Why Sex Work Should be Decriminalised in South Africa

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Metrics details. Australian mortality statistics suggest that young female suicides have increased since in comparison to young males, a pattern documented across other Western high-income countries. This may indicate a need for more targeted and multifaceted youth suicide prevention efforts. However, sex-based time trends are yet to be tested empirically within a comprehensive Australian sample. The aim of this study was to examine changes over time in sex-based rates and characteristics of all suicides among young people in Australia — National Coronial Information System and Australian Bureau of Statistics data provided annual suicide counts and rates for 10—year-olds in Australia —stratified by sex, age group, Indigenous status and methods.

Negative sex regressions estimated time trends in population-stratified rates, and multinomial logistic regressions estimated time trends by major suicide methods i. Whilst, overall, youth suicide rates did not increase significantly in Australia between andthere was a significant increase in suicide rates for females incident rate ratio [IRR] 1. Overall, the odds of using hanging as a method of suicide increased over time among both males and sex, whilst the odds of using drug-poisoning did not change over this period.

We showed that suicide rates among young females, but not young males, increased over the study period. Recent Australian mortality data indicate that the suicide rate for young females has increased steadily over the past 10 years while the rate for young males has fluctuated, despite remaining comparatively higher [ 3 ]. In addition, a comparative study of OECD countries showed sharp decreases in suicide rates among male adolescents across several European countries, while female rates remained stable or increased [ 9 ].

These time trends across the OECD suggest that rates of suicide are changing among young females and raise the possibility that public health approaches to prevention have not adequately targeted the factors contributing to this increase. Consistent with this, an epidemiological study of 21 OECD nations showed that government-led programs were associated with declines in suicide rates among males but not females, and among young people specifically, declines were greater among males than females [ 10 ].

Furthermore, Australian research has shown most local prevention programs have had negligible effects on national rates [ 11 ], and no impact on suicide rates in young women [ 1213 ]. Given observed increases in young female suicide across the OECD and the significant public health burden conferred by suicide, an examination of time trends in sex-specific rates and characteristics of youth suicides in Australia is timely.

This could inform the development of targeted and effective prevention strategies in order to attenuate suicide rates. Recent population studies have highlighted several time trends in epidemiological factors known to be associated with increased suicide risk among young people, which may have contributed to rising rates among young females in Australia. These include a growing number of early adolescent 10—year-old females at risk [ 614 ], elevated rates among young Aboriginal and Torres Strait Islander Indigenous females [ 315161718 ], and growing use of lethal methods specifically hanging [ 619 ].

The transition from adolescence to young adulthood marks a period of rapid change [ 212223 ]. In particular, high prevalence mental disorders, which are significantly associated with heightened risk of suicide, typically emerge during this period, and continue into young adulthood [ 24 ]. Indeed, depression and anxiety, which are common, show greater continuity into early adulthood among females compared with males [ 25 ].

As such, existing research supports the transition to adolescence as marking the beginning of a period of heightened suicide risk in young females. Several OECD studies have documented recent growth in suicide rates among females as young as years-old, and show rates increase across the adolescent years.

Recent population studies in Finland, the US and Canada found rates have increased significantly in female adolescents and young adults over the past two decades. Canadian and US data further indicate that the greatest increase occurred among 10—year-old females, while overall rates remained significantly higher among 15—year-old females [ 614 ]. Indigenous young people are consistently over-represented in Australian suicide statistics, raising the possibility that a rise in young female suicide rates may be driven in part by increases among young Aboriginal and Torres Strait Islander females in particular.

National statistics indicate rates are four times higher among 15—year-old Indigenous females and three times higher among Indigenous males compared with their non-Indigenous peers [ 15 ].

Furthermore, between and —16, Australian statistics showed crude mortality rates increased among young Indigenous females alongside declining rates among same-aged males [ 318 ]. Risk of suicide within Indigenous communities is underpinned by a myriad of systemic factors contributing to significant disadvantage in health and socio-economic outcomes for a review see: Zubrick and colleagues [ 26 ].

Population studies have also shown that rates of depression and anxiety among Indigenous youth have sex [ 27 ]. Hence, a growing proportion of young Indigenous females may be experiencing poor social and emotional wellbeing which, in turn, may be contributing to increased suicide rates. A further factor that may be contributing to possible increases in young female suicides relates to changes in suicide methods used by young females. Method lethality refers to methods which increase the probability of a fatal outcome [ 28 ], and is a well-documented risk factor for youth suicide.

Typically, males have used more lethal methods of suicide e. Accordingly, males account for more completed suicides [ 15 ] while females account for more non-fatal attempts [ 130 sex. Thus, if young females have increased their use of more lethal methods this may be contributing to a rise sex suicide rates. Indeed, research has shown a rise in the use of lethal methods of self-harm and suicide among young females [ 614193233 ], and hanging is now the leading method among female youth in both Australia and across the OECD [ 6715193435 ].

Whilst these factors have been investigated for their impact on youth suicide individually, the contribution of these factors in concert has never been examined in a nationwide cohort of young people to date.

The present study therefore aimed to examine sex-specific suicide rates among 10—year-olds in Australia over the period towith a key focus on investigating whether or not key epidemiological risk factors i. Our secondary aim was therefore to examine if one explanation for the change in rates was increasing use of hanging a highly lethal method.

This descriptive study employed a retrospective case series design, including all suicides and probable suicides in individuals aged 10—years in Australia, between and The NCIS reports demographic information, external causes and mechanisms of death as recorded in coronial files. The quality and completeness of this information varies between cases sex to legislative differences across jurisdictions, and is often delayed due to coronial processes [ 37 ]. Therefore, deaths occurring within the period — were selected for inclusion in order to balance data recency with completeness.

Several adjustments were made to prepare the data for analysis. This enabled us to sex rates between groups with well-documented disparities in suicide risk. Suicide methods were classified by ICD codes cross-referenced with cause of death and mechanism data, to reflect methods used rather than medical cause of death [ 38 ]. Three categories of methods were examined: hanging X70drug poisoning X60 to X65and all other methods including 11 cases using unknown methods.

Mid-year estimated resident populations were obtained from the Australian Bureau of Statistics, stratified by year, sex, age group, and Indigenous status [ 39 ]. We used this data to calculate annual crude mortality rates CMR perperson-years and as an offset term for regression analyses to estimate rates over time.

Statistical analyses, including multinomial logistic regressions and negative binomial regressions, were conducted in Stata, version We estimated trends in suicide rates over time stratified by age and Indigenous origin using negative binomial regression.

This method is similar to Poisson regression but adjusts for possible over-dispersion in the data occurring when the variance exceeds the mean. Our outcome was the number of deaths for groups defined by the age, sex, Indigenous origin and year group covariate pattern. Our models included an offset term to account for population size, and predictors for sex, age group, and Indigenous status, and interaction terms between these predictors and year of death.

An initial model examined the total sample, and subsequent models examined each sex. In each instance, our first model included all predictors, while subsequent models removed non-significant interaction terms. We present the results of our final, best fitting models.

We used individual-level data to examine predictors of major suicide methods i. Predictors were as above. Counts and proportions by socio-demographic characteristics described the sample, crude rates sex calculated by sex, age-group, indigenous status and year. The CMR was The rates increased by age group for both sexes, and Indigenous males and females were both at elevated risk of suicide For both sexes, rates among older and Indigenous young people were consistently higher than younger and non-Indigenous young people, respectively.

Among males, rates for 20—year-olds exhibited a distinct downward trend Fig. Comparing Fig. Additionally, female rates differed significantly by age; compared with the 10—year-old age group, suicide rates were 6. Most young people used hanging Indigenous females had 6. Throughout the study period, hanging was the most commonly used suicide method, and females and males were equally likely to have used hanging. Overall the odds of using hanging increased significantly over the period, although this was not the case among females.

In contrast to earlier reports [ 11 ], this study found that overall rates of youth suicide did not increase significantly in Australia between and However, broadly stable rates among youth masked significant increases in young females. This finding adds to a growing body of research concerning the epidemiology of suicide among young females, which demonstrates increasing rates across OECD countries [ 4567sex ].

Significant rate increases among younger females 10—year-olds in this study are consistent with findings from the US and Canada, suggesting that an increasing number of early adolescent females are dying by suicide [ 614 ].

This trend is concerning, given our findings that 10—year-old females showed greater odds of dying by hanging; a highly lethal method [ 40 ] that is difficult to restrict in community settings [ 41 ]. As such, these findings hold implications for prevention efforts. Given crude rates in 10—year-olds were higher among females than males over several years, the gap in suicide rates typically observed between the sexes was not as evident in this younger age group.

Rather, the rate ratio between the sexes appeared to widen with increasing age. This may be sex in light of earlier findings regarding sex and age differences in lethality of suicide attempts, which has shown that lethality tends to be lower among females than males for all methods [ 42 ], and elevated among younger age groups overall [ 43 ]. Therefore, sex differences in attempt lethality might depend on age. Future research linking sex-based trends in suicides with attempt data might thus elucidate whether the transition to adolescence marks the onset and peak lethality of suicide-related behavior in young females.

Contrary to expectations, no variable studied accounted for increased rates among females. These include concurrent increases in rates of depression and self-harm [ 30 ], alcohol misuse and related harms [ 45 ], and declines in vocational participation [ 46 ]. As this study focused on epidemiological risk factors coded in the NCIS, examining clinical risks and their cumulative effects was beyond our scope, but ought to be prioritized in future research to inform targeted interventions.

This contrasts with prior studies that have consistently reported increases in the use of hanging among young females [ 193233 ]. However, such studies did not report on younger-age females separately to older groups [ 32 ], and examined longer time-periods resulting in a larger number of cases [ 3233 ]. A novel finding was the emergence of distinct profiles of females who died by specific methods. Taken together, opportunities to intervene following an index attempt may be greater among young adult and non-Indigenous females presenting to services following drug-poisoning.

In such cases, the risk of dying by suicide following health service contact for an index attempt ought to be carefully evaluated and followed up by health professionals. Groups demonstrating sex higher odds of using hanging indicate that suicide attempts are more likely to be fatal in pre- and early-adolescent compared with young adult females, late adolescent compared with young adult males, and Indigenous young people of both sexes compared with their non-Indigenous peers. This might be particularly salient for younger Indigenous females, in whom suicide rates are both high and rising.

The higher risk of cluster suicides among Indigenous youth [ 11 ] make this broad sub-group of young females a clear public health priority. Supporting local Indigenous communities to improve the social and emotional wellbeing of young people is crucial [ 48 ].

Key strengths of this study included comprehensive sampling of suicides among youth in Australia, including probable suicides, over an year period. Additionally, this study reported on suicides among individuals as young as years-old, and used standardized data thereby minimizing bias in reported estimates. Use of stratified mid-year population estimates facilitated standardization of population-stratified rates, controlling for annual variations in population distributions.

Finally, this study employed statistical methods appropriate for empirically testing time trends for count data negative binomial regression [ 49 ]while multinomial logistic regressions examined trends in the use of specific methods.

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Attacks on female sex workers by clients, persons pretending to be clients, police, partners, and others should be understood within the context of a country suffering an epidemic of violence against women and girls. A progressive constitution, targeted legislation such as the Domestic Violence Act and the Sexual Offences Act, and government policies designed to prevent, respond to, and eventually eradicate gender-based violence all exist. Despite this legislative and policy framework, violence against women remains pervasive and, although such violence is believed to be underreported, statistics paint a disturbing picture.

In , 39, rapes 71 per , population were reported to the police, down from 41, 77 per , population in Certain groups of women face increased vulnerability to violence, including women and girls with disabilities, elderly women, poor women, and lesbian, bisexual, transgender, and gender nonconforming women.

Women in sex work also experience disproportionately high levels of physical and sexual violence at the hands of both clients and police officers. Access to justice is particularly elusive for sex workers, for reasons explored in this report in later chapters.

The Department of Social Development, the Department of Justice and Constitutional Development, and the Ministry for Women, Children, and Persons with Disability are the most heavily involved in policymaking related to violence against women.

But a critical missing step is a focus on changing the law and police practices on sex work, which is dominated by women. The following chapters provide information based on our interviews with 46 female sex workers in 10 different sites about how criminalisation of sex work is linked to multiple experiences of violence experienced by this especially vulnerable population. Searching suspected sex workers for condoms as evidence of prostitution and similar practices by police can lead sex workers to carry and use fewer of the prophylactics.

Unchallenged and exacerbated by criminalisation, stigma from health workers can keep sex workers from seeking health care including, for example, after rape or if a condom breaks during sex. These problems persist in South Africa, as described below. All of the sex workers interviewed for this report said they had free, relatively accessible, nondiscriminatory access to health care, including reproductive health care and HIV treatment.

In most cases, sex workers not only knew clinics often run by NGOs with international HIV funding where they could talk openly about sex work but were also often visited by outreach health workers or peer educators on the streets or in brothels who provided them with condoms, lubricants, information and education, and sometimes transport to clinics.

Coverage is not complete, and health workers and government officials both underlined the necessity of ongoing sensitization and the importance of large-scale HIV funding to maintain momentum. This approach is in clear contrast to ongoing patterns of arrests and harassment of sex workers by the SAPS described later in this report. South Africa has the largest HIV epidemic in the world, with 19 percent of the total number of people living with HIV, 15 percent of global new infections, and 11 percent of AIDS-related deaths, in The HIV infection rate for women between 15 and 49 years is International experience has demonstrated that human rights abuses against key populations i.

Ending the AIDS epidemic will depend on sex workers and other key populations being able to obtain services and confidential information about HIV prevention and health care without fear of harassment or discrimination.

In South Africa, health statistics suggest that decriminalisation is all the more urgent: HIV prevalence rates amongst female sex workers are thought to be between 40 percent and 88 percent, compared to In the Foreword, the now-former Minister of Health Dr.

There are complex relationships between and among factors like poor health, criminalisation of sex work, poverty, and violence against sex workers by police and others who take advantage of their vulnerability. The connection between health care services and rights-based organizations was noted by other interviewees; the same sources of funding are sometimes available to both kinds of organizations. Arrested sex workers can call peer educators or outreach workers with medical NGOs.

Even in small towns like De Deur, about 40 kilometres south of Johannesburg, and nearby Eikenhof, sex workers were regularly getting visits from peer educators and health workers.

Tash Sithole is just one sex worker who regularly gets check-ins from peer educators. All of the sex workers interviewed in Johannesburg for this report knew about the clinic, knew they could go there, and expected they would be cared for, for free and with respect. Many sex workers also feel a sense of sisterhood with others using specialized services and have been empowered by the knowledge at least some in society see them as ordinary people.

One fundamental obstruction is when police arrest and detain peer educators from key clinics, such as the Esselen Street Clinic. Getting peer educators and sex workers out of detention often via sex worker organizations like SWEAT or Sisonke , takes up precious time and resources for overstretched clinics and medical NGOs. Health workers told Human Rights Watch that sex workers are sometimes unwilling to accept large numbers of condoms from them in case this makes them a target for police attention.

Getting patients living with HIV onto ARVs and ensuring daily adherence is important both for the health of individual patients and as part of a comprehensive public health approach to HIV prevention and treatment.

In addition to creating time-consuming barriers to accessing health workers, the dissonance between practices and approaches from different parts of the government also causes frustration and undermines trust. Frustrating, useless, and frightening: some of the words sex workers interviewed for this report used to describe their treatment by the South African Police Service SAPS. The SAPS interactions with sex workers varied greatly across the ten interview sites, but only in two towns—Hoedspruit in Limpopo province and Bushbuckridge in Mpumalanga province—did interviewees say that they felt some trust in the police.

In both of these towns, unlike in other interview sites, interviewees generally reported few or no arrests and detentions. Elsewhere the police were described negatively. Poor perceptions are unsurprising. Research over the past 15 years by academic, government and NGO researchers has shown that abuses against sex workers by police in South Africa under criminalisation have been cruel and rampant.

Reports have described patterns of arrests that are harassing and abusive rather than useful policing, as well as repeated arbitrary detentions that change nothing and keep sex workers from their families and work. One recent report by the NGOs Sonke Gender Justice and SWEAT found that 33 percent of survey respondents had been sexually assaulted or raped by a police officer and 25 percent had been pepper sprayed by police.

Human Rights Watch made direct inquiries to the SAPS but has not received any response and has been unable to ascertain whether there has been any action taken by the SAPS to punish police abuse and bring an end to such practices.

In the meantime, available data suggests that arrests of female sex workers have been on the rise national arrest data does not disaggregate different arrest charges under the sexual offences act. Police treatment did not meet South African arrest protocols as outlined in the Criminal Procedure Act, which requires that individuals be told why they are being arrested.

Sex workers were almost always arrested, as far as they could tell, as a result of police profiling, i. Demands for on-the-spot fines were commonly reported, as were demands for bribes; the line between them, at least in the eyes of sex workers, was sometimes blurry. Some sex workers reported that police officers sexually exploit them, including coercing them to give them free sex under threat of arrest, a form of rape. She added that the police officers would typically take her number down, check that it worked and then call her for sex later.

According to our interviewees, arrests and police detentions, which generally lasted for about a day or one or two nights, do not deter sex workers from working in the industry. The SAPS practices seem to vary enormously both between towns.

South Africa is currently facing high levels of violent crime, including armed robbery and widespread violence against women. A moratorium could help shift police resources away from these easy arrests for victimless crimes in order to focus on serious crimes.

A moratorium could also open a door to improving the poor reputation of the SAPS, in part, a legacy of apartheid, as an abusive force, including by removing some opportunities for corrupt officers to extort, rape, or otherwise coerce vulnerable and desperate sex workers.

Of the 45 female sex workers interviewed for this report, only 11 had never been arrested and these interviewees mostly worked in the towns of Hoedspruit Limpopo province or Bushbuckridge Mpumalanga province.

Arrests are a frequent, even a twice-monthly event for street-based sex workers in De Deur and Eikenhof, two small towns south of Johannesburg. Pride Williams, who is 52 years old, had been arrested, transported in a police van and held overnight in the De Deur police station four times since the beginning of Most street-based sex workers in the Johannesburg Central Business District had been arrested once or twice in the year preceding the interview.

Perhaps because a volunteer at a local sex worker organization asked the police what evidence they had that the women were sex workers, the police told them to tear up the arrest slips given to them. Arrests of sex workers appeared to almost always be the result of police profiling, rather than any observed illegal activity.

All interviewed sex workers who had been arrested said that they were targeted by the SAPS because they were standing in a location known to be a hot spot, or because police officers already knew them as sex workers. Mondo Adams, an Eikenhof-based sex worker who waits for clients under a roadside gum tree in the small town, described a May arrest when everyone in the desultory hot spot was arrested and forced to get into a police van:. Several sex workers in smaller towns said that, as far as they could tell, they were also sometimes arrested because their faces were already known.

I was just walking like a normal person, I was not even at a hot spot! Sex workers often expressed a grim humour when responding to questions about the reasons for their arrests. One interviewee, Thuli Modiselli, last arrested one very early morning in March , snorted before she responded. Interviewees said their requests for more information about why they were arrested, or on what charges, have been met with abusive language or threats. In three towns in Limpopo province, especially Musina a town close to the border with Zimbabwe , Makhado, and Tzaneen, sex workers reported that police often asked for bribes during arrests.

A Musina sex worker said:. In four cases, however, sex workers reported clients being caught by police with them, but in each case the client was able to evade arrest by paying a sometimes hefty bribe. Verbal harassment and humiliation of sex workers by police was reported frequently and occurred even when they were not working. It was embarrassing. Sex workers interviewed for this report said they were usually detained in police custody for several hours, or most of a day, or for one or two nights.

South African law provides that arrested persons can be held for up to 48 hours before they must be seen by a magistrate or judge or released. However, as with arrest patterns, detention practices varied greatly from place to place. At some police stations, officers seemed to consider that the detention itself served its purpose of punishing sex workers and so released them without a fine or order to go to court; at other stations, officers fined or demanded bribes from sex workers for varying amounts.

In other places, officers did not ask for money, but sex workers were taken or told to go to magistrate courts. Telling sex workers to sign slips, which are, at least sometimes, admissions of guilt, using threats or without explaining the charges appears to be common practice at police stations.

Under South African law, the police must clearly explain to people being arrested and detained the reason for the arrest. Several sex workers told Human Rights Watch that they had no idea what they had signed.

Time spent in police stations was sometimes humiliating. One Johannesburg-based sex worker said that when she was arrested in early , police officers took photographs of her breasts, she guessed, to shore up indecency charges. Several sex workers interviewed in Johannesburg and De Deur complained that police officers have in the past year taken saliva samples from them, a procedure that seemed undignified for the sex worker and also mysterious.

Police detention was often reported to be uncomfortable, and sex workers said they sometimes did not have access to medications that they were taking.

However, the loss of time and income as sex workers are unable to work when detained, was more problematic than any discomfort, sex workers said. Sometimes detentions also imposed additional childcare costs on sex workers, especially Johannesburg-based sex workers who often use creches or daycare centres to take care of small children while they work.

Many of the sex workers interviewed said that they had never been brought before a magistrate or judge, despite repeated arrests and police cell detentions. Most of them were released after a day or one or two nights in the police cell, often after paying a fine or a bribe. Thirty-one-year-old Yolanda Nkgapele still has scars on her head, back, and shoulders from an attack in July She said:. Violence and other criminality directed at female sex workers appears to be a major problem in South Africa.

Roughly one-third of the sex workers interviewed for this report said they had been raped, mostly while at work, and several more than once.

Others had experienced brutal physical violence, again, usually when they were working. Interviewees showed scars on their bellies and faces where they had been cut and broken teeth from punches or bottles slammed against their mouths during terrifying abductions. They expressed fears about continuing to do the work and risking exposure to sadists, rapists, and thieves. Sex workers and those that work with them complained to Human Rights Watch about a widely held perception that sex workers are linked, perhaps even inherently connected, with crime, criminality and criminals, drugs, theft, and other dark happenings in dark corners.

This seems a perverted understanding of a more mundane truth. The 46 sex workers we spoke to are victims of violent crime, not accomplices or perpetrators. While some interviewees said they used marijuana or other drugs, none said they sold drugs or knew sex workers who did. The previous section detailed some of the ways interviewees and other South African sex workers have been victimized by police. South African sex workers are also made more vulnerable to other crimes because the sale and purchase of sex is criminalised.

Criminalisation pushes sex workers into darker streets, bushy areas empty of other people, and isolated shacks. Many interviewees regarded themselves as easy targets—working informally, usually on the streets or from bars —and, as would-be perpetrators know very well, without the protection of the law.

Most of the sex workers interviewed said that they would not report crimes committed against them in the course of their work to the police.

When it came to other crimes, for example domestic violence not directly linked to work, there was more willingness to report. And unwillingness to report violence to police was not ubiquitous. Some sex workers also did report some crimes, for example, when they knew who the perpetrator was.

Some positive experiences of policing were reported. In towns where sex workers interviewed did not fear police arrest, they expressed more confidence in the idea of reporting crimes t0 the police.

Of the 46 sex workers interviewed only one was a former victim of trafficking. Some of the many hardships of sex work are described in the next chapter, but all sex workers interviewed for this report said that they worked for themselves, had no pimps, and worked when and how they wanted to without coercion from any other person. Levels of perceived safety varied greatly, and while some women said they felt constantly exposed to criminals, others said they were generally safe from abuse because of their better circumstances.

Criminalisation of both the sale and the purchase of sex interferes with the ability of sex workers to build physical, financial, civil society and social infrastructure around themselves. A terrifying gang rape stopped Margaret Sisulu from working at night, even though she used to charge more after the sun went down on Johannesburg. Sixteen of the forty-six sex workers interviewed reported being raped, mostly when working and mostly in the past five years.

Pume Mbatha, a Johannesburg-based sex worker for fifteen years and originally from Kwa-Zulu Natal province, described three vicious rapes over the past five years. One attacker broke a tooth when he hit her with a bottle; in another case the rapist held her arm when she was on her knees and then stamped down on it, breaking a bone.

She never reported any of the attacks to the police. Rapists generally did not use condoms in reported incidents.

Sometimes an argument between the sex worker and the perpetrator over condom use preceded the rape. Many of the reported rapes also included others forms of violence and seemed to be especially sadistic in nature. Zandile Makuyaa, a mother of two young boys, was raped by a man in and still has scars on her arms and chest from where he beat her with an electric cable. In several cases, rapists held women for hours before letting them go. A Zimbabwean sex worker, Lucy Kege, who works in the South African border town of Musina to support her year-old daughter back home, described being held for 6 hours by a man.

Most of the sex workers who had been raped said that they had chosen to access post-rape care from clinics or hospitals and were satisfied with the treatment they received. However, choosing to report rapes to the police was much rarer. Sisulu, whose rape was described at the beginning of this section, provided a typical explanation as to why she did not report:.

Anna Matamela, who is 33 years old and has been selling sex since she was 17 to support a son, was raped by a man who said he wanted to be a client in February The man then raped her without a condom after seizing her by the throat and threatening her with a gun.

She was so depressed and hurt by the attack, she could not get out of bed for a week. No one had reported these incidents. Use of stratified mid-year population estimates facilitated standardization of population-stratified rates, controlling for annual variations in population distributions. Finally, this study employed statistical methods appropriate for empirically testing time trends for count data negative binomial regression [ 49 ] , while multinomial logistic regressions examined trends in the use of specific methods.

Several limitations need to be acknowledged. Our model parameters assume a linear relationship between suicide prevalence and time whereas, in fact, suicide rates in both males and females fluctuated over time Fig. Therefore, whilst we can be confident that suicide rates increased over this time period in females, but not males, the observed magnitude of this increase may be different to that predicted by our model, highlighting the challenges in using linear prediction models to estimate changes in suicide rates.

Relatively small annual counts may also have contributed to under-powered analyses in some instances, particularly among females. A longer study period may facilitate aggregating counts over several years and improve statistical power for testing interaction effects. The variables under study comprised a small proportion of established risk factors for youth suicide.

Therefore, the scope of this study did not address potential contributions of clinical risk factors, including mental disorders and self-harm history.

This, in turn, may have contributed to the discrepancy between our model parameters and the magnitude of change in suicide rates observed for both males and females over this time period. However, we restricted data to that reliably recorded by the NCIS to clarify the magnitude of rates and the contribution of key epidemiological risk factors. Additionally, by limiting our models to those factors that have been implicated in previous work as underlying the increase in suicide rates in females, we ensured our models were protected from over-fitting.

A final limitation relates to data coding. These cases were included in order to minimize previously reported underestimations, as coronial determination of intent is influenced by multiple factors including legal definitions and jurisdictional processes [ 37 ], as well as social and cultural sensitivities [ 51 ]. Additionally, data for and were incomplete at the time of writing [ 15 ] as data for equivocal deaths remain open for several years throughout the revisions process.

Therefore, suicide counts for study years prior to , and for —, may be conservative. Variations in data collection are also reflected in incomplete data for Indigenous origin, which may be unavailable or not reliably reported [ 51 ].

However, this likely resulted in an underestimation of the true number of Indigenous suicide deaths, which could not be verified using the available coded data.

Relatedly, the absolute number of suicides among Indigenous young people was low although the relative risk was high , meaning that our estimates of risk for this group may be measured imprecisely. This study highlights the importance of broadening current conceptualizations of youth suicide within public policy from that of a male problem to one increasingly involving young females. National policy on suicide prevention benefits from a greater understanding of recent time trends in young female suicides stratified by age and Indigenous background, which informs the need to target prevention efforts from a younger age and across both Indigenous and non-Indigenous groups.

Current national approaches to suicide prevention in Australia may have overlooked preventative opportunities among young females, given females are more likely to seek help than males [ 30 , 52 ]. A substantial body of research has shown that young females more often seek help for suicide-related behavior compared to males, including professional and non-professional sources of help [ 53 ]. Preliminary research within Victorian emergency departments has also shown that, among 12—year-olds, females make up the greater proportion of presentations for suicide-related behavior, and over half are sent home without a mental health assessment or referral [Donaldson A, Hetrick S, Redlich N, Spittal MJ, Robinson J: Youth Emergency Department Presentations for Self-Harm: A Retrospective File Audit Study, in preparation.

Such findings underscore a clear imperative for policy-makers to advocate for a more coordinated response to suicide-related behavior in young females, and to resource services accordingly. At a population-level, restricting access to lethal means has proven to be an important and largely effective universal prevention strategy [ 55 ].

Although research highlights the potential for means restriction to reduce the population-level burden of suicide, difficulties with restricting hanging in community settings [ 41 ] necessitates the use of multiple evidence-based prevention strategies that target young people.

Access to lethal means is a well-documented environmental precipitant that increases the risk of a fatal suicide attempt among young people [ 24 ], and hanging is both highly accessible and lethal. Combining alternative, evidence-based prevention strategies might include a combination of school-based awareness programs, gatekeeper training and screening, and cognitive behavioral and dialectical behavior therapies [ 55 , 56 , 56 , 59 ].

Such programs ought to be made available to younger age groups in recognition of the growing evidence that suicides are increasingly occurring among early adolescent females. In summary, this study expands current knowledge regarding the epidemiology of young female suicide in Australia, and reflects a broader trend of increasing young female suicide observed across the OECD.

Stable rates among youth overall masked increases among young females between and , highlighting the need for prevention strategies to address the rise in young female suicide, and, in particular, among Indigenous females in whom rates are considerably higher. While the majority of young females who died by suicide used highly lethal methods hanging , this alone did not explain the rate increase.

Rather, concurrent trends in rates of self-harm, depression and hospitalization for self-harm present a picture of morbidity and mortality that is complex, and indicate that vulnerability to suicide in young females is conferred by multiple risk factors which may exert a cumulative effect. However, the solution may be relatively straightforward. Young females engage in more help-seeking behavior, and more often speak about their difficulties with peers and professionals compared with young males.

Therefore, opportunities exist to provide more targeted, responsive and effective support for young females, when and where they seek help. The suicide count data that support the findings of this study are available from the NCIS but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Australian Institute of Health and Welfare. Suicide and hospitalised self-harm in Australia: trends and analysis.

Canberra: Australian Institute of Health and Welfare; World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organisation; Australian Bureau of Statistics. Causes of death, Australia, cat. Accessed 10 Oct Ministry of Health. Suicide Facts: Deaths and intentional self-harm hospitalisations Wellington: Ministry of Health; Suicide trends among persons aged 10—24 years—United States, — Skinner R, McFaull S.

Suicide among children and adolescents in Canada: trends and sex differences, Can Med Assoc J. Youth suicide trends in Finland, Office for National Statistics. Suicides in the United Kingdom: registrations. London: Office for National Statistics; A comparative study of suicide rates among 10—year-olds in 29 OECD countries. Psychiatry Investig. Matsubayashi T, Ueda M.

The effect of national suicide prevention programs on suicide rates in 21 OECD nations. Soc Sci Med. Raising the bar for youth suicide prevention. Effectiveness of Australian youth suicide prevention initiatives. Br J Psychiatry. Increase in suicide in the United States, — Canberra: Australian Bureau of Statistics; Suicide in Indigenous people in Queensland, Australia: Trends and methods, — Aust N Z J Psychiatry. Rising Indigenous suicide rates in Kimberley and implications for suicide prevention.

Australas Psychiatry. Causes of Death, Australia, cat. J Adolesc Health. Adolescence: a foundation for future health. Risk-taking and decision-making in youth: relationships to addiction vulnerability. J Behav Addict. Impulsivity increases risk for coping-motivated drinking in undergraduates with elevated social anxiety.

Personal Individ Differ. Binge drinking, reflection impulsivity, and unplanned sexual behavior: impaired decision-making in young social drinkers. Alcohol Clin Exp Res. Self-harm and suicide in adolescents. The prognosis of common mental disorders in adolescents: a year prospective cohort study. Social determinants of social and emotional wellbeing.

Canberra: Commonwealth of Australia; Declines in the lethality of suicide attempts explain the decline in suicide deaths in Australia. PLoS One. What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries.

The mental health of children and adolescents. Report on the second Australian child and adolescent survey of mental health and wellbeing. Canberra: Department of Health; Beautrais AL. Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatr. Epidemiology and trends in non-fatal self-harm in three centres in England, — findings from the Multicentre Study of Self-Harm in England. BMJ Open. Oxford Academic. Google Scholar. Cite Citation. Permissions Icon Permissions.

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sex 3 95

Selling sex has been illegal in South Africa since at least the early s and buying sex was criminalised in The criminalisation of sex work has not deterred people from sex sex to make a living. Criminalisation has, however, made sex work less safe. Most sex workers in South Africa are poor, black, and female, and sell sex primarily in order to sex their children, as well as other dependents. This report attempts to represent some of the fear, emotional pain, and frustration that South African sex workers experience because the work they do to try to ensure a better life for their children is criminalised.

The report calls for law reforms including the decriminalisation of sex work in South Africa and encourages the Department of Justice and Constitutional Development to take up this task now with seriousness and urgency after years of debate on the issue.

Rofhiwa Mlilo a pseudonym is a year-old sex worker and a single sex of two children. Almost none of the 46 women interviewed for this report matriculated from school; Rofhiwa Mlilo did not go at all. She sees sex work as one of the very few options available to earn an income to keep a roof over the heads of her children, for her, preferable to backbreaking farm work that brings in less money.

Rofhiwa Mlilo described the sometimes dangerous contradictions inherent in selling sex in South Africa: her relationship with the police is characterized by arbitrary arrests, lack of due process, and abusive policing practices.

Interviews were conducted with female sex workers, including three transgender women, in ten sites in three provinces. Around 40 government and nongovernmental experts in health, law, and provision of services for sex workers and were also interviewed. The report documents how the criminalisation of sex work fuels human rights violations against sex workers, including by police officers, and undermines their right to health.

The report provides recommendations to reform the legal system to provide protection for sex workers. Almost three-quarters of the sex workers Sex Rights Watch interviewed have been arrested multiple times, some as often as two or three times per month. Sex workers who worked indoors were less vulnerable to arrests but were also targeted from time to time.

The pattern of arrests described to Human Rights Watch suggest that sex workers are targeted for arrest because the police either know them from previous contact, or believe they match the profile of a sex worker, and not because they have been seen to engage in illegal activities.

Every sex worker interviewed for this report with a history of arrest had been arrested or detained by police for apparently nothing more than standing or sitting where sex workers were known to wait for clients, or because they were already known to the arresting officers. Sex workers believed that their arrests were part of a wider pattern of police harassment that includes extortion, coercive sex, and insulting language.

Academics and nongovernmental organizations NGOs have often in the past reported rape by police and abusive use of pepper spray. Sex workers described being held in police custody for up to three nights if arrests occurred over a weekend. Some police officers appeared to view such short-term detention sex a permitted form of punishment in and of itself and released sex workers without charging them. Others demanded sex or a bribe in exchange for release or issued fines in the police station that, in at least some cases appeared to be simply extortion.

Sex workers told Human Rights Watch they believed that legalising sex work would be the only way to end police harassment against them. They also called on the South African government to help them find safer ways and places to work.

Sex workers described often falling victim of crimes, including rape and armed robbery, as a result of engaging in sex work in a criminalised context. Few, however, were willing to report these crimes to the police, including because they feared that they themselves would be arrested or because they did not believe that their cases would be taken seriously. Sex workers said that they were vulnerable because criminalisation forced them to work in or go to dark or dangerous spots sex because criminals, including sadists, thieves, and rapists, pretending to be clients, knew they had bad relations with the police.

Sex workers described being laughed at by police when they tried to report rapes, or being told that as sex workers, they could not be raped. The experiences with seeking health care that sex workers reported to Human Rights Watch stand in sharp contrast to their reports of treatment by the criminal justice system.

Rofhiwa Mlilo and all of the other sex workers interviewed for this report did not face discrimination in accessing health care and most described having access to health settings where they could safely disclose what they did for a living and receive access to useful and relevant health-related information, services and commodities.

However, it should be noted that many interviewees were identified with the assistance of health care NGOs that ran clinics and outreach services for sex workers, which may make their experiences with access to health care different from other sex workers see methodology for more on this.

Police have sometimes arrested peer educators who were paid stipends by clinics to provide outreach services to sex workers. Police reliance on the carrying of condoms as evidence of criminal activity has discouraged sex workers from carrying, and therefore using condoms. Health officials interviewed for this report expressed frustration and concern at how criminalisation of sex work undermined access to health care and efforts to prevent new HIV infections amongst sex workers, their clients, and sexual partners.

Arrests and detentions were particularly concerning for sex workers living with HIV on antiretroviral treatment. Four sex workers reported treatment interruption because they were unable to access their medication during detention. Others reported missing clinic or hospital appointments. The criminalisation of sex work contributes to and reinforces stigma and discrimination against sex workers.

Many of those interviewed for this report described multiple experiences of stigma and discrimination, ranging from being denied access to housing to verbal abuse by members of the public. Sex workers were particularly concerned about protecting their children from knowing that they were sex workers. Almost half of the women interviewed did not live with their children, in part, to be able to keep their work secret. Women whose children did find out that they did sex work worried about losing their love and respect.

Although sex work is illegal in South Africa, people who engage in sex work are entitled to the same rights and freedoms as other people, including the rights to equality and privacy, security of person, freedom from arbitrary detention, equality before the law, due process of law, health, and the right to a remedy when their rights are violated. The criminalisation of voluntary, consensual sex between adults violates several internationally recognized human rights, including the rights to personal autonomy and privacy.

In many countries, Human Rights Watch has found that criminalisation of sex work creates barriers for those engaged in sex work to exercise basic rights such as availing themselves of government protection from violence, access to justice for abuses, access to essential health services as an element of the right to health, and other available services.

Sex workers interviewed for this report described how poverty, lack of education and severely limited economic opportunities, amongst other factors, made sex work one of the only viable options for supporting themselves and their families.

Many were single mothers, often supporting children of siblings as well as their own, and many said they were proud to be able to provide for their families.

While many expressed sadness and frustration at the lack of opportunities that would allow them to leave sex work, most were clear-eyed and pragmatic about their desire, in the near future at least, to undertake sex work more safely and without fear of police abuse or being arrested and detained.

A discussion about the legal status of sex work has been ongoing in South Africa for almost three decades. There is significant support for decriminalisation, including from various government ministries and institutions, trade unions, public health officials, civil society, and most importantly, sex workers themselves. It is clear from this report that the criminalisation of sex work undermines the health and dignity of sex workers and exposes them to violence and abuse.

The South African government should act urgently to end criminalisation of sex work and work with sex workers to protect their rights. Human Rights Watch interviewed 46 women currently working as sex workers in semi-structured interviews that generally lasted 45 minutes to an hour.

Three sex workers were trans sex, six of the interviewees worked in a building and the rest found customers in bars or on a street. All these interviews were conducted in person and all were conducted in English except two interviews, conducted in Xitsonga with the assistance of peer educator activist. Six sex workers were interviewed in Musina town, four in Makhado and five in Tzaneen and four in Hoedspruit. In one case, two sex workers chose to be interviewed together but all other interviews were conducted individually.

Privacy for interviews was provided in the offices of NGOs or where the sex worker was working, except for some interviews in Johannesburg where sex workers expressed a preference to do the interview on the streets where they were working.

Human Rights Watch identified interviewees through the assistance of organizations or individuals working with sex workers, which were either sex worker rights organisations or health care NGOs that ran clinics and outreach services for sex workers see Acknowledgements for details.

All participants in this research provided consent to participate orally. All participants were informed of the purpose of the interview, its voluntary nature, and the ways the data would be collected and used.

Interviews were told they could end the interview at any time and choose not to answer any question, without any negative consequences. All sex worker participants were assured that a pseudonym would be used when documenting their experiences in this report. No interviewee received compensation for providing information but sex workers who travelled to interview sites in Limpopo and Mpumalanga provinces were provided with compensation for transport expenses.

Staff members in the health NGOs that helped coordinate the interviews provided guidance on how much compensation should be provided for transport. Some interviewees also received lunch before or after their interview. First, we chose to narrow our focus to the experiences of female sex workers, and almost all women interviewed were cisgender, meaning their gender identity matches their sex as assigned at birth.

Only three transgender female sex workers were interviewed, and no male sex sex were interviewed. The Sex Worker Education and Advocacy Taskforce SWEATan organisation that addresses the health and human rights of sex workers in South Africa, estimated in that 90 percent of sex workers in South Africa are cisgender females, while 5 percent are transgender females and 4 percent are males. We recognize the limitations of this focus, in that our findings cannot be generalized to male and trans female sex workers, although it is clear from the work of other organizations that male and trans female sex workers also experience violence and discrimination in South Africa.

Further research on these abuses through an intersectional lens, looking at the particular ways in which violence and discrimination impact sex workers who are marginalized on the basis of their race, sexual orientation, or gender identity, as well as their profession, is warranted. We believe, however, that decriminalisation of consensual adult sex work would benefit all sex workers, not only women. A second limitation of our sex stems from the fact that most sex workers we interviewed were already in contact with sex workers rights organizations or health organizations that provided services to sex workers, meaning that our interviewees were more likely to have access to nondiscriminatory health care than sex workers who are unconnected to such services.

In addition, sex workers in Johannesburg probably have better access to health care, on the whole, compared to other parts of South Africa, especially rural areas. Sex work in South Africa is enormously varied and not all women who sell sex self-identify as sex workers, as our interviewees do. Attempts were made to speak to women working on streets and indoors, in smalls towns and in Johannesburg, but it is inevitable that the experiences and perceptions represented here do not speak to those of all South African sex workers.

Human Rights Watch also interviewed over 40 representatives of a wide range of NGOs that provide services sex sex workers, including health care services and legal or other protections, in both urban and rural areas.

Human Rights Watch also sent the SAPS a formal letter requesting information on arrest numbers and standard operating procedures among other issues but received no reply. The term excludes child sex work and other forms of coercive sexual exploitation such as sex trafficking, both strictly prohibited under international law. South Africa has a population of approximately 55 million people, with black South Africans accounting for just over 80 percent of the population.

Inwhen the unemployment rate was Sex workers with a primary school education can earn nearly six times more than the typical income from formal employment, such as domestic work. The legal status of sex work is currently a subject of debate in South Africa and some pressure exists for legislative change. What that change should look like is deeply contested. Another sex of civil society, including some religious and anti-trafficking organizations, maintain that while current laws may need to be reformed, full criminalisation should be retained to protect morality or society as well as vulnerable women from the harms of sex work.

South Africa currently uses a model of total criminalisation or prohibition of sex work, which means that the conduct of an estimatedtosex workers is subject to criminal sanction. The law also broadly bans solicitation or enticing a customer. The Sexual Offences Amendment Act, passed inalso makes buying sex criminal and specifically criminalises all those involved in the prostitution of children persons below the age of Inanti-trafficking legislation was signed into law.

As a result, officials lack adequate training on identifying potential trafficking victims, which occasionally leads the government to arrest, detain, and deport victims. Advocates for decriminalisation, academic researchers, and health workers working with sex workers complained to Human Rights Watch that politicians, police, and journalists commonly conflate trafficking and sex work, assuming everyone who sells sex is a victim of trafficking. The US Department of State, which tracks global efforts to end trafficking by state, has also heard reports that police often fail to identify and refer to appropriate services victims of trafficking and instead sometimes charge them with prostitution-related offences and other violations.

Decriminalisation of sex work has been under discussion since shortly after the end of apartheid. Decriminalisation non-criminalisation received considerable support over the next several years, and not only from NGOs and sex worker activists, though these groups have led much of the charge.

The SALRC position frustrated decriminalisation proponents who have said the report writers failed to consult widely enough with sex workers and that, because the writers took a prima facie moral position from the start that sex work is harmful, no other option but abolition sex properly considered.

Finally, the report recommends better practices and guidelines for police to end long-running abuse of sex workers and investigate police crimes against sex workers. Attacks on female sex workers by clients, persons pretending to be clients, police, partners, and others should be understood within the context of a country suffering an epidemic of violence against women and girls.

A progressive constitution, targeted legislation such as the Domestic Violence Act and the Sexual Offences Act, and government policies designed to prevent, respond to, and eventually eradicate gender-based violence all exist.

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Relatively few sex differences in performance on memory tasks have been whereas males are more likely to use a navigation strategy based on distal cues 3, 4, 5. .. of CREB is stronger in the hippocampus in male rats than in females [​95]. FRANKLIN W MARTIN; Sex Ratio and Sex Determination in Dioscorea, Journal of Heredity, Volume 57, Issue 3, 1 May , Pages 95–

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