Decriminalisation of prostitution has led to a dramatic decline in female gonorrhea, found a study published in the Review of Economic Studies that looked at how Rhode Island’s 6-year-old policy of legalising sex trade has affected the society there. The study also found that rape incidents had gone down during this period.

Gonorrhea is a sexually transmitted disease. Prostitution prohibition is mostly due to moral concerns, though disease transmission and victimization risks associated with sex markets are also policy concerns. Spread of gonorrhea is a significant public health concern and paid sex workers report a far higher incidence of the infection. The 1992 National Health and Social Life Survey showed that 23% of female sex workers report they have ever had gonorrhea compared to 4.7% for females who have never been paid to have sex.

The average sex worker sees 200-300 clients per year, and men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman, while women have a 60-80% risk of getting the infection from a single act of vaginal intercourse with an infected man. Most governments around the world, including India and the US, prohibit sex work; knowledge about the impact of decriminalizing sex work is largely conjectural. But between 2003 and 2009 Rhode Island unexpectedly decriminalized indoor sex work.

The aim of the paper was to provide quasi-experimental estimates of the causal effect of decriminalizing indoor prostitution on the composition of the sex market (supply and price), population sexually transmitted infection outcomes, and reported female rape offenses. The researchers focused on reported rape offenses and gonorrhea incidence due to the high association each has with prostitution.

The study used six unique datasets: crime arrests and reported rape offenses from the Uniform Crime Reports; gonorrhea cases from the Centers for Disease Control’s Gonorrhea Surveillance Program; data on sex worker and transaction characteristics from a popular website called The Erotic Review; weekly classified advertisements from the “adult services” section and restaurant advertisements from The Providence Phoenix ; sexual behavior outcomes from the 1992 National Health and Social Life Survey; and state level covariates from the Current Population Survey.

Researchers estimated that approximately 5 to 50 percent of the decline in gonorrhea was from sex workers, with the rest coming from the general female population in Rhode Island. Decriminalization also improved public health outcomes by decreasing female gonorrhea incidence by more than 40 percent. The results of the study also indicated that decriminalization reduced sexual violence by 30 percent.

More sex in the population, even among sex workers, may reduce a sexually transmitted disease epidemic if the marginal sex worker has lower background risk or engages in safe behaviors that dilute the risk in the sexual network.


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