Sex Work and Infection: What's Law Enforcement Got to Do with It?

A number of countries are pursuing the regulation of sex work to decrease the spread of sexually transmitted infections (STIs) and to reduce the probability of a generalized human immunodeficiency virus/acquired immunodeficiency syndrome epidemic. We study the effects of enforcing licensing regulation laws on sex worker STI rates, using nationally representative sex worker data from Ecuador. We find that increasing enforcement in the street sector significantly decreases STIs. However, increasing enforcement in the brothel sector increases the probability of a sex worker ever being infected with any STI. Increasing enforcement in the street shifts some sex workers from the more risky street into the less risky brothels and increases street prices, reducing the overall number of street clients. As a result, overall infection rates decrease. In contrast, increasing enforcement in the brothel sector can exacerbate public health problems by inducing some unlicensed brothel sex workers into the riskier street sector.