The legal status of sex work is one of the most contentious topics of public policy. The topic is often defined by moral arguments. But, in Australia, a close examination of the decriminalisation legislative approach, especially in Victoria and New South Wales (NSW) in Australia, uncovers a compelling public health narrative.
Essentially, by legalising and normalising sex work as a legitimate profession, these states have created an environment with exceptionally low rates of HIV and other Sexually Transmitted Infections (STIs). This positions decriminalisation as the international gold standard for safeguarding the health and human rights of sex workers.
Decriminalisation as a public health strategy
The center of the decriminalisation model is the removal of criminal penalties for sex workers, clients, and third parties. This brings the industry out of the shadows. In contrast, under the criminalisation of the Nordic Model, where clients are criminalised, sex work is driven underground, where workers are invisible, and must work in isolation, fear, and secrecy.
This approach is hostile to public health goals, because workers are unlikely to report violence to police, seek medical care, or speak up for fair working conditions, for fear of police surveillance and legal repercussions.
In stark contrast, the system pioneered in NSW, and increasingly adopted in Victoria, treats sex work like any other business. With this policy shift, open communication between workers, police, and health professionals is facilitated. Additionally, this allows for professional organisation and the integration of sex work into public health infrastructure.
Empowerment through peer education and safe practices
Through greater empowerment of sex workers in decriminalised settings, public health outcomes improve. This correlation occurs because sex workers use the knowledge gained through robust peer education programmes to work safely. Take NSW, where organisations like the Scarlet Alliance alongside local sex worker groups work openly, creating networks where information is shared, and safety prioritised.
Sex workers are the most trusted source of knowledge, of both health and safety, for their colleagues. This peer-led model focuses on genuine advocacy and information sharing for safe work practices. In the decriminalised space, safe sex is not just a topic of discussion; it is a professional standard that workers enforce through a range of tools.
They do this by sharing best practices with each other. Peers share up-to-date knowledge on risk reduction with each other, outline safe sex tips, like consistent condom use, and strategies for discussing safer sex with clients.
By using this collective, self-regulatory approach, sex workers in NSW ensure that safety knowledge is relevant, current, and appropriate. The result? A widespread adoption of protective measures that curb HIV and STIs/STDs.
A seamless integration of testing and healthcare access
Regular testing and early intervention are key to the low reported numbers of HIV and sexually transmitted diseases/infections in these states. When the law can’t criminalise a worker’s livelihood, the largest barrier to accessing healthcare is removed. USA for UNFPA, the lead United Nations sexual rights agency, found that sex workers under regulated systems routinely test for sexually transmitted infections without fear of being harassed, reported, or exposed.
Specialist public health bodies in Victoria and NSW have developed collaborative, non-judgemental relationships with the sex worker community. These services are tailored to address their specific needs. Open and frequent access means that infections are treated rapidly, reducing the duration of infectiousness within the community.
Prevention strategies like widespread availability of Pre-Exposure Prophylaxis for at-risk populations create layers of protection against HIV. The integration of testing and prevention into routine professional life is in stark contrast with models where fear prevents workers from seeking medical help until the infection is advanced.
Targeting prevention for vulnerable groups
The public health success of decriminalisation is further boosted by its ability to reach the most vulnerable subgroups in society and the industry. The European Sex Workers Rights Alliance found that decriminalisation improves sex workers' health and wellbeing, while the most effective strategies use specific campaigns to target migrant and transgender workers.
This is because migrant workers often face unique barriers to seeking health checks: language issues, precarious visa status, and unfamiliarity with the local healthcare system. Transgender workers encounter stigma and discrimination in mainstream healthcare settings. With decriminalisation, healthcare agencies can work directly with sex worker organisations to create needs-based, tailored outreach programmes. These campaigns provide information in multiple languages, offer culturally sensitive support, and ensure health services are non-discriminatory. All this combines to ensure that workers' unique physical and mental health risks are met.
It is through acknowledging and supporting vulnerability, rather than pushing it away, that the decriminalisation model achieves better health outcomes for all.
Final thoughts: A model for global sex worker health policy
That data is unanimous: low rates of HIV and STIs in Victoria and NSW are a product of measurable outcomes of deliberate policy choices that prioritise human rights, health, and safety of sex workers. With a regulatory environment free of stigma and fear, this model facilitates peer support, normalises safe practices, and enables seamless access to early testing and treatment.
The model is an unarguable case for global sex worker health reforms. It proves that treating sex work as a public health and labour issue, not a criminal one, is the most effective way to safeguard the well-being of sex workers and the health of the entire community.