Oireachtas Joint and Select Committees
Wednesday, 23 January 2013
Joint Oireachtas Committee on Justice, Defence and Equality
Review of Legislation on Prostitution: Discussion (Resumed)
The purpose of the meeting is to have a discussion with some of those who made written submissions on the review of the legislation on prostitution in Ireland. The joint committee will hear from two organisations and two individuals. On its behalf, I welcome Dr. Derek Freedman and Ms Linda Latham. From Doras Luimní I welcome Ms Patricia Stapleton, anti-trafficking officer, and Ms Okeremute Okeregha, legal officer; and from Gay Men's Health Service, I welcome Mr. Michael Quinlan, manager, and Mr. Daniel McCartney, researcher, Gay Health Network. The format of the meeting is that we will hear from the representatives of each organisation and individual who will make opening remarks for five minutes or thereabouts, as we have received the submissions, which will be followed by a question and answer session.
Before we begin, I draw attention to the position on privilege. Witnesses are protected by absolute privilege in respect of the evidence they are to give to the committee. However, if they are directed by it to cease giving evidence on a particular matter and continue to do so, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person or an entity by name or in such a way as to make him, her or it identifiable. Members should be aware that under the salient rulings of the Chair, they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.
I ask everyone to switch off his or her mobile phone. Leaving it in silent mode is not good enough because it interferes with the recording system; therefore, it should be switched off completely.
I invite Dr. Freedman to make his opening statement. I understand he is making a Powerpoint presentation.
Dr. Derek Freedman:
I want to speak about the public health dimension. I have been in genito urinary practice in Dublin for close on 40 years in St. James's Hospital and my practice in Ranelagh. I have spent most of my time in my practice in Ranelagh.
Essentially, we have a lot of data and information on sex workers but very little on clients, which is obvious because it is difficult to get to study them as a group. I see clients as patients, but who are they? Everybody is represented - it is the man in the street, from Members of the Oireachtas to down and outs. There are no exceptions, which is something we have to bear in mind. The issue impacts on the entire population.
Hooking up, as it is called in the United States, is easy through the Internet, media, mobile phones and parlours. There is very little happening on the street now compared to when I started in practice, partially because of the Irish weather but also owing to the Internet and mobile phones, as people work out of apartments and hotels.
A question one might ask is: why do people go to prostitutes? Sometimes they go out of curiosity but alcohol is probably the biggest factor. People go out, drink too much, struggle on their way home, go down streets where prostitutes may be available or go into so-called night clubs. Sometimes we see big groups; this was particularly the case when the construction boom was at its height, during the builders' holidays after Christmas, and trips to Thailand were common. The committee will be aware of how plasterers work as a team. On one occasion a full team came to me and said to me they had been to Thailand. It also happens at stag parties. However, alcohol remains a common denominator.
Another group may suffer from sociophobia; they cannot make contact and meet people and do not have the necessary social skills. They may be very good in other social contexts, but when it comes to being intimate, they do not have the ability to make the jump to be close to somebody.
Loneliness is another factor. People can be very lonely and have nobody to contact them. Once they start, they can become addicted. I see quite a number of people each year who admit they have become addicted to using prostitutes and sex workers, the Internet and so on. They need a particular intervention to help them.
There is also the occasional person who is a sociopath, somebody who has no concept of the consequences of his or her behaviour. One could ask why this is the case when sex is so readily available in Dublin. One only has to go to Temple Bar, Kilkenny or anywhere else-----
Dr. Derek Freedman:
One aspect we should consider is the reason people look for sex workers. Sometimes they are just seeking comfort. I do not know if any of the members of the committee has seen the Visconti film, "The Leopard", in which the prince deals with social change in Italy - Sicily - at the time of Garibaldi. In his family there is complete coldness.
At the end of the film, he walks down town to a woman whom he obviously visits frequently and who actually talks to him and gives him comfort in times of stress. We must appreciate that many people do receive comfort. Many of the girls and men say much of what they do is not just providing sex but actually giving comfort to people.
There is a social stigma and a barrier associated with the use of sex workers. People do not feel it is the right thing to do, but when they break that barrier, there is the potential to be hooked. We are probably most interested in the public health consequences. The reality is that sexually transmitted infections are rare among the thousands of clients of sex workers I have seen during the years, particularly those who use sex workers from western Europe, North America and Australia. One is safer with a professional than a gifted amateur.
Where there has been contact in South-East Asia, eastern Europe or Africa, in particular, there are substantial risks. The consequences in practice are anxiety, stress, guilt, remorse and a great fear of infecting a spouse or partner. This can be overwhelming or disabling. On occasion, we have had to have patients admitted for psychiatric care because the stress, anxiety and remorse was so overwhelming.
When a patient comes to us, our aim is not just the elimination of infection. The WHO has a much wider perspective on sexual health that involves the enhancement of the expectation of a good and full sex life. Our aim in checking for infection is merely the technical one; the real aim is the preservation of the marriage, relationship or family unit. What we never want to happen is for a stupid drunken night out to destroy a family unit. We try to identify underlying causes such as addiction, sociopathy, inadequacy and alcohol, but we do not want to destroy the family.
In that context, one of the subjects of debate is the concept of criminalising the client. One must think extremely carefully before doing so. It would certainly make our rehabilitation work much more difficult. If people are not only fearful of infection but also of a criminal charge, the consequences for their health, particularly their psychological and psychiatric well-being, could be immense, especially since there are inadequate health service resources to deal with the actual problems we face rather than anything else. We all like solutions, but we sometimes like simple solutions and believe certain approaches are obvious. However, at the hard end of an STD clinic life is much more like a scrambled egg. There are many things going on and the simplistic solution does not work.
We need to set boundaries for both the client and the sex worker to protect both. We must protect the client from the pushers and the sex worker from the serpents, the pimps. That is the context in which we should examine this problem and the surrounding legislation. We must seek to protect people from harm, be it caused by oneself or others. It is well recognised that trying to eliminate sex work or prostitution, irrespective of how broadly one defines it, is really trying to take away something that has always been part of society.
I thank Dr. Freedman for his presentation. He mentioned his role in private practice and in St. James's Hospital as part of the clinic. He is qualified in physiology rather than psychiatry or psychology.
Dr. Derek Freedman:
One practises medicine in its totality. In the specialty of genito-urinary medicine we recognise that sex is not just genitally driven but also by the head. We do have a lot of psychological input. It is important to know what drives and motivates people in order to deal with the problem in an holistic way rather than simply dealing with the infections.
I am asking about the qualifications of those involved both in Dr. Freedman's practice and the clinic. Are the staff qualified to deal with the physiological problem or are they trained in the use of the required psychological and psychiatric approaches?
Dr. Freedman says one is safer with a professional than a gifted amateur. Will he clarify what he means? If I am not incorrect, he is making a distinction between the countries from which the people concerned come and where they practice. Is he stating it is safer in some countries than in others?
Dr. Derek Freedman:
I am emphasising that the patients who come to us who have had contact with a prostitute or professional sex worker are much less likely to have an infection than an ordinary person who has been picked up in any bar in town and had unprotected sex. The point I am making quite clearly is that sex workers are professionals and look after their business. They use protection and infection through them is rare. Studies of sex workers carried out extensively in many countries have shown that when a sex worker acquires an infection, it is much more likely to be acquired from a boyfriend or pimp than an actual client.
Are the clients who attend Dr. Freedman’s practice predominantly male? What is the percentage? With how many sex workers or prostitutes does Dr. Freedman deal, either in his clinic or St. James’s Hospital?
Dr. Derek Freedman:
One must recognise that declarations of one's sexual history are unreliable. I have no specific data and I am speaking from experience of having seen many patients over a long period. I do not always believe what I am told, but I always screen for the full set of infections to ensure nothing is missed. Many people come to see me who have paid for sex but who would certainly be hesitant to admit it. Most say they picked somebody up at a bar or club, or another place of that nature. I have been to many bars and clubs and certainly never been picked up or received an offer; therefore, one must certainly take what people say with a pinch of salt in any walk of life, particularly when one is taking a sexual history.
Dr. Derek Freedman:
What I was going to say was there has always been the phenomenon that people might not work in their home town and that workers in Ireland may go back to England or to the other countries they come from to get checked out there. People usually like to go to a physician who speaks their own language and has their own cultural background.
I thank Dr. Freedman. I have discussed this with him before and I do not accept quite a number of his basic premises, particularly the idea that because prostitution has always existed in society we should somehow be persuaded against criminalising the purchase of sex. All sorts of human behaviour has been around for a long time but it does not stop us from seeking to regulate, restrict or prohibit it where we feel harm is being done.
Dr. Freedman said he did not think it was a good idea to criminalise the client exclusively, but under the 1993 Act, although the purchase of sex is not an offence, clients are criminalised in other ways. Doras Luimní will make a presentation on the targeting of clients by the gardaí in various operations they have had, notably in Limerick but elsewhere too. That is already there. Is Dr. Freedman's objection to the exclusive criminalisation of the client?
I am curious to know whether Dr. Freedman approves of the idea of decriminalising the sale of sex. We are looking at the Swedish model. Some of us visited Sweden, saw it in operation and spoke to many of the stakeholders. We were very impressed by it. We were impressed not only by the enormous benefit it has provided to former sex workers, who had been the sellers of sex, but also to the positive good in society. I was struck, in particular, by what we heard about Swedish law enforcers. When they arrest a client for the purchase of sex - they are not arresting the seller anymore because the sale of sex is no longer criminalised, so she is protected by the law in a way that she is not here - they also offer the client social services and support mechanisms to deal with some of the issues raised in Dr. Freedman's presentation which may have motivated him in seeking to buy sex. It is not just a criminal procedure. They have built into that supports to try to prevent reoffending by the client, which I thought was impressive. It is not all criminal justice in that there is another motivation to it too.
The main point is that the Swedish approach protects sellers of sex - the sex workers - from the harm and exploitation that many people who work in the front line say is inherent in the act of prostitution, and I am looking at Ms Linda Latham's presentation. Harm reduction models such as those advocated by Dr. Freedman and others, under which one does not criminalise the purchase of sex, sidestep that fundamental issue. Is the act of prostitution itself harmful and exploitative of the mostly women involved in it? I am sorry; that became a very long question.
Dr. Derek Freedman:
I would not like Senator Bacik to have any impression that I am against decriminalisation. I am strongly in favour of decriminalisation. What I was trying to put forward was the concept of setting boundaries of what is and is not acceptable.
The Swedish model is very attractive, as presented in Sweden, but this is not Sweden and this is not Swedish society. Swedish society is different and is very controlled. In terms of STIs, for instance, there is compulsory notification. If one catches chlamydia, one's doctor must make a list of all one's partners, which is then notified to a public health authority. It then becomes part of the public remit. That is the type of very tight control that exists there.
Senator Bacik is implying - it would be an absolutely marvellous idea - that if clients are taken into the system, they would be helped to deal with their problems. Since we are doing so poorly at protecting our children, I do not think I could see resources being applied to protect the clients of prostitutes at this time. This would be a very idealistic thing. I deal with people on the ground who have problems, and we have to face that.
In a presentation made here in the autumn, people from Sweden said they were happy that they had virtually eliminated street prostitution. We have done that here through the mobile telephone, the Internet and the Irish weather. When I was thinking about this, I googled the words "Stockholm" and "escort" and got 2 million hits, so the problem has not been eliminated or dealt with in Stockholm. I never did see many people come back to me having had sex worker exposure in Scandinavia at any time, and there certainly has not been any sort of change. One sees the odd one and they are readily available.
I listened with interest to Dr. Freedman's presentation. It probably came from a different perspective from that to which we have been exposed in regard to the Norwegian or Swedish model, which is also in place in Iceland and other countries. This committee is trying to garner evidence to see what we can do about the problem. There are dark sides, such as the terrible situation of women being trafficked for prostitution and the safety of women in many instances. We do not have the Swedish model or the Amsterdam model; in one sense, it is a sort of underground and turn-a-blind-eye model.
What would Dr. Freedman say to the committee, which has no particular agenda, on the introduction of laws or regulations which would make it better for society? Does he feel a Swedish model is unlikely to work? Would he suggest what is done in Amsterdam and other cities, where the industry is very transparent, workers are registered and so on? What could we do to stop the terrible trauma and crime of trafficking women and the exploitation of women? How can we protect women without damaging the workers?
I accept some of what Dr. Freedman said in regard to the effect on men who have addictions or psychological difficulties. I am not saying I condone it, but Dr. Freedman, as a medical person, has dealt with such people. What should this committee do to make the situation in Ireland better?
Dr. Derek Freedman:
-----what it might do for the tourism industry. Senator O'Donovan has hit precisely on the correct points in that what we should be looking to do is to protect people from harm - in particular, to protect sex workers from exploitation and trafficking - and to protect under-age people.
We must put our resources into helping these people develop their lives into something different from sex work, which is a short cul-de-sac in anybody's life. We need to be sensitive in order to protect and acknowledge the dynamics of why people become sex workers. We need to ensure that if the clients of sex workers become exploitative or violent or display confrontational behaviour, they feel the full weight of the law and society upon them.
Senator O'Donovan touched on most of what I had planned to say. I acknowledge the presentation and I appreciate that it is a perspective the committee needed to hear.
With regard to protecting people in the sex industry, does Dr. Freedman advocate the legalisation of prostitution? I do not necessarily mean the Amsterdam model, which is the most noteworthy legalised version. Does he advocate legalising prostitution in a similar manner?
Dr. Derek Freedman:
Certainly not. As Members sit here they are focused on legalisation and the law, but I deal with and see human beings and human behaviour. The law sets barriers and protection and that is what the committee needs to do. The Amsterdam model would be totally inappropriate for Irish society. Heavy criminalisation would be equally inappropriate for the occasional person who needs or desires the services of sex workers, where no harm is done. We all seem to think that prostitution, in neon letters, equals exploitation and degradation. It is my feeling and understanding over the years that prostitution has a much wider context. We all prostitute ourselves in some ways, or rather for different advantages and different things. Some do it for money, some do it for sex and some do it for advantage. It is all part of the wide spectrum of human behaviour.
I thank Dr. Freedman for his presentation. Is he in favour of the status quo? The committee seeks clarity and a subtle steer from various submissions. Dr. Freedman's presentation suggests - I do not wish to put words in his mouth - that he wants to retain the status quo. Is that correct? I am not just concentrating on legislation. In his final comment he outlined the connection between trafficking and prostitution, which we also believe exists. Is he in favour of the status quo? If not, what does he recommend? Does he acknowledge that there is a link between prostitution and trafficking?
Dr. Derek Freedman:
By providing more services and protection for sex workers and more services for clients who have addiction and alcohol problems. Certainly, one can improve on the status quo. I am sure we all find under-age workers, trafficking and exploitation repugnant, and members have an obligation to legislate and provide resources.
I thank Dr. Freedman for his presentation. He brought a different perspective to the debate when he outlined what motivates the clients of sex workers.
As Oireachtas Members, we have been lobbied and received many representations on this subject. Obviously we have received representations from organisations who work on the front line with prostitutes and sex workers. We have also had representations from immigrant groups, women's groups, domestic violence groups and trade unions. All of them have asked us to understand that it is unacceptable for a man to purchase the services of a woman, that it is exploitative, and that it cannot be described as work under any international definition of work. Dr. Freedman gave a compassionate assessment of what motivates individuals. In contrast, according to the organisations I listed, sex work is a cause of profound injustice and exploitation and is a global challenge for all parliamentarians and societies. What are Dr. Freedman's thoughts on the matter?
My understanding of the Swedish model, although I may be wrong, is that where a man - or a woman, which happens in much rarer circumstances - is caught purchasing sex, he or she has the option to make an admission and receive a fine, thus avoiding court. Therefore, the name-and-shame element or disruption of the family does not happen. Only one case has ever gone to court and the rest made an admission and received a fine.
There is another aspect. When we met practitioners such as the police and social services, particularly the latter, their approach was to offer men assistance with what they defined as a problem in the form of counselling. This was to ensure that the client, who is almost always a man, can understand why he needed to avail of the services of a sex worker. What does Dr. Freedman think of both issues?
Dr. Derek Freedman:
The stereotype of a person who engages in prostitution or sex work is that he or she has been driven into the work because of a severe need or want and that there is exploitation. I heard an interesting plenary talk at a meeting of the International Union against Sexually Transmitted Infections, IUSTI, in October by Professor Sevgi Aral, who had studied in the Ukraine. Her report was interesting and the findings were stunning to me. She reported that rather than being recruited by pimps, the girls approached the pimps asking to be put on their books because they wanted to work.
There is not one universal model. The workers do not fit the stereotypes. The way some of the girls who were workers spoke at the meeting in the Department of Justice and Equality in October was not talk of being exploited. I do not believe that all of the workers fit into this stereotype. There is a much wider spectrum of people doing sex work. Some people may be doing it and not even know in certain social contexts.
The second point refers to what the Deputy described as happening in Stockholm. About 20 or 25 years ago, during a World Health Organization fellowship in Stockholm, I saw the way the systems work there, and they are admirable. It was very interesting. In the late 1970s and early 1980s in particular there was tremendous social support. In the hospitals in Sweden I saw some of the worst cases of deprivation, including cases of skin ulcers and frostbite, that I have ever seen, because people who had fallen through the network had fallen to the ground and there was no support. If someone was in the system it was fantastic but if he or she fell out of the system it could be much worse than anything one could imagine. I would be afraid the same thing would happen here. When I was in Sweden we saw the wonderful clinics, the systems and the contract tracing but if someone fell out of that system he or she could be lost. I am afraid the Deputy may have been shown the system but perhaps not what happens in the apartments, hotel rooms and so on. There is a much wider context. It may not be quite as ideal as what he was shown, and nothing I have heard from my colleagues who work in STI clinics - which are at the hard edge in terms of seeing people who avail of services - tells me there has been any major change.
I thank Dr. Freedman, and I am sorry I was not able to be present for his presentation. In the course of proceedings he may have answered some of my questions. I ask him to forgive me in advance for that. It might sound discourteous to ask a question which the doctor has already answered.
Dr. Freedman made reference to the idea that were we to criminalise the purchaser of persons for sex, it might impel some kinds of vulnerable unfortunate - what we might call sad types - to harm themselves in some way.
What I want to tease out is whether it would it would hurt such people less, for example, if there were to be a consistent social message against the purchase of persons in prostitution. Would Dr. Freedman favour such social messaging? If we consider, for example, the resources we spend on discouraging drink driving, speeding and other kinds of behaviour that we would describe as anti-social or dangerous, directly or indirectly, to other persons, would Dr. Freedman favour a social consensus against prostitution as something that is anti-social?
While there are people who might well compete for the money, and some people might enjoy a certain kind of lifestyle because they are at a certain level in prostitution, is it not possible that what Dr. Freedman is dealing with are people who have been desensitised to a considerable degree by their life experiences and low self-esteem and who then find themselves in a situation in which they compete for money or resources, because that is the means?
Dr. Derek Freedman:
That brings to mind a working girl who came to attend my clinic. She attended regularly and there were no problems other than a significant infection. She met somebody and stopped working, and her family were outraged because they had become used to the money. What happens in some cases is that while some of the clients are addicted to the sex, some of the workers become addicted to the money. This is not a case of one simple answer fits all. There are so many strains and threads of human behaviour that work through this; the purchase of sex for money is just one manifestation. I remember reading an article in The Observer many years ago about a wife who discovered her husband was using sex workers. She asked him what was going on and then said she would go with him. She went with him and suddenly realised that the sex worker was talking to the person, putting the person on a pedestal and making him feel good. She bailed out rapidly and it gave her a considerable insight into relationships.
Organisations such as Ruhama do not like to refer to a person as a prostitute because they feel it portrays the person as doing something wrong. However, neither do they use the term "sex worker" because they believe it sanitises something which should be socially discouraged. It tends to use the term "a person in prostitution". I was wondering whether the term "sex worker" implies some kind of attitudinal neutrality?
Does Dr. Freedman believe that in the effort to combat trafficking there is none the less a strong argument that if we criminalise the purchase of sex we inhibit a certain category of people from going with persons in prostitution because they now know that what is going on is illegal? However one deals with it, whether it is a case of the Probation Act or some kind of merciful sanction to take account of the vulnerability or inadequacy of some of the clients Dr. Freedman describes, making it illegal in itself might help make the country a colder house for traffickers.
Dr. Derek Freedman:
The Senator raises an interesting point: in the same way that there is a statutory age process, purchasing sex from somebody who is being trafficked or is under age could be deemed a criminal offence. That could have some practicality in currency, but it is exactly what I was saying about protection and the setting of a boundary. That would have some currency in my mind.
I concur with what the Senator says about the use of the term "sex worker" or "prostitution". People sometimes use the word "promiscuity", but what does that mean? Is it twice a day, three times a year or four times a night? There is no definition. It is a pejorative term and it would be much nicer if we had other ones.
I just want to make a comment. I am uncomfortable when I hear people referring to people in prostitution as "girls", because girls are of a particular age group and we need to be careful about the language we use in that regard.
I would be interested to hear Dr. Freedman's views on whether in some societies, be it the Ukraine or wherever, young women or young boys who have a good education and a meaningful life in which they have options and good communications with other people would choose to take the route of creating an income for themselves as a person in prostitution.
I have two questions. In his brief Dr. Freedman mentioned sexual addiction. Will he briefly describe the incidence of that and the treatments available? He also talked about setting boundaries. Will he please give some examples of what he means as briefly as possible?
Dr. Derek Freedman:
Addiction is repetitive use of a situation. Some people become addicted to sex as they become addicted to alcohol or cigarettes. The same mechanisms apply. Maybe one does not become addicted to sex quite as quickly as cigarettes. One can become addicted to cigarettes within 24 hours. In regard to boundaries, I do not have the expertise to advise on legislation. I wanted to give a background perspective that was different from what the committee has heard from others.
I thank Dr. Freedman for his presentation, which was most interesting and challenging. We went a little over time because the interaction was so intense and challenging. I invite the representatives from Doras Luimní to make their presentation.
Ms Patricia Stapleton:
My name is Patricia Stapleton. I am anti-trafficking officer with Doras Luimní, a migrant rights NGO based in Limerick. I am speaking from the perspectives of our outreach work with those in prostitution in Limerick and our case work with victims of trafficking. It is a two-pronged approach. We thank the Chairman and the joint committee for the opportunity to contribute to the discussion. Doras Luimní is an independent NGO working to support and promote the rights of migrants living in the Limerick area. Doras Luimní is also a member of the Turn Off the Red Light campaign. We work on integration, advocacy, immigration advice and support, racism and anti-trafficking.
From our experience, the majority of women who are engaged in street prostitution in Limerick are migrant women. Our multi-agency outreach initiative was formed in 2011 amid growing concerns about the increase in on-street prostitution and the visibility of migrant women in Limerick. Additionally, the need for support became apparent due to the marginalised and stigmatised nature of the work and the lack of support via mainstream services for those engaged in it. Our concerns for this cohort are shared by other service providers in the Limerick area.
Outside Dublin, Limerick has recorded the highest number of detections of prostitution and brothel-keeping in the Republic. We have encountered mostly migrant eastern European women in the course of our outreach in Limerick City. The indoor sex trade, as advertised on escort websites, consists of Irish, European and non-EEA nationals. Arguably, prostitution is very complex. The reasons people become involved are varied. However, we will not expand on this today as I believe this has been well covered in previous sessions.
Our concerns are shared by other local organisations and we relate them to the committee briefly as follows. Upward of 90% of women working in on-street prostitution in Limerick are migrant women. Some of the women appear to have little or no English and have trouble communicating the most basic information to non-customers. The women involved appear to be quite young, between the ages of 18 and 24, and sometimes we guess they are younger. There appears to be a high level of transnational organised crime involved in the prostitution industry in Limerick. Some women have worked in several European countries prior to working in Ireland. This increases our concern in regard to trafficking and the likelihood that they were trafficked as minors. High levels of mobility are indicative of human trafficking. We know that those who organise prostitution use different means to control women or coerce them into selling sex, varying from subtle manipulation to outright extreme violence. The families of these women often enter into an agreement with the suspected traffickers whereby the girl or woman involved is brought to Ireland and is then in a position of debt bondage. These women continue to be criminalised by the existing legislation. Penalties are usually in the form of a fine. We have had cases of migrant women from non-EEA countries - mostly Brazilians and Africans - who are involved in off-street prostitution and advertise via web-based escort agencies. Through Operation Quest in 2012, one woman came to our attention as a victim of trafficking.
We believe, in light of the above, that the Criminal Law (Sexual Offences) Act 1993 has had an adverse affect on the people who work in prostitution, mostly women. The prostitution industry has changed considerably since 1993, with most prostitution being organised through the Internet and mobile telephones. We are aware that migrant prostituted women in Limerick work in both on- and off-street environments. Their business is a combination of Internet trade, via websites such as Escort Ireland, and the street trade, often through the organisation of criminal gangs. The minority of Irish women we have encountered appear to be drug users and operate by themselves or with their partners.
As the committee is probably aware, the Garda in Limerick responded to on-street prostitution in 2011 by launching Operation Freewheel. Some 27 men were arrested under the 1993 Act for solicitation. This operation is still ongoing. Due to its effects, street-level prostitution has decreased somewhat in the past year. However, the indoor sex trade continues to flourish and indoor prostitution in Limerick is considered to be rampant.
Based on our experience, we recommend the criminalisation of the buyers of sex in line with the Swedish model. This appears to have had the necessary deterrent effect, as evidenced in Limerick in the past year. It would also have the effect of deterring families from consenting to exploitation and trafficking of their daughters, wives, sisters or mothers. If a country is not seen as a soft touch for prostitution and sex trafficking it will become a less attractive destination. We recommend increased penalties and custodial sentences for persons who profit from the organisation and control of prostitution - pimps, landlords and those who recruit women abroad for the purposes of prostitution. We also recommend that those who work - who are mostly women - should be decriminalised, as they are the ones who are prostituted. The level of vulnerability and exploitation cannot be overestimated. We recommend the establishment and funding of exit programmes for those seeking to exit prostitution. The habitual residency condition and immigration policy should not have a negative impact on established and funded exit routes out of prostitution; they should not hinder a victim from accessing such programmes. Currently victims of trafficking are housed within RIA accommodation, which is highly unsuitable.
Arguably a disconnect exists in the public consciousness between how society has traditionally viewed the prostituted and how it views those who buy sex. For example, the prostitute is considered deviant or immoral, while those who buy sex have, until recently, simply remained anonymous. This is the inequality that is inherent in prostitution. This was evident in the public response to the recent Operation Freewheel in Limerick, which meant that local gardaí had to defend their work and actions.
Criminalising the purchase of sex would have a normative effect. It sends the message to the public that by treating human beings as commodities one is committing a crime. We believe that this will have a deterrent effect on prospective buyers. It could also serve to shrink the industry, making Ireland a less desirable destination for human trafficking.
I thank Ms Stapleton for her presentation and I apologise as I should have thanked Dr. Freedman also. We are particularly interested in the experience in Limerick, where there has been a recent targeting of clients by the Garda. While Ms Stapleton said that had no effect on indoor prostitution, has it had an effect on on-street prostitution? Has it had the effect of driving prostitution indoors?
Ms Patricia Stapleton:
I do not know whether it has driven it indoors. I know from speaking to gardaí regularly through our outreach work that it did have the effect of decreasing the on-street trade, because people have become more cautious. The women who work on the street also work off the street; they advertise both online. The chances are it already exists in both areas. What we see on the streets is only a small percentage of what is actually happening in the entire sex trade in Limerick. We do outreach only one or two nights per week and it has only a very small effect. We know the sex trade is booming every day of the week - daytime, lunchtime, all times. We believe that what we see on the street is only a small proportion of what is going on. I do not know if the operation has driven it indoors; I think it was already indoors.
We heard from previous groups and witnesses who appeared before the committee about the blurred line between trafficking and prostitution, which is hard to establish - everyone is agreed on that - and the question of whether somebody has been trafficked, or exploited but not quite to the point of being illegally trafficked. I note Ms Stapleton said that 90% of the women working in street prostitution are migrant women, many of whom appear to be young and some of whom appear to have little or no English. Can she say anything about that blurring of the line? Is there a clear distinction?
Ms Patricia Stapleton:
The trafficking legislation is very narrow. Only three elements are needed to prove trafficking. Some of the women we have met who have worked in on-street prostitution appear to have quite a lot of autonomy. However, we know that many of the women are from one particular country and one particular area, and how long they have been in the country is indicative of their autonomy.
Some of the women appear to have little or no English and we are very worried about them, as they are particularly vulnerable.
In respect of the line being blurred, we meet some women who have been exploited horribly and had very negative experiences but who nevertheless do not satisfy the criteria to meet the trafficking definition. The definition of trafficking must be broadened at some point to reflect the complexity of what drives people to migrate. We have met women who have been exploited for seven years in Limerick who would not consider themselves to be trafficked persons. They support families and travel back and forth, but the fact remains that they are exploited and must hand over some of their wages. Some of the women who come to Ireland do so to repay a debt by agreement between their families and the traffickers. That to me is trafficking, yet it is not defined as such because the women can travel and have freedom of movement. It is, therefore, a tricky and nebulous matter.
In the main, what age groups are being dealt with? Is there an increased demand on foot of the normalisation of pornography and the appearance of prostitutes in television programmes and films? If so, would a public awareness programme by, for example, the HSE be useful to challenge people's behaviour by asking them to think about its impact on their own families, as well as to think about where a person has come from, why he or she is in the relevant circumstances and whether he or she might be part of a criminal organisation? For years we drove around without safety belts, whereas now no one would take that chance. Behaviour can be changed. Would a campaign be useful to challenge behaviour and reduce demand?
Ms Patricia Stapleton:
We have had real concerns about people's ages. Most of the women we have encountered via outreach services have been aged between 18 and 25 years. We have often wondered if some were younger, but gardaí in Limerick are very aware and active in ensuring where women are present on the streets that no one under age is being exploited. Generally, women are not much older than 25 years; therefore, it is an issue which involves young women.
I agree that demand has increased owing to the normalisation of pornography. The increased use of technology, including mobile phones and the Internet, is a huge driving force. There is normalisation via pornography, films and myths, but the issue is more complex than this. Public awareness campaigns are very important and should target those in schools and at third level. Workshops, for example, could be used to get people to think about these issues and what prostitution actually is and where people come from. That is the way forward. Awareness-raising is fundamental.
I thank Ms Stapleton for her presentation. Why does she think that in Limerick there is such a high level of prostitution compared to other cities? She pointed out at the beginning of her presentation that there were significant levels of prostitution in Limerick. I remember the Garda operation of approximately two years ago. I spoke to a businessman in the vicinity of the location of the swoop and he was of the view that come 6 p.m. or 7 p.m., he could not do business owing to the fact that the streets were filled with people looking for prostitutes and involved in the prostitution business. Why Limerick? Is there a particular reason?
Prostitution is a problem across the island of Ireland. I am from Donegal North-East where there have been a number of well publicised cases involving brothels and prosecutions. Unfortunately, what happens is that the sex workers and prostitutes are exposed to the media glare and have their stories told, while the high numbers of people using the service never have theirs told. I apologise to the Chairman. We are not here to make observations but to ask questions.
We heard Dr. Freedman's presentation explaining the perspective of clients. What is Doras Luimní's response to the issues raised? Does it tally with what it finds from the women with whom it works?
One of the criticisms of the Swedish model is that it would drive prostitution underground and put women in more danger. A criticism of our existing legislation is that while a woman on her own in her own accommodation can sell sex legally, a number of people co-operating cannot, which puts women involved in prostitution in danger. They are much safer working with one or two others in a house. What is the Doras Luimní view of these two criticisms?
Ms Patricia Stapleton:
I do not know if prostitution can move any further underground. There is a certain amount of violence inherent in prostitution and the level in Sweden before the legislation came in was the same as it has been since. It cannot be eradicated. It is about harm reduction, rather than harm minimisation. One cannot ever get rid of the violence.
It is very unfair that one person can work alone, while two persons working together are seen as running a brothel. It is very problematic. We see in Limerick that people work in pairs and are safer when they do. For example, one could take a licence plate number if there was a problem. From what we can tell, however, brothels in Limerick are not run by independent sex workers but by gangs. For that reason, I do not know how to answer the Deputy's question.
The committee has been told that some people choose to go into prostitution of their own free will and are not coerced. That was criticised and it was questioned whether anyone would make that choice, but we were told that people did so. Does Doras Luimní have a view on the matter?
Ms Patricia Stapleton:
While some people enter prostitution of their own free will, that free will is very circumscribed and there are few options open to them. While a gun may not be held to one's head, one's options are very limited. People choose to go into prostitution because they have no access to social welfare or the jobs market because of limitations in the work permits system. While it may be a choice, the issue is: what are their options?
I thank the representatives of Doras Luimní for attending and express the committee's appreciation for its presentation. We apologise for the delay, but it can be seen that this is a topic which is particularly exercising members.
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.
On the assumption we would follow the Swedish model, Ms Linda Latham stated that we would perhaps have to re-examine our attitudes to the commercial sex industry. Will she elaborate on this? Ms Latham also raised the short working week permitted on a student visa here. Will she also elaborate on this?
Ms Linda Latham:
I feel there is a strong wave of normalisation of the purchase of sex. It becomes okay to buy sex and a laddish or studdish opinion seems to well up. We need to be more effective in educating people about this, asking if it is okay and highlighting the harm it causes women. I see women who have been harmed by prostitution week in, week out. What impressed me in the Swedish case was that they did a general campaign educating young lads and girls about these harms. Previously, users of prostitution were called studs, but they are now called losers. Social change is possible with proper education campaigns.
We have noted many cases of South American women. They have a study visa that allows them to work for 19 hours a week. However, that prohibits them from looking for alternative types of work because it would not be enough to sustain them. While I understand this is tied into immigration legislation, perhaps, for particularly vulnerable groups such as these women, some leniency could be considered.
I was struck by Ms Latham's point that Ireland has a sizeable sex market led by Irish men's demands but serviced by migrant, impoverished women. This sums up the harms Ms Latham has observed in her clinical practice. I am also interested in her point that it is not a case of either/or. Clearly support needs to be given to exit strategies and routes out, whatever legal model for the regulation of prostitution is adopted. Will she expand on the current model, under which trafficking is singled out for particular criminalisation? Ms Latham stated that the sellers of sex she has observed are similar, irrespective of their routes into prostitution. The question of blurring of lines comes up. Is it hard to distinguish between those who have been trafficked and those who have not but are in prostitution?
Ms Linda Latham:
Sometimes it is hard to distinguish between them. Often one can clearly see the difference in different presentations. One does not know the definite fact until one is told by the person. Very few such women have presented to us. Of those who did, some of them had escaped from brothels with STIs. It was clearly evident that they had run out and they had clearly been trafficked. What is difficult now is that they have to go through the Garda National Immigration Bureau, GNIB, to become a suspected victim of trafficking. We looked at UK models of social care for women who were trafficked and in prostitution, and there was a far more participatory role in determining that. In my experience, the harms caused to women in prostitution are similar whether they have been trafficked, are controlled or freely chose to enter it.
Ms Linda Latham:
The statistic I used is research-backed.
In my experience, people who have drug addictions themselves demonstrate difficult backgrounds, proclaiming issues of abuse, drug addiction and homelessness. They themselves are giving us the history of that. Therefore, we can see their vulnerability and that they are already predisposed to any sort of exploitation.
The case of the migrant women, who make up the majority of the persons who come into the clinic, is very different. We saw 360 women last year. Almost 100 of these were on the streets and the rest were women working indoors in prostitution. Some 93% of them were migrant women. Clearly, they have poverty issues. What I thought was that their aspirations would suggest they were seeking to find a way out and to improve their standard of living in some capacity, to get a home and education for their children and an income for themselves. However, often there are layers to their situation and they are funding families and relations back home as well. Therefore, the pressure is enormous on them to stay within the sex industry, although that may not have been their original plan. They may have thought they would do it for a period and then get out of it. That is often what we hear, but then five, six or seven years later they are still there.
Ms Linda Latham:
It happened extensively when we saw persons attending from the African countries. This year, for the first time, our African cohort has reduced significantly. Previously we saw a lot of this happening. There were certain antibiotics that could be bought over the Internet and many women told us they had taken them. Sometimes, the termination by that method was inadequate and we had to refer women to the maternity hospitals for completion of the termination. Therefore, its extent was significant enough to make an impact on us. I suspect we do not even get to hear about half of it. However, it was more frequent among the African community than we have witnessed here before.
I have a final question. In the area of child abuse and child sexual abuse, I am interested in what percentage of these children end up being exploited in later life and in the sex trade. Has Ms Latham any comment to make on that or are there any statistics on it?
Ms Linda Latham:
There is significant research done on that, but I cannot give the Deputy any statistics on it. However, the Deputy could look at Stolen Smiles, the report done by Cathy Zimmerman or similar research pieces. I could get some for the Deputy. The Home Office clearly draws the connections between early child abuse and later prostitution.
When the committee was in Sweden, the point was made on a number of occasions that while some women and men are in prostitution of their own free will and want to remain there, we cannot legislate for the minority but must legislate for the majority. I put this to the Sex Workers Alliance Ireland representative here last week, but I will now put the question to Ms Latham. Does she think there is a way we could legislate to facilitate those women who, according to Dr. Freedman and others, want to remain in prostitution and to provide a service?
Ms Linda Latham:
Yes, I think the model and idea of decriminalisation for women within the sex industry is the most obvious change that could be made, because this would remove the threat of court prosecutions for those women. I am not speaking for all women, but considering all the options available to them, if some women wish to take the option of continuing in prostitution, decriminalisation would leave them in a freer position than they are currently to continue in prostitution.
I must ask an obvious question in that regard. One of the criticisms of the Swedish model is that it drives women underground, because the men who purchase sex are criminalised. Therefore, decriminalisation for women is not a better scenario for them, because the user is criminalised. The argument made is that it puts them in more danger in terms of what they do.
Ms Linda Latham:
Again, in all or our reports and estimates, danger and violence are inherent in prostitution, regardless of whether it is on the streets or indoors or whether it is legal or, as currently, not legal, although there is a technicality with regard to whether there is one person or two people involved. Fundamentally, it is not legal to prostitute here. Currently women still come in to our services. They come from all over the country, not just from larger towns - a great presentation was made on Limerick - to Dublin to access services. Men who have to buy sex must be able to find women. It is easy to locate these women and I do not feel the "underground" argument carries any weight.
I am interested in the point made about exit strategies and what should be made available to people who want to get out of the situation they are in. I would welcome Ms Latham's opinion on what is available in this regard currently and on what we could do to improve it. Will she expand on that?
Ms Linda Latham:
From the point of view of our service, traditionally we were more concerned with dealing with harm reduction measures, such as protecting oneself, the medical models, assessment for any clinical dysfunction, provision of condoms and safe needles and so on. However, it does not have to be one or the other. Our service has most direct access to women working in prostitution and women who say they have exited prostitution. Therefore, our service is more involved with women who work indoors, week in and out.
I believe we need a joint model of partnership between services like Ruhama and ourselves, that really works in partnership. From our experience of trafficking, I saw that when the services worked together and grouped their expertise and set up a clear referral path, it worked. If we do not make it part of our policy or do not say we will do something, it does not happen. I have been a long time in the clinic running the service and for a long time I felt we were not offering enough to these women. It has made a big difference that now all the staff offer all women an opportunity to avail of the service. We do not have the scale or expertise to deal with all of this, but we refer to and work with Ruhama in that regard. A joined-up statutory pathway would make a significant difference.
However, we must consider the prohibitive factors that stop women exiting prostitution, such as money. They have no money. A couple of months ago one woman left the building crying. She thought that when she came into us that would be it and she would be out of it with what we could offer. However, we had nothing to offer her. We had no home to send her to or anything. She needed money, so she had to go back out again that very night, despite having made the leap of faith that she was getting out. We had no social welfare payments to pay out. She cannot come to us if she is not in prostitution any more. These are the issues we need to consider.
Mr. Michael Quinlan:
We were afraid the discussion was going to be cut off at 4 p.m. My name is Mick Quinlan and I am the manager of the Gay Men's Health Service in the HSE and I am a qualified social worker. I have been involved in HIV and Aids and LGBT issues over 26 years. Mr. McCartney is a researcher and represents the Gay Health Network. He has worked and studied global health at TCD and is currently working with the international planned parenthood federation as HIV programme officer. We thank the committee for inviting us to this meeting. I would also like to acknowledge the attendance of the Minister for Justice and Equality, Deputy Alan Shatter, at the conference which covered this issue last October. I was delighted he stayed for the whole day and heard directly from former and current female sex workers. It would be great if this committee could arrange a similar meeting with sex workers.
We hope the reference report we have submitted and this presentation will help provide some understanding of the complex issues with regard to commercial sex work, men who have sex with men and disabled people availing of commercial sex, dealt with in chapter 8 of the report.
We request that members take time to read the report in its entirety. As men who have sex with men and commercial sex are both taboo subjects and seldom discussed, the report is welcome.
In 1993 the law which criminalised homosexual men and that relating to the availability of condoms were both changed. These changes were the direct result of campaigning and rulings of the European courts but also the health implications relating to HIV. In 1992 the then Eastern Health Board established the Gay Men's Health Service, GMHS, which remains the only statutory service for men who have sex with men. The GMHS provides an STI clinic, counselling and support and education and prevention programmes among men who have sex with men. Over 9,000 men have registered with us, of whom some 15% reside outside County Dublin.
The GMHS is a member of the Gay Health Network, GHN, which was founded in 1994 and leads the way in HIV prevention and awareness of sexual health for men who have sex with men. The Gay Health Network runs the Man2Man campaign in partnership with the HSE. Many HIV and LGBT organisations are members of the network. Last year the Minister of State, Deputy Alex White, and the former Minister of State, Deputy Róisn Shortall, launched campaigns relating to stigma and discrimination.
In Ireland there is a high incidence of HIV and other STI infections, particularly syphilis and gonorrhoea, among men who have sex with men. In 2011 and early 2012 the health promotion surveillance committee reported that up to 40% of all new HIV infections were among men who had sex with men.
The GMHS's involvement in the area of male sex work began as part of its outreach work and contact with various agencies and groups from 1997 onwards. It helped to establish networks and produced many reports. In 2003 we made a presentation to the Hidden Stories Conference in Stockholm.
As a health and social administrator and manager, it is important to raise some of the issues concerning the introduction of new legalisation. I was going to use a large brush to highlight that a whole section of people and situations were being painted with one brush. This approach is unsustainable and misleading, especially when it seems to be portrayed that only men buy sex and that they only purchase it from women. In Ireland there are three studies highlighting that men who have sex with men buy or sell sex. We are presenting the more recent European MSM Internet survey, EMIS, which shows that there is a significant number of gay and bisexual men and men who do not identify as gay engaged in buying and selling sex in countries throughout Europe, including Ireland.
Mr. Daniel McCartney:
The EMIS of 2010 was the largest such survey ever conducted. Of the over 180,000 respondents across Europe, approximately 7% indicated that they had bought sex from another man, while in the region of 5% stated they had sold sex to another man within the previous 12 months. Some 4% indicated that, while abroad, they had paid men for sex. A further 2% said they had received payment while abroad. In the case of Ireland, the Real Lives survey conducted in 2004 and the EMIS of 2010 of over 2,600 respondents show that between 9% and 11% of men who had had sex with men were involved in buying or selling sex. In the EMIS 4.7% of men who had had sex with men indicated that they had paid for sex, while 4.1% said they had been paid for sex. Men who have sex with men in Ireland live in all parts of the country - with almost half residing in Dublin; up to one quarter were not born on the island of Ireland; just over two thirds are only attracted to men, while three quarters identified themselves as being gay. The survey also showed that three quarters were not in a steady relationship, while 6% of those who had been paid for sex and 8% who had paid for sex were in a relationship with a woman. The locations where these men were most likely to meet for sex included websites, saunas and bars, while they were much less likely to meet in public places. Most importantly, 44% of those who had been paid for sex had not been tested for HIV. This compares to a figure of 28% for those who had paid for sex and had not been tested. This was also greater than the figure for the overall survey, namely, 38% of those sampled had never been tested for HIV. The position on sexually transmitted infections was similar. In that context, some 50% of those who had been paid for sex had not been tested, while 38% of those who had paid for sex had not been tested. The overall figure in this regard for all of those sampled was 42%. Significantly, men who have sex with men who had been paid for sex were less likely to access services for a variety of reasons, including stigma. These data appears to agree with international experience to the effect that sex workers often find accessing services such as HIV and sexual health services difficult owing to real or perceived stigmatisation on the part of health workers, a general social stigma or discrimination within society.
Men who have sex with men who buy and sell sex are very much part of the gay and bisexual male community and are, therefore, difficult to distinguish. Both groups access the GMHS and other sexual health services. Each group has significant health needs in the context of HIV prevention and sexual health. Access to support, sexual health and support services, including information, condoms and lubricants, is vital. Reports show that those who use services and are tested are more informed and inclined to look after themselves. Introducing further legislation would inhibit this and make it more difficult to access services or supports. Legislation may delay people attending, especially if they have symptoms or if they are obliged to search out what facility they can attend for STI services. In addition, they would be reluctant to discuss or make disclosures about the type of sex in which they engaged. Legislation would also directly affect the statutory notification process. I refer in this regard to the syphilis notification form which requests information on commercial sex. Furthermore, legislation could create a further stigma and impede the destigmatisation process advanced by the National AIDS Strategy Committee, NASC, and the HSE-Gay Health Network programme.
All of these issues are covered in various Irish, European and international reports, including the UNAIDS report 2012, the recent WHO guidelines and the final report of the UNDP Commission on HIV and the law, which was published in 2012. I strongly urge the committee to review these reports, all of which call for decriminalisation of sex work and the establishment of laws to protect against discrimination, violence and other rights violations faced by sex workers.
Mr. Michael Quinlan:
A Gay Health Network study compiled last year indicates that LGBT people, including gay and bisexual men, experience homophobia, violence, discrimination and stigma. These are all added to if the individual involved is living with HIV. The HSE report, LGBT Health: Towards Meeting the Health Care Needs of Lesbian, Gay, Bisexual and Transgender People, published in 2009, outlines the effects on people's mental and physical health as a result of discrimination, violence and marginalisation. Men who have sex with men who sell sex and men who buy sex from men can certainly experience homophobia and stigma. Further sanctions could and would add to this rather than create a situation where we can engage with people. If we are really concerned about a section of society being exploited, used or abused, should we not set about organising, training and empowering sex workers and offering them support and services in order that they might enhance their lives, rather than taking their livelihoods away? Criminalising the buyers would also directly affect the sellers. For example, in order to make a case, evidence would be required and sex workers' activities would have to be monitored. How would such evidence be collected? Who would police gay bars, saunas, cruising areas and the relevant websites, not to mention those for heterosexual men and women who wish to buy and sell sex? Would various groups be charged with following and spying on sex workers, seeking sexual health records and so on?
Another hidden group is that which comprises disabled people who already experience difficulties in respect of sex and sexuality. Commercial sex services for these individuals are very much taboo. However, there are many reports, etc., on disabled people buying sex - from women - an activity in which they have been facilitated by local authorities and carers in Britain and elsewhere. Could these people or their carers be classed as being criminals?
The most important issue for health and sexual health support services is the provision of a confidential and non-judgmental service. Such a service must be confidential in the context of those who use it. We do not have a social work service similar to what is provided in Sweden, where the social worker's job can be to observe and control sex workers or people living with HIV. Even during the criminalisation period in Ireland, the relevant law which had been introduced by the British in Victorian times was seldom, if ever, used. Unlike their counterparts in Britain, homosexual men in Ireland were not arrested. It must be noted that this was not because there were no pretty male officers in the Garda ranks. It appears that it was just not the done thing in Ireland. When HIV and AIDS became an issue in Ireland, gay saunas were not closed. However, those in Sweden were. Creating a "them and us" scenario leads to stigmatisation, whereas accepting that people selling sex can be lesbian, gay, bisexual, transgender or heterosexual males and females and that those who buy sex can also be lesbian, gay, bisexual, transgender or heterosexual males and females might lead to the provision of better services and supports.
In 2003, at the Hidden Stories conference in Sweden, Katarina Lindahl, the chair of the service and a feminist, spoke about being involved in the discussion about penalising men who buy sex, which has been the case since the 1970s in Sweden, though we forget the law has been in place for such a long time. She stated:
Today RSFU does not approve of the current law in Sweden though I see a very positive effect emerging from the discussion. The focus has shifted from only seeing the women to talking about the extremely important role on the demand side. This has to be addressed but criminalisation cannot do this.
I have a November 2012 report from the Swedish Board of Youth Affairs, a government-funded body, which revealed that in Sweden in 2012 more than twice as many young men as women sold sex. According to the study, 2.1% of Swedish males aged 16 to 25 years said they had prostituted themselves in 2012, compared to 1% of women. While in general young men almost exclusively sell to men young Swedish men sold sex to both men and women. Half of the clients of both male and female prostitutes aged under the age of 26 were also aged under 26. This was in 2012 after the law had been in place for a number of years.
In 2003 Ms Lindahl stated:
It has been said a punishment is important because it gives a clear norm about what is not acceptable in our society. But we know there is already a strong stigma related to prostitution and to the people involved. Stigmatisation is never a good thing if one claims to support the individuals concerned. Stigmatisation is only a way to draw a line between us and them.
In Ireland we have only begun to challenge stigma in regard to HIV, and also to challenge homophobia and bullying. We must ensure we do not hinder this work.
I want to take away the large brush I was supposed to bring with me and replace it with a number of small brushes. Perhaps then we will realise that legislation to control adult sexuality and consensual sex is more complex than is thought and, perhaps, is not possible.
My apologies for having to leave shortly to attend the Chamber. I thank the delegates for the presentation and pay tribute to the work of the Gay Men's Health Service and the Gay Health Network in tackling homophobia and discrimination against people with HIV. It is important to make that point.
I will focus on legislation and the approach to take. I am reminded that some people have said we should not say the Swedish "model", rather the Swedish "approach", because this has already been adapted for use in other countries, and other jurisdictions such as France and Ireland are looking at it very seriously with a view to adapting it. Nobody suggests it is a one-size-fits-all model that should not be tweaked to fit any particular society. Does that approach not have some benefit, however, from the point of view of the arguments Mr. Quinlan made about decriminalising those who sell sex, thereby destigmatising the people engaged in the sale of sex? I am interested in that point and raised it before.
Mr. Michael Quinlan:
It is interesting that Senator Bacik has asked this. One thing that occurs to me is that were there six people present who were sex workers there might be a really important element to the discussion. I have looked at all of this and really cannot understand how the one can be done without the other; how it is possible to criminalise the one and decriminalise the other and vice versa, without looking at the issue of the adults who consent to have sex and thereby get into this situation. All I know comes from the reports I have read. We are talking about the Swedish model because the committee has stated that its members visited Sweden. I would have asked the committee to look at the models in Australia, New Zealand and other countries and to consider how we might adapt those too rather than look at only one model.
I would consider how we might protect both parties.
Mr. Daniel McCartney:
May I add something to that point? Coming here I was surprised that the Swedish approach is the one that has been spoken about most. I thought that, at a minimum, the committee would look at what recently happened in Canadian legislation where the laws are quite similar to those in Ireland. I believe a stronger example would be the New Zealand model, which is more a form of legalisation and regulation. With regulation, however, I am completely against the mandatory HIV testing that New Zealand had originally included in its model before retracting it. That is the kind of idea I would consider.
The one report that has not been raised is that published by the global commission on HIV and the law which was organised by the United Nations development programme. It does not focus only on public health but looks a range of different issues. There are also some working papers that were submitted as part of this worldwide consultation on issues of criminalisation elsewhere, not only in sex work.
I thank the delegates for their presentation. Will they clarify one thing for me? They are stating that the people they come in contact with who are selling sex are doing so willingly and are completely autonomous. Am I clear on that?
We are trying to get our heads around this. Mr. Quinlan's final comment was on adults and consensual sex, whether those adults are paying for it or otherwise. I am looking at the consensual point. Is a person being consensual if he or she is forced into this work simply because there are no other opportunities? Is one consensual if somebody else is controlling one's actions, for whatever reason? I accept Mr. Quinlan's point that we have focused greatly on the female in prostitution, for very obvious reasons. Mr. Quinlan has attended the committee to represent men who have sex with men. I am trying to get my head around this. In the early part of Mr. Quinlan's presentation, which I cannot quote because the battery in my laptop has died, he stated that part of the lifestyle of men who have sex with men is to purchase sex. Am I right about that? Similarly, did Mr. Quinlan state that some men who are in heterosexual relationships may wish to purchase sex?
Mr. Michael Quinlan:
This is really the first time we have discussed men who have sex with men in this context, after two committee meetings. It was good that we were asked to make the presentation. I included references to many reports and these are also embedded in the other report I made, which covers the whole range of different issues. Even now, as I look back over certain points, I can state there is a whole range of men who buy and sell sex - all for different reasons. The men who buy sex are also affected by homophobia and the stigma that relates to men who are gay or bisexual. Some of these men are autonomous. The context is not that men who have sex with men will automatically go and buy sex. That is not what I am saying.
I have some brief questions. I thank the delegates for their presentation. I will be honest. I read the submission and it was the first time I have encountered this part of the sex industry in the context of the discussion we have been having. It is very useful.
What percentage of the overall sex market is homosexual? A rough idea will do; I just want to understand the market.
What percentage of individuals would be trafficked? Is the number of men being trafficked lower than the number of women? I presume it is but is the figure available? Is pimping commonplace with men offering sex to other men? In the context of the discussion, I understand the dilemma and we will probably face the same dilemma in reaching a decision on the Swedish approach, as Senator Bacik has correctly called it, when we present our report to the Minister. The dilemma is whether to criminalise the users and thus release the providers to choose to avail of the support which clearly they require and are not being offered coherently. Perhaps there is an attempt to offer the kinds of support they require but clearly we are not doing enough.
I think I need to do a great deal more reading on the issue of trafficking, which I hope to do in the next few weeks. Do the witnesses have a view on the Swedish approach to the solution of the problem?
Mr. Michael Quinlan:
We set up the Irish Network Male Prostitution, INMP, in 1995. A series of meetings were held in Dr. Steevens Hospital and we drew up the document, Such a Taboo - Service needs for males in prostitution in Ireland, 2001. I ask the members to read it. It shows up the different needs of the different areas, such as what is needed about providing services for men engaged in sex work. I used to have four outreach workers in the Gay Men Health Service, but I have none now because of the reduction in service as result of cutbacks. We conducted the first survey of male sex workers some years ago. The difference between then and now is the changes that have taken place. The profile of the men who sell sex has changed a lot. Even I was surprised at the Swedish findings at one level but not surprised at another level. People are more confident now about their sexuality.
Mr. Michael Quinlan:
I was going to come to that point. Within the HSE, we have separated trafficking from prostitution. It was moved from the women's health project to a separate service. I think that speaks in itself. Representatives from the Garda attended the conference last year and trafficking was separate from sex work and prostitution. In regard to Meno sex and men, I have not come across any situation of it.
Mr. Michael Quinlan:
I have not come across it.
We have done a small report on migration. We have found that men who came to Ireland as asylum seekers experienced abuse and so on when they were travelling. That is because they were coming from countries in which a person could be killed if he was gay.
Mr. Michael Quinlan:
No. When one is discussing proposed legislation, one must arrive at a definition of prostitution. Even if one had a meeting on that it would be difficult to come to a consensus. From the ITRA study, the figures could be 113,000 men who buy sex from women, in the MSM community one could be talking about numbers in the region of 2,500 men buying sex or just over 2,000 men selling sex. It is not a small population.
I think people have an image in their head of what a prostitute or sex worker is but when it comes to men who are buying or selling sex, one can forget about the preconceived ideas because it is not simply the person on the street. That is the reason I was afraid about the brush.
People need to stand back, they need to go other countries. I would like members to visit MSM sex worker services and also women's services in Britain and then, by link, look at the way services are provided in Sweden and Australia. Rather than limiting the exploration to the Swedish model we should look at the model in the whole that can provide service and support.
This is our third day of hearings on this subject; we have had approximately 15 hours of hearings so far and I think we are only scratching the surface. The more we delve into it, the more we are learning. Does Deputy Corcoran Kennedy wish to put a question?
Yes. What we heard in the presentations in the past couple of days is that a number of people want to leave the life of prostitution, whatever the length of time they have been engaged in prostitution, and as we have heard from a number of different groups, there are services available to help them.
In Mr. Quinlan's opinion how many of the 2,000 men he knows who are selling sex wish to exit this way of life? We have heard quite clearly of the number of women who wish to leave prostitution.
Mr. Michael Quinlan:
I honestly do not know. The men I know who are sex workers, but not all of whom admit to being sex workers, continue to work into an older age. The reason they stop is because of their age. I have quotations from young middle class men, students, actors. My colleague, Mr. McCartney, may wish to add to my contribution.
Mr. Daniel McCartney:
There is a perception that people who engage in sex work are stuck in that situation, but I do not necessarily think the data we have show that, but they might show that men who had been paid for sex in the past 12 months said this had occurred only once or twice. They are doing a lot of other things; they are not necessarily stuck in sex work and looking to exit it.
I welcome the speakers. I am very struck by the disparity there appears to be between women's and men's stories. When one listens to presentations from Ruhama and others who work with women in prostitution, one does not have to look long before one hears stories of misery and exploitation. I wonder if that is because organisations such as Ruhama are dealing with people at the level of psychological well-being, exploring their past, looking at it as a social problem. I wonder if there is any equivalent effort to try to understand what brings people to the place in which they are selling themselves or purchasing other people in the context of sex. Have people explored this behaviour at the level of people's psychological and mental health to consider whether there is a social problem and that people who need care are not being cared for?
My second question is the same question I put to Dr. Freedman; do the witnesses agree as a matter of principle that the sale or purchase of sex from another person is anti-social? Would they support public expenditure, for example, on campaigns to discourage such activity as a matter of principle, whatever about the important work they do in working to secure people's health on an individual basis?
Mr. Michael Quinlan:
In response to the Senator's question on whether it is a social problem, again it comes back to how people perceive prostitution and sex work and the reasons people get involved in it. There are people who engage in sex work on an occasional basis or they fall into it by accident, through poverty or addiction. This includes men who have sex with men. A fair number of men would have been thrown out of their homes and made homeless because they were gay. They ended up in the park or out and about. Some men who were addicted to substances came into sex work and were paid a fair amount at the beginning but they could be exploited in the sense that if the buyer found out they were addicted he could reduce the amount of money he paid.
In some areas, there is no doubt there is discrimination, but it is less visible in Dublin than in the past. It is a phenomenom that is probably not talked about, that is, women selling sex. There are cases - men have talked about it - in which they have found a way to make money. I know gay men who go out cruising and, suddenly they meet someone who asks if they are buying. The instigator is not the man going out to buy sex but the person who comes up to him in a cruising area and asks, "Are you buying sex?" All of that happens in the MSM community. If a law is brought in, the question is: how can it be implemented? I was so surprised by the policeman from Sweden at the conference last year. They were practically talking about telephone bugs and listening outside the door. The only way they could get the buyer was to monitor the seller. Although they said they were decriminalising the activities of sellers, they were still monitoring them. Social workers were controlling them, especially if they had children. Therefore, it is not as easy as introducing a law. I was asked about the law, but I cannot come down on one side or the other as I am employed by the HSE. However, I cannot see it working.
Mr. Michael Quinlan:
Social messaging is another aspect and I am glad the Senator has asked about it. One of the things that struck me about this discussion was that we should be talking about this issue in schools. We should be talking about human sexuality and LGBT issues. We need to talk about how people engage with each other, but we need to be very careful. I refer to some of the recent posters used. There was an image of what was supposed to be a sex worker, which can stigmatise sex workers.
Mr. Daniel McCartney:
We did not get to comment on anti-sexual behaviour. There are strong parallels between this aspect and what happened when we criminalised sex between men. There are strong parallels between that argument and the issue about sex workers. We should not criminalise the private sexual behaviour of consenting adults, including voluntary sex work.
The presentation states the MSM buying and selling of sex are very much part of the gay and bisexual community scene. What I am trying to tease out is whether it is an acceptable part of it, or something that is hidden? For example, if a heterosexual seeks a prostitute but does not want his wife to find out about it, it happens underground and is not acceptable to many. Is the buying and selling of sex more acceptable in the gay and bisexual community?
Mr. Michael Quinlan:
It is has been hard to distinguish, but there is no doubt that over the years there were cases of discrimination against people who sold sex within the community. Some of it was based on class and whether one was a drug user. The other day President Obama spoke about the Stonewall riots, but who would have thought that people who had fought against oppression for three days were gay, drag queens and sex workers? In the history of the LGBT movement there has been a close association between men and women sex workers. In London, for instance, the police used to arrest the women sex workers. If they were carrying condoms, they were under threat; therefore, the men would carry the condoms, while the women would carry jars of Vaseline. That was one of the associations between them. Within the community and the broader community, in many cases, sex workers, in particular women sex workers, feel safer among members of the gay community and have taken part in LGTB pride events. Who is able to say who is the buyer and who is the seller?
Our concern is for people who are being trafficked and exploited - it is almost sexual slavery against their will. That is the other side of this argument, or the continuum, about which we are really concerned. I am sure our guests will agree that it is a serious concern for everybody. I thank everyone for being here and giving of their time and expertise. I apologise for the lateness of the hour, but everyone was taking this issue very seriously. We will continue our work and hope to produce some recommendations for the Minister.