Country of Denmark -- Age of Consent

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DENMARK

Source: http://www.actwin.com/eatonohio/gay/world.htm

DENMARK LAWS: 1. Has no sodomy laws, the age of sexual consent is 15 for all, but it is an offence to "induce" a person under 18 to sexual acts   "by gravely abusing superior age or experience". 
2. Allows homosexuals to register their partnership and gives them  (with some exceptions) the same rights and responsibilities as a  heterosexual married couple.
3. Allows foreign partners of its homosexual citizenry to receive  residency permits.
4. Has a national gay rights law that bans some anti-gay discrimination.
5. Allows homosexuals in its military.
6. Bans assisted insemination for lesbians.
7. Allows homosexuals in registered partnerships to adopt their
partners' children, but not other children.

Source: http://www.interpol.int/Public/Children/SexualAbuse/NationalLaws/

Denmark - Danemark - Dinamarca    copenhague


I. Ages for legal purposes
Age of simple majority     The full legal age is eighteen (18) years.

Age of consent for sexual activity
When a person is fifteen (15) years old s/he can consent to sexual intercourse.

Age of consent for marriage
A person can get married without permission of the parents when s/he has reached the age of eighteen (18) years.

II. Rape
§ 216 of the Danish Penal Code
" (1) Any person who enforces sexual intercourse by violence or under threat of violence, shall be
guilty of rape and liable to imprisonment for any term not exceeding 6 years. The placing of a
person in such a position that that person is unable to resist the act shall be equivalent to
violence.

(2) If the rape has been of a particularly dangerous nature, or in particularly aggravating
circumstances, the penalty may be increased to imprisonment for any term not exceeding ten
years. "

III. Other forms of child sex abuse
§ 217 of the Danish Penal Code
" Any person who by other unlawful compulsion (as described in section 260 of this Act) than
violence or threat of violence, procures for himself sexual intercourse, shall be liable to
imprisonment for any term not exceeding four years. "

§ 218 of the Danish Penal Code
" (1) Any person who, by exploitation of another person's mental illness or mental deficiency,
procures for himself extra-marital sexual intercourse with that person shall be liable to
imprisonment for any term not exceeding four years.

(2) Any person who procures for himself extra-marital intercourse with a person who is in such a
position that he is unable to resist the act shall be liable to imprisonment for any term not
exceeding four years, unless the act is covered by the provisions of section 216 of this act. "

§ 219 of the Danish Penal Code
" Any person who is employed in or in charge of any prison, welfarehome, children's or young
person's home, hospital for treatment of mental disorders, institution for the mentally deficient or
any similar institution, and who has sexual intercourse with any person who is an inmate of the
same institution shall be liable to imprisonment for any term not exceeding four years. "

§ 220 of the Danish Penal Code
" Any person who, by grave abuse of the subordinate position or economic dependence of another
person, has extramarital sexual intercourse with that person shall be liable to imprisonment for
any term not exceeding one year or, where the person is under twenty-one (21) years of age, to
imprisonment for any term not exceeding three years. "

§ 222 of the Danish Penal Code
" (1) Any person who has sexual intercourse with any child under the age of fifteen (15) shall be
liable to imprisonment for any term not exceeding six years.

(2) If the child is under the age of twelve (12), or if the perpetrator has enforced the sexual
intercourse by coercion or by intimidation, the penalty may be increased to imprisonment for any
term not exceeding ten years. "

§ 223 of the Danish Penal Code
" (1) Any person who has sexual intercourse with a person under the age of eighteen (18) who is
his adopted child, step-child or foster child, or who has been entrusted to him for instruction or
education, shall be liable to imprisonment for any term not exceeding ten years.

(2) The same penalty shall apply to any person who, by gravely abusing superior age or
experience, induces any person under the age of eighteen (18) to sexual intercourse. "

§ 225 of the Danish Penal Code
" The provisions in sections 216-220 and sections 222 - 223 shall similarly apply in connection
with sexual relations with a person of the same sex . "

IV. Child prostitution
§ 228 of the Danish Penal Code
" (1) Any person who-
1) induces another to seek a profit by sexual immorality with others; or
2) for the purpose of gain, induces another to indulge in sexual immorality with   others or prevents another who engages in sexual immorality as a profession   from giving it up; or
3) keeps a brothel;
-shall be guilty of procuring and liable to imprisonment for any term not exceeding four years.

(2) The same penalty shall apply to any person who incites or helps a person under the age of
twenty-one (21) to engage in sexual immorality as a profession, or to any person who abets some
other person to leave the Kingdom in order that the latter shall engage in sexual immorality as a
profession abroad or shall be used for such immorality, where that person is under the age of
twenty-one (21) or is at the time ignorant of the purpose. "

§ 229 of the Danish Penal Code
" (1) Any person who, for the purpose of gain or in frequently repeated cases, promotes sexual
immorality by acting as an intermediary, or who derives profit from the activities of any person
engaging in sexual immorality as a profession, shall be liable to imprisonment for any term not
exceeding three years or, in mitigating circumstances, to simple detention or a fine.

(2) Any person who lets a room in a hotel or an inn for the carrying on of prostitution as a
profession shall be liable to simple detention or imprisonment for any term not exceeding one
year or, in mitigating circumstances, to a fine.

(3) Any man who allows himself to be maintained, in whole or in part, by a woman who makes her
living by prostitution shall be liable to imprisonment for any term not exceeding four years.

(4) Any man who, in spite of warnings by the Police, lives with a woman who makes her living by
prostitution shall be liable to imprisonment for any term not exceeding one year. A warning given
by the Police shall be valid for five years.

(5) The penal provisions in subsections (3) and (4) above shall not apply to male persons under
the age of eighteen (18) whom the woman are under a legal obligation to support. "

§ 233 of the Danish Penal Code
" Any person who incites or invites other persons to prostitution or exhibits immoral habits in a
manner which is likely to annoy others or arouse public offence shall be liable to simple
detention or to imprisonment for any term not exceeding one year or, in mitigating circumstances,
to a fine. "

V. Child pornography
§ 235 of the Danish Penal Code
" (1) Any person who commercially sells or otherwise disseminates, or who, with such an
intention, produces or procures obscene photographs, films or similar objects of children shall be
liable to a fine, to simple detention or to imprisonment for any term not exceeding six months.

(2) Any person who possesses photographs, films or similar objects of children engaged in sexual
intercourse or other sexual relation other than sexual intercourse shall be liable to a fine.
Similarly liable to a fine is any person who possesses photographs, films or similar objects of
children engaged in sexual intercourse with animals or making use of objects in a grossly
obscene manner. "

VI. Extra-territorial legislation
§7 of the Danish Penal Code states
" (1) Acts committed outside the territory of the Danish State by a Danish national or by a person
resident in the Danish State shall also be subject to Danish criminal jurisdiction in the following
circumstances, namely ;

where the act was committed outside the territory recognised by international law as
belonging to any State, provided acts of the kind in question are punishable with a
sentence more severe than simple detention ; or
where the act was committed within the territory of a foreign State, provided that it is also
punishable under the law in force in that territory. "

 

 

Commercial sex: The bottom line  (Sept 15, 1999)

Prostitution in Thailand? Peanuts!I very much appreciated Jaime Cabrera's article about prostitution (Perspective, August 29, 1999).

Why put the blame on Thailand? The author presents facts that should be food for thought for those people in Europe and the US, who still consider this country to be the "paradise of sex tourism", because it is not.

I was born in Amsterdam, a city famous for its medieval canals and red light district, visited by tourists from all over Europe and the States.

Dutch TV and newspapers, however, brandish Thailand as the "Garden of Eden" for males looking for cheap sex. The first question that pops up is: 'What is prostitution?'The common answer: 'Having sex for money, instead of love or libido.'Is that so? Then how about the decent woman married for fifteen years, making love with her husband, going through the
movements without any feelings, just because he provides food and shelter for her children?Why restrict the word 'prostitution' (from Latin: to maintain ones stature) to sex?How about the salesman trying to sell a car to a customer he'd rather kick in the belly? He or she doesn't get any mental or physical satisfaction from the interaction with the potential buyer, except for money, when the deal is made... Prostitution!Perhaps in some aspects we are all prostitutes when it comes to keeping standards
of living, our position in society, or achieving our goals, acting friendly and smiling without any feelings if necessary.

The next question I like to ask people talking about Thailand in this connection is: 'Did you ever learn mathematics?' OK, here we go: a Dutchman in his forties decides to spend his three weeks holiday having sex in Thailand.

The cheapest flight from Amsterdam to Bangkok will cost about 900 guilders (about 16,000) baht. His accommodation in the 'City of Angels' in a fifth-grade guesthouse costs 100 baht a day. If he does not use taxi's or tuk tuks, visit a-go-go bars and is satisfied with meals from street-stalls, he will spend another 150 baht a day. Theoretically he could live on 300 baht a day. Apart from airport tax and transportation to and from the airport he could stay three weeks in Thailand for a minimum of
8,000 baht.

So this miserable creature spends next to nothing for three weeks 'sex tourism'. In Holland the cheapest sex will cost him about 1,500 baht for half an hour. So for the money he spends on the flight and accommodation, he could have sex 17.5 times at home. Thus in three weeks Bangkok, he has to visit a prostitute at least 17 times to earn back the money for the ticket and guesthouse. The lowest price you can get is at Lumpini park where he will have to pay an average of 250 baht, adding another 4,250 baht to his budget, the equivalent of having sex three more times in Holland.

But let's be realistic with this mathematical equation. In Holland he has to pay 1,500 baht for one sexual encounter, in Thailand at least 250 (we are not talking about quality, just figures). So he will 'save' 1,250 baht every time he has sex in Thailand compared to Holland. To earn back his ticket and other expenses, he has to have sex once a day. Not impossible, but
why the hell fly over 5,000 miles to get the same you would get at home?And this guy is only hypothetical. Most 'sex-tourists' fly with decent airlines paying 30,000 baht return and stay in guesthouses with fewer cockroaches. They use taxi's, eat in restaurants and visit a-go-go bars.

I will not bother you any more with maths, but the average sex tourist would have to make love with a Thai boy or girl at least four times a day to get even financially. Again: not impossible, but not very relaxing either.

However, child abuse and forced prostitution, is another chapter. It is evil and cruel and should be eradicated by all possible means. But in Amsterdam heroin-addicts aged 13 or 14 offer their services for sex. In Thailand the age of consent for sex is 18, in Holland 12. But in Amsterdam a lot of guys, especially Moroccans, force their Dutch girlfriends into prostitution.


So let's make things easy and put the blame on Thailand. Far away from your bedside you can close your eyes to the mess in your own house.

Prostitution is, indeed, 'an international passion.' I have travelled all around the world and never visited a country without prostitution.   Sometimes you have to shop around a little, sometimes it surrounds you with every step you take, but it is always there.

The evil is not prostitution, but religious prejudice (especially Christian and Islamic) and laws based on their dogmas. A prostitute, male or female, is not inferior to anybody in any other profession. Some even take pride in their jobs, but being outlawed, they lack the protection other workers have.

There is a lot to be criticized in Dutch politics, but in Holland there are trade unions for prostitutes, like for airline crew and factory workers.  That is the way it should be.   Peter van der Zon, Chiang Mai

 

 

This is the only entry we have been able to find regarding Denmark.  We have lost the site id but we believe the site to be accurate in its information.

The age of consent

Sexual intercourse between individuals (both heterosexual and homosexual) under 15 years-old is illegal.

 

Additional General Information:

 

COUNTRY REPORT OF DENMARK

PROSTITUTION AND ITS CONTEXT IN DENMARK

Extent, organisation and legal issues

Reliable estimates of the number of prostitutes in Denmark do not exist. But one estimate from 1990 calculates that 1500 prostitutes were active nationally each day. Most of these worked in massage parlours (700) or bars (600), while 150 - primarily drug using prostitutes - worked on the streets. Another 125 worked as escort prostitutes. These numbers only count women who offer services to men during the course of one day and the total number of prostitutes is therefore much higher.

The picture changes if the extent of prostitution is measured by the number of client-prostitute contacts. The primary role of massage parlours then becomes obvious: 70% of all contacts take place there. Fifteen percent of all customers have contact with street prostitutes, another 12% with bar prostitutes and 3% with escort girls.

There have been no major changes in this picture during the last four years though non-Danish prostitutes now comprise a larger part of the prostitutes in massage parlours than before. One way of monitoring changes in the prostitute population is to follow the changes in the adverts offering sexual service which are published in the daily newspaper, Ekstra Bladet.

The ethnic make-up of the prostitutes has changed slightly during the last 14 months according to the advertisements. The percentage of adverts that mention Thai women, 'black'/'brown' women and other immigrants rose from 8-10 % to 13-15 % of the total. None of these indicate that they come from the former Soviet Union or Eastern Europe. A few prostitutes (less than 1 % of all advertisements) claim to come from other EU countries.

Another change was noticed during the project period. The mobile telephone became increasingly popular, first within escort bureaux, but lately also among massage parlours. Mobile phones provide an effective guarantee against identification of the people involved in the business, especially for escort activity where the prostitute visits the customer. Also the escort bureau itself becomes mobile; the bureau is to be found wherever the manager is located at any particular time. The introduction of mobile phones then is the latest stage of a long process of withdrawal of the prostitute from public view in a known geographical area /street to an indoor location.

Danish prostitutes do not travel across the country's border to work, while inside Denmark the experience of working in different parts of the country varies. Copenhagen prostitutes have seldom worked in other parts of Denmark, except for escort girls who might cover most parts of Zealand (Sjælland). But in Jutland (Jylland) and Funen (Fyn) prostitutes usually have worked in cities other than their home city. Women in Jutland especially travel a lot to other cities in the region, partly because many cities are too small to provide anonymity vis-a-vis the clients, partly because prostitutes who are 'new' to a small area attract more customers.

Numbers for male prostitutes in Denmark are not available. Researchers and service providers have been in contact with 30 male prostitutes who have male clients in Aarhus and with more than 100 in Copenhagen. A recent round table discussion between the police, social workers in contact with the prostitution milieu, and the social counsellors for parents and children in crisis, concluded that there is no child prostitution involving children below the age of consent (15 years) in Denmark. The flow of teenagers into street prostitution is rather limited, especially for teenagers under 18. The owners of bars and massage parlours are generally very careful not to let in persons younger than 21 years, as this is illegal and might give the police an opportunity to intervene. Thus, most prostitutes start work after they reach 20 in massage parlours or bars. A relatively small group start at a younger age and do so on the streets.

Pimping (in the sense of a man who in one way or another forces a person to take customers and hand over the money to him) is extremely rare in Denmark. The absence of a large group of very young girls (Lolitas) partly explains this lack of pimps. Another reason is that sexual transactions as such are legal and the police do not conduct raids among prostitutes who work indoors. Finally, the very liberal advertising policy in the sex industry enables individual prostitutes to advertise in newspapers or magazines without fearing economic reprisals. (In reality, they do commit social security fraud if they are also claiming welfare but the authorities do not track them down). It is not illegal in Denmark to provide sexual services for money or goods as long as this sex work is not the main source of income for the prostitute. The police otherwise might arrest the person on charges of vagrancy. This is one good reason for a prostitute to be claiming social welfare. Aside from this, prostitution is not as lucrative as it might have been earlier. Prices for sexual services have been stable during the last decade while, for instance, advertising fees and expenses have increased just as have living expenses in general. Many prostitutes therefore also claim benefits because they need the money and they avoid giving any information about their prostitution to the social worker.

The extent of procuring is more difficult to assess. Most bars and massage parlours are owned by one or a few persons who organize the work, procure the women and take a larger or smaller part of their earnings. A small part of the growing number of prostitutes from the Third World have entered Danish bars and massage parlours through business channels. For instance, this is the case for some of the Thai women in Aarhus. It is likely to have happened in other major cities too, but no evidence is available at present. Aside from this, it is a matter of definition whether one would judge some of the massage parlour owners to be procurers. Unless the prostitute owns the massage parlour herself/himself (or together with a few colleagues), the user must pay a fee to the owner for each day's work. This fee varies greatly, ranging from 300 kr to 1400 kr (40-185 ECU) or even more. An amount at the upper end of the scale covers more than the expenses of the owner. In comparison, the price for 'Danish' intercourse (vaginal intercourse) ranges from 300 kr to 400 kr (40-50 ECU) among those working in massage parlours in Copenhagen. Other intermediaries also claim part of the money earned by the prostitutes, notably the newspapers which are used by almost all massage parlours and escort prostitutes in Denmark to advertise their services.

Brothels are not allowed in Denmark, and neither is pimping or procuring. But except for routine visa checks on immigrant prostitutes the police has not initiated investigations into possible cases of procuring over the last decade. One bar owner was prosecuted a few years ago and cases against massage parlour owners occasionally arise. The police only intervene if a complaint has been received; if they encounter a prostitute below the age of sexual consent; if they find women younger than 21 years at the bars or massage parlours; or, if they discover an immigrant prostitute who has no valid permit to stay in Denmark.

To sum up: at least 5.000 sexual transactions involving female prostitutes take place in Denmark every 24 hours, corresponding to 1.5 million transactions per year (+/- 0.3 million; activity level decreases during weekends and holidays). This results in a total payment far in excess of 525 million kr (70 million ECU; this amount is arrived at by multiplying the mean price for 'Danish' intercourse by the number of transactions). Most clients have contact with massage girls, some of whom are 'imported' from the Third World, especially Thailand, but quite a few 'black'/'brown' women work in the massage parlours, too. Most of these stem from Africa and they are apparently not controlled by a third party. The organization of prostitution in Denmark differs from many EU countries in its lack of pimps, a situation partly caused by the restructuring of prostitution that began back in 1973 after the prohibition on 'immoral' advertising was repealed.

Social and medical services available to prostitutes

Prostitutes enjoy the same welfare rights as all other residents. However, non-resident prostitutes have no welfare rights. Those who are entitled to welfare have access to unemployment benefits, education, health care etc, as long as this is unconnected to their sex work. If prostitutes, however, wish to join an unemployment insurance fund, they will not be allowed to if they reveal that they are also prostitutes. Neither is any insurance company willing to insure massage parlours. When a prostitute applies for benefits at her/his local social service department s/he runs the risk of being accused of fraud. In line with this, a prostitute does not discuss her/his experiences with the social worker. Prostitution thus acts as barrier - effective if invisible - to receiving help to solve prostitution-related social problems. This counts as true for non-prostitution related problems as well. This issue is further discussed in connection with the outreach project in Aarhus. All medical services are free of charge to Danish residents. (An insignificant number of private clinics provide treatment of special diseases; but treatment for these diseases is also available within the public health system). Consultation and treatment of STDs or HIV is provided by the 'family doctor' or by one of the 10 venereal clinics in the country. The patient is free to choose which one to go to. HIV tests - but not STD examinations - can be made anonymously. If a patient is found HIV seropositive and wishes to receive treatment, he/she has to give up their anonymity.

The AIDS epidemic and HIV prevention in Denmark

It is very important to assess the need for prostitution-related HIV prevention. Only then can steps be taken to evaluate existing efforts at prevention and whether to initiate new interventions. Three aspects are discussed below:

  • what is the level of HIV transmission among prostitutes so far?
  • what is the rate of HIV seropositivity among clients and prostitutes?
  • does client-prostitute sex lead to HIV transmission? In particular, are condoms used?

As in other European and North American countries, the AIDS epidemic in Denmark originated in the homosexual population and then spread to the IVDUs. Sex between men continues to be the main way the infection is transmitted. Of the heterosexuals who are infected, the number of women surpassed the number of men in 1994, but almost half of these women were immigrants. A total of 1446 people with newly diagnosed HIV infection were reported between August 1990 and December 1994. Of these 322 were women. Seventeen (7%) of the male heterosexuals with HIV reported sex with a prostitute as the way they were infected with HIV.

As compared to the much higher numbers of men who acquired the virus from prostitutes in some other countries, 17 men over a period of 4 years does not appear to be many. In addition, it is unlikely that all of them acquired the virus from female prostitutes in Denmark. Some may have provided misleading responses (concealing their homosexual activities), others may have acquired HIV during tourist travel (Thailand has been a popular location for vacations for some years). But information on these issues is not available. It is possible to approach the question of HIV transmission via prostitutes in two ways. First, the fear that prostitutes might function as 'vectors' for disease transmission seems to prevail in most epidemiological studies. In the Third World this has often led to the scapegoating of prostitutes. But there has been no tendency at all in Denmark to stigmatize prostitutes in connection with the HIV epidemic.

A second, more balanced, approach would be to investigate the interaction between prostitutes and their clients, as well as seroprevalence in both groups. As will be apparent below, with one exception no data exists for clients in Denmark. There are two key questions to be asked in assessing HIV transmission through prostitution. Firstly, is one of the partners already infected? Secondly, do they use a condom? The rate of condom use is difficult to assess. To begin with, he/she may claim condom use just to please the interviewer (or to avoid being reprimanded). Moreover, to admit to using condoms is to break a professional ethic, a directly punishable act among some groups of prostitutes. Self-reported condom use therefore should always be treated with some scepticism. According to behavioural data, Danish prostitutes who work in bars or in massage parlours use condoms consistently with their clients. But many express uncertainty as to the risk of transmission through certain sexual practices. Condoms also frequently break and the response is not always appropriate. Use of and/or the attitude towards condoms has changed radically among prostitutes since the late 1980s when a minority still claimed to not always use condoms with clients. The clients also seem to have learned to accept condoms as part of the trade though middle aged men and the clients of street prostitutes may still occasionally ask for sex without a condom (according to the EUROPAP investigations).

Very little is known about the behaviour of escort girls because they are very difficult to get access to; the manager in most cases obstruct all contacts between the girls and field organizations. The interviews by EUROPAP suggest that a few of the escort bureaux might persuade a girl to allow a client not to use a condom if he insists. Some of the young escort prostitutes are also rather inexperienced and simply forget to bring a condom to work. Those who are a little older are more consistent in their condom use. The nature of the relationship between street prostitutes and their clients increases the risk of these women of acquiring HIV and STDs. They also experience more violence. The issue is further discussed in connection with the description of Reden. In-depth interviews with male prostitutes make it reasonable to assume that condoms are usually - but not always - used by male prostitutes. But a concrete assessment of the sexual practices of male prostitutes and their clients does not exist. Available information on the contact between Danish clients and immigrant prostitutes is insufficient. Condom use increased in the Thai massage parlours in Aarhus after the local authority started an outreach program. According to the prostitutes in some of the Thai parlours in Copenhagen who are in contact with the outreach workers condoms are available at these places and are used with the customers.

Epidemiological data is fragmentary. In Copenhagen, none of the 213 female prostitutes tested in 1990/91 were HIV positive nor were the 160 tested during 1993/94. But it is noteworthy that the prostitutes tested in 1990/91 had a much higher level of self-reported STDs for the preceding 6 months than the population in general, even higher than among clinic attenders at the STD clinic in charge of the investigation. Approximately 40 street prostitutes (all intravenous drug users) participated in an HIV test project in the autumn of 1994 but the results are not yet available. All three investigations and HIV test groups were a result of outreach projects. In Aarhus, none of the 53 female prostitutes tested between 1988 and 1990 was HIV seropositive (test group membership was based on clinic attendance and outreach). Non-Danish clinic attenders in Aarhus were HIV tested in the autumn of 1994; 1 out of 32 was HIV seropositive. In addition, the level of STDs was very high.

Sero-epidemiological data on immigrant prostitutes does not exist. Neither does data on Danish male prostitutes. In a recent (unpublished) study the presence of HIV has been measured in semen. This technique makes it possible to measure the HIV status of a man by investigation of his semen. Thus, semen collected from approximately 325 clients at massage parlours in Copenhagen January 1994 all failed to reveal HIV among the men. The semen specimens also will be tested for hepatitits B antibodies in the near future. No other data on the level of HIV among clients exists for Denmark.

In conclusion: though the level of STDs are higher among prostitutes than in the population in general, the transmission of HIV from clients to prostitutes and vice versa seems to be rare in Denmark. This is partly due to a low prevalence of HIV among prostitutes and clients (at least those clients who frequent massage parlours), partly because condoms are used quite regularly. But among some prostitute groups condoms are not used consistently and these groups of clients and prostitutes might include HIV seropositive individuals. Thus, there is a need to provide programmes to prevent HIV transmission among prostitutes and their clients but their content and methods need to be appropriate to the target groups in question. At present, too little is known about the sexual practices and levels of HIV seropositivity among immigrant prostitute women and male prostitutes. Further, we know almost nothing about the clients of all types of prostitutes. The AIDS secretariat at The Ministry of Health has co-ordinated and initiated HIV prevention programmes for a decade. Initially, the focus was on non-stigmatizing national campaigns. But as early as 1987 efforts were made to stimulate local initiatives. 'Key persons' from all over the country and from various public sectors were educated by the Health Department in collaboration with the counties. From 1990 onwards the strategy of the Department has been to stimulate central-local (CEN/LOK) preventive activities, public as well as private, and to co-ordinate these with the national AIDS campaigns. Most counties today have an AIDS consultant. Several target groups are mentioned within the CEN/LOK strategy, among them prostitutes. None of the national campaigns have dealt explicitly with HIV transmission in prostitution but several of the AIDS consultants in the counties have taken the initiative to send pamphlets and condoms to prostitutes in their county. A few do so periodically but most have sent materials only once. Response from the prostitutes have been sparse or nonexistent and the effect of this distribution of information is unknown.

Other AIDS preventive initiatives are decentralised. For instance, most counties have some arrangement enabling IVDUs to get access to clean needles. In Copenhagen, distribution of needles free of charge began in 1986 and special needle-disposal outlets were installed in the 'drugs area' of the city.

Existing service provision for prostitutes and the promotion of new initiatives

Projects aimed at the needs of prostitutes have mostly emerged within the last five years. They have focused on HIV prevention or on social problems, often combining both objectives. There is no doubt that some of these projects would not have emerged if money had not been made available for AIDS prevention; part of the nationally available money for AIDS goes towards prostitution projects. In the long-term AIDS prevention directed at prostitutes should continue and be better developed. But there can also be little doubt that the social problems faced by prostitutes are severe. Decent resources and planning are needed to solve the social problems of prostitutes, either tackled on discretely or in combination with general health prevention programmes.

The Social System and processes of decision making have been a focus of EUROPAP Denmark because one of our main objectives has been to motivate local authorities to initiate prostitution related projects in their city/community. Our approach has been to combine medical and social issues in the program outline. Trends in Danish social policy are described below. There have been drastic cuts in the Danish welfare system during the last decade. The policy of the conservative/liberal government during the 1980s was to increasingly leave the provision of social services to private initiative. This policy was promoted through 'social development projects', financed by the government. The resulting 'project culture' has in fact developed a range of new approaches to social issues. Old questions have been dealt with in a new manner and new issues - like counselling for prostitutes - have been taken up. But there have been clearly negative consequences of this approach. Among these is the imposition of a two to three time limit on any social project. Also the tendency to leave some problems to 'free social enterprise' have left some issues untouched. All of the projects described below have been effected by this. They also have had to deal with frequent neglect or resistance from politicians and suffer from a lack of private funds when it came to finding solutions to the prostitution related social problems. Furthermore, in the wake of sexual liberation, prostitution is generally not thought of as something problematic. Withdrawing prostitutes from public view after 1973 has also seen them disappear from the public mind; prostitution was acknowledged as a private sexual matter for people and the authorities are expected not to intervene in the private life of people.

These attitudes towards prostitution have had a major influence on the (lack of) social research and intervention. Thus, little money has been released for scientific research on prostitution for over 15 years. Legal aspects of prostitution have been debated several times in Parliament during the last three decades but revision of the relevant legislation (dating back to 1930) has not taken place. Neither has enough money been set aside to deal with the problems during the last decade. But the situation seems to be changing now! The Ministry of Social Affairs decided in January 1995 to make prostitution one of several priority areas for funding and social development. There is a further aspect of social policy in Denmark which has a major influence on projects and initiatives drawn up to tackle the social and medical needs of prostitutes. Danish counties and local authorities have a high degree of autonomy. They are free to decide local policies within the framework of guidelines issued by the state - as long as local initiatives do not lead to an increase in the level of tax. Responsibility for the provision of health services and disease prevention lies with the counties while local authorities are the major social service providers. In both cases, the major part of any expenses incurred are reimbursed by the state as a result of annual negotiations. In recent years, a restructuring of work tasks and models of co-operation has taken place in the administrative systems of counties and local authorities. It has given rise to a very heterogeneous structure of local decision making, types of public departments and patterns of client-social worker interaction. In some instances, new models of collaboration between public and private institutions have also emerged.

In conclusion: in the future money should be made available for those providing services to prostitutes as well as for further needs assessment and targeted interventions aimed at the prevention of HIV transmission through prostitution. It might be an advantage for such initiatives to combine social and health elements. If so, they need to participate in the process of social development.

PROJECTS AND SERVICES DEALING WITH HIV PREVENTION FOR PROSTITUTES

Review: prostitution related initiatives, 1985-1995

There have been very few services or projects dealing with HIV prevention for prostitutes in Denmark during the last ten years. The few projects in existence mostly have dealt with the social aspects of prostitution. After a major debate in Parliament in March 1990 the DAPHNE centre was established for a period of 3 years. The centre's brief was to investigate social problems surrounding prostitution and inform public and private agencies about how they could prevent young people from entering prostitution. In addition the centre was to formulate ways of preventing 'social damage' to active prostitutes and find means to support those who wished to stop their sex work.

A service centre for male prostitutes, PAF (Prostitution af Fyre: prostitution of gays), was established in 1991 with the main objective of supporting male prostitutes by individual councelling and by outreach work in the respective milieus. In 1994, the HIV prevention efforts of PAF were limited to a monthly social gathering in which an employee from the gay and lesbian movement also participated.

The PRO-line (a national HOT-line for prostitutes) was started 1993. The main objective of this telephone councelling service is to provide welfare support to female prostitutes.

Only two service providers in Copenhagen actually dealt with HIV prevention among prostitutes. In Reden (The Nest) - a drop-in centre for drug using prostitutes - the main objective was and remains to help the women get off drugs and stop prostitution. But the staff also handed out condoms to the prostitutes and aimed to expand the safer sex education they could offer by undertaking further training. Their HIV prevention activities were therefore evaluated. The evaluation is summarised below. The other service provider, RAP (Rådgivning af Prostituerede: prostitutes council prostitutes) has as its main objective to councel prostitutes about HIV and AIDS. This project started February 1994 after preparation of the project in the 'prostitution and drug use' subgroup of WOMEN AND AIDS. The co-ordinator followed RAP during the start-up phase but since the staff needed to establish the content and method of work themselves they found it disruptive to be part of an evaluation scheme at the same time. The co-ordinator therefore decided not to evaluate RAP. However, the project is described below.

Initiatives aimed at the self organisation of prostitutes were taken in 1991. The interest organisation, VI STÅR SAMMEN (Stick Together), has succeeded in editing a bimonthly periodical for its members and it also runs a hot-line on any prostitution related issue. But it has no systematic HIV/STD prevention programme.

Outside Copenhagen, only three initiatives have been taken to support female prostitutes. No services exist for male prostitutes but preparation for a project has been undertaken in one city. Aalborg was the first city to run a project, NATSVÆRMERNE (The Moths). The project ran in 1990-91 and focused on social aspects of prostitution. The municipality of Aarhus developed and implemented a project which combined social support and health counselling for prostitutes. The project ran during 1992 and outreach work in the risk groups continued after the project period as a part of the work of the social services department. A recent investigation by FIP (Fyre i Prostitution: guys in Prostitution) among male prostitutes in Aarhus points to the need to provide support for male prostitutes also. But until now there has been little interest among officials in establishing outreach work and councelling male prostitutes. Finally, a drop-in centre for drug using female prostitutes was established in Odense in 1993 by KFUK. Its aims and methods correspond to those of Reden in Copenhagen.

This section of the report thus first describes the activities of RAP in Copenhagen. The HIV prevention outreach work in Aarhus municipality is also described at some length as Aarhus is the only city in Denmark so far to have implemented outreach work aimed at HIV prevention in collaboration with the STD clinic in the city. Next, the evaluation process and its outcome in Reden in Copenhagen is summarised. Finally, the results of an EUROPAP investigation on the social and medical needs of 'indoor' prostitutes in Copenhagen are summarised. The focus is partly on the encounter between prostitutes and the health sector, partly on the interest among the prostitutes for a centre which could deal with health and social problems of individual prostitutes.

RAP (Prostitutes Council Prostitutes)

RAP started in February 1994 with the aim of contributing to the prevention of HIV and STDs among female prostitutes in Denmark. This was achieved by a combination of outreach work in the different milieus, telephone counselling and training prostitutes themselves in peer support and counselling. To secure the start-up phase of RAP, money was found by WOMEN AND AIDS to employ a former prostitute who was experienced and trained in HIV counselling. RAP has been supported by the national AIDS secretariat and by the PUF-pulje (a pool for support to self-help organisations and initiatives). A range of activities has been carried out by RAP during its first year. A pamphlet on HIV/STDs and prostitution - Safe sex: Avoid working hazards - was finished and translated into English and Thai. The telephone line was opened for two hours each week and arrangements were made for five prostitutes to take part in telephone counselling. Training in counselling those with or who may have HIV/STDs was arranged. The attendance at training and phone counselling sessions was expected to be unstable or low, as prostitutes do not like to lose their anonymity, not even towards other prostitutes. They also lack sufficient spare time. At the training sessions one of the five peer counsellors showed up. Moreover, they all showed up regularly for their monthly day on 'duty'. Outreach work started in June 1994 with the project worker and a few prostitutes. Total anonymity was perceived as a precondition for contact building between the project worker and the prostitutes. She was well received at the massage parlours. Her former experience in the field enabled easy access and almost all the prostitutes appreciated her visit. The pamphlet was received with great interest. The Thai prostitutes especially appreciated the discussions on safer sex. The employee also frequently phoned the parlours and counselled the women about HIV/AIDS. But the prostitutes rarely called the hot-line. This was partly due to the lack of problems with HIV, partly due to the method chosen to advertise the existence of the hot-line. In order to secure anonymity, the hot-line was not advertised generally but cards with information on RAP and the phone number were handed out whenever the project worker visited the prostitutes. RAP also organised three evening gatherings on special topics with invited lecturers. The themes chosen were: the legal rights of prostitutes; keeping ones limits; spanking. Only two to five prostitutes attended the sessions. RAP has therefore decided to suspend these gatherings and use the resources for outreach work. The project worker visited bars and massage parlours which had Thai prostitutes throughout the period and established good contact with some Thai women, especially in one bar and half of the parlours with Thai prostitutes (8-10 parlours). The experience proved that contact needs to be developed during a prolonged period. To help these women, RAP has organised and secured money for teaching in Danish on the subjects of client negotiation and safe sex. The last major area of RAP work has been the organisation of a weekend for drug using prostitutes. The theme of the weekend was 'prostitution, violence and HIV' and besides direct teaching a lot of effort was put into providing care and support for the women. The major conclusion to be drawn from the first year's work by RAP is that getting in contact with various parts of the target group takes time, especially due to the high degree of discretion needed and the very few prostitutes involved in the work. As anticipated, the attendance at activities and training sessions was low. Very few also took the initiative to call the hot-line. But the outreach work aimed at both Danish and Thai prostitutes seems to be successful. Thus, outreach work has been much more appropriate than counselling by phone.

HIV Prevention Among Female Prostitutes in Aarhus: an Outreach Programme of the Municipality of Aarhus

In 1991, DAPHNE and the Municipality of Aarhus assessed the intervention needs in three areas of female prostitution in Aarhus:

  • psycho-social counselling and treatment;
  • special support to very young prostitutes who wish to leave the business;
  • AIDS/HIV prevention by means of an outreach information campaign among prostitutes.

The local authority decided to start a project to deal with these issues. Staff were selected and relocated among persons already employed by the departments of health and social welfare. A small amount of money (25,000 D.Kr) (3,300 ECU) was donated by the local authority's AIDS prevention fund. The AIDS prevention programme was developed and implemented in 1992 by two social workers. They identified a profound lack of materials dealing with the issue of 'safe sex for prostitutes' and therefore produced a video tape on the issue. Outreach work took place over the following eight months. At the beginning co-operation was initiated with the section of the social services department that provides anonymous counselling for people experiencing a social crisis. Co-operation also began with the STD clinic at Marselisborg Hospital. In accordance with the wishes of some prostitutes, special opening hours at the clinic (4 hours a week) were introduced for prostitutes and a psychologist was assigned to the clinic during these hours. The project found that more than 125-150 prostitutes worked in massage parlours, 20-30 women worked from one of the city bars, and an unknown number worked as street prostitutes (16 were contacted during outreach work on the streets). Occasionally, prostitutes also worked from inns and cafes, or they had clients referred to them by taxi drivers. Three of the massage parlours were staffed by Thai or African women. Only 4 of the 16 street women were IVDUs. Thus, the overwhelming majority of the prostitutes were Danish, not on drugs, and worked in massage parlours. The project did not attempt to reach male prostitutes but the social workers were told by people engaged in the 'Stop AIDS Campaign' of the Gay and Lesbian Movement that more than 25 male prostitutes worked in the area. Eighty prostitutes were counselled about HIV and STDs during the outreach period. With one exception the social workers managed to reach all of the 27 massage parlours in the city. They were well received by the prostitutes who showed great interest in the information provided about HIV and 'safe sex', although they were already very knowledgeable. The prostitutes reported a high rate of condom use with clients. However, condoms were not used with private partners, and the women were uncertain about the risk of acquiring HIV or STDs through oral sex or S.M. Also, they were not familiar with the appropriate response to condom breakage. All contacts were offered the 'safe sex' video tape, pamphlets and free condoms, and they were informed about the service for prostitutes at the hospital. Psycho-social problems often came up during visits to the massage parlours, especially where visits were repeated. The woman was then referred to the anonymous social counselling service. But in most cases, the woman expressed distrust of the social system, and the prostitutes seldom made use of this opportunity to get help. Two concrete factors were identified as barriers in the way of their contact with the social security system. First, the women were worried that their children might be taken away from them by the authorities. Secondly, as most prostitutes received some kind of social benefits, they were afraid of being charged with fraud.

Other major conclusions:

  • it is possible to communicate information about AIDS and STDs to prostitutes in all of the settings, provided that outreach work continues for a prolonged period of time;
  • the prostitutes were very content to receive the information on HIV, STDs and 'safer sex'. They were asked to pass on the information to their colleagues and to their customers but they seldom did so;
  • many of the women expressed a wish to discuss their prostitution related experiences with others but found it difficult to do so in the work setting; furthermore, communication or social contact with other prostitutes outside the work place was rare;
  • drug using street prostitutes did not carry condoms when at work;
  • the prostitutes from Thailand and Africa were vulnerable to acquisition and transmission of HIV and STDs as they did not speak the language, had no access to the medical system, had no social security rights due to their 3 months tourist status, or due to a lack of residence permit. They claimed to use condoms but appeared inexperienced in the handling of condoms and condoms were not always available at their workplace. Among the Thai prostitutes in the massage parlours a 'third person' negotiated the concrete details of their sexual service to clients.

Recommendations:

  • staff from the district offices of the social services department should be educated about tell-tale signs of prostitution among social clients and how best to support these clients;
  • employees at clubs and homes for young people should have a similar offer of education;
  • active support should be considered for prostitutes who wish to start self-help groups and peer education;
  • an alternative to counselling at 'the acute centre' for people in a social crisis should be investigated;
  • AIDS /safe sex information and other services for male prostitutes should be initiated;
  • a delivery system for free distribution of condoms to street prostitutes should be arranged;
  • continued outreach work and counselling among prostitutes from the Third World is essential. Materials informing them about HIV and STDs should be produced in their native language.

Most of these proposals have yet not been taken up by the local authorities. But the social services department decided to make the outreach counselling on HIV/STDs permanent and it is now integrated as part of the work of the centre for young people. Periodic outreach work took place in 1993 and 1994. Recently, the outreach team was changed. A former prostitute was trained in HIV prevention and started to visit prostitutes with one of the social assistants. All prostitutes contacted during October and November 1994 were unknown to the assistant, pointing to the importance of frequent recurrent outreach work in the milieu. The offers of free access to a psychologist and the possibility of anonymous counselling at the acute centre have not become more popular. As a consequence, the social services department is considering the inclusion of a social worker in the outreach team. The intention is to make the social worker a familiar face in the milieu. It is a moot point whether a social worker (representing the social system) can create an atmosphere in which prostitutes are confident enough to discuss their situation with their district office. This is especially so since there is no common response throughout the social system to fraud. Thus, a month ago, a former prostitute was charged with fraud and tried in a major Danish city after being reported to the police by her social worker. The woman was sentenced to 200 hours community service and to repay the full amount of the social benefits she received during the time that she also worked as a prostitute. This does not occur very often since many social workers are more flexible and supportive and both types of reaction are allowed for by the law. But the point is that a prostitute does not know in advance, how her (his) social worker will respond.

The STD clinic in Aarhus still has special opening hours for prostitutes. Experience with this service is mixed. At times outreach work in the milieu leads to more prostitutes showing up for a consultation. Fifteen prostitutes now have an understanding with the staff that they will be notified every third month. But they often do not show up, especially in between the outreach periods. This seems to be because it is inconvenient rather than because of resistance on behalf of the prostitutes. The number of massage parlours staffed by foreign prostitutes has increased since 1992, especially those with Thai women (9-10 massage parlours now employ Thai women). Outreach work in these places a year ago resulted in some turbulent reactions but also led to the establishment of an agreement between the STD clinic and key contacts in the milieu. The Thai prostitutes now make regular visits to the clinic for HIV tests and STD checkups. The question arises of what will happen should one of the women test HIV positive in the future. If the woman stays in Denmark on a tourist visa she has no right to receive treatment and she is unlikely to receive support and counselling beyond the counselling provided by the clinic staff who inform her that she is HIV seropositive. She may have to conceal information about her HIV status in order not to be sent home. In order to prepare for such an eventuality more information on the living and working conditions of Thai prostitutes is needed. The purpose and possible outcome of the visits to the clinic should also be reconsidered. To sum up: Aarhus municipality is the only local authority so far to have set up a joint project between the social services and a STD clinic in the city. It was and remains possible to reach women working at massage parlours and on the street through outreach work, while bar and escort prostitutes were difficult to reach. The prostitutes are very interested in receiving information about HIV and AIDS. Though their clients are already consistent condom users, they often do not know what to do if the condom breaks and they often are uncertain about risks associated with oral sex. Due to the turnover of prostitues and the lack of communication between those working at the same workplace, repeated visits to each workplace are needed throughout the year. Many prostitutes seem to use the contact as an occasion to discuss more serious work related problems. They do not seek help with these problems in the social service departments as they fear being accused of benefit fraud and some also fear having their children removed.

Evaluation: HIV prevention support to the users of REDEN

The Christian Foundation for Young Women (KFUK) has provided social support since 1947 to prostitutes and other women in the poorer district of Copenhagen, close the central station. In 1983 KFUK opened REDEN, a drop-in centre and a base for outreach work in the area. The centre is today staffed by a manager, six paid workers and 16-17 volunteers. The salaries of two of the staff and half of the centre's rent are reimbursed by the public authorities and KFUK itself covers the remaining expenses. Reden is open to all visitors every weekday between 10am and 10pm (Sundays 15pm to 10pm), and outreach work is done once a week in the area. Reden has 1000-1200 visits each month and comes into contact with approximately 350 street prostitutes over the course of a year. The users (note: the clients of Reden will be referred as 'users' in order to avoid confusion with the clients of the prostitutes) are all drug users, most are IVDUs. Two thirds are homeless. The prime objective of Reden is to motivate the women to stop their drug abuse (and thus their need to work as prostitutes) but Reden places no pressure on the users. A drug treatment programme is run from a separate location in Copenhagen, aiming at detoxification, followed by residence on a farm and reintegration into social life. Reden also counsels prostitutes who prefer to continue with their sex work. Finally, Reden offers food and tea to the women and provides a place of refuge; men are not allowed to enter. Until 1991 Reden was situated right in the centre of street prostitution but the police started to hound the women on the street three years ago and they now work in some of the nearby streets. Evaluation of the AIDS prevention activities in Reden took place between August and November 1994. The evaluation was limited to sexual transmission of HIV as Reden refuses to allow drug use, drug dealing, or the cleaning of needles inside the house. Clean needles are available through needle exchange services at several pharmacies in the area. The prime objective was to help the prostitutes to protect themselves better against infection by HIV and STDs and to address this issue within a broad approach of client-prostitute interaction. The street prostitutes are vulnerable to assaults and violence due to their working conditions and due to their sometimes confused condition when providing a service to a client. 'Safe sex' therefore only constitutes a part of a broader category of 'safe client contact'. Three concrete objectives for evaluation were set:

  • to assess the appropriateness of the remedies (condoms etc.) distributed by Reden;
  • to assess the extent of safe and unsafe sex by the prostitutes;
  • to spread the message of safer sex to the users by the staff at Reden.

An active research method was chosen, involving the project workers in the process of collecting information on the sex work of the women and also involving the staff in decisions about what to investigate and how to make appropriate changes in getting across their message and the distribution of their materials. The evaluation had two phases: the first month was used by the evaluator to conduct participant observation in Reden. During the following three months the staff was involved in the investigation and in implementation of the changes. Observation of user-employee interaction in Reden during the first month revealed that condoms were distributed without much information provided about their use. A prostitute typically might ask for five condoms. When asked about what type she preferred it was not unusual to hear answers like: "I don't know, the same as last time", or: "It doesn't matter, just give me five". But most women asked for a special type or a mixture. Condoms have been delivered free of charge to Reden from the municipal health officer since 1986. Reden is free to choose among 10-15 different types of condoms, all the same brand. At the beginning of the evaluation five different types of condoms were distributed to the prostitutes but lubricants or other contraceptives were not available. Conversation with the staff revealed great enthusiasm for the message of 'safer sex' to the users. But several employees were uncertain about specific practices, including the appropriate response when condoms break. Employees already showed an awareness of the dangers of violence and assault but many did not know where the women went with their customers and the type of services they usually provided. Concise guidelines to 'safer sex precautions' were written and handed out to the staff. A short questionnaire on condom use by the prostitutes was also developed. It was not intended to collect a large number of filled-in questionnaires. The aim was to let the employees conduct the interviews in order to widen their knowledge of the issues and the language used. All employees therefore were encouraged to interview one or more of the prostitutes (one at a time). Three employees conducted 12 interviews. Many of their colleagues expressed a desire to participate in the interviewing but since it had been a rather turbulent period at Reden, they had not found time for it. During an organised discussion with all employees, their experiences with interviewing - especially the more surprising responses - were related and in this way a collective pool of knowledge emerged within the group. The frequent use of two condoms at once had been the most surprising revelation to emerge from the interviews. But rather frequent condom splitting also caused concern. Only one interviewee had never experienced breakage of a condom and half the women had experienced breakage within the preceding 6 months. Among all the interviewees only two had reacted 'correctly' in that situation. Washing, sluicing, and insertion of fingers and various objects to clean the vagina was frequently reported by the prostitutes. Three of the prostitutes used lubricants while the rest used their own saliva - or nothing at all. Almost all interviewees were keen to get access to lubricants and nonoxynol-9 suppositories.

The discussion led to the following conclusions:

  • It is a task of all project workers to discuss condom use and other 'safe sex' practices with the users of Reden.
  • These issues were already discussed with some users sometimes but in order to ensure discussions with all users, a more systematic method of communication should be introduced. Then, for a period, frequency of and response to condom rupture should be discussed with any woman who asked for condoms.
  • A pamphlet with information on safer sex practices and response to condom breakage should be handed out to the prostitutes who only use Reden as a place to pick up condoms (these women never stay long enough for a conversation).
  • Several employees felt that they knew too little about the working conditions and experiences of their users; it was therefore decided to expand the questionnaire on this issue.
  • Lubricants (without nonoxynol-9) in small tubes and suppositories (containing nonoxynol-9) for distribution to the users should be arranged.

The decisions were put into effect and the results evaluated three months later. During this period there were repeated complaints from the prostitutes of price undercutting and of increased demands from clients for sex without condoms. One prostitute called for a meeting in order to reestablish a common price level and a common practice of condom use. Many of the prostitutes claimed to be interested in the meeting but only two showed up. The meeting led to a stabilisation of the prices charged due to a minimum prices list put up at Reden - probably because the list also contained threats to beat up those who undercut prices or offered a service without condoms. A few of the prostitutes also participated in a weekend seminar on violence and safe sex, arranged by WOMEN AND AIDS. When asked later about what emerged from the seminar, they agreed that they were in a better position to protect themselves. But they passed on almost nothing of their experiences to other prostitutes at Reden. Six of the staff conducted another nine interviews, making use of the expanded questionnaire. The pattern of condom rupture and use of condoms and lubricants did not diverge from that of the first 12 interviewees. Four of the nine women had experienced enforced intercourse without a condom but they all reported attempts by customers to enforce such sex or to cheat with the condom. Furthermore, five of the women had suffered a severe violent assault at the hands of a client but only two had reported the episode to the police. To sum up: the prostitutes might be at risk of exposure to the semen of their clients due to inappropriate condom use. But they also from time to time encounter a customer who simply enforces his will. Two other factors influence the risk of exposure to diseases. To begin with, the women who inject drugs need 7.500-14.000 Dkr (1-2.000 ECU) each week to pay for their drugs. With a mean price of 350 Dkr (45 ECU) for 'Danish' (vaginal) intercourse an IVDU requires many clients to cover the cost of drugs. Desperation is likely on occasion to drive some of the prostitutes to accept different conditions for their service but this is very difficult to investigate. On the surface, all prostitutes claim always to use condoms during sex. The last - and perhaps the most important - factor influencing the risk of exposure to disease concerns how the prostitutes relate to their non-paying partners. Only one of the 21 prostitutes that were interviewed claimed that she would not have intercourse with a boyfriend if he refused to use a condom. Six women claimed not to have a boyfriend and professed a lack of interest in finding one. The remainder did not use condoms with their boyfriend or had not done so the last time they had a stable partner. In general, the argument went: 'boyfriends do not have affairs on the side'. In comparison, all the IVDUs claimed never to have borrowed needles from other IVDUs. Quite a lot of street prostitutes do not have a boyfriend but when they do, the boyfriend is usually himself an IVDU and might be HIV seropositive. However, the prostitutes connected the risk of HIV transmission to drug injections and with the prostitution necessary for buying the drugs. In their private affairs, they did take precaution not to acquire HIV from the infected equipment of their boyfriend but sex with the boyfriend was seen as quite a different issue. A pilot distribution of lubricants and nonoxynol-9 suppository free of charge to the users of Reden was introduced. These items were only handed over after counselling on how to use them and it was especially emphasised that a suppository*

EDITOR NOTE:  Most consider a suppository to be anally inserted.  We believe this article refers to a vaginal insert - sometimes called a "vaginal suppository".  We inject this only for clarification. 

is not as safe as a condom and should only be used in case of an 'emergency'. The staff also checked that none of the prostitutes frequently received suppositories as this would indicate that they had replaced condoms by suppositories. An organised discussion with the employees was conducted towards the end of the evaluation. The discussion picked up on experiences from the new interviews, assessed the efficiency of the distribution of lubricants and suppositories, and assessed the outcome of safer sex messages on the users. The staff concluded:

  • lubricants and suppositories were well received by the prostitutes. Several women had informed the staff that they had made use of the suppository when a condom ruptured. After initial success the lubricants became less popular, partly because the tube was unwieldy, partly because the cream was too fluid;
  • the users frequently complained of condom breakage and claimed this to be due to the bad quality of the condoms. The quality of the condoms seemed acceptable, with the possible exception of the non-lubricated condom (used for oral sex); this condom was frequently reported to break;
  • all but one of the condom types were delivered in strips of five and had identical wrapping, when removed from the 10 piece packet;
  • the condoms were delivered in strips of five. Perforation between the condoms was poor. Detachment of one condom from the strip often teared the wrapping of the next condom in the strip;
  • the condom delivery system was unstable. Reden ran out of stock for the most popular type of condoms during the period of evaluation. Such a temporary break in delivery had been experienced before;
  • all employees had talked to the prostitutes about 'safer sex' issues and all those receiving condoms had been informed. The group of prostitutes who made frequent visits to Reden now had been informed and showed no interest in further discussion of the issue for the time being;
  • a few employees stated that it might not be appropriate for all employees to take part in getting the safer sex message across. They felt that only those interested in this aspect of the life of the users ought to particpate in this in the future;
  • the prostitutes had no problem discussing their sex life but there had been a tendency to avoid discussions on the assaults and violence they had experienced, prefering to forget the episodes;
  • interest among the prostitutes in taking part in interviews had reached its maximum and it had become difficult of late to conduct interviews.

Overall, the staff concluded that they had gained new insight from the evaluation, especially on concrete issues like what to do in case of condom rupture. Most employees found that they had been able to pass this information onto the users too. The staff decided to continue distribution of suppositories and lubricants but to search for a better lubricant in more appropriate tubes. The municipal officer - or the condom manufacturer directly - should be informed about the problems experienced with the condom wrapping and quality of the condoms themselves. Thus, information about the condom should be written directly on the wrapping of each condom, the perforation should be better, and the supply more stable. It was further decided to stop the safer sex communication for a period but to repeat it after some months. Recently, better lubricants have been bought and will be introduced by the staff.

Needs assessment among female bar-, escort- and massage parlour prostitutes in Copenhagen (EUROPAP investigation)

In several of the EU countries centres have been established for prostitutes, centres that provide a broad range of services like medical check-ups, social councelling, consultation with a psychologist, legal advice etc. In order to assess the need for a centre for prostitutes in Copenhagen, in-depth interviews were planned and carried out. A total of 19 female prostitutes were interviewed: eight women working at massage parlours, five bar prostitutes and six escort girls. (Note: social worker Lene Nyvang was the main interviewer. A prostitute conducted the bar interviews, and social worker Hanne Zahle made a few of the interviews with escort girls). Each interview focused on working conditions, encounters with the medical system, and the need for services as experienced by prostitutes, both by women who had no plans to stop and by women who expressed a wish to end their sex work career.

MAIN RESULTS:
Long term consequences of prostitution were similar to those described by two other recent investigations in Denmark. They include addiction to drugs and/or alcohol, being in debt, sex problems with their private partners, and living in social isolation from other people. The longer they were involved in prostitution the more severe these problems became. But the degree of secrecy sustained by the women in regard to people outside prostitution , - especially vis-a-vis parents, children and other family members - also had a major influence on their current experience of wellbeing. This need for this secrecy is related to the widespread double moral standards in regard to prostitution in Denmark. The prevailing attitude is that prostitution is a 'natural' phenomenon but it would in no way be 'natural' for one's own daughter to work as a prostitute. Yet, secrecy is also forced upon the individual prostitute by the semi-criminalised legal status of prostitutes and by their fear of prosecution by the authorities for benefit fraud and fear of the state taking away their children. Consequently, none of those interviewed had told their social security office about their involvement in prostitution. All the interviewees had been examined for STDs at least once and most also had had a test for HIV. But only a few had had a medical check up within the last 12 months. The prevailing attitude of the interviewees was that prostitutes are not at risk of acquiring HIV or STDs because they protect themselves by using condoms. On the other hand, condoms do break and most also felt that they ought to have a regular check up. The reason why they had not been examined for a long time was usually put down to the lack of symptoms. This was much like not going to the dentist due to not having problems with one's teeth. All the massage parlour prostitutes said they would be interested in participating in outreach work with a doctor if a project was set up. So did the bar prostitutes except one. But it may be difficult to arrange a place to carry out a physical examination in the bars; all available space is usually in use. Escort girls cannot be visited in this way as they most do not have a regular place of work. Most prostitutes had a preference for male doctors - whether during outreach or in a clinic - since they were felt to be the most gentle during a physical examination. The prostitutes were told about the special opening hours at the STD clinic in Aarhus and asked whether they would like a similar arrangement at clinics in Copenhagen. None had heard about these special opening hours before and very few found the idea especially good. When discussing their latest check up, two thirds said they had contacted a STD clinic, the rest had been examined by their 'family doctor'. One of these women found it reassuring when she was being treated that the doctor knew about her prostitution but otherwise the prostitutes concealed their sex work activity when consulting the 'family doctor'. When in contact with a STD clinic, half had informed the staff about their sex work. None of these had experienced negative reactions from the staff as a result of this information. All interviews included some kind of councelling. HIV and STDs were discussed if the interviewee expressed a wish to do so or if responses from the interviewee revealed a lack of knowledge or inappropriate response in their dealings with clients. Frequently, interviewees did not know how to protect themselves in case of condom breakage. Uncertainty also persists on how and whether to use condoms during oral sex. Interviewees were divided on the usefulness of a centre with services aimed at prostitutes. Slightly less than half of the women expressed no interest in a centre. The lack of interest was strongest among escort girls who are also the prostitutes with greatest anonymity, even vis-a-vis other prostitutes in the milieu. They would not use the centre due to the risk of meeting other prostitutes at the centre. A few of those who found a centre to be an interesting idea thought that the centre should only provide professional services (social councelling, legal advice, medical check ups). The rest of the women (half of those interviewed) appreciated a centre with these functions but also felt that the centre could provide a space and an opportunity for social meetings, social rights meetings and self organisation. They all pointed to the importance of involving prostitutes in setting up the centre and deciding on its function.

AREAS WHERE EUROPAP HELPED PROMOTE HIV PREVENTION FOR PROSTITUTES

Promoting HIV prevention in Denmark includes applying for money, lobbying politicians, assessing unmet needs, elaborating models and proposals for intervention. EUROPAP DENMARK has been involved with all these areas during the last year. Fund raising and the development of a plan to address the social and health issues of prostitution throughout the country constituted a major task for EUROPAP, especially in the second half of the project period. The plan proposes to start-up prostitution outreach projects in several Danish cities. This work was done in collaboration with the PRO-line. Presentation of the plan to local authorities will hopefully result in a range of local and regional projects this year - or next year (we are still applying for money). EUROPAP also took more concrete HIV prevention initiatives. The evaluation of getting the message across and of condom hand outs at Reden resulted in better practice, sensitive safer sex messages between staff and users of Reden and introduced lubricants and nonoxynol-9 suppositories for distribution to the street prostitutes. Reden received the suppositories as a gift for pilot testing and EUROPAP bought the lubricants. A written report with a recommendation to freely distribute lubricants and suppositories to street prostitutes is in process and will be delivered to the municipal health officer. EUROPAP and the PRO-line also have collaborated on the distribution of pamphlets and remedies to a contact in the escort milieu. This particular person gets in contact with approximately 100 different escort girls in the course of 6 months. These girls will be offered lubricants and suppositories and instruction in their use as well as pamphlets on HIV and STDs. Condoms also will be available to those who forgot to bring them.

PROPOSALS FOR INITIATIVES IN DENMARK

A list of proposals for initiatives in Denmark is provided below.

  • A medical doctor should provide an outreach service in Copenhagen to prostitutes at massage parlours and bars, preferable in collaboration with a social worker.
  • A centre in Copenhagen for prostitutes with a range of services is unlikely to achieve success if established 'top down' but it might evolve from the medical outreach work mentioned above.
  • Free distribution of lubricants and nonoxynol-9 suppositories should be arranged for street prostitutes and escort girls, not only in Copenhagen but also in other parts of the country if reliable channels of distribution can be identified.
  • Barriers to anonymous STD check ups should be removed.
  • Outreach work among female prostitutes with provision for social support and councelling for HIV/STD prevention should be initiated in the major Danish prostitution cities. Such initiatives should also aim at establishing revised routines towards social clients active within prostitution.
  • Outreach work with provision for social support and councelling for HIV/STD prevention to male prostitutes in Jutland and Aarhus should be initiated.
  • The establishment of a new centre for social development and information will have prostitution as one of its themes. This is a major achievement. The centre should direct special attention to collecting information on male prostitutes and immigrant female prostitutes and develop a service for them. Research on clients across the prostitution milieus is also needed.
  • The law needs to be revised: prostitutes and their cohabiting family members should be decriminalised.

ACKNOWLEDGEMENTS

The work of EUROPAP took place as a result of cross-disciplinary collaboration between teacher/anthropologist Marianne Högsborg, Dr. Med. Anne Marie Worm and social worker Lene Nyvang. In addition, social worker Hanne Zahle conducted part of the escort interviews while a prostitute conducted the interviews with bar prostitutes and contributed valuable critical comments on other parts of needs assessment among female prostitutes in Copenhagen.

We would like to thank the 'Europe against AIDS' programme from the E.U. DG V and the AIDS - secretariat, the Ministry of Health, for the grant that made it possible to carry out the work of EUROPAP during the first year. We are also thankful to K›benhavns Venerea Klinik for collaboration and for providing work facilities.

Finally, we like to thank the prostitutes that participated one way or another in the project. Hopefully, their contribution will make social and health services better for prostitutes in the future.

LIST OF PROJECTS

  • PAF - Prostitution af Fyre
    Linnésgade 25 st - 1361 København K
    (+45) 33.33.81.67
  • REDEN
    V/ Dorit Otzen
    Gasværksvej 24 st.tv. - 1656 København V.
    (+45) 31.23.40.52
  • VI STÅR SAMMEN
    V/ Jackie Siwens
    Kløvervænget 5 - 4571 Grevinge
    (+45) 53.45.95.37
  • PRO-Linien
    V/ Lene Nyvang
    Gasværksvej 24 st.tv. - 1656 Kbh V
    (+45) 33.25.30.50
  • EUROPAP Denmark
    V/ Marianne Høgsborg
    Kbh's Venerea Klinik
    Rudolph Berghs Hospital
    Tietgensgade 31 d - 1704 København V
    (+45) 33.93.70.22/Fax (+45) 33.33.04.48
  • FIF (Guys in Prostitution)
    V/ AIDS co-ordinator Jens Thygesen
    Landsforeningen af Bøsser og Lesbiske
    Jægergårdsgade 42-44 - Postboks 362 - 8100 Århus C
    (+45) 86.13.19.48
  • AIDS and Prostitution Outreach
    V/ Lene Jensen
    KONTAKTCENTRET
    Valdemarsgade 18A - 8000 Århus C
    (+45) 86.13.61.00
  • RAP
    Skindergade 27, 2. TH - 1159 København K
    (+45) 33.33.88.82

REFERENCES

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Alary, M.; A.M. Worm & B. Kvinesdal: Risk Behaviours for HIV Infection and Sexually Transmitted Diseases among Female Prostitutes from Copenhagen. Int. J. of STD and AIDS 1994; 5.

Bechmann Jensen, Torben; Ida Koch; Annalise Kongstad & Anders Dahl: 'Prostitution i Danmark'. Copenhagen 1990 (Socialforskningsinstituttet).

Bjønholk, Janne: 'DAPHNE-Syndromet: om føgler af et liv i prostitution'. 1994 (Sydjysk Universitetscenter, Notat no.10).

Christensen, Bjørn & Birgitte Beckert: 'DAPHNE-CENTRET: treårigt udviklingsprogram om prostisatution. Vurdering af metoder og resultater'. Hornbæk 1994 (Evaluation Report; Konsulentkompagniet)

Dahl, Anders; Henning Jensen; Steffen Jöhncke; Lissi Rolandsen & Kai Vorf: 'Tr'æk af den mandlige prostitution'. Copenhagen 1988 (Projektgruppen, Kommunehospitalet).

The Daphne Centre: 'Prostitutionsdebut'. Copenhagen 1992 (Socialpolitisk Forlag).

The DAPHNE Centre: 'På vej ud af prostitution. Social-forvaltningens handlemuligheder'. Copenhagen 1994 (Socialpolitisk Forlag).

van Deurs, Susanne & Susanne Springborg: 'Prostitutionsliv'. Copenhagen 1988 (Gyldendal).

Døgnkontakten: 'Unge piger og prositution. Ops gende arbejde som metode'. Copenhagen 1993 (The Department of Social and Health Affairs, Municipality of Copenhagen).

Fisker, Jesper: 'Experiments as a Strategy for Change ? A Survey of Danish Projects within the Area of Social Welfare and Health.'. Copenhagen 1992 (AKF memo).

Høgsborg, M.; A.M.Worm; L.Nyvang & H.Zahle: 'Are Female Prostitutes in Denmark at Risk of Acquiring AIDS ?' Abstract. The congress: AIDS in Europe - the behavioural aspect. Berlin, September 1994.

Høigård, Cecilie & Liv Finstad: 'Baggader. Om prostitution, penge og kærlighed'. Copenhagen 1987 (Hans Reitzel. First version: Oslo 1986. English version 1992: Backstreets).

Høigård, Cecilie: 'The victim as expert: active and captive'. NORA 1993; no.1; pp 51-64.

Järvinen, Margaretha: 'Skal prostitution forebygges ?'. SOCIAL KRITIK 1991; 15; 16-22.

Jensen, Lene & Anita Bergmann: 'AIDS og prostitution, Århus 92'. Århus 1992 (Project Report; the Municipality of Århus).

Johansen, Birthe et.al.: 'Natsværmerne. Om prostitution i Aaborg anno 1991'. Aalborg 1991 (Project Report; The Youth Centre of the Municipality of Aalborg)

Krogsgaard, K. et.al.: 'Widespread use of condoms and low prevalence of STDs in Danish non-drug addict prostitutes'. BRITISH MEDICAL JOURNAL 1986; 293; 1473-74.

Madsen, Bente Østergaard: 'Et lys i mørket. Evaluering af "Reden" på Halmtorvet - KFUKs Sociale Arbejdes prostitutionsprojekt'. Copenhagen 1992 (CASA).

Mak, R.P. & J.R. Plum: 'Do prostitutes need more education regarding sexually transmitted diseases and the HIV infection ? Experiences from a Belgian city'. SOCIAL SCIENCE AND MEDICINE 1991; 33(8); 963-66.

Manata, Hanne et.al.: 'AIDS, prostitution og kommunikation'. Odense 1991 (Report to the County of Funen).

Patton, Michael Quinn: 'Qualitative Evaluation and Research Methods'. London 1990 (80) (Sage)

Pedersen, Knud Erik et.al.: 'PAF - opsøgende arbejde med mandlige prostituerede'. SOCIAL KRITIK 1992; 20; 39-44.

Rasmussen, Nell: 'Hvad ved vi om prostitution i Danmark ?' - postscript in Høigård and Finstad 1987.

Social- og Sundhedsforvaltningen i København: 'Socialt arbejde med mandlige prostituerede'. Copenhagen 1992 (The Department of Social and Health Affairs, Municipality of Copenhagen)

Socialministeriet: 'Redegørelse om prostitution.' Copenhagen March 1990 (The Ministry of Social Affairs).

Sørensen, Marie: 'HIV og prostitution'. Århus 1993 (Institute for Epidemiology and Social Medicine, University of Århus).

Sundhedsstyrelsen: 'Erfaringer vedrørende centrale/lokale kampagner. CEN/LOK 1989-1992.' Copenhagen 1992 (The ministry of Health).

Whyte, William Foote (ed): 'Participatory Action Research'. London 1991 (Sage).

AUTHORS

Marianne HØGSBORG
Anne Marie WORM Local coordinator:

 

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