Police interactions linked to increased risk of client violence for female sex workers

The more abusive interactions street-based female sex workers have with police, the higher their risk of violence at the hands of clients, a new study by researchers at the Johns Hopkins Bloomberg School of Public Health suggests. The findings suggest the need for interventions that address relationships between FSWs and police to help alleviate negative impacts on FSW work environments, the authors say.

The findings were published online in the American Journal of Public Health.

"It's no secret that street-based sex work can be dangerous in the context of criminalization," says senior author Susan Sherman, a professor in the Bloomberg School's Department of Health, Behavior and Society. Research suggests that, globally, FSWs experience considerable work-related violence, including physical, verbal, and sexual abuse, robbery, kidnapping, and murder. Over their lifetime, the prevalence rate for work-related violence among FSWs is 45 to 75 percent.

But, Sherman adds, the role of the police in violence against this vulnerable population hasn't been well understood.

The study, which involved 250 FSWs, found that FSWs interact with the police—not only because of the illegal nature of their jobs, but also because many are engaged in the drug market, says Katherine Footer, assistant scientist at the Bloomberg School and the paper's lead author.

An analysis of the study data showed that all participating FSWs had experienced police interactions in their lifetimes, with nearly half having weekly encounters and about one in 10 having daily police encounters. These interactions ranged from regular patrol or enforcement activities—such as asking the women to move along or performing a routine stop—to abusive, such as verbal or emotional harassment or sexual harassment or assault. Excluding arrest, 92 percent had experienced at least one patrol/enforcement activity, and 78 percent had experienced at least one abusive encounter in their lifetime.

The research is part of the SAPPHIRE study, short for Sex Workers and Police Promoting Health in Risky Environments. Launched earlier this year by a team at the Bloomberg School, SAPPHIRE's research will examine the type, frequency, and associations of police practices with FSW's work-related risks, including violence.

For this study, the researchers gathered data from 250 Baltimore cis-gender FSWs recruited between April 2016 and January 2017. The researchers found these volunteers by waiting at specific locations they identified using a combination of publicly available arrest data, emergency services calls, a "johns" website, and 300 hours of police ride-alongs. When potential study participants came in contact with study staff, the researchers asked a few screening questions to confirm that they were street-based FSWs and invited those who qualified to participate.

These volunteers then answered a series of questions administered by interviewers on a variety of topics, including sociodemographic factors, their history of sex work and drug use, the nature and frequency of their interactions with police, and any client-related violence. Participants also underwent testing for HIV and common sexually transmitted infections.

Drug use appeared to boost the frequency and type of police encounters; for example, 42 percent of daily heroin users reported that at least one patrol/enforcement activity occurred weekly and 14 percent reported that at least one abusive encounter occurred over the same time frame, compared to 25 percent and 5 percent, respectively among other participants.

Client violence was also common among participants—more than half had experienced physical or sexual client violence in the past three months. The researchers found that for every additional type of patrol/enforcement practice experienced, FSWs had 1.3 times the odds of experiencing client violence. In addition, each additional type of abusive police interaction was associated with a 30 percent increase in the odds of experiencing client violence.

Although the study didn't examine the exact mechanism of police interactions associated with client violence, Sherman says, the build-up of frequent negative interactions accumulated over months and years promotes mistrust or fear of the police. Studies have previously linked this mistrust to different types of riskiness that might boost the odds of client violence, including rushing of client negotiations and moving to unfamiliar or unsafe areas.

"Criminalization and social marginalization place female sex workers in persistent positions of vulnerability," says Footer. "The fact that we found these two factors to be conjoined speaks to the clustering of the incredible risks to these women."

Decriminalizing sex work would help alleviate the pressure that intensifies this risk, Sherman adds. But in an environment of continued illegality, there are still structural interventions that could help improve sex worker safety, she says. For example, she and her colleagues helped launch a drop-in center where FSWs can not only take care of basic needs, such as showering or doing their laundry, but also seek assistance in filing complaints about abusive interactions with the police. They have also developed a "know your rights" brochure and talk to women about how to protect themselves in police interactions.

The paper underscores the importance of the impact of police and their responsibility in reducing their harmful behaviors. On the police side, Sherman and her colleagues suggest developing training specifically to address how police treat FSWs and having an ombudsman in police departments specifically for sex workers to make sure their voices are heard.