Ms Linda Latham:

I thank the committee for giving me the opportunity to address members on the future direction of legislation on prostitution. I attend in a personal capacity, but my knowledge and experience have been accumulated in the past 13 years in my professional life as a clinical nurse and manager of the HSE's women's health services and through my master's thesis research on the inadequacy of harm reduction measures in relation to prostitution. I make this presentation and my views public with the greatest of respect for women's differing perspectives on entry into the sex industry and with an understanding of the complexity of the issues that affect many women.

I do not propose to speak for women but rather to convey to the committee my considered thoughts on how my long experience and study of prostitution have affected my analysis and directing of services to women involved in, and seeking to exit, prostitution.

To put the services available to women in prostitution in context, our service is the sole dedicated provider of health care to women affected by prostitution and to victims of trafficking into the sex industry. I planned and implemented the statutory health and social care plan for victims of trafficking in 2009 as part of the Department of justice's anti-human-trafficking unit action plan and, with my team, holistically cared for those women for several years before the unfortunate division of the two teams. We now have two care teams, one for women in prostitution and one for victims of sex trafficking. My work caring for victims who are trafficked into the sex industry here gave me an understanding of the whole sex industry, with all its horror, control and abuse, and at the same time was the most rewarding work I have ever done in my nursing career. What I learnt helped me to direct the women's health service and adopt a holistic health care management approach. This enables women to attend in a non-judgmental environment to their health care needs, including full sexual health checks, smear tests and contraception, and we make referrals to and liaise with other local hospitals as necessary. As part of our health promotion work, outreach staff give information on a range of issues including sexual health, safety, Garda liaison, safer sex and condom use, needle exchange and drug treatment referrals to specialist centres. We do outreach in the evenings on the streets and give out information and safety packs there too.

As a health care provider I believe it is imperative that we respond to the needs of women. My participation in conducting interviews for the Immigrant Council of Ireland's globalisation, sex trafficking and prostitution research and my weekly work demonstrates that many women need and require intense support in planning a route out of prostitution. I am pleased to say that concurrently with our harm reduction services we run a three-step exiting plan that creates the opportunity for life planning and gives a focus to planned and supported access to further training and development. In this regard we rely on and are grateful to Ruhama, which develops with our service users the practical skills that empower and enable women to make positive changes in their lives.

At one of the last clinics before Christmas, a woman with whom I had no particular relationship other than a rather curt and functional one, as determined by her, came in and said "I won't see you any more in the new year because I'm going home." I put my hand to my heart and said "I am so pleased for you, so pleased." She began to cry and we hugged one another and I wished her well for the rest of her life. I really wished her a new beginning, a new chapter. I could see for the first time there was a truthful exchange apart from our curt medical concerns over the past number of years - an acknowledgement of what she was about to leave behind and relief for her at the potential for a normal life. I know well that she may not face an easy transition and only now that she has escaped the life will she begin to reflect and weigh up over the years to come the impact of prostitution on her.

I strongly recommend that a routes-out strategy be adopted and formalised with the key players who work with women in prostitution and with women themselves. Here we could jointly consider and utilise previous research on the barriers to exiting prostitution and bring about a standardised referral procedure and a funded statutory and NGO pathway. All my years of work and observation convince me that this is crucial. Many of the issues that prevent women from exiting are related to financial hardship and disadvantage. Provision and consideration of some of the following would greatly help those seeking to exit: some form of social welfare payment or financial assistance; medical cards; free counselling; transitional safe housing; a review of the very restricted 19-hour work permits for students; direct access on referral to, and support from, certain named agencies who work with women in prostitution, such as our organisation and Ruhama; and training courses and schemes that may lead to employment opportunities. When I took over as manager of this service I visited Glasgow and was introduced to city councillors and politicians who had implemented the policy view that prostitution is a form of violence against women. I also visited services such as Base 75 and its routes-out partner. They run a two-pronged service approach: harm minimisation, which includes all sexual health services, and a routes-out programme. It is not an either-or situation. It is possible to run the same service with two different aspects, which is crucial. Over the time I have been observing women I have felt that we are not offering adequate services.

We partnered Scotland on the dignity programme between 2009 and 2010 and visited five countries to observe and analyse models of good practice in care for victims of trafficking and women in prostitution. The Scottish system is very straightforward in acknowledging the harm and the reality of prostitution but very constructive and strong from political to service level in dealing with the issue. We also visited Sweden, which underpinned my inspiration. I was greatly encouraged to see how a state's response to the global phenomenon of prostitution and sex trafficking could change social attitudes and dramatically reduce the incidence of prostitution and trafficking. The conversations we had with and the things we learnt from people such as Anna Skarhed, the Supreme Court judge mentioned last week, on attitudes to prostitution, gender equality, and the implementation of Swedish law criminalising the purchase of sex were truly inspirational. The experience of the Swedish rapporteur on trafficking and the work of the prostitution unit, which I took time out of the schedule to visit and discuss services with, were very useful and practical. The Swedish approach, which comprehensively addresses prostitution and sex trafficking, is holistic and makes sense to me as someone working in this area. Policies, backed by legislation with which most committee members are by now familiar, include education and awareness campaigns in schools and society in general; criminalising the buyers, exposing them publicly and imposing fines; outreach for men buying sex and programmes addressing those issues; and comprehensive services for women involved in the sex industry, including victims of trafficking.

Ireland has already implemented a well-thought-out action plan for victims of trafficking, comprising State and NGO participation in the anti-human-trafficking unit. Educational interdepartmental structures have been put in place over recent years. Measures taken to tackle sex trafficking could easily be piggybacked onto these structures, including measures to highlight the damage prostitution inflicts on girls, women, families and society. We do not have to reinvent the wheel but rather adapt measures or services to include the needs of women affected by prostitution. I was very disappointed, when the anti-human-trafficking unit was set up, to find that it focused only on sex trafficking. To me it did not make sense that we were not covering the whole issue of prostitution and sex trafficking, because it is all one industry, the sex trade. The needs of all of these women are very similar, irrespective of their entry into the sex industry, as they have been exploited and often suffer the consequences of prostitution, such as trauma and violence, health impacts, and a need for counselling, money and safe housing.

I would like to draw the committee's attention to the health impacts of prostitution. In our weekly clinics and in our research with the Immigrant Council of Ireland we analysed approximately 70 patient files and found significant numbers of related illnesses and infections, including chlamydia, bacterial vaginosis, candida, herpes, positive smear test results related to human papillomavirus - the wart virus, hepatitis, syphilis, cystitis, pain on intercourse and intermittent bleeding. These are regular occurrences at our clinic. Every week we see these diagnoses. Our staff also regularly deal with issues such as slipped or burst condoms, crisis pregnancies, sometimes terminated with medication bought on the internet, sexual and physical violence, drug use and homelessness. We have no specific data on the psychological impact of prostitution on women as, unfortunately, we have no counselling service, but from my professional assessment it is an area of great need, and great skill is required to rehabilitate many women affected by prostitution and sex trafficking. I refer to the work of Judith Herman in my submission document and her in-depth analysis of mental health implications, such as post-traumatic stress disorder, for women involved in the sex trade.

If poverty, early sexualisation of girls and boys, drug addiction, unstable school attendance and difficult family backgrounds are such risk factors for entry into prostitution, as demonstrated by much research, including the 2004 Home Office study Paying the Price, and as we know from our experience in women's health services, then surely we have an obligation to tend to those social injustices and address local concerns. We must also tackle the demand for sex, which further perpetuates exploitation by legalising the sex industry, permitting people to buy sex because they can afford it and it is okay to do so.

I have met hundreds of women over the years in clinical practice for whom the indicators and risks are apparent. It has become blatantly obvious to me that it is unethical and unjust to sanitise and legalise an industry driven by financial gain and demand for sexual gratification at the expense of others. I have met women whose lives have been devastated, women who have felt they are no longer good enough to be a mother to their children. I recall one woman in particular who felt her child was better off with her sister. I have met women who sacrificed so much to earn money to send home for all sorts of reasons. Of course, there are women who earn money out of prostitution and claim they are fine with it. I respect that opinion and wish them well. However, in my clinical experience observing women at different stages over a long period, I can see changes in many women's personalities. The bright and bubbly people who first attend saying all is fine are gradually flattened and numbed by the experience. If any one of the committee were to engage with the social histories and trauma of the women who have been trafficked or involved in the sex industry, they too would sense the violation. Recently, I attended a sexual health conference on the impact of early sexual experience on young persons. It was suggested that we ask at what age a person had first had sex. I thought about using that question in my practice instead of asking when my patients had first started in prostitution. I recently did so with a young transgender woman who answered that it was at ten years of age and that she was homeless and prostituting at 13. Her mother had had her at 13. Her friend also said she been 14, and that it was very common in their country of origin for girls to be pregnant at 11 and 12 years.

It has been suggested that if prostitution were decriminalised for women and the purchaser of sex were criminalised, that would make it harder for women. I believe the opposite. By decriminalising women we will be relieving them of the pressure they are now under to be covert and they will not face court cases for prostitution-related offences as they do now. They would be encouraged to report violence, robberies and rape without fear of retribution or further incriminating themselves. They would not face fines, imprisonment or deportation, and would be able to access services such as women's health services and obtain full support to exit prostitution.

I am all for an open and diverse society that welcomes those of different sexualities and genders as well as affording all boys and girls the opportunity to reach their maximum potential freely and without coercion or exploitation. In my opinion, the sex industry does not offer that. Rather, it is a corrupt, harmful and demoralising experience. I hope for all those affected in Ireland and in other jurisdictions that there will be a better way forward.