Negative Effects of Legalized Prostitution in the US State of Nevada Women’s Human Rights (No. 14) December, 2015 Michael Shively, Ph.D. Senior Associate Abt Associates 55 Wheeler St. Cambridge, MA 02138 Introduction Prostitution is widely acknowledged by both proponents and opponents to be inherently dangerous, but there are strongly opposing views about the most effective methods for minimizing risks. Laws addressing prostitution pursue three main objectives: Prohibition legally bans prostitution, and seeks its prevention or abolition. Legalization establishes laws and regulations allowing prostitution to function as a type of legitimate business, if it operates within specified parameters. Decriminalization eliminates legal and regulatory restrictions on prostitution, allowing it to function freely in response to market forces. There are also hybrid or “limited legality” laws that borrow elements of the other basic approaches, such as decriminalizing the sale of sex but prohibiting its purchase. This paper examines whether the implementation of legal prostitution in the American state of Nevada has produced the intended reduction in harmful outcomes. Like all jurisdictions that have legalized prostitution, Nevada’s model was driven by a belief that criminalizing and attempting to suppress prostitution is not achievable, and its pursuit produces more harm than good. Efforts to enforce prohibitions result in unintended consequences such as driving commercial sex “underground” where those selling sex are more vulnerable to being abused, stigmatized, harassed by police, and unable to fully access health and social services. Criminalizing prostitution is also said to unleash black market forces, inviting the involvement of organized crime in the sex trade, much like efforts to prohibit alcohol in the early 20th century spurred the Mafia’s proliferation in the United States. Legalization proponents proceed from the assumptions that prostitution is inevitable and the pragmatic approach to effectively reduce risks is managing commercial sex as a legitimate industry operating in plain view. They contend that safety and health outcomes can be improved by regulation, and that the infrastructure for enforcement and compliance and enforcement can be supported by taxes and/or fees paid by the industry. Safeguards for both buyers and sellers of sex can be mandated, and include requiring those selling sex to obtain licenses, mandating frequent screening for sexually transmitted infections, and requiring condom use. Laws legalizing prostitution may require transactions to occur only in licensed and inspected premises, and if so, may impose requirements added specifically for this business, such as panic buttons in bedrooms, the presence of electronic security and/or security staff, minimum sanitary standards, and mandating that brothels use only licensed adult employees or independent contractors. Such standards are intended to reduce disease transmission and deter abuse and exploitation of commercial sex providers. In 1971 the Nevada State Legislature passed statutes legalizing prostitution, and later created regulations containing parameters within which prostitution businesses must adhere to operate in compliance. The regulations outlined a system defining brothels as the only legal venue for commercial sex transactions, requiring licensing of both brothels and the people working within them, and mandating frequent health screenings and certification renewals. This paper provides an assessment of whether the implementation of legalization in Nevada has produced its intended improvements to health and safety. Before describing the history and content of the state law and details about its implementation, we first briefly review the core problems that legalization is meant to solve: the wide range of risks and harms faced by those involved in commercial sex. Dangers of Prostitution The negative consequences of prostitution for all parties involved are well documented. Those working in the illicit sex trade, their “customers,” and residents and businesses in areas in which prostitution occurs all suffer tangible harm (Deering et al., 2014; Kinnell, 2013; Newman, 2006; Nixon et al., 2002; Rekart, 2006; Shannon et al., 2010; Walker, 2002). People typically enter prostitution as minors (Edwards, 2006; Goldenberg et al., 2013; Estes and Weiner, 2002), and key predictors of entry include child sexual abuse, financial insecurity, family discord, violence, and coercion (e.g., Bittle, 2002; Crime and Misconduct Commission, 2004; Halter, 2010; McIntyre, 1999; McNaughton & Sanders, 2007; Reid, 2011; Tyler & Johnson, 2006; Wilson & Widom, 2010). Traumatic experiences with childhood abuse and family dysfunction contribute to prostitution risk via homelessness and a lack of economic self-sufficiency, and vulnerable youth are often are targeted for recruitment into commercial or survival sex within 48 hours of becoming homeless (Minnesota Attorney General’s Office, 1999). Commercial sex involving minors is, by definition, sex trafficking since minors cannot legally consent to prostitution, but studies find the inherent exploitation is frequently compounded by traffickers’ use of coercion and force (e.g., Chapkis, 2003; Kennedy et al., 2007). Once involved in selling sex, the vast majority can expect to experience a wide range of serious health problems and other trauma resulting from infectious disease, assaults, and drug abuse, including traumatic stress, elevated suicide risk, shorter life expectancy, and vastly elevated homicide risk. Systematic reviews of hundreds of studies have found the majority of women in prostitution to experience workplace violence committed by pimps, sex buyers, and co-workers (e.g., Deering et al., 2014; Kinnell, 2013; O’Doherty et al., 2011; Raphael & Shapiro, 2004). Involvement in prostitution is also linked to post-traumatic stress and a variety of health problems, including tuberculosis, HIV, STDs, anemia, and hepatitis (e.g., Campbell et al., 2003; Farley et al., 2003; McDonnell et al., 1998; Nixon et al., 2002; Valera et al., 2000; Walker, 2002a; Wood et al., 2007). Rates of infectious disease are from five to 60 times higher among providers of commercial sex than in general populations (Jeal & Salisbury, 2004). The risk of homicide for providers of commercial sex is at least 17 times higher than any other occupation or identified group, and the life expectancy of women in commercial sex was found to be as little as 34 years (e.g., Brewer et al., 2006; Dudek, 2001; Potterat et al., 2004; Salfati et al., 2009; Spittal et al., 2006;). After enduring child sex trafficking and extreme levels of risk for rape, assault, homicide, suicide, drug abuse, and infectious disease, prostituted persons often retain only a small portion of their earnings after supporting drug addictions and “third party extortions of net residual earnings” (DeRiviere, 2006). Those leaving the sex trade are often without savings or career skills, and suffer from debilitating health conditions, addictions and mental health disorders (e.g., Choi et al., 2009; Dalla, 2006; DeRiviere, 2006; McIntyre, 1999; Monroe, 2005). It is not only abolitionists (e.g., Farley, 2007; Raymond, 2013) who argue that child sexual exploitation, violence, etc. are normative for those who sell sex. Advocates for decriminalizing commercial sex agree that the majority of women involved in prostitution have been the victims of child or adult sex trafficking, and that other forms of violence and infectious disease are ubiquitous (e.g., Shannon et al., 2009; Strathdee et al., 2009). For example, review of dozens of epidemiological studies led Goldenberg and colleagues (2013) to conclude that “…up to 40% of female sex workers and marginalized adolescents are involved in sex work as youth, and between 10–25% may be forced or deceived into the sex industry.” In that study’s survey, 85% of the sample of current “sex workers” reported being sold for sex before the age of 18. A coauthor of the Goldenberg study (Strathdee) has conducted primary research in which the median ages of entry into prostitution for her survey samples were 16 and 17 years of age (e.g., Shannon et al., 2009; Strathdee et al., 2009). Understanding that commercial sex markets are highly stratified and segmented is a key to resolving the conflicting portrayals conveyed by proponents and opponents (Chapkis, 2000; Lowman and Fraser, 1996; Sanders, 2005; Weitzer, 2012), and for understanding the outcomes of legalization. By all accounts, those involved in street prostitutes make the least money and suffer the greatest violence and distress, and this market occupies the lowest rung on the commercial sex ladder. Somewhat better conditions are generally (but not always) available to those working indoors in brothels, massage parlors, and clubs (Albert, 2001; Argento et al., 2014; Church et al., 2001; Krusi et al., 2012; Sanders & Campbell, 2007; Weitzer, 2012). Operating at the highest levels of the commercial sex business are elite escort services, which some have referred to as serving the “luxury prostitution” or “high-end escort” markets (e.g., Ringdal, 2004). In the top strata, women often feel safer, have greater access to health care, have greater control over their schedules and work environments, attract wealthier clients and can be more selective about providing sex for them, make (and keep) more of the money they earn, and are less vulnerable to violence, drug addiction, and sexually transmitted diseases,