Ms Vanessa Hetherington:

The Irish Medical Organisation is the representative body for all doctors in Ireland and represents over 5,000 medical practitioners. It thanks the committee for giving it the opportunity to present its views on the future of prostitution legislation in Ireland.

International research shows that sex workers and those trafficked for sex are exposed to a wide range of physical and mental health problems, in addition to sexually transmitted diseases. The demand for unprotected sex puts pressure on sex workers and exposes them to a higher risk of sexually transmitted infection and HIV. Sex workers, particularly those involved in street prostitution, are exposed to high levels of violence, including sexual and physical assault, rape and murder. Studies show that the majority of women and adolescents who have been trafficked or are involved in prostitution have been physically assaulted or raped and show symptoms of post-traumatic stress disorder. Other mental health issues are common among sex workers, including depression and anxiety disorders which can continue long after a woman has exited prostitution.

Drug and alcohol addiction is also prevalent among sex workers. Sex workers often enter into prostitution to support a drug addiction, but they can also become reliant on drug use as a support mechanism to cope with the trauma of prostitution. Sex workers who use drugs are more likely to risk unprotected sex and neglect their health, seeking care only at more advanced stages of illness. Research has also found that mortality rates are higher among females involved in prostitution than in the general population. In London, mortality rates are estimated to be 12 times higher among women involved in prostitution than the national average, while a Canadian study estimates that mortality rates are up to 40 times higher.

Data compiled from the HSE's women's health project in 2007 showed that the majority of women recorded symptoms related to sexually transmitted infections, reproductive tract infections or other health complications related to prostitution, including bacterial vaginosis, thrush, hepatitis A and B, chlamydia, vaginal-genital warts, urinary tract infections and cervical cell abnormality. Project workers received regular reports from women of violence inflicted on them and expressed concern about the long-term impact of prostitution on the women's health.

A study by the national advisory committee on drugs, NACD, of drug using sex workers in Dublin found that the women and men interviewed were dependent heroin users before engaging in sex work and that a significant minority were minors at the time. Most had grown up in marginalised communities and experienced prolonged periods of homelessness. Most entered sex work for financial reasons or to maintain their drug dependency, while increased income from sex work invariably contributed to an escalation in drug use. Drug use enabled sex workers to work longer hours and minimise distress levels as a consequence of the work but increased the risk of engaging in unprotected sex or affected their ability to assess the dangers of a situation. A total of 78% of interviewees reported having hepatitis C, while 21% reported that they were HIV positive. The vast majority had been physically or sexually assaulted by a client.

Most women do not choose prostitution but are forced into it because of poverty, homelessness or a drug addiction. Purchasers of sex exploit their desperation. A wide range of measures is necessary to combat prostitution and sex trafficking, including the provision of health and social supports for prostitutes to enable them to exit prostitution, as well as social supports for young people at risk of prostitution. There is also a need to change attitudes towards prostitution and the growth of the sex industry through legislation criminalising the purchase, not the sale, of sex and a public awareness campaign to educate the public on the physical and mental harm caused by prostitution and trafficking.

Experience in Sweden shows that criminalising the purchase and not the sale of sex has reduced demand and contained the extent of prostitution. A recent evaluation by the Swedish Government found that since the introduction of legislation in 1999 street prostitution in Sweden had halved. In 2008 the number of people involved in street prostitution was estimated to be two thirds lower than in neighbouring Norway and Denmark. While the level of Internet prostitution had increased, as elsewhere, the report found no overall increase in the level of indoor prostitution or trafficking as a result of the legislation. Police officers and social workers report that purchasers of sex have become more cautious and surveys show that the legislation has had a deterrent effect on men.

The IMO supports the Turn Off The Red Light campaign and calls on the Government to introduce legislation to make it illegal to purchase sex.