Introduction

Within public health research, there is growing consensus that full sex work decriminalisation, understood as the removal of all sex work-related activities from criminal law and the regulation of sex work as a form of legitimate labour, is the best available legislative approach to promote harm reduction and protect the health and well-being of sex workers (Kim, 2015; Platt et al., 2018; Rekart, 2005; The Lancet, 2014; UNAIDS, 2002). Sex work decriminalisation has been argued by sex worker advocates, international health and human rights organisations such as the WHO, UNAIDS and Amnesty International to be a necessary step to improve sex workers’ health, facilitate their access to health services, justice, rights and protection and in the long term, help in reducing stigma and discrimination directed towards them (Goldenberg et al., 2021).

Outcomes of Criminalisation and Decriminalisation

In 2014, The Lancet published a global series on HIV and sex work in which it was established that, among other benefits, sex work decriminalisation would reduce global HIV infections by 33–46% in the coming 10 years (Shannon et al., 2015). Four years later, a review found that recommendations to fully decriminalise sex work had been widely ignored and sex workers were still burdened by a high prevalence of HIV and STIs (Shannon et al., 2018). Following a systematic review of 40 quantitative and 94 qualitative studies published between 1990 and 2018 on sex work-related legislation, policing and health outcomes, Platt et al. (2018) concluded that all forms of sex work criminalisation, including the criminalisation of clients and licensing systems, deprioritise sex workers’ safety and health, particularly those of the most marginalised, while decriminalisation facilitates sex workers’ access to health, services and justice. Licencing regulatory models are increasingly being understood as forms of criminalisation, rather than “legalisation”. In fact, recent qualitative research with diverse sex workers in Victoria, Australia showed the harms to sex workers’ health and well-being caused by a licencing two-tiered system which effectively criminalises sex workers who do not comply with existing regulations (Macioti et al., 2022). The so-called Swedish model that criminalises clients of sex workers in a bid to “end demand” has been found to put sex workers, particularly those who are most marginalised, at further risk of violence and to increase barriers to accessing health care (Argento et al., 2020; Le Bail et al., 2019; Vuolajärvi, 2019).

What It Means to Decriminalise

The model of sex work decriminalisation most widely supported by public health research and international sex worker organisations is defined as the removal of all criminal laws that prohibit or regulate sex work and the operation of the sex industry markedly different from other industries. It is important to note that this type of sex work decriminalisation does not entail leaving the sex industry unregulated. Under decriminalisation, sex work is subject to the same “whole of government” regulatory mechanisms as other professions, including work health and safety, planning laws and industrial standards (Scarlet Alliance, 2014).

Forms of sex work decriminalisation corresponding to the above definition are currently to be found in five jurisdictions globally: New South Wales, Victoria and the Northern Territory of Australia, Belgium and New Zealand. In Slovenia, on the other hand, sex work was decriminalised in 2003 but remains unregulated and not recognised as work. While research in Slovenia has indicated some benefits in terms of the capacity of sex workers to organise and work together (Pajnik & Radačić, 2020), the lack of recognition and regulation of their work results in enduring social exclusion and lack of access to social security and health protection for sex workers (Markelj et al., 2021).

The Current Context of Decriminalisation

New South Wales (NSW) was the first jurisdiction globally to decriminalise and regulate sex work in 1995, followed by New Zealand in 2003, the Northern Territory in 2019, and both Victoria and Belgium in 2022. However, in NSW, street-based sex work close to dwellings, schools and churches is criminalised (Bates & Berg, 2014), while in Victoria it is criminalised close to schools and places of worship on designated times and days. In NSW, other sanctions also remain that apply to advertising, recruiting or inducing a person to work in the sex industry (by coercive conduct or undue influence, to commit an act of prostitution or to surrender the proceeds of an act of prostitution) and to “solicit” or offer sex in premises claiming to be a non-sexual massage service (Donovan et al., 2012). In New Zealand, migrants on valid temporary work visas commit an offence against the Immigration Act 2009 if found working in the sex industry and face deportation if apprehended (Bennachie et al., 2021). The NSW, Victoria and New Zealand models are therefore better understood as “partial decriminalisation”. The Northern Territory and Belgium are so far the only jurisdictions in the world that have decriminalised sex work without specific restrictions on either street-based or work-visa-holding migrant sex work (Northern Territory of Australia, 2019). In all the above settings, migrants without a valid visa, including those working as sex workers, face detention and deportation.

As more jurisdictions globally are adopting, or actively considering, the decriminalisation of sex work, there is a pressing need to understand what (if anything) has changed in health-related outcomes, behaviours and access to health care for sex workers following decriminalisation, as well as what can be learnt to inform and potentially improve existing and new models of decriminalisation. This includes the formulation of services that have been introduced to meet the needs of sex workers in a decriminalised environment. It is unfortunately too early to review the impact of Belgium’s, Victoria’s or the Northern Territory’s decriminalisation models on the health and well-being of its diverse sex workers as there is no published research to inform a review. Conversely, the decriminalisation models of New South Wales and New Zealand have been the subject of considerable scrutiny, research and evaluation.

This scoping review of relevant literature attempts to shed light on the health-related impact of decriminalisation for sex workers in NSW and New Zealand, with a focus on identifying promising practice for sexual, general and mental health provision and services and on particularly marginalised sex workers, including street-based, migrant, First Nations and trans sex workers. We acknowledge that access to resources, human and labour rights are crucial health determinants, yet it is beyond the scope of this review to evaluate in depth the impact of decriminalisation on the access to rights of sex workers.

Methodology

This article presents findings of a scoping review, informed by the methodology proposed by Arksey and O’Malley (2005) and as such aimed at providing an overview of existing evidence on the health impact of sex work decriminalisation on sex workers in NSW and New Zealand. This method has been chosen in order to account for a diversity of literature (which includes academic and grey literature) and for a broad topic (Peterson et al., 2017). Literature searches were conducted in July 2021 and updated in July 2022 using academic databases (Ovid Medline, Psych Info, Web of Science, Embase, CINAHL Plus, Global Health) and Google Scholar for quantitative and qualitative research on sex workers’ health and well-being and on evaluations of decriminalisation in NSW and New Zealand. Searches were conducted also for grey literature such as reports commissioned by governmental bodies and sex worker organisations. The authors initially identified search terms including “sex work*”; “decriminalisation”; “health”; “evaluat*”; “New Zealand”; and “New South Wales [NSW]”. They then identified the need to specify searches further, to include literature on diverse cohorts of sex workers in the two jurisdictions, including “migrant”; “transgender”; “street-based”; “Aboriginal and Torres Strait Islander”; “male”; “Māori”; “Indigenous” and “First Nations” sex workers in each setting.

Two main search algorithms were used, one for searching literature from NSW published after 1995 and one for searching literature from New Zealand published after 2003: (“sex work” OR “sex workers” prostitution*) AND ("New South Wales" OR "NSW") AND (health* OR decriminalisation* OR evaluate* OR female* OR male* OR trans OR transgender* OR Aboriginal OR "First Nations" OR "street-based") (“sex work” OR “sex workers” OR prostitution*) AND ("New Zealand") AND (health* OR decriminalisation* OR evaluate* OR female* OR male* OR trans* OR transgender* OR Māori OR "First Nations" OR "street-based").

The authors also conducted directed searches for grey literature and contacted researchers in their networks to inquire about possible further studies and be able to access documents not readily accessible. The inclusion criteria were broad according to the need to account for as many nuances as possible within a sensitive area that has not been explored comprehensively before. Included within scope of the review were peer-reviewed journal articles, as well as book chapters, government and community organisations’ reports that referred to and included empirical evidence from primary data with sex workers on health and well-being outcomes, behaviours and access to services for diverse, adult sex workers in NSW and New Zealand since decriminalisation was introduced. Articles, commentaries, letters or blogs where description of primary data was not the primary object were excluded. Studies focussing on third parties (e.g. sex industry operators), underage sex work and/or on marketing and advertising strategies and trends were also excluded. Different publications stemming from the same research data were included when they were introducing new information about specific themes or sub-groups of sex workers.

After conducting searches and applying the above selection criteria (see Fig. 1), we identified a total of 52 papers from both NSW and New Zealand. Of these, 28 papers, which included 21 peer-reviewed articles, referred to 22 different quantitative and/or qualitative data sets collected in New South Wales (Table 1). As far as evidence from New Zealand, we identified 26 papers, including 12 peer-reviewed articles, which referred to 13 different quantitative and/or qualitative data sets (Table 2). One journal article and one research report (Mai et al., 2021b) discussed research on both NSW and New Zealand and were therefore included in the review in both sites. When this article refers to other literature beyond studies with sex workers, it does so in order to contextualise the information reviewed within both national and international contexts.

Fig. 1
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Flowchart of the review

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Table 1 Research from NSW included in the review
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Table 2 Research from NZ included in the review
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Given the different timing, context and implications of decriminalisation efforts in each jurisdiction, we synthesise the findings of these papers separately for NSW and New Zealand, although we collectively consider their contributions in the closing discussion section.

The Impact of Sex Work Decriminalisation on the Health and Well-being of Sex Workers in NSW

As the first jurisdiction globally to decriminalise sex work, there has been a significant investment in research to explore if and how sex work practices have changed in NSW since the legal change. This includes studies that have focussed on the number and diversity of people engaging in sex work, the sexual health practices of sex workers and how they engage with health services. Research has also explored how decriminalisation affected migrant sex workers, as well its impact on trafficking and exploitation in the sex industry (Mai et al., 2021b). Recent research expanded areas of inquiry to focus on stigma and mental health (Treloar et al., 2021). The below subsections will review and summarise the findings of sex work studies in NSW since 1995.

Size of the NSW Sex Industry

In 2012, a comprehensive report on the NSW sex industry was commissioned by the Ministry of Health of NSW and produced by the Law and Sex Worker Health team (LASH), in a collaboration with the Kirby Institute, the Law Department of UNSW and Sydney Sexual Health Centre (Donovan et al., 2012). The researchers surveyed over 200 sex workers and analysed databases from Sydney Sexual Health Centre (SSHC) between 1992 and 2009 as well as conducting research with several NSW councils. The authors concluded that the size of the sex worker population in NSW had not increased since decriminalisation was introduced in 1995. Their findings were confirmed by a 2016 study with buyers of sexual services based on interviews with 8074 men in NSW (Rissel et al., 2017).

Changes in Sexual Health Practices

Research on the impacts of decriminalisation on sex workers’ health in NSW has so far identified a number of health-related benefits on diverse sex work populations, particularly regarding their sexual health. In the years since decriminalisation in NSW, several quantitative and mixed methods studies produced data on the rates of STI and HIV diagnosis and screening among (majority cis women) street-based and indoor-based sex workers. As early as 1998, research with 42 cis and six trans women who were street-based sex workers in Sydney, Newcastle and Wollongong established low rates of STIs and HIV among the sex workers sampled. Comparing their results with research among street-based sex workers in other industrialised settings, they validated the appropriateness of NSW health programmes and the legal framework of decriminalisation with respect to lowering STI and HIV rates (Harcourt et al., 2001). The same research also involved analysis of two Sydney sexual health centres large database samples (n = 679 and n = 869) of indoor and street-based sex workers, confirming low rates of STIs and HIV as well as very high rates of condom use. Street-based workers had lower rates of condom use (91% compared to 98.8%) and higher rates of hepatitis B and C than indoor workers (Harcourt et al., 2001). Rates of condom use continued to rise after this study and subsequent research suggested condom use with clients approached 100% among sex workers of different genders, particularly in the indoor sector (Donovan et al., 2012).

In 2016, a report to the NSW Ministry of Health on the sexual health of cis women and men sex workers in NSW reviewed data from 32 NSW sexual health clinics and found that both cis men and women sex workers had high rates of STI and HIV testing (92% among cis men and 85% among cis women sex workers), steady and high rates of condom use with clients and their sexual health was generally comparable to that of non-sex workers (Callander et al., 2016). Recent research on cis men sex work in Australia presented clinical data from another source on a large cohort of gay men in NSW which reported 44% cis men sex workers used PrEP as opposed to 33% of non-sex workers, but could not identify any link between taking PrEP and having condomless sex with clients as data showed that condom use with clients remained high (Callander et al., 2021).

Following reports in the 1990s of less consistent condom use among Asian migrant sex workers compared to non-migrant sex workers in NSW (Fox et al., 2006), research continued to monitor and document sexual health outcomes and condom use among cis women Asian migrant sex workers in NSW. Between 1993 and 2003 considerable improvement was registered, with condom use for vaginal sex among migrant sex workers increasing from 52 to 85% (Pell et al., 2006). These findings were confirmed by further studies that accessed data from NSW sexual health centres (Donovan et al., 2010).

However, in a 2014–2015 study, a lower rate of consistent condom use than the one found in the abovementioned 2003 study (72% rather than 85%) was identified among Thai and Chinese migrant sex workers after a cross-sectional survey in a Sydney sexual health clinic in 2014–2015, particularly so among Chinese sex workers. The authors clarified that the reason for this result may lay in the fact that 30.2% of survey respondents in 2014–2015 had less than 1-month experience in sex work compared to only 4.4% in 2003 (Foster et al., 2018). In 2015, a large study on migrant sex work in Australia by Scarlet Alliance and the Australian Institute for Criminology surveyed 412 Thai, Korean and Chinese migrant and 151 non-migrant sex workers (Renshaw et al., 2015). The authors found that 95% of migrant and 97% of non-migrant sex workers reported to always use condoms at work. More than half (52%) of the sample worked in NSW (Renshaw et al., 2015). A subsequent survey among 201 cis women sex workers (of whom 133 identified as Chinese) in a Northern Sydney sexual health clinic, found condom use for fellatio among all, but particularly among Chinese participants was declining, when compared with previous studies among Asian-ethnicity or Chinese-ethnicity cis women sex workers (from 61% in 2014–2015 to 85% in 2017–2018). Such trends were contextualised by the authors, who remarked that declining condom use for fellatio had been identified in studies among diverse sex workers across Australia and the globe and was strongly associated with monetary inducement by clients (Lee et al., 2021).

Studies associate sustained positive outcomes in sexual health and practices among the vast majority of sex workers in NSW to the increased access to information, peer education, community and services within a decriminalised environment (Berg et al., 2011; Callander et al., 2021; Donovan et al., 2010, 2012; Harcourt et al., 2001, 2006, 2010). However, a 2011 gap analysis in South Eastern Sydney and the Illawarra region identified street-based sex workers to be at risk of engaging in unsafe sex practices because of financial precarity and lack of shelter (Berg et al., 2011).

Access to Health Services and Promising Practice for Outreach and Service Provision

Existing research on sex workers’ health in NSW indicates a significant improvement in sex workers’ access to health promotion and sexual health services since decriminalisation, particularly so for migrant sex workers (Berg et al., 2011; Donovan et al., 2010, 2012; Harcourt et al., 2001, 2006, 2010).

A 2001 study among street-based sex workers in NSW found they were less likely to access sexual health services than brothel-based workers (12.8% of street-based sex workers never had been tested for STIs). Good practice to increase access was identified as having clinics located in proximity of work areas (Harcourt et al., 2001). Later research confirmed that street-based sex workers were less likely to access services and come in contact with outreach workers due to being driven to isolated outskirts by police persecution and resident vigilance (Berg et al., 2011; Donovan et al., 2012). A qualitative study with street-based cis men sex workers in Sydney noted that after 2001, prostitution offences in a central Sydney area had increased, which dispersed street-based sex workers and potentially made them harder to reach for outreach and support workers (Leary & Minichiello, 2007).

Harcourt et al. (2010) conducted mixed methods comparative research among 605 sex workers (201 in Sydney, 229 in Melbourne and 175 in Perth) and three health promotion programmes in Sydney, Melbourne and Perth. Their findings indicated that health promotion in Sydney was better funded and staffed and reached larger number of diverse sex workers than in the other two settings. The authors found that the decriminalised nature of sex work in Sydney facilitated the access of outreach organisations such as SWOP (Sex Work Outreach Project) NSW and sexual health centres to most indoor sex work premises (as none was classed as “illegal”), while in both Melbourne and Perth health promotion could not take place in any workplace classed as illegal in those jurisdictions (Harcourt et al., 2010). A qualitative study with nine cis women sex workers in an urban region in NSW highlighted their risk management strategies and the way, despite serious challenges some had due to experiences of violence at work, participants reported several coping strategies and accessed health services (including SWOP NSW) to manage those risks (Harris et al., 2011).

Research from NSW identified improved access to sexual health and outreach services among migrant sex workers in NSW and linked this to decriminalisation and improved health promotion strategies. Several studies identified that since migrant sex workers in NSW could legally work in the mainstream sex industry, they have been able to access information provided by outreach services. Importantly, they accessed information and support by peers in their own language, thanks to the employment of peer culturally and linguistically diverse (CALD) staff within peer-only outreach services such as Sex Worker Outreach Project (SWOP) NSW as well as within the Sydney Sexual Health Centre Multilingual Programme (Donovan et al., 2010; Harcourt et al., 2006; Pell et al., 2006). In 2015, a large survey among migrant and non-migrant sex workers in Australia (with over half of respondents based in NSW) found that migrant sex workers were largely satisfied with their working conditions, similarly to non-migrant, but experienced more barriers to accessing sexual health and other service provision due to “fear” and self-rated poor English skills. The authors acknowledged the limitation of their survey, which did not allow them to explore what the respondents meant by indicating “fear”. They suggested sex work stigma and lack of knowledge about existing specialised services act as barriers for migrant sex workers to access support. The report highlighted the importance of translating information and increasing multi-language peer support and services (Renshaw et al., 2015). In 2019, the Christian support organisation, Baptist Care Hope Street, published a report based on surveys with 100 Asian migrant indoor sex workers in Sydney, which they identified as working in brothels whose prices were lower than average sex industry prices in Sydney. They reported on experiences of stigma and fear of disclosing sex work among their participants, yet a majority of these (88%) reported knowing how to access sexual health clinics for check-ups (Davidson et al., 2019).

Research also identified that in NSW cis men sex workers have overwhelmingly good access to resources and good working conditions because of the combination of decriminalisation, publicly funded sexual health clinics and world-leading peer support (Callander et al., 2021). The authors particularly emphasised the role of peer education and outreach programmes for cis men sex workers by SWOP NSW, “SWOPmale”, which includes sustained online outreach and peer support through diverse profiles on men who have sex with men (MSM) sex work platforms (Callander et al., 2021).

Mental Health and Stigma

A 2005 quantitative study with 72 cis women street-based sex workers in Sydney, the majority of whom were injecting drugs, had found just under a half of participants met the study criteria for post-traumatic stress disorder and all but one reported trauma (Roxburgh et al., 2006). A gap analysis on street-based sex work in Eastern Sydney and the Illawarra Region had indicated that these were likely to experience undiagnosed and untreated mental (and physical) health problems while outreach workers struggled to reach out to them as they dispersed to escape police (Berg et al., 2011). In their 2012 report, Donovan et al. (2012) looked at the mental health of diverse sex workers in NSW and found that sex workers’ mental health was comparable to that of the general population, except for psychological distress associated with drug use, which was twice as prevalent as in the general population.

A qualitative study on stigma conducted in 2017 among 31 diverse sex workers in Australia (of whom 23 worked in NSW) found that sex workers’ mental health and their access to quality mental health support are overwhelmingly impacted by enduring stigma (Treloar et al., 2021). These findings confirm those of qualitative research among 118 sex workers with mental health needs in Germany, Italy, Sweden and the UK (Macioti et al., 2021), of community-based mixed method research among sex workers in Europe and Central Asia (ESWA, 2021), and of qualitative research on health needs among 31 diverse sex workers in Victoria, Australia (Macioti et al., 2022). Treloar et al. (2021) found stigma against sex work to be rife in Australia, including among mental health services and practitioners. In another article from the same research data, Stardust et al. (2021, p. 144) examined the way sex work stigma is also embedded in the criminal legal system in Australia, which results in sex workers being largely regarded as “irresponsible citizens” and causing a widespread lack of trust in police among sex workers. The authors found that stigma affected sex workers’ experience of the criminal legal system particularly in state-contexts in which sex work was criminalised or licensed, while NSW was the only context in which few participants expressed some trust in the police (Stardust et al., 2021). These recent studies not only conclude that decriminalising sex work is a necessary step to start addressing stigma, but also highlight the need for further, systematic commitments, such as a radical transformation and defunding of policing and “justice reinvestment into communities” (Stardust et al., 2021, p. 155). As far as mental health is concerned, the abovementioned studies recommend the development of specialised, non-stigmatising, culturally sensitive mental health services for sex workers and the funding and promotion of peer-led mental health support initiatives (ESWA, 2021; Macioti et al., 2021, 2022; Treloar et al., 2021).

Drug Use

Associations between sex work, particularly street-based sex work, and injecting drug use (IDU) in NSW have been identified in several studies (Berg et al., 2011; Donovan et al., 2012; Harcourt et al., 2001; Roxburgh et al., 2005, 2006), which estimated that > 85% of sex workers who inject drugs work on the streets (Donovan et al., 2012). However, the 2012 report by UNSW Law Department and the Kirby Institute found that only 2% of Sydney-based respondents were injecting drugs, as opposed to 10% in Melbourne and 14% in Perth (Donovan et al., 2012). In their 2016 report comparing cis men and women sex workers (in all sectors, though the vast majority were brothel workers) and non-sex workers attending 32 sexual health centres between 2007 and 2015, Callander et al. (2016) found that injecting drug use was decreasing but overall still more prevalent among sex workers than non-sex workers.

Further Intersectional Concerns

Sex workers are not a homogeneous group but comprise a very diverse population with potentially specific and differing needs. In order to assess the impact of decriminalisation on particularly marginalised and/or often under-researched sub-groups of sex workers, we have identified and reviewed further research available on the following cohorts: migrant, Aboriginal, trans women and cis men sex workers.

Migrant Sex Workers

Recent qualitative research with 46 (majority Asian) migrant sex workers in Sydney and Melbourne found that the vast majority felt more exploited in other industries they had worked in than in sex work (). This confirmed findings from previous research with migrant sex workers in Australia (Renshaw et al., 2015). Mai et al. (2021a) found that in Sydney, migrant sex workers felt more empowered to leave exploitative work conditions because of having more legal work options under decriminalisation, while in Melbourne they were more likely to experience blackmailing and exploitation in licensed venues, while they risked deportation if found working in breach of licensing laws. Based on data from the same study, researchers also established a link between sex work decriminalisation, increased networking among migrant sex workers, more visa options for migrants and the dramatic decrease of trafficking cases linked to the sex industry in Australia (Macioti et al., 2020). In comparative research with New Zealand’s decriminalisation model, which deports migrant sex workers who are temporary visa holders, migrant sex workers in NSW were found to enjoy better working conditions and greater access to justice, health and peer outreach services (Mai et al., 2021a).

Aboriginal and Torres Strait Islander Sex Workers

There is very little research with Aboriginal and Torres Strait Islander sex workers in Australia generally, including NSW specifically. Gaining access to such a multiply-stigmatised community for research purposes has been found to be complex, requiring careful reflection and planning as well as resources to facilitate meaningful community engagement (Sullivan, 2020).

Harcourt et al.’s 2001 study on cis and trans women street and indoor-based sex workers in Sydney had found street-based sex workers to be significantly more likely to be of Aboriginal or Torres Strait Islander origin than indoor ones. A 2003 study comparing sex workers and non-sex workers injecting drugs in Sydney found that the sex workers were more likely to be cis women and of Aboriginal/Torres Strait Islander origin than the non-sex workers (Roxburgh et al., 2005).

Recent qualitative research with seven cis women, trans women and trans men, some of whom identify as sexually diverse, Aboriginal sex workers in NSW sheds light on issues relevant to this marginalised population (Soldatic et al., 2021; Sullivan, 2020, 2022). Sullivan, who is herself of Aboriginal descent, reads the experiences of Aboriginal sex workers under the lens of agency rather than victimisation, challenging dominant colonial narratives. She indicates that some Aboriginal people describe sex work as a form of resistance and power, despite the stigma they may experience in their communities (Sullivan, 2022). In a joint publication from the same data, Soldatic et al. (2021) highlight participants’ multiple experiences of racism, sexism and homo/transphobia, of isolation and fear of judgement within Aboriginal communities and a felt lack of belonging in the wider sex worker community. Testimonies reported in Sullivan’s research point at the invisibilisation of Aboriginal sex workers by their own communities, who largely reject sex work as ever taking place among them, causing Aboriginal sex workers to steer away from accessing Aboriginal health services for fear of being judged (Sullivan, 2020, 2022). This was also reported by Aboriginal participants in qualitative research among diverse sex workers in Victoria (Macioti et al., 2022). In order to foster empowerment, health and well-being of Aboriginal sex workers, researchers point at the need for increasing visibility by building a community of Aboriginal sex workers (Soldatic et al., 2021) and at promoting peer health promotion projects with Aboriginal sex workers involved (Macioti et al., 2022).

Trans Sex Workers

Evidence on, and research specifically with, trans women sex workers in NSW since 1995 is scarce (and practically absent with respect to gender diverse and trans men sex workers). Harcourt et al. (2001) interviewed six trans women street-based workers and found that they were less likely to inject drugs compared to cis women sex workers and that their work options beyond sex work were limited due to discrimination for being trans. A 2000 study on trans people, violence and policing ran focus groups with two trans men and six trans womenFootnote 1 and several interviews with key informants, including the police (Moran & Sharpe, 2002). This study indicated that police tended to conflate engagement with sex work, being trans and using drugs and that this led to invisibilise the specific experiences of trans people, including those of violence by the police themselves (Moran & Sharpe, 2002). More recently, the abovementioned qualitative research with trans Aboriginal sex workers sheds some light on the possible positive role of sex work in their lives, despite experiences of stigma in their own communities (Soldatic et al., 2021; Sullivan, 2020, 2022).

Cis Men Sex Workers

Cis men sex workers in NSW (as in most industrialised settings) have been deemed harder to research than cis women and trans sex workers because they nearly exclusively utilise online spaces to work and connect with clients (Donovan et al., 2010). An early (1991–1998) comparison of clinical data of 94 cis men sex workers, 3541 non-sex working cis gay men and 1671 cis women sex workers found that cis men sex workers used condom at work at a similar rate than cis women sex workers, were less likely to engage in condomless sex with clients and less likely to be HIV positive than non-sex working cis gay men, while their risk was more confined to condomless sex with private partners than at work (Estcourt et al., 2000). A quantitative study among 185 cis men sex workers in Sydney, Melbourne and Sydney found that participants were getting regularly tested, 6% were homeless and 7.3% reported injecting heroin (Minichiello et al., 2002).

A 2021 expansive contribution on the history of cis men sex work in Australia reviewed existing research, reports produced by research institutes and sex worker organisations as well as clinical records on sexual health compared to global scales, indicated that cis men sex workers in Australia report highest rates of condom use globally (between 59 and 95% as opposed to an average of 15%). The authors conclude that sex workers in Australia enjoyed some of the best and safest professional experiences globally, particularly in NSW. Decriminalisation, peer support and the sustained collaboration between “community advocates, peers, law makers, clinicians, researchers and sex workers” were found to be key for cis men sex workers to sustain and continue improving their working lives (Callander et al., 2021).

Regulatory Concerns

While the health and well-being of diverse sex workers in NSW stands out globally, and in comparison to other states in Australia, research highlights a number of regulatory concerns that may require attention within the current model of decriminalisation in NSW.

Street-Based Sex Workers

Since 1995, street-based sex work in NSW is no longer illegal, yet criminal sanctions still apply to the location in which street-based work takes place (that is near or within view of a church, school, hospital or dwelling). Due to such criminal sanctions, research reported that after decriminalisation, street-based sex workers were still persecuted despite being the smallest (5%) and most traumatised component of the NSW sex industry (Donovan et al., 2012). High levels of PTSD were identified by qualitative research with cis women sex workers in NSW (Roxburgh et al., 2006). Berg et al. (2011) found that street-based sex workers were a marginalised and at-risk cohort, who experienced less positive health outcomes than sex workers in other sectors and were less likely to engage with services due to being targeted by police and led to move to hidden areas that were harder to reach for services and outreach workers.

Work Health and Safety

Following decriminalisation, NSW Health (now the NSW Ministry of Health) in association with Safework NSW (formerly Workcover NSW) and SWOP NSW developed the first health and safety guidance resource for brothels in NSW (SSPPAP, 2004). This resource, which was updated in 2017, provides best practice measures for the maintenance of a safe and healthy environment for sex workers, other employees, clients and visitors along with public health legislative provisions (Safework NSW, 2017). However, several studies indicated that adherence to health and safety guidelines in the indoor sex industry was not sufficiently ensured by Safework NSW and NSW councils (Donovan et al., 2012; Orchiston, 2016). A 2016 mixed methods study including qualitative interviews with 21 sex workers with experience of brothel-based sex work in NSW (14) and Queensland (11)Footnote 2 found that working conditions (such as operators issuing unfair penalties on their workers) were comparatively worse in NSW’s decriminalised brothels than in Queensland’s licensed ones, because the latter’s (much lower in number) were more successfully monitored for compliance (Orchiston, 2016). In 2015, a government inquiry into the regulation of brothels in NSW was undertaken by a Select Committee (ROB Select Committee, 2015). The Committee recommended against introducing licensing restrictions that would criminalise unlicensed sex workers and premises as this would create “second tier” sex workers who would risk more exploitation and barriers to health services and rights. The Committee also recommended NSW Health to work with Safework NSW and local councils for these to make sound development assessment decisions around sex services premises from a public health perspective (ROB Select Committee, 2015). The NSW Government subsequently decided in favour of maintaining sex work decriminalisation.

Similar to the Select Committee, several reviewed studies in NSW recommended that local governments and Safework NSW should receive increased support to better ensure health and safety compliance in premises and to endorse existing best practice guidelines that establish better regulatory practice for local government when devising planning controls for sex industry land uses (Safework NSW, 2017; Donovan et al., 2012). Some also specifically recommended councils and Safework NSW to be trained by the Ministry of Health, in collaboration with sex worker organisations, in matters of ensuring compliance with work health and safety in sex services premises (Berg et al., 2011; Mai et al., 2021a; Orchiston, 2016).

Restrictive Town Planning Provisions, Home-Based Sector and Unauthorised Sex Premises

One important regulatory concern that may warrant attention in NSW is the difficulty in gaining development approval for sex work premises in a variety of council areas due to an inclination of local governments to deny applications (Donovan et al., 2012; Mai et al., 2021a). Such inclination was argued to be linked to enduring moral attitudes that deem the sex industry an undesirable land use, fit only for industrial zones. Crofts and Prior (2012) pointed at the lack of reliable data on local neighbours’ experiences with sex work premises and suggested that councils do not base their restrictive planning decisions on empirical data but on moral attitudes. As a consequence, many NSW councils deem sex work premises unfit for residential areas and relegate sex industry land use to industrial zones, deserted at night, which renders them potentially dangerous for sex workers (Crofts & Prior, 2012). In order to support councils in non-restrictive planning provisions, in 2004 a Sex Services Premises Planning Advisory Panel prepared the “Sex Services Planning Guidelines” (SSPPAP, 2004), which were updated in 2017 (Safework NSW, 2017). As mentioned above, research indicates that these guidelines remain insufficiently applied (Donovan et al., 2012).

In another 2012 study, Crofts and Prior highlighted that many NSW councils do not exempt private, home-based sex workers from planning provisions equal to those of sex work premises. The authors argued that such restrictions are based on moral judgements against the sex industry, and they do not reflect the minimal impact home-based sex workers have on amenities. They hence recommended that sex work in the home should be regulated in the same way as other home occupations (Crofts & Prior, 2012). Donovan et al. (2012) went further, recommending that up to four private sex workers working cooperatively should not be classed as a “brothel” and be exempted from having to obtain council development approval, as is the case in the New Zealand model of decriminalisation. Incentives for working together cooperatively in small numbers were also linked to increased safety for private sex workers, who were estimated to be approximately 40% of sex workers in NSW (Donovan et al., 2012).

The difficulty of obtaining development approval in suitable areas was also linked to the emergence of unauthorised sex premises, mostly majority Asian massage parlours. While these venues are not subject to criminal law and policing,Footnote 3 they are often depicted by media as harbouring exploited and trafficked sex workers and are thus subject to inspections by council, immigration and private investigators (Mai et al., 2021b).

Research based on over 500 h of ethnographic observation in Sydney’s unauthorised erotic massage venues and on 22 in-depth interviews with migrant massage workers conducted between 2017 and 2020 found that they were largely satisfied with their working conditions and appreciated the protection from stigma provided by the fact they are advertised as “massage only” (Mai et al., 2021b). However, the same research indicated that council checks are often experienced as traumatic, particularly by massage workers on temporary visas, who feared that being found selling sex in a massage parlour would jeopardise their rights to stay in Australia (). Migrant workers accused of selling sex in unauthorised premises risk heavy fines, losing their job, and may risk deportation if found working without a valid working visa or if in breach of their visa requirementsFootnote 4 (Mai et al., 2021a). The massage workers interviewed within Mai et al.’s research spoke about the need to hide condoms and other safer sex equipment in order not to be caught by council inspections, who would use condoms as evidence of sexual services taking place (Mai et al., 2021b). As a result of their research, Mai et al. (2021a) recommend ending council inspections aimed exclusively at unveiling sexual services; ending the use of condoms as evidence that sexual services take place; and improving the accessibility to developmental approvals for erotic massage premises.

The Impact of Sex Work Decriminalisation on the Health and Well-being of Sex Workers in New Zealand/Aotearoa

In the nearly two decades since the introduction of sex work decriminalisation in New Zealand, there has been a consistent effort to critically evaluate the impact of this law reform on the health, safety and well-being of sex workers. Research mostly focused on sexual and general health outcomes, access to support and protection from health services and police, as well as stigma and discrimination among specific sections of sex workers, including local, migrant, cis and trans and street-based sex workers. We summarise the findings from these studies below.

Size of the New Zealand Sex Industry

In 2007 and 2008, two reports commissioned by the Health Research Council and the Ministry of Justice were published (Abel et al., 2007; Prostitution Law Review Committee, 2008), following a 4-year long research project aimed at evaluating the changes in size of the sex industry and the effects of the 2003 Prostitute Reform Act, that is the New Zealand model of sex work decriminalisation, on sex workers’ health and safety. These reports, and further studies that compared 2006 size estimates with data on the size of the sex industry available in 1999, indicated the Prostitution Reform Act 2003 had little impact on the size of the sex industry or on the numbers of sex workers in New Zealand, which seemed to have remained stable across its different sectors (including indoor and street-based sex work) (Abel et al., 2007, 2009; Prostitution Law Review Committee, 2008).

Sexual and General Health Outcomes, Practices and Access

Between 2006 and 2007, Abel et al. (2007) conducted a survey involving 772 sex workers and 58 qualitative interviews with street-based and indoor-based cis and trans women and cis men sex workers across different locations in New Zealand. The vast majority of sex worker survey participants (n = 656) were cis women, 68 were trans women and 48 cis men sex workers, 37.8% of all participants were of Māori/Pacific Islander ethnicities, while non-resident, migrant sex workers were not included. The qualitative study included 45 cis women, 11 trans women and two cis men (Abel et al., 2007; Prostitution Law Review Committee, 2008). Consistent condom use for all sexual practices was reported by 80.3% of cis women, 69.6% of trans and 58.5% of cis men sex worker participants (Abel et al., 2007; Prostitution Law Review Committee, 2008). Cis men and trans workers also reported highest numbers of requests for unprotected sex from their clients. The authors called for more research to assess the health needs of trans women and cis men sex workers (Abel et al., 2007).

Overall, research found that 86.9% of all participants had a “regular” doctor, 77.8% of all sex workers always used condoms for oral, anal and vaginal sex, and that 96.3% of survey participants and 100% of the workers interviewed in depth went for “regular” sexual health check-ups with doctors, sexual health centres and the national peer organisation NZPC: The Aotearoa New Zealand Sex Workers’ Collective (NZPC) (Abel, 2014; Abel et al., 2007). However, the research did not specify what counted as “regular”. Importantly, sex worker participants felt more empowered to refuse clients and to require them to always wear condoms after decriminalisation came to force. The 2007 Abel et al. report generally found high rates of sexual health checks, STI and HIV testing and condom use and a considerable improvement in the general health, confidence and well-being among New Zealand’s sex workers since 2003, and strongly recommended the Ministry of Health to continue to fund the NZPC for sexual health promotion and services (Prostitution Law Review Committee, 2008). Participants had positive experiences with sexual health checks within the different offices of the state-funded sex worker peer organisation NZPC: 15.5% of participants used their testing services, while on average 71.6% attended the NZPC’s drop-ins for condoms, health promotion, emergency assistance and advice (Abel et al., 2007).

Qualitative doctoral research conducted in 2013 comparing the experiences of (non-migrant) sex workers in New Zealand (n = 9) and in Scotland (n = 12) found decriminalisation to have positively impacted on the autonomy, agency and access to protection in case of violence of sex workers in New Zealand (Ryan, 2019). Another doctoral thesis based on interviews with 41 sex workers indicated that since 2003 (non-migrant), sex workers’ general well-being in relation to several aspects of their life and working conditions had greatly improved because of the integrative, health and rights-based approach of sex work decriminalisation (Rottier, 2018). In a recent publication, Armstrong analysed 46 qualitative interviews from two different studies with (majority non-migrant) sex workers to explore their experiences of social harm. The author found that sex work under decriminalisation had provided participants with improved quality of life and protected them from social harm (Armstrong, 2021).

Research on the health and well-being of migrant sex workers in New Zealand indicates a more complex picture. Mixed methods research conducted analysed clinical records of migrant and non-migrant sex workers collected by NZPC’s between 2007 and 2012 and conducted surveys with 124 migrant sex workers (Roguski, 2013). The authors reported migrant sex workers displayed high rates of condom use and low levels of STIs similar to non-migrants, yet higher incidence of urinary tract infections than non-migrants. While the research did not find that migrant sex workers were exposed to riskier practices at work, several participants reported not accessing primary health care and services, out of fear of being reported to authorities and deported (Roguski, 2013). Recent qualitative research based on 58 interviews with 53 migrant sex workers presented evidence of a paradox of access to health for migrant sex workers in New Zealand: After decriminalisation, confidential health care and services were incentivised for all sex workers, yet because of their enduring criminalisation, migrant sex workers are reluctant to use these, as they fear health services would contact the police (Bennachie et al., 2021). Many of the migrant sex workers interviewed reported planning to go back to their country of origin if in need of medical assistance. The researchers gave the example of a migrant sex worker who risked her life, trying to avoid hospitalisation for fear of being identified as a sex worker and deported (Bennachie et al., 2021).

Emerging Promising Practice in Service Provision

As mentioned above, New Zealand’s sex workers benefitted from the sustained access to peer-based health promotion by the national sex worker organisation NZPC, which has offices in Auckland, Tauranga, Wellington, Christchurch and Dunedin. The role of the NZPC has been key in promoting good practice in service provision under decriminalisation. Recent contributions highlight how the NZPC were involved in shaping the law (Aroney, 2021) and, thanks to sustained funding and being rights-based and peer-based, it has been able to play a central role in providing advice, information and sexual health care for all sex workers, including particularly marginalised and criminalised sex workers such as migrant sex workers. It is important to highlight that, despite their vulnerability and lack of work rights, high numbers of migrant sex workers are reported to be attending clinic and drop-in at NZPC, who employs migrant peer staff and translates material in different languages (Bennachie et al., 2021; Roguski, 2013). This confirms findings in NSW that highlight the benefits of utilising multi-lingual peer staff in order to reach out and be more accessible to marginalised migrant communities (Donovan et al., 2012). Beyond peer support, advocacy and health promotion, NZPC provide sexual health checks, doctors and nurses in three of their community bases and coordinate a text alert system to signal violent clients in one (Rottier, 2018). While most (non-migrant) sex workers in New Zealand access their GPs for sexual health checks, offering sex worker specific, confidential sexual health services within a peer sex worker organisation was indicated to be of particular importance for migrant sex workers and for those who still fear stigma if disclosing their work to mainstream health services (Abel, 2014).

NZPC also actively promote health and safety in workplaces in collaboration with Medical Officers of Health, which was argued to bring sustained improvements in OHS compliance in sex services premises, while they mediate with and train the police to ensure access to justice for sex workers, and provide information and advice to people intending to work in sex work (Abel & Healy, 2021).

Street-Based Sex Work

In the first, large mixed method evaluation study of sex work decriminalisation in New Zealand, street-based sex workers were found to be more likely than indoor or private sex workers to be of Māori/Pacific Islander descent, be drug using and be trans women (Prostitution Law Review Committee, 2008). New Zealand’s model of sex worker decriminalisation includes the decriminalisation of street-based sex work. A number of qualitative and quantitative studies established that working conditions, safer sex practices such as condom use and access to health and justice greatly improved for this population after decriminalisation (Abel et al., 2007; Prostitution Law Review Committee, 2008; Roguski, 2013). Armstrong’s (2014) qualitative research with 28 cis women street-based sex workers highlighted several benefits of decriminalisation on the health and rights of street-based sex workers, including allowing them time and room to better screen clients without having to fear and risk arrest of either parties. In another publication based on the same data, Armstrong (2016a) highlighted the improved relations between street-based sex workers and police since sex work was decriminalised, which she found to have shifted from law enforcement to providing protection. Alongside important changes, the size of street-based sex work was found to have remained unchanged (Abel & Fitzgerald, 2012; Prostitution Law Review Committee, 2008). Abel and Fitzgerald (2012) argued this is partially due to the specific needs of this cohort. The authors highlighted that street-based sex workers are conscious of the higher risks involved in their modality of work, yet deliberately choose the street over an indoor work setting as it allows them to maximise income and move more freely and increase their autonomy by feeling free to work the hours they chose and not have to answer to management (Abel & Fitzgerald, 2012).

Abel and Fitzgerald (2012) recommended opting against stricter regulations for street-based sex work, maintaining these would be unlikely to reduce the size of street-based sex work as street-based workers deliberately chose the street because of their pressing financial needs. In line with the conclusions of other studies (Armstrong, 2014, 2019; Easterbrook-Smith, 2020), the authors argue that under regulations that restrict street-based sex work workers would continue to operate in a more clandestine, hidden manner, which would increment their marginalisation, vulnerability and lack of access to justice, health and support (Abel & Fitzgerald, 2012). Abel and Fitzgerald (2012) concluded that, on top of fully decriminalising street-based sex work, cultural, economic and social policies aimed at tackling social and economic inequalities and structural factors that underlie the needs and social marginalisation of particular disadvantaged groups were needed. More recent research conducted by Abel between 2017 and 2019 with street-based sex workers (n = 23), outreach workers, business owners, residents and council staff in different areas of Christchurch highlighted how street-based sex workers had very different experiences depending on the areas where they were working: They tended to be accepted and welcome in diverse, heterogeneous areas, while in more homogeneous, middle-class suburbs they were subject to stigma and harassment (Abel, 2020). The author concluded that, rather than regulation, community engagement and the work of NZPC had been key to better cohesion in more diverse areas.

Stigma and Discrimination

Sex work stigma in Australia has been a rather recent focus of research (Treloar et al., 2021). Conversely, in New Zealand, public health scholars have long insisted on the need to expand the focus of sex work research beyond sexual health, given that sex workers display very high rates of testing and good sexual health outcomes, while their general health and well-being are greatly affected by stigma and discrimination, which may persist after decriminalisation (Abel & Fitzgerald, 2010a).

Abel and Fitzgerald (2010b) analysed the way stigma still affects diverse sex workers in New Zealand after the Prostitution Reform Act 2003, and highlighted that sex workers themselves are aware that law reform is not enough to end stigma. Based on qualitative interviews with diverse sex workers, the authors point not only at the effects of stigma on sex workers’ emotional health, but also at the way sex workers develop an array of strategies to cope with stigma, and to detach themselves from internalising its effects (Abel & Fitzgerald, 2010b). In an another article from the same research aimed to evaluate sex workers’ emotional health, Abel (2011) indicated that, despite stigma still being present, many sex workers are able to manage their emotions by separating their public and private identities, through strategies of professionalisation facilitated by the recognition of sex work as work. In terms of the effects of stigma on sex workers’ ability to be open about their work, only 46% of sex workers surveyed by the authors disclosed their work with family members, 66.2% did so with health workers, though only 43% disclose their sex work to their GP (Abel & Fitzgerald, 2010b). Qualitative research with 15 social workers also concluded that despite an important shift in understanding sex work as labour since decriminalisation, social workers still held stigmatising, victimising views about the vulnerable sections of sex workers they worked with (Wahab & Abel, 2016).

Armstrong’s (2016c, 2019) research with 28 cis women street-based sex workers evaluated the effects of Prostitution Reform Act on the persisting stigma, harassment from the public and higher levels of violence against street-based sex workers in New Zealand, compared to those working indoors. Armstrong (2016c) argues that decriminalisation was a necessary first step that improved the working conditions and lives of street-based sex workers, yet negative attitudes towards them are still pervasive, linked to women’s perduring subordinated role in society and reinforced by mainstream media and anti-sex work narratives that portray street-based sex workers as either victims or social pollutants. Armstrong (2019) argues in favour of sustained positive, anti-stigma cultural and mediatic representations of sex work as important strategies to keep working towards changing negative attitudes. Sex work stigma and harassment coupled with transphobic stigma were indicated to still disproportionately affect trans women sex workers (Easterbrook-Smith, 2020; Gilmour, 2020).

Scholars of sex work and migration have suggested that, due to their enduring illegality, migrant sex workers in New Zealand are subject to intersecting stigmatisation, which includes racializing stereotypes. In order to address the specific stigma and discrimination against migrant sex workers, research urges the New Zealand government to grant them the same rights accorded to non-migrant sex workers (Bennachie et al., 2021).

In a 2018 qualitative study with 20 cis and trans women and cis and trans men sex workers from different sectors (mostly non-migrants), Armstrong and Fraser (2020) discussed in-depth experiences of stigma, concluding that while all participants shared experiences of stigma within their family or social circles, none of them displayed internalised stigma, which they saw as a positive consequence of decriminalisation.

Further Intersectional Concerns

Recent research with trans and Māori/Pacific Islander sex workers in New Zealand is limited. In Abel et al.’s (2007) report to the New Zealand Ministry of Justice, 37.8% of study participants were of Māori/Pacific Islander ethnicities. Their large quantitative study included 68 trans women and 48 cis men sex workers, while the qualitative study included 11 trans women and two cis men. The research found that trans workers were more likely to identify as being of Māori ethnicity and to have started sex work before the age of 18, though none was under 18 at the time of the study. Cis men and trans sex workers were more likely than cis women to have sex work as the only source of income; to have started work through social influence of friends who were working; to find sex work fun, or a way to explore their sexuality; and to report using the money to buy drugs and alcohol. For trans women sex workers, sex work was experienced as a positive way to experience and learn about trans identity and community. Yet, trans participants experienced the highest barriers to finding employment in any other sector than sex work (Abel et al., 2007). A 2018 book chapter based on qualitative interviews with eight trans women sex workers in Christchurch identified a persistence of stigma and experiences of harassment among the participants, despite an improvement of their relations with police (Gilmour, 2020). A Master’s thesis in human rights submitted in 2016 collected qualitative interviews with 30 Māori sex workers in New Zealand and reported that both their health and autonomy had improved since sex work decriminalisation, yet there were still challenges posed by racism within both the sex industry and wider society; drug use; and social exclusion (Escaravage, 2016).

Regulatory Concerns Around Migrant Sex Work

Research has highlighted the positive impact of the Prostitution Reform Act on access to health services, rights and support for sex workers who are citizens or permanent residents. However, migrant sex workers on temporary visa permits in New Zealand were purposely excluded from the 2003 Prostitution Reform Act. When the Prostitution Reform Act was passed, Sect. 19 was introduced against advice by the NZPC, which determined temporary visa holders would still commit an offence if found working in any sector of the sex industry. Section 19 was introduced as a form of protection against trafficking into sex work (Bennachie et al., 2021) but it is likely to make illegal large numbers of migrant sex workers, considering that 30% of New Zealand’s population are migrants (Stats NZ—Tatauranga Aotearoa, 2020b) and 60% of migrants arriving to New Zealand in 2019 were on temporary visas (Stats NZ—Tatauranga Aotearoa, 2020a).

In 2011, the NZPC commissioned a mixed methods research project to examine the work health and safety needs of migrant sex workers in New Zealand (Roguski, 2013). The research included twelve qualitative interviews, a survey with 124 migrant sex worker participants and a review of anonymised clinical records on 51 migrant sex workers’ sexual and reproductive health from the NZPC from 2007 to 2012. According to the study, there was no evidence of trafficking among participants, but rather they had migrated and started work voluntarily. Yet, migrant sex workers were not allowed by managers to refuse clients, many were not accessing primary health care and services out of fear of being reported to authorities and deported, while any police intervention was avoided, including when violence was perpetrated against them. This research concluded that there was no evidence to sustain the claim that migrant sex workers are at risk of trafficking in New Zealand and Sect. 19 was therefore misguided and counterproductive (Roguski, 2013). As part of a Master’s research thesis, in 2017, Ting conducted 20 qualitative interviews with Asian migrant sex workers; one of his findings was that some participants feared deportation more than violence and exploitation (Ting, 2018). Qualitative research commissioned by the Ministry of Business, Innovation and Employment which included in-depth interviews with 11 migrant sex workers also found that none of the participants had been trafficked, yet they experienced exploitation and blackmailing by clients, partners and others who threatened to report them to immigration authorities (Abel & Roguski, 2018). Another qualitative study based on interviews with four sex workers and four members of the NZPC highlighted the crucial work of the latter supporting migrant sex workers come clear of exploitative third parties, yet remarked how their efforts are strongly restricted by the current law that threatens to deport migrant sex work (Armstrong, 2018).

Qualitative research conducted between 2017 and 2020 on sex work, migration and trafficking undertook 24 months of fieldwork and 56 interviews with 35 cis women, seven cis men and eight trans and/or gender diverse majority Asian migrant sex workers in New Zealand. The results of this research indicated that migrant sex workers in New Zealand experience violence and exploitation and huge barriers to accessing police and health care, even when severely ill or if victims of violent crimes such as rape (Bennachie et al., 2021).

Discussion

Existing evidence on the impact of sex work decriminalisation in New South Wales and New Zealand on the health and well-being of diverse sex workers shows improvements in sex workers’ sexual health; in accessing health services; in sexual health testing rates as well as in avoiding exploitative work relations (Abel & Healy, 2021; Abel et al., 2007; Armstrong, 2014, 2016b; Callander et al., 2016; Donovan et al., 2010, 2012; Estcourt et al., 2000; Harcourt et al., 2006; Mai et al., 2021a). In both jurisdictions, the sex work industry has not increased in size since decriminalisation (Abel et al., 2009; Donovan et al., 2012; Rissel et al., 2017).

In terms of promising practice in health service provision, both jurisdictions similarly show positive outcomes associated with the funding of peer-based health promotion programmes that include culturally and linguistically diverse (CALD) peer staff (Donovan et al., 2012; Roguski, 2013). In New Zealand, the NZPC is an important provider of sexual health checks within some of their community bases. In NSW, the peer-only health promotion organisation SWOP NSW does not offer sexual health checks on premises, but large sexual health centres are referred to by SWOP NSW and have a very high attendance rate by both resident and migrant sex workers, thanks in part to their employment of CALD staff. Crucially, both jurisdictions have specific programmes and peer staff from diverse sex work communities, such as trans, cis men migrant and First Nations sex workers. These programmes have been shown to be effective in reaching out to particularly stigmatised populations (Donovan et al., 2012, 2010; Gil et al., 2021; Harcourt et al., 2006, 2010; Macioti et al., 2022; Renshaw et al., 2015).

Existing research points at a further number of promising practice examples, as well as shortcomings in each jurisdiction. First, neither jurisdiction has fully decriminalised the sex industry, given laws on street-based sex work and the threatened deportation of temporary visa holding sex workers in New Zealand. Evidence shows that the health and safety of street-based workers in New Zealand has greatly benefitted from the Prostitution Reform Act, while the population of street-based workers has not increased in size (Abel et al., 2007; Armstrong, 2014, 2016a, b). On the other hand, in NSW, migrant sex workers, who form a very large proportion of sex workers, have greatly improved their sexual health outcomes (Donovan et al., 2010; Harcourt et al., 2006; Pell et al., 2006) and decreased their vulnerability to exploitation and trafficking since sex work decriminalisation (Macioti et al., 2020; ). Although they form a very small proportion of sex workers, street-based sex workers in NSW still commit an offence if working in specific settings (Berg et al., 2011; Donovan et al., 2012). In New Zealand, sex workers on temporary visas face barriers to accessing basic lifesaving health support, rights and protection from violence and exploitation, while there is no evidence of trafficking in the sex industry (Abel & Roguski, 2018; Armstrong, 2018; Bennachie et al., 2021; Mai et al, 2021a; Roguski, 2013; Ting, 2018). This wide and temporally spread body of evidence provides strong arguments in support of a model of full decriminalisation, which includes decriminalising both street-based and migrant workers.

In NSW, local governments and Safework NSW were found not to sufficiently ensure compliance with health and safety measures in sex premises as outlined by existing guidelines (Berg et al., 2011; Donovan et al., 2012), while the need to involve sex workers and the Ministry of Health to provide councils with training around work health and safety in sex services premises has also been identified (Bates & Berg, 2014). Councils were agued to engage in morally biased land use planning that aimed at restricting sex work premises to industrial areas and to fail to comply with existing planning guidelines (Crofts & Prior, 2012; Donovan et al., 2012). The requirement of developmental approval from private sex workers working from home occupations was also found to be counterproductive (Donovan et al., 2012). Recent studies highlighted that councils in NSW concentrate efforts and funding on shutting down unauthorised sexual service premises in a manner that risks harming migrant sex workers, rather than improving opportunities for sex industry businesses to be treated in a similar manner to other like land uses of a commercial nature, or home occupation (Mai et al., 2021a). NSW councils’ crackdowns on unauthorised massage parlours were feared to potentially contribute to unsafe sexual practices, as condoms are used as evidence and workers risk fines, losing their jobs and migrants fear possible repercussions on their residence rights. Researchers have, therefore, strongly recommended that this practice come to an end (Mai et al., 2021a).

In New Zealand, small cooperatives of sex workers (as opposed to larger managed businesses) are encouraged by exempting up to four sex workers working together cooperatively from having to obtain authorisation (Donovan et al., 2012). Furthermore, there is evidence of good practice and successful collaboration between NZPC and the Medical Officers for Health (MOH) in ensuring compliance with work health and safety in brothels (Abel & Healy, 2021). Research from NSW recommends councils engage in collaboration with health officials and local sex worker organisations to prioritise the implementation of and compliance with work health and safety measures (Bates & Berg, 2014). The NSW Ministry of Health and sex worker organisations were working towards the reintroduction of the Ministry of Health as training provider with council officials, after the NSW Green Party passed a motion in Parliament in relation to this matter (NSW Legislative Council, 2021). At the time of writing, the Ministry of Health has actioned a training project for NSW councils, which will see the funding of SWOP NSW as lead agency, in association with other experts in public health and (town) planning, to develop an online training package for local governments. This training will also include the detrimental aspects associated with the locating of sex services premises in industrial zones along with the prohibition and restrictive controls on the home-based sector.

In both NSW and New Zealand, stigma against sex workers is still rife, affecting their emotional and mental health as well as their well-being and inclusion in society. Research in both NSW and New Zealand shows the need to go beyond decriminalisation in order to address and tackle pervasive sex work stigma (Abel & Fitzgerald, 2010b; Armstrong, 2019; Macioti et al., 2021; Stardust et al., 2021; Treloar et al., 2021). In both jurisdictions, specifically sex worker-friendly and peer-based specialised mental health services are lacking or insufficient, which have been strongly recommended by recent research, together with peer-led trainings for health providers and public officials, as well as anti-stigma campaigns and cultural initiatives (Macioti et al., 2022; Treloar et al., 2021).

Conclusions

Existing evidence on sex work under decriminalisation indicates that full sex work decriminalisation is a necessary first step in the effort to improve the health and well-being of diverse sex workers. Crucially, evidence from decriminalised settings highlights that in order to be most effective, legislative change must be accompanied by pursuing social justice and better practice regulatory responses that uphold the intentions of decriminalisation; redistributing resources; addressing structural factors such as unequal access to resources; and tackling intersectional stigma and discrimination (Abel, 2018).

Recommendations for Future Research

Despite the wealth of research available in both NSW and New Zealand, we identified a few areas that would benefit from further study. In NSW, we recommend future research focus on the effect of town planning obstacles on diverse sex workers’ health and safety and on the impact of decriminalisation on street-based, trans men and women and Aboriginal or Torres Strait Islander sex workers. In New Zealand, we identified the need for more research on the impact of decriminalisation on cis men and trans men and women, as well as on Māori sex workers.