St. James Infirmary: Statement of Support for AHPA’s “Addressing Law Enforcement Violence As a Public Health Issue” Policy Statement

  St. James Infirmary stands behind the American Public Health Association on adopting a recent policy statement addressing law enforcement violence as a public health issue. The APHA policy statement, “Addressing Law Enforcement Violence as a Public Health Issue”, acknowledges that law enforcement-centered approaches to public health disproportionately target marginalized communities[1].

We applaud the APHA for taking a position on the public health impacts of law enforcement violence–both physical and psychological. We commend the The End Police Violence Collective for authoring the policy statement. As a peer-based, sex worker led organization, we support public health approaches that engage with our community, and we are keenly aware that criminalization and policing only serve to further harm those who are already at the margins of society. Marginalized communities often times feel mistrust toward law enforcement as a result of witnessing, having a historical knowledge of, and being victim to abuses of power. Contact and involvement with the criminal legal system more often exacerbates, rather than mitigates, the cycles of trauma, poverty, and violence that too many people who trade sex experience.

St. James Infirmary is aware of increased law enforcement activity targeting the sex trades during our outreach program in the Mission District. The increased law enforcement activity coincides with the implementation of two programs in the Mission District, Law Enforcement Assisted Diversion Program (LEAD), and a sex worker abatement task force of the Mission PD. The LEAD program is intended to divert people who trade sex and people who use drugs to social services rather than criminal convictions. The sex work abatement unit is meant to increase criminal prosecution of clients and third parties. The increase of prostitution-related arrests in the Mission District correlates with the passing of FOSTA/SESTA[2] in April 2018, and community oriented policing tactics adhere to the demands of mostly white, property owning residents in the area[3].

Furthermore, policing initiatives that target buyers of sex intensify unsafe conditions for people who trade sex. These conditions include rushed negotiations that increase rates of HIV and violent encounters[4], a higher potential for trafficking situations, and increased poverty when a client base is unavailable[5]. Though we support the intention of LEAD programs to provide social services rather than incarceration, the fact that they are inherently initiated by law enforcement means that they violate numerous social work ethical standards[1], welcome profiling[2], and are unable to prioritize the safety and self determination of people who trade sex[3]. Police are not social workers, and police-centered initiatives reinforce inequalities in key determinants of health[4].  As noted in the APHA statement, programs that initiate police contact with marginalized communities increase opportunities and risks for physical and psychological violence.

We seek to hold law enforcement accountable through efforts such as the 2017 “Prioritizing Safety for Sex Workers” policy[5], but we know that relying solely on policing reform to uphold the safety of the communities we are a part of is not best practice from a public health standpoint. While we agree that providing access to resources is a needed alternative to incarceration, St. James Infirmary stands by the recommendations of the American Public Health Association. The APHA recommends for the decriminalization of “activities shaped by the experience of marginalization”, including sex work, and for the implementation of community-based programs for addressing violence and harm that do not involve law enforcement contact[6]. We believe these are necessary steps in order to combat stigma and the systemic oppression of people who use drugs, people experiencing poverty, and people who trade sex.

[1] E.g., people of color, immigrants, individuals experiencing houselessness, people with disabilities, the LGBTQ community, individuals with mental illness, people who use drugs, and sex workers. End Police Violence Collective. (2018, November 14). Addressing Law Enforcement Violence as a Public Health Issue [Policy statement]. Retrieved November 30, 2018, from

[2]Jackson, C. A., & Heineman, J. (2018). Repeal FOSTA and Decriminalize Sex Work. Contexts, 17(3), 74-75. doi:10.1177/1536504218792534

[3] Rodriguez, A. (2018, August 29). 'Sex Worker Abatement Unit' formed at Mission Police Station. Retrieved from

[4] Landsberg, A., Shannon, K., Krüsi, A., DeBeck, K., Milloy, M.-J., Nosova, E., Hayashi, K. (2017). Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting. Journal of Urban Health94(4), 563–571.

[5]Ham, J. (2011). Moving Beyond Supply and Demand Catchphrases: Assessing the Uses and Limitations of Demand-Based Approaches in Anti-Trafficking. Global Alliance Against Traffic in Women (GAATW).

[6]Wahab, S., & Panichelli, M. (2013). Ethical and Human Rights Issues in Coercive Interventions With Sex Workers. Affilia, 28(4), 344–349.

[7]Strangio, C. (2014, April 2). Arrested for Walking While Trans: An Interview with Monica Jones. Retrieved from

[8]Y. (2018). Diversion from Justice: A Rights-Based Analysis of Local “Prostitution Diversion Programs” and their Impacts on People in the Sex Sector in the United States(Working paper). New Haven, CT: Global Health Justice Partnership of Yale Law School and School of Public Health.

[9] End Police Violence Collective. (2018, November 14). Addressing Law Enforcement Violence as a Public Health Issue [Policy statement]. Retrieved November 30, 2018, from

[10] City and County of San Francisco, Department on the Status of Women. (2018, January 11). San Francisco Announces First-in-the-Country Policies to Support Sex Workers who are Victims or Witnesses to Violence in Reporting to Law Enforcement [Press release]. Retrieved December 16, 2018, from

[11] End Police Violence Collective, Addressing Law Enforcement Violence as a Public Health Issue. (see footnote 9).