Evidence assessment of the impacts of the criminalisation of the purchase of sex: a review
Review of evidence on the impact of the criminalisation of the purchase of sex.
Experiences Of Individuals Involved In Prostitution
This section examines the evidence on the impacts of criminalisation of demand on individuals involved in prostitution, specifically on safety and displacement; experiences of marginalisation; and, relations with police. The research in this area is predominantly based on small samples and largely reflects the experiences of street-based women. There is a notable absence of literature on the experiences of individuals involved in online prostitution and of the experiences of transgender individuals or men involved in prostitution.
Safety and displacement
In interviews with individuals involved in prostitution and authorities, it has been noted that the characteristics of the fewer clients buying sex on the street are more violent and unstable (Socialstyrelsen, 2004; Norwegian Ministry of Justice and Police Affairs, 2004; Kulick, 2005 cited in Levy, 2005; Levy, 2015). While opponents of the legislation to criminalise the purchase of sex claim that this is a result of the law, it can equally be said to demonstrate the ongoing dangers associated with prostitution as such (for example, Deering et al, 2014).
The Swedish National Board of Health and Welfare interviewed informants from agencies involved in prostitution work of which some stated that they felt there had been a rise in violence against individuals involved in prostitution since the Sex Purchase Act as women cannot afford to refuse more 'dubious clients' (Socialstyrelsen, 2004). However, this claim is based on perception rather than evidence and again, appears to highlight the dangers inherent in prostitution per se, rather than as a direct consequence of the introduction of legislation. Östergren's (2004) and Levy's (2015) respective research on sex workers' experiences, where both authors are critical of the legislation and draw on small samples using interviews, shows that post-legislation, some individuals claim that negotiations with clients have become rushed and clients agitated and stressed, lessening the time available to sex workers to assess potential risks of the client, the transaction and the general situation. Again emphasising the risks that individuals involved in prostitution can face on an ongoing basis.
Fewer clients, increased competition and reduced prices 'can alter the balance', posits Levy (2015, p. 186), leading to a reduced likelihood of condom use. Several research studies have concluded that condom-less sex is more common in street-based prostitution (Socialstyrelsen, 2004; Norwegian Ministry of Justice and Police Affairs, 2004; Levy, 2015). Again, it is the most marginalised and 'vulnerable' individuals who may be subject to these riskier options (Levy, 2015), a situation that can be applied to street based prostitution in all regimes where the most vulnerable individuals are subject to greater risks. Levy (2015) found that the experience of selling sex online had also become riskier as some clients were reluctant to give any identifying information, challenging notions that safety is easily negotiated.
Where individuals involved in prostitution experience violence, research undertaken by the Swedish National Board for Health and Welfare (Socialstyrelsen, 2008) provides evidence from a representative from the Stockholm Prostitution Unit who argued that the law meant that victims of violence were taken more seriously. On the other hand, in interviews with individuals involved in prostitution, some argued that they do not need the Sex Purchase Act in order to report battery and other abuse as laws are already in place for that purpose (Socialstyrelsen, 2008). Nevertheless, the framing of the law is likely to influence how police respond to individuals selling sex. The impacts of the legislation in terms of greater competition among individuals involved in street-based prostitution as a result of reduced numbers of clients post law, has also been explored, with suggestions that this has resulted in conflict between individuals (Socialstyrelsen, 2008). However, as pointed out by Levy (2015), conflicts may have existed prior to the law particularly given the competitive nature of prostitution markets.
Research by the Norwegian Government found that individuals involved in prostitution in Sweden relied on 'pimps' for protection, which could be seen in the context of decreased safety on the street and increased difficulty for social workers in accessing individuals (Norwegian Ministry of Justice and Police Affairs, 2004). However, an evaluation of the Norwegian legislation found that there was no evidence of increased violence towards individuals involved in prostitution after the law was introduced (Rasmussen et al., 2014)  .
Krusi et al. (2014) examined the experiences of individuals involved in street-based prostitution over an 11-month period post-implementation of an enforcement policy targeting sex buyers in Vancouver  . In January 2013, the Vancouver Police Department adopted an enforcement policy prioritising sex workers' safety over arrest. Whilst the guidelines did not specifically address the enforcement of clients, in effect the policy meant that the clients were targeted and therefore that Vancouver had become a 'demand criminalisation' environment. The aim of the study was to explore how criminalisation of purchase and policing of sex buyers shapes sex workers' working conditions and sexual transactions, specifically risk of violence and risk of HIV/sexually transmitted infections and primarily reflects the experiences of street-based sex workers. Based on interviews with 31 street-based sex workers and ethnographic observations triangulated with longitudinal data on prevalence of sex work-related violence and police statistics, Krusi et al. (2014) concluded that criminalisation of purchase and the policing of sex buyers impacted on sex workers' ability to negotiate their working conditions and transactions with clients. Examples of the impact on sex workers' safety included evidence of sex workers having to 'rush screening clients' due to reductions in the time in which sex workers could assess the client and negotiate terms due to increased policing. This concern expressed by sex workers does however indicate the dangerous nature of street-based prostitution per se. Rather than deterring women from engaging in street-based sex work however, the Vancouver policy was perceived to have had the adverse effect of leading to sex workers needing to spend longer hours on the street due to fewer clients (Krusi et al., 2014). There was also evidence of displacement to isolated 'outlying areas' resulting in increased risks of violence; and claims of increased pressure from purchasers for unprotected sex (Krusi et al., 2014). However, statistical analysis of the prevalence of physical and sexual violence against individuals involved in street-based prostitution showed no statistically significant change in violence rates post-policy implementation  (Krusi et al., 2014).
A study of the Ipswich/Suffolk Street Prostitution Strategy in England (Poland et al, 2012) also focused on a multi-agency approach to intervene in street-based prostitution to tackle demand by focusing policing on kerb-crawling and supporting individuals involved in prostitution to exit, as opposed to introducing harm-reduction measures while sex work continued. The evaluation of the initiative (Poland et al, 2012) indicated that surveillance and enforcement efforts to tackle demand (in 2007) resulted in a 'dramatic' reduction in kerb crawling in the following year (2008), and no follow-up prosecutions. While this may be a direct result of the enforcement policy it is also possible that policing priorities changed in the following year which would result in a marked reduction in subsequent prosecutions or, as the report suggests, some types of sex work continued in off-street but public areas (p14). However the Strategy is expected to extend to include off-street sex working with country-wide police activity expected to support this move. The Home Office claims that after 18 months of this policy, sex sales and purchases on the street had practically disappeared with no indications of other forms of prostitution growing as a result and with police and prosecutors working together to address sex purchasers via the issue of cautions, instructions to potential buyers to leave the area, and in some cases, the imposition of charges.
A Northern Irish survey with sex workers, prior to the ban, asked questions specifically on the potential impacts of the criminalisation of purchase. While it should be noted that this is based on responses that were merely hypothetical when the study was carried out, Huschke et al. (2014) note that comments made by 79 sex workers highlighted concerns which included a potential decrease in security; an increase in violent clients and a decrease in 'decent' clients; and, increased involvement of organised crime groups and 'pimps'. The majority of respondents (85%) believed that making payment for sex illegal would not reduce sex trafficking. Negative views on the criminalisation of purchase were also expressed by other research participants, including police officers.
Ekberg (2015) has noted that similar concerns were expressed in Sweden by opposers of the legislation but were successfully addressed by contextualising legislation in a broader publicity campaign, resources to support individuals involved in prostitution to access services to support exit and police training and awareness-raising. Awareness-raising campaigns have been carried out focusing on the prevention of prostitution and trafficking for sexual exploitation, and joint school awareness raising campaigns, which also focused on raising awareness of human trafficking in women and girls.
Marginalisation and stigmatisation
It has been suggested that legislation to criminalise the purchase of sex is likely to result in the further marginalisation of those for whom it has been difficult to exit prostitution and/or to move indoors since the ban came into force in Sweden; for example, women who have substance abuse problems (Socialstyrelsen, 2004 and 2008; Levy, 2015). Scoular (2004) notes that in Sweden, the government argued that these negative impacts would be outweighed by the message that prostitution should not be tolerated, thus overlooking the increased risks that marginalised street sex workers would be exposed to. This claim is challenged by Waltman (2011b) who argues that the de-criminalisation of the sellers of sex is a positive impact of the legislation and that marginalisation and stigmatisation continue to be experienced by individuals involved in prostitution in decriminalised regimes such as New Zealand (see also Kelly et al, 2009; 2014).
Based on Levy's (2015, p. 177) qualitative research with sex workers (n = 26), it was evident that individuals involved in prostitution in Sweden continue to experience stigmatisation; an issue that appears to be reflected internationally and regardless of the legislative context. Levy (2015) also argues that by taking sex work to represent a form of violence itself, this has impacted on debates on whether sex work is more or less safe since the Sex Purchase Act. However, Ekberg (2004) highlights that violence and marginalisation are features of prostitution and it is this concern for the safety of individuals involved in prostitution that has driven developments in Sweden and elsewhere.
Services to exit prostitution
Sweden has a long-standing tradition of providing services for women including support for those experiencing domestic abuse and for exiting prostitution. The legislation on the criminalisation of the purchase of sex was expected to increase the numbers of individuals accessing services to support their exit from prostitution. In Sweden, there are differing approaches adopted by the three support units in Stockholm, Gothenburg and Malmö. These units engage in outreach work, including online, and collaborate closely with health services offering counselling, treatment, practical assistance and referral to other services. Florin (2012) refers to a paper (in Swedish) which notes that between 2009-2011, a study of 34 service users who had sold sex, showed improvements in self-esteem, mental health and a reduction in the sale of sexual services. 
Social services units specialising in prostitution exist in Stockholm, Gothenburg, and Malmö with small-scale support introduced to provide a service for sex purchasers. Florin (2012, p. 274) writes: 'They [social services units] engage in outreach work, including online, and offer counselling, treatment, practical assistance as well as referral to other resources. Their mission is to help people voluntarily give up selling or buying sex'. Between 2009 and 2011, the units registered contact with 112 sex buyers and 326 sellers, 181 of which held a Swedish residential permit  (Åkerman and Svedin 2012 cited in Florin, 2012). Florin (2012) writes that this is a low number in comparison to estimates of the total number of sex buyers and sellers in Sweden, although as research by the National Board for Health and Welfare reveals, social services rarely support clients who have had experiences of buying sex ( SOU, 2010).
Opponents of the legislation have criticised the absence of ring-fenced public funds or national guidelines for prostitution services (Dodillet and Östergren, 2011). The less visible circumstances of sex workers can make it difficult for outreach workers to identify and reach them and Jordan (2012) writes that as a consequence of the Swedish Act, sex workers have been forced to go 'underground' making it more difficult to reach them. Levy (2015, p. 187) argues that there is limited service provision in Sweden and that this is particularly concerning given that the Stockholm Prostitution Unit does not provide street sex workers with condoms in situ, safer sex selling information, or with harm reduction initiatives.
Danna (2012), based on case-study research on the local application of the prostitution policy model in Stockholm (which included a small number of interviews with 'observers' including researchers, police officers, practitioners from a social services street unit and sex workers (N = 12) as well as 'informal chats' with sex workers during observations), found that sex workers reported experiencing negative judgments from public social work services and it was perceived by some, that services were only available for those individuals who wanted to exit prostitution. The Norwegian Ministry for Justice and Police Affairs (2004) noted that a reduction in street prostitution had not led to more resources being directed to indoor prostitution. Florin (2012) cites a range of studies which have shown that sex workers experience low trust in authorities as a consequence of inadequate support and experiencing prejudicial attitudes (cites Östergren 2006; Jakobsson 2008; Olsson 2007, SoS 2008, 2010a, b; Larsdotter et al. 2011; Jonsson and Svedin 2012). However Ekberg (2014) citing information provided by Prostitution Centre Representatives in Stockholm notes that a number of the women with whom they work, and who have exited prostitution, cite the legislation as an incentive in their decision to seek assistance  . A need for more training for social services has been identified more broadly ( SOU, 2010).
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