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Worldwide, female sex workers have high rates of HIV. Many factors that escalate their risk lay outside of their control, name in the environments in which they practice sex. An understudied yet powerful risk environment is that of police.

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Thirty-five female sex workers were purposively sampled in Baltimore, MD in Women discussed experiences of police verbal harassment, sexual exploitation, extortion, and a lack of police responsiveness to calls in emergencies, largely partner violence. Women's mistrust of police was often developed at an early age, and further reinforced by interactions in their personal and professional lives.

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The case for police's role in generating risk is evident, which could be addressed through structural interventions targeting both police practices and policies. A large body of research has focused beyond individual biological and behavioral factors facing vulnerable groups, including FSWs, to the social contextual factors that shape their risk environment.

A review of female sex work literature from the past 18 months puts forward a structural HIV determinants framework. Where sex work is criminalized, FSWs experience the negative health consequences of a punitive legal environment with few legal protections Erausquin et al.

These studies highlight how police practices and policies at the level of the work environment operate as a proxy for understanding the role of macro-structural determinants i. Coercive police behaviors that extend beyond sanctioned law enforcement practices are an important social feature of this complex and dynamic work environment. The current study examines the range of interactions between police and FSWs both in their professional and personal lives, which directly and indirectly generate HIV risk among FSWs.

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For example, FSWs throughout the world have reported police harassment as among one of their most ificant challenges, with police leveraging their power and the threat of arrest to extort financial bribes or sex Erausquin et al. The HIV implications of police interference have been confirmed in a of cross-sectional surveys.

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Research has also documented that police perpetrate sexual violence against FSWs, in turn compromising the sexual, physical, and mental health of those violated Crago, ; Baral et al. Police are not typically aware of the public health impact of their actions, despite the fact that they not only manage, but can also contribute to the health risk environment.

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Traditionally police role emphasize public safety Wood et al. The current study explores the nature of police interactions with street- and venue-based FSWs in Baltimore, Maryland, moving beyond a singular focus on law enforcement practices, to consider the breadth of interactions between police and FSWs, both in their professional and personal lives. We use the conceptual framework of risk environment developed by Rhodes and colleagues Rhodes, The framework posits that HIV risk behaviors are socially produced, in that behaviors are shaped by contextual and environmental factors.

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In the current study we focus on the microenvironment of police and FSW interactions, recognizing at the same time the dynamic interplay with upstream macro-structural factors such as stigma and sexism, in addition to criminalization. Eligible participants were ages 18 and over who reported having traded sex for drugs, money, or a place to stay within the three months prior to being interviewed.

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Recruitment was conducted through outreach to clients of four organizations that targeted FSWs who worked on the street, in dance clubs, and in drug houses; participants were invited to recruit up to three peers into the study to ensure inclusion of FSWs who were not receiving services. Once eligibility and interest were determined, participants were invited to a private office or car to complete informed consent, a brief survey, and undergo a minute in-depth interview that explored women's entry into sex work, current working situation, condom use and negotiation, substance use, experiences of violence, and police interactions.

Participants were guided by semi-structured interview questions, but encouraged to describe their stories to ensure rich narratives.


Interviews were audio-recorded and transcribed verbatim. All interviews were conducted by graduate-level researchers with a history of qualitative research and experience working with survivors of sexual abuse.

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Participants were provided with a discreet resource sheet documenting local support services. Four research team members read a set of transcripts to develop an initial coding scheme. This initial structure was applied to a set of transcripts, with each transcript coded independently by a set of two coders who met to review codes and discuss emergent themes. Through this process, codes were generated and finalized, and three team members independently coded the remaining interview data.

Inter-coder reliability across coding was reached via a standard approach wherein coders came to agreement on all codes Carey et al. A of themes emerged from the data surrounding women's experiences with and feelings toward the police, including a recurring disregard for women's safety by the police, as well as experiences of verbal harassment, sexual harassment, and entrapment. Women's ages and self-reported ethnicities are reported with the quotes.

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Shit no I don't trust them. They can't be trusted. I'd rather go to a stranger on the street before I go to the police half of them are crooked. My thing, how I was raised, you don't go to the police. You handle it yourself. A deep-rooted sense of distrust for the police was pervasive across interviews.

In many instances this mistrust predated women's involvement in sex work. As the quote above illustrates, women came from communities in which police are not trusted. These formative experiences with, and perceptions of the police, were simply reinforced by later experiences as FSWs.

Marginalization by the police emerged as a cumulative experience and life cycle that left women disempowered and vulnerable, in their personal as well as professional lives.

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Several s emphasized the lack of, or inappropriate nature of, responses to calls made by women who had experienced violence in their private life:. They say they're there to protect and serve. I called the police on a boyfriend of mine a couple of weeks ago.

He was in the house, threatening to hit me with a stick and to beat me up I was really afraid for my life. I called the police. They said someone was on the way.

No one came. I didn't hear any sirens I didn't hear anything. So I called back again, by that time he had gotten out of the house. And when the police came they hollered at me. If he didn't have a gun you weren't in danger! Substance-using FSW experienced a double stigmatization at the hands of police.

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Unequal power relations and the ability of police to exert their own moral judgment was evident in the stories of the women interviewed:. I had a bad experience with the police, one ex-boyfriend hit me Just because I wasn't a person they [the police] didn't do nothing to him.

Another participant reported the police's response to an attack by her boyfriend that was so severe she suffered numerous bruises, a dislocated jaw, and strangulation that resulted in her losing consciousness:. It took them like forever to get there.

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He put a gun up to my head. Because I'm a drug addict and he's not, he's got 14 years clean and he's clean cut and I dance on the block [of strip clubs], they pretty much was going to lock me up.

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They disregarded all my bruises, and I had a witness. Multiple s highlight how women's occupation as a FSW and presence on the street seemed to negate their right as citizens for protection from violence:. This guy tried to rape me, one day last year, right down the street here. I saw somebody coming by and I started screaming.

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They came over to help me, and the guy fled. I went to the police station and they acted like I had done something wrong.

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They really did. They turned it around They basically didn't believe me. I shouldn't be out there. You got what you deserved. The police don't look at us as victims when we're raped and when we're beaten and stuff like that. If we get into a physical altercation and we have to fight for our lives, we're most likely to be jailed because of it. Regardless of what we do, we don't deserve to be beaten and raped. If we say no, we say no.

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And I fee like it's not right, that the police are supposed to be there to protect us regardless of what we do. And they're against us. Beyond police's failure as custodians of women's safety on and off the street, police harassment emerged as an insidious tool of social control, with little connection to women's street work:. They harass you. Sometimes you don't even be doing anything You could just be coming out the gas station and they harass you just walking by.

1. Introduction

You don't even have to be in the drug area A of women described pervasive verbal harassment within the context of being out on the street:. What are you standing here for? Are you trying to get picked up? Why don't you get away from here?

Where are you walking to? I can be out jogging. Sometimes they'll tell you if I see you again you're going to jail. For what?

I haven't done anything. I could see if you see me get out of a car or you caught me doing something, but you can't just keep harassing me because I'm walking down the street

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