Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies

摘要: Background Sex workers are at disproportionate risk of violence and sexual emotional ill health, harms that have been linked to the criminalisation sex work. We synthesised evidence on extent which work laws policing practices affect workers’ safety, access services, pathways through these effects occur. Methods findings searched bibliographic databases between 1 January 1990 9 May 2018 for qualitative quantitative research involving all genders terms relating legislation, police, health. operationalised categories lawful unlawful police repression or their clients, including criminal administrative penalties. included studies measured associations outcomes violence, explored related pathways. conducted a meta-analysis estimate average effect experiencing sexual/physical HIV sexually transmitted infections (STIs), condomless sex, among individuals exposed repressive compared those unexposed. Qualitative were iteratively, inductively, thematically. reviewed 40 94 studies. Repressive was associated with increased from clients other parties (odds ratio [OR] 2.99, 95% CI 1.96–4.57), HIV/STI (OR 1.87, 1.60–2.19), 1.42, 1.03–1.94). The synthesis identified diverse forms abuses power, arbitrary arrest, bribery extortion, physical failure provide justice, forced testing. It showed in contexts criminalisation, threat enactment harassment arrest displaced into isolated locations, disrupting peer support networks service access, limiting reduction opportunities. discouraged carrying condoms exacerbated existing inequalities experienced by transgender, migrant, drug-using workers. Evidence decriminalised settings suggests greater negotiating power better justice. Quantitative limited high heterogeneity some insufficient data conduct meta-analyses others, as well variable sample size study quality. Few reported whether another offence, our ability assess relative penalties observational, prohibiting any causal inference. trans- cisgender male workers, little health healthcare beyond Conclusions Together, demonstrate extensive work, enforcement targeting sale purchase activities organisation. There is an urgent need reform sex-work-related institutional so reduce barriers realisation