, Mme Patricia Schillinger, MM. René Teulade, François Vendasi, Michel Vergoz, Dominique Watrin.
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SURVWLWXWLRQVXUODVXUYHQXHGHFHVWURXEOHVG·DXWUHVIDFWHXUVHQWUDQWHQFRPSWH QRPEUH GH WpPRLJQDJHV LQGLTXHQW TXH O·H[HUFLFH GH FHWWH DFWLYLWp QH ODLVVH SDV LQGHPQHVXUOHSODQSV\FKLTXH 'HWRXWHVFHVGRQQpHVpSLGpPLRORJLTXHVQRXVGUHVVRQVOHFRQVWDWG·XQHWUqV JUDQGHYXOQpUDELOLWpVDQLWDLUHGHVSHUVRQQHVSURVWLWXpHVpWDQWSUpFLVpTXHOHQLYHDX G·H[SRVLWLRQ DX[ ULVTXHV VDQLWDLUHV HW OD IUpTXHQFH GHV SDWKRORJLHV UHQFRQWUpHV YDULHQW IRUWHPHQW VHORQ OHV VLWXDWLRQV LQGLYLGXHOOHV HW OHV PRGHV G·H[HUFLFH GH OD SURVWLWXWLRQ ,O DSSDUDvW HQ HIIHW FODLUHPHQW TXH OHV YLFWLPHV GHV UpVHDX[ GH SUR[pQpWLVPHHWGHWUDLWHVRQWSDUWLFXOLqUHPHQWIUDJLOHVVXUOHSODQVDQLWDLUH 'DQV FH FRQWH[WH GH TXHO VXLYL PpGLFDO EpQpILFLHQW OHV SHUVRQQHV SURVWLWXpHV"7RXWFRPPHO·H[SRVLWLRQDX[ULVTXHVVDQLWDLUHVOHUHFRXUVDX[VRLQV GLIIqUHVHORQOHVSXEOLFVHWOHVFRQGLWLRQVG·DFWLYLWp/DSURVWLWXWLRQGHUXHVHWUDGXLW DLQVLSDUGHVGLIILFXOWpVG·DFFqVDX[VRLQVHWGHVXLYLPpGLFDOSOXVPDUTXpHVTXHOD SURVWLWXWLRQHQVDORQGHPDVVDJH OHVSHUVRQQHVWUDYDLOODQWGDQVODUXHVRQWPRLQV QRPEUHXVHV j rWUH LQVFULWHV DXSUqV G·XQ PpGHFLQ JpQpUDOLVWH PRLQV VRXYHQW GpSLVWpHVSRXUOHV,67HWHQUHJLVWUHQWSOXVGHUHWDUGVGDQVOHXUVFRQWU{OHVGXFROGH O·XWpUXV 6,78$7,2162&,$/( '(63(56211(635267,78e(6 3OXV JpQpUDOHPHQW OH UHFRXUV DX[ VRLQV V·DYqUH G·DXWDQW SOXV SUREOpPDWLTXHTXHODVLWXDWLRQGHODSHUVRQQHSURVWLWXpHHVWSUpFDLUH&RPPHSRXU G·DXWUHV SXEOLFV YXOQpUDEOHV OH FXPXO GH GLIILFXOWpV pFRQRPLTXHV HW VRFLDOHV DJLW FRPPHXQIUHLQjO·DFFqVDX[VRLQV/HVSHUVRQQHVTXLVHSURVWLWXHQWRQWWHQGDQFHj DWWHQGUHOHGHUQLHUPRPHQWSRXUFRQVXOWHUODVDQWpQ·pWDQWSDVODSUHPLqUHGHOHXUV SULRULWpV /H PDQTXH GH VXLYL PpGLFDO HVW SDUWLFXOLqUHPHQW SDWHQW VXU OH SODQ J\QpFRORJLTXH DORUVTXHOHWDX[GHVXLYLV·pOqYHjGDQVODSRSXODWLRQIpPLQLQH JOREDOH LO YDULH HQWUH HW SDUPL OHV IHPPHV SURVWLWXpHV /H UHFRXUV DX GpSLVWDJHGX9,+HVWOXLDXVVLLQVXIILVDQWHQSDUWLFXOLHUV·DJLVVDQWGHVSHUVRQQHV SURVWLWXpHVpWUDQJqUHVHWGHFHOOHVH[HUoDQW©LQGRRUª Mme Chantal Jouanno, rapporteure. – Nous poursuivons avec le volet social. Les personnes prostituées bénéficient théoriquement des mêmes droits sociaux que les autres citoyens. Il leur est possible de s’affilier à un régime de sécurité sociale et d’accéder ainsi à la couverture maladie et à l’assurance retraite. Toutefois, ces possibilités leur sont, dans la réalité, difficiles d’accès dans la mesure où la prostitution ne constitue pas une activité professionnelle juridiquement reconnue. C’est toute l’ambiguïté voire l’hypocrisie de la position abolitionniste de la France. La question de l’accès aux droits sociaux se pose en outre en des termes différents s’agissant des personnes prostituées de nationalité étrangère victimes des réseaux. Du fait de leur statut juridique précaire et surtout de l’emprise exercée par leurs proxénètes, ces personnes sont, pour la grande majorité d’entre elles, très éloignées des dispositifs de prise en charge. En matière de couverture maladie, les personnes prostituées relèvent, selon leur situation juridique et sociale, soit des dispositifs de droit commun, soit des dispositifs complémentaires destinés aux personnes n’ayant pu faire valoir leurs droits par la première voie d’accès. Ainsi, pour les personnes françaises ou étrangères disposant d’un droit de séjour, catégorie dont relèvent principalement les personnes prostituées dites « traditionnelles », sont ouvertes l’affiliation au régime social des indépendants (RSI) ou l’inscription à la couverture maladie universelle (CMU) et complémentaire (CMU-c). Pour les personnes étrangères en situation irrégulière, catégorie à laquelle appartient la très grande majorité des personnes prostituées, sont possibles la demande d’aide médicale de l’Etat (AME) ou, à défaut, l’accès aux soins d’urgence. Alors qu’elles sont pour la plupart éligibles à l’un ou l’autre de ces dispositifs, les personnes prostituées accèdent, dans les faits, très difficilement à une couverture maladie. Plusieurs facteurs contribuent à expliquer ce constat. En premier lieu, le renoncement aux droits et aux soins chez les personnes en situation de précarité est principalement motivé par des raisons financières ou lié au fait qu’elles ont d’autres priorités, comme le logement ou l’alimentation. En deuxième lieu, la mauvaise maîtrise du français constitue un obstacle important à l’accès aux soins. Elle conduit à des incompréhensions sur les informations délivrées par les professionnels de santé, à des erreurs de diagnostic, sans compter qu’elle rend quasiment impossible les prises en charge psychologiques. C’est pourquoi nous recommandons de développer le recours à la médiation et à l’interprétariat dans les établissements de santé et les services sociaux, sur le modèle de ce que nous avons pu voir à l’hôpital Ambroise Paré où une professionnelle issue du milieu de la prostitution est chargée d’établir un lien de confiance avec les personnes prises en (;$0(1(1&200,66,21 charge. En troisième lieu, la constitution des dossiers et la production des justificatifs nécessaires pour ouvrir les droits s’apparentent à un véritable parcours du combattant, en particulier pour les personnes en situation irrégulière. Non seulement les délais d’instruction des dossiers sont parfois très longs mais, en outre, des disparités importantes existent dans leur traitement selon les caisses primaires d’assurance maladie. Une harmonisation des règles de gestion administratives de l’AME est donc nécessaire, de même qu’une sensibilisation des personnels à la situation particulière des personnes prostituées victimes de la traite. Enfin, les personnes prostituées n’ont qu’une faible connaissance de leurs droits ainsi que du fonctionnement du système de soins. Une brochure intitulée « vos droits, votre santé » est en cours d’élaboration. Sa diffusion doit être la première étape d’une réelle stratégie d’information et d’orientation, dont les associations seraient le principal relai. Le rôle de ces dernières est en effet essentiel compte tenu de la méfiance que suscitent les institutions. La question de l’accès à l’assurance retraite ne se pose que pour les personnes prostituées en situation régulière. Depuis 2004, les personnes prostituées peuvent cotiser auprès de la Caisse interprofessionnelle de prévoyance et d’assurance vieillesse (Cipav), qui accueille l’ensemble des professions non classées, notamment les professions libérales non affiliées au RSI. Il est cependant impossible de connaître le nombre de personnes prostituées ayant recours à ce dispositif dans la mesure où elles ne se déclarent pas comme telles. Par ailleurs, la possibilité de cotiser auprès de la Cipav ne permet pas de remédier à la situation de celles qui sont d’ores et déjà en âge de prendre leur retraite. Or un nombre non négligeable de femmes – nous en avons rencontré au cours de nos maraudes – sont contraintes de poursuivre leur activité malgré leur âge avancé et la dégradation de leur état de santé. Seule une minorité dispose d’une pension de retraite. Au-delà de ces difficultés, plusieurs facteurs liés à l’environnement dans lequel évoluent les personnes prostituées freinent l’accès aux droits sociaux et aux soins. Les violences, inhérentes à toutes les formes de prostitution, sont à la fois physiques et psychologiques. Elles émanent principalement des clients, mais aussi des proxénètes, des personnes prostituées entre elles, voire des passants et des riverains. Les conditions d’hébergement, souvent très précaires, accentuent le risque de propagation des infections, participent d’un rythme de vie décalé, favorisent une alimentation peu équilibrée et ne permettent pas l’établissement d’une adresse fixe pour la constitution des dossiers administratifs. La stigmatisation et l’isolement constituent des facteurs de vulnérabilité supplémentaires. Il est temps que la société inverse son regard sur ces personnes afin qu’elles soient considérées comme des victimes et non plus comme des présumées coupables. Enfin, le sentiment de méfiance à l’égard des « institutions », particulièrement manifeste chez les personnes en situation irrégulière, a été renforcé par la mise en œuvre de la loi pour la sécurité intérieure de 2003. Cette méfiance peut aussi s’exprimer à l’égard d’acteurs censés leur venir en aide, attitude qui s’explique par la barrière linguistique, les différences culturelles et les histoires personnelles des personnes prostituées, en particulier lorsqu’elles ont été confrontées aux « parcours de dressage » que nous vous avons décrits précédemment. M. Jean-Pierre Godefroy, rapporteur. – La focalisation du débat public sur le volet pénal de la prostitution aurait tendance à faire oublier que celui-ci est indissociable de son pendant social. Comment, en effet, aider les personnes qui le 6,78$7,2162&,$/( '(63(56211(635267,78e(6 souhaitent à sortir de la prostitution sans leur proposer d’alternatives crédibles en termes de garantie de revenus, d’hébergement, de formation professionnelle et d’accompagnement psychologique ? Aussi, sans présager des futurs débats sur l’évolution du cadre légal de la prostitution, nous plaidons pour la mise en œuvre d’un accompagnement social global des personnes désireuses de quitter la prostitution ainsi que des victimes de la traite. Il faut tout d’abord agir dans le champ de la fiscalité. L’impôt sur le revenu étant payé avec une année de décalage, la fiscalisation des personnes prostituées constitue un obstacle important à la cessation de leur activité. Des remises gracieuses peuvent leur être accordées, mais les conditions pour y être éligible sont dissuasives et irréalistes. Il faut en effet que la personne prostituée prouve qu’elle n’a conservé aucun bien de son activité antérieure. C’est pourquoi nous proposons que seules deux conditions guident cette politique de remise fiscale : l’arrêt de la prostitution et l’engagement dans un parcours d’insertion professionnelle. Nous pointons, par ailleurs, l’attitude ambigüe de l’Etat s’agissant du régime fiscal applicable aux proxénètes : d’un côté, il s’est fixé comme objectif la lutte contre le proxénétisme, de l’autre, il a édicté des règles juridiques précises pour imposer les personnes se livrant à ce type d’activité ! La personne prostituée peut par exemple déduire des revenus qu’elle déclare les sommes reversées à son proxénète ! Quel que soit le mode d’exercice, tout arrêt de la prostitution entraîne mécaniquement une perte de revenus qui met les personnes concernées en situation de précarité et de vulnérabilité accrues. Se pose dès lors la question d’un soutien financier de transition permettant de faire face à la période d’inactivité avant l’insertion dans un parcours professionnel. Aujourd’hui, les personnes prostituées peuvent, selon leur nationalité et la régularité de leur séjour, avoir accès soit au revenu de solidarité active (RSA), soit à l’allocation temporaire d’attente (ATA). Or une catégorie demeure exclue de ces dispositifs : les personnes prostituées étrangères qui n’ont pas voulu ou pas pu porter plainte contre le réseau de traite ou leur proxénète. Une piste consisterait à leur ouvrir le droit à l’ATA à condition qu’elles soient engagées dans un parcours de sortie de la prostitution. Les capacités d’accueil des personnes prostituées souhaitant abandonner cette activité ne sont ni suffisantes, ni toujours adaptées à la nature de la demande. Il nous paraît dès lors souhaitable de les faire bénéficier en priorité de l’accès au contingent d’un tiers des places d’hébergement d’urgence qui, conformément à l’engagement présidentiel, doivent être réservés aux femmes victimes de violence. En outre, les personnes prostituées souhaitant sortir de la prostitution ne sont pas considérées comme un public prioritaire pour l’accès au logement social, alors qu’elles entrent théoriquement dans le champ de l’article L. 441-1 du code de la construction et de l’habitation. Une circulaire doit donc être adressée aux bailleurs sociaux afin de remédier à cette mauvaise interprétation des textes. La sortie de la prostitution suppose de donner aux personnes concernées des perspectives crédibles en termes de formation professionnelle, au risque sinon de les voir « replonger ». Outre la question de la maîtrise de la langue, l’accès aux dispositifs de formation de droit commun se heurte, pour les victimes de la traite, à un obstacle : la détention d’un titre de séjour suffisamment long pour pouvoir suivre une formation professionnelle dans la durée. Nous estimons donc nécessaire de revoir les modalités de délivrance des titres de séjour pour ces personnes, qu’elles aient ou non porté plainte. (;$0(1(1&200,66,21 La violence subie est souvent telle que les répercussions sur la santé et le psychisme des personnes prostituées sont profondes et durables. Des troubles comme la honte de soi ou la peur des autres rendent difficiles tout parcours de « reconstruction ». Aussi, ces personnes, en particulier celles victimes d’exploitation, doivent pouvoir bénéficier d’un accompagnement psychologique ou psychiatrique sur le long terme. Sur ce sujet de la sortie de la prostitution, l’Italie – où nous nous sommes rendus en juin dernier – a mis en place une politique globale qui s’inspire des mesures relatives à la lutte contre les réseaux mafieux et dont de nombreux aspects pourraient à nos yeux être transposés en France : la reconnaissance du statut de victime indépendamment du fait que la personne ait dénoncé ou non son trafiquant/proxénète et dès lors qu’elle est engagée dans un parcours d’insertion ; l’octroi d’un permis de séjour temporaire à titre humanitaire ; la protection immédiate dont bénéficie la victime grâce à son hébergement dans un « centre de fuite » ; la mise en place d’un accompagnement personnalisé en vue de sa réinsertion sociale et professionnelle ; la saisie de l’argent des réseaux de traite au profit des victimes, soit directement sous la forme d’un dédommagement, soit indirectement via le financement de programmes d’insertion sociale et professionnelle ; la complémentarité d’action entre la politique d’aide aux victimes et la politique de lutte contre les réseaux. Mme Chantal Jouanno, rapporteure. – Enfin, il nous a semblé que la question de la cohérence de l’action publique en direction des personnes prostituées nécessitait d’être approfondie. Force est en effet de constater l’oubli dans lequel celles-ci ont été reléguées depuis des décennies. Celui-ci se traduit tout d’abord par l’absence quasi-totale de données publiques et partagées sur les conditions d’exercice, ainsi que sur la situation sanitaire et sociale des personnes prostituées. La loi sur la sécurité intérieure de 2003 prévoyait qu’un rapport soit transmis chaque année au Parlement sur le sujet. Celui-ci n’a, en pratique, été publié qu’une fois et, faute de pouvoir s’appuyer sur une expertise suffisamment étayée, n’a pu proposer qu’une analyse de portée très limitée. Une seule enquête récente permet de disposer d’un aperçu relativement global de l’état de santé des personnes qui se prostituent. Or, dresser un constat partagé par l’ensemble des acteurs de la situation démographique, sanitaire et sociale des personnes prostituées constitue la première et indispensable étape à la mise en place de politiques intelligentes en la matière. Nous estimons donc nécessaire d’aller beaucoup plus loin sur ce point. Notre deuxième sujet de préoccupation porte sur l’évolution des financements alloués par l’Etat aux associations qui agissent auprès des personnes prostituées. Si la baisse ininterrompue enregistrée entre 2006 et 2012 semble aujourd’hui enrayée, les associations continuent de regretter le manque de visibilité pluriannuelle dont elles disposent, alors même qu’elles sont confrontées à des charges croissantes. En 2014, la direction générale de la cohésion sociale (DGCS) devrait leur attribuer 2,4 millions d’euros. Si les comparaisons doivent être maniées avec prudence, il faut tout de même noter que l’Italie consacre chaque année 8 millions d’euros aux questions d’assistance et d’intégration sociale des personnes prostituées. 6,78$7,2162&,$/( '(63(56211(635267,78e(6 A la faiblesse des subventions, s’ajoute le manque de coordination des administrations centrales en charge des questions sanitaires et sociales. En effet, la DGCS et la direction générale de la santé (DGS) mènent des actions parallèles qui ont leurs logiques propres, les unes centrées sur la lutte contre les violences faites aux femmes, les autres sur la lutte contre les IST. Cette absence de coopération est mal comprise par les associations de terrain. Or, dans la période de contraintes budgétaires que nous connaissons, il serait logique de travailler à une meilleure complémentarité des mesures engagées dans les champs sanitaire et social, ainsi qu’à la définition d’une politique de subventionnement partagée. Plus généralement, nous dégageons trois enjeux essentiels en matière de pilotage de l’action publique auprès des personnes prostituées. Le premier consiste à renforcer les moyens alloués à la lutte contre le proxénétisme et la traite des êtres humains. Mis en place en 2001, le dispositif national d’accueil et de protection des victimes de la traite des êtres humains dit « Ac.Sé » permet d’assurer l’éloignement géographique et l’hébergement des personnes qui en sont victimes. Quarante-sept structures d’hébergement y participent, réparties dans trente-sept départements. En 2012, soixante-six personnes ont été prises en charge dont près d’un quart étaient des femmes accompagnées de leur(s) enfant(s). Ce dispositif constitue l’une des rares actions de portée quasi-nationale dont l’efficacité est reconnue et saluée par le plus grand nombre. Il est dès lors d’autant plus regrettable qu’une baisse des financements qui lui seront alloués dans les deux prochaines années soit envisagée. A nos yeux, le dispositif Ac.Sé doit au contraire être conforté et étendu à l’ensemble du territoire. Une mission interministérielle pour la protection des femmes contre les violences et la lutte contre la traite des êtres humains, la Miprof, a été créée au début de l’année 2013. Il s’agit d’une évolution souhaitée et importante, susceptible de contribuer à améliorer ce pilotage qui fait tant défaut aujourd’hui. S’il est encore un peu tôt pour dresser un premier bilan, nous insistons pour que ses missions en matière de lutte contre la traite des êtres humains soient renforcées, notamment pour qu’elle soit en mesure de développer une véritable expertise sur le sujet. Par ailleurs, nous ne pouvons que regretter le fait que la DGS n’ait pas été intégrée à son comité d’orientation. Le deuxième enjeu porte sur la coordination des acteurs associatifs et institutionnels dans les territoires. Ceux-ci sont en effet bien souvent désemparés pour arriver à structurer leurs actions et à concilier des objectifs parfois contradictoires. S’y ajoute différence de philosophie entre associations. Plusieurs circulaires ont été publiées depuis les années 1970 pour mettre en place des structures de pilotage dédiées au niveau des départements. Elles ont en pratique été peu appliquées et nous restons circonspects quant à la pertinence de dispositifs trop rigides. La région bordelaise semble au contraire être parvenue à trouver un mode de fonctionnement adapté sous la forme d’un réseau d’intervention sociale, structure relativement souple qui permet d’associer collectivités territoriales, services de l’Etat et associations de toutes tendances autour de principes d’actions communs et de valeurs partagées. Grâce à la dynamique créée par ce réseau, une convention cadre départementale pour la coordination des actions concernant les victimes de la traite des êtres humains a pu être signée en avril 2012. Nous souhaitons que ce type de partenariat très souple puisse être étendu et reproduit dans les territoires. (;$0(1(1&200,66,21 Le troisième et dernier enjeu tient au renforcement de la présence du système de santé auprès des personnes prostituées. Celles-ci doivent en effet pouvoir bénéficier d’un accompagnement adapté et personnalisé vers les dispositifs de prise en charge de droit commun. Le rôle des permanences d’accès aux soins de santé (PASS) nous parait à ce titre essentiel. Nous en avons eu la preuve en nous rendant à l’hôpital Ambroise Paré qui a mis en place depuis plusieurs années une structure dédiée à la prise en charge des personnes prostituées en s’appuyant sur une de ces permanences ainsi que sur un partenariat associatif et sur une médiatrice culturelle. Les agences régionales de santé (ARS) ont également un rôle à jouer. Quelques-unes prennent déjà en compte les questions relatives à la prostitution dans leurs documents de programmation. Cela devrait être plus systématique. Elles peuvent également contribuer à décloisonner les pratiques et encourager la mise en œuvre de travaux communs sur les enjeux sanitaires et sociaux. Les débats très formels auxquels nous sommes habitués sur le cadre légal de la prostitution masquent trop souvent la réalité humaine de celle-ci. Or ce monde est d’une violence inouïe. Nous insistons donc sur la nécessité, avant toute chose, d’inverser le regard que nous portons sur les personnes prostituées. La législation italienne est à ce titre intéressante dans la mesure où elle considère celles-ci en premier lieu comme des victimes potentielles. Nous partageons avec Jean-Pierre Godefroy la conviction qu’il faut tout faire pour agir au mieux pour les personnes prostituées. Mme Annie David, présidente. – Je pense en effet qu’il est nécessaire d’inverser notre regard sur la prostitution. Il faut mettre en pratique la position abolitionniste de la France et prendre en considération ces personnes, qui sont des victimes pour la plupart d’entre elles. 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