Protecting sex workers in Thailand during the COVID-19 pandemic: opportunities to build back better.

The Government of Thailand was prompt to launch social and economic measures to mitigate the effects on the general population following lockdown measures to counter coronavirus disease 2019 (COVID-19). However, sex workers were one of the vulnerable groups who were unable to access state support. A rapid survey of sex workers in Thailand showed that almost all had become unemployed and lost their income as a consequence of the lockdown, restrictions on international flights into the country and the closure of entertainment venues. Most were unable to cover the costs of food and shelter for themselves and their dependents. COVID-19 had also disrupted testing and treatment for sexually transmitted infections and HIV services for sex workers. As in other countries, community-based organizations were essential to providing an immediate, short-term COVID-19 response for sex workers. Also as in other countries, the pandemic has demonstrated that many people's health and well-being depends on very fragile foundations. This presents a clear opportunity to build back better by committing to a longer-term vision for the overall societal inclusion of sex workers. Thailand should advocate for decriminalization of sex work and ensure sex workers are entitled to equal labour rights and inclusion in the government social protection programme. Progress in innovative government initiatives aimed at ending HIV stigma and discrimination show how structural change can come about through harnessing community-based organizations. In turn, HIV services for sex workers need to expand and incorporate targeted interventions to reduce sex workers' occupational susceptibility to COVID-19.

The impact of end-demand legislation on sex workers' access to health and sex worker-led services: A community-based prospective cohort study in Canada.

BACKGROUND: Following a global wave of end-demand criminalization of sex work, the Protection of Communities and Exploited Persons Act (PCEPA) was implemented in Canada, which has implications for the health and safety of sex workers. This study aimed to evaluate the impact of the PCEPA on sex workers' access to health, violence, and sex worker-led services. METHODS: Longitudinal data were drawn from a community-based cohort of ~900 cis and trans women sex workers in Vancouver, Canada. Multivariable logistic regression examined the independent effect of the post-PCEPA period (2015-2017) versus the pre-PCEPA period (2010-2013) on time-updated measures of sex workers' access to health, violence supports, and sex worker/community-led services. RESULTS: The PCEPA was independently correlated with reduced odds of having access to health services when needed (AOR 0.59; 95%CI: 0.45-0.78) and community-led services (AOR 0.77; 95%CI: 0.62-0.95). Among sex workers who experienced physical violence/sexual violence or trauma, there was no significant difference in access to counseling supports post-PCEPA (AOR 1.24; 95%CI: 0.93-1.64). CONCLUSION: Sex workers experienced significantly reduced access to critical health and sex worker/community-led services following implementation of the new laws. Findings suggest end-demand laws may exacerbate and reproduce harms of previous criminalized approaches to sex work in Canada. This study is one of the first globally to evaluate the impact of end-demand approaches to sex work. There is a critical evidence-based need to move away from criminalization of sex work worldwide to ensure full labor and human rights for sex workers. Findings warn against adopting end-demand approaches in other cities or jurisdictions.

Are genital examinations necessary for STI screening for female sex workers? An audit of decriminalized and regulated sex workers in Melbourne, Australia.

BACKGROUND: The Victorian legislation prohibits sex workers from working when they have visible anogenital herpes or warts. The aim of this study was to determine the proportion of asymptomatic female sex workers (FSW) diagnosed with anogenital herpes or warts by genital examination. METHODS: We analysed all computerised medical records of consultations with FSW at the Melbourne Sexual Health Centre (MSHC) in 2018. All asymptomatic sex workers were offered screening sexually transmitted infections (STIs) and a genital examination to identify visible anogenital herpes or warts at MSHC. FSW consultations were categorised into either 'asymptomatic' or 'symptomatic' based on the presence of symptoms reported by the FSW to the triage nurse. The proportion of asymptomatic FSW diagnosed with visible anogenital herpes or warts during a routine screening examination was calculated. RESULTS: In 2018, 4055 consultations were provided to 1979 FSW. 3406 of these consultations were asymptomatic and all were examined by an experienced clinician for signs of STIs. Of these 3406 asymptomatic consultations, seven FSW (0.21%, 95% CI: 0.08% to 0.42%) were diagnosed with visible anogenital herpes and/or warts following a genital examination. Four were diagnosed with warts (0.12%, 95% CI: 0.03% to 0.30%), two with herpes (0.06%, 95% CI: 0.01% to 0.21%) and one with both herpes and warts (0.03%, 95% CI: 0.001% to 0.16%). CONCLUSION: Based on these data, approximately 500 asymptomatic FSW would need to be examined to identify one case of anogenital herpes or warts. Genital examinations consume considerable clinical resources, increase the duration of consultations and provide essentially no significant benefit to the mandated testing for gonorrhoea, chlamydia, HIV and syphilis. Our clinic will use self-collected samples and no longer examine FSW who are asymptomatic.

The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City.

Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (ß = 0.71, p = 0.037), in daily sex work (ß = 1.32, p = 0.026), arrested in the past 12 months (ß = 1.44, p<0.001) or injecting drugs in the past 3 months (ß = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations' health outcomes, including HIV risk.

The Influence of Legal Brothels on Illegal Sexual Service Purchasing Habits: The U.S. Context.

In this study, we use a survey of sex workers' clients to examine the relationship between having paid for services in legal brothels in Nevada and paying for criminalized sexual services among male clients. Using ordinary least squares (OLS) and generalized ordered logistic regression models, the use of legal brothels is found to be negatively related to reported purchasing of criminalized sexual services, regardless of criminal history, income, and most other demographic factors. When tested by criminalized purchase context, purchases made using the Internet, from public, outdoor contacts (such as the street) and indoor, public contacts (like bars), were less likely to occur with brothel experience. This study addresses a critical gap in scholarship on sex workers' clients purchasing choices with consideration to both market choice and frequency of purchase when having been exposed to a legal replacement for an illegal transaction. Implications and areas of further study are discussed.

[The German prostitute protection act and its implementation: Stocktaking from the Public Health Office of the city of Dresden]. / Das Prostituiertenschutzgesetz und seine Umsetzung: eine Bestandsaufnahme aus dem Gesundheitsamt Dresden.

On July 1, 2017 the German sex workers protection act came into force. Numerous institutions and groups expressed their disagreement towards this action in preceding discussions. A major criticism was the underlying one-sided understanding of prostitution and on the dilution of protective spaces for sex workers resulting from control by the authorities. Nevertheless, the law was adopted. Legal basis As the act is to be implemented by municipalities, the federal states were obliged to implement the laws. In the federal state of Saxony, the adoption was delayed considerably, since initially it was unclear which department had the responsibility to implement the law. Furthermore, there was a long-lasting political need for clarification regarding the burden of additional finances on municipalities. Only on July 26, 2018 was the sex workers protection act implemented in the federal state of Saxony. Experiences In the city of Dresden, structural conditions were established, allowing a clear separation between the processes of health counselling by the Public Health Office and the registration of the sex workers by the Public Order Office. Also, the different services of the Public Health Office are kept physically separate due to competing federal laws. Simultaneously, a new specialist area was created including both counselling centres, which thus prevents different standards in the services provided for sex workers within the Public Health Office. Whether the sex workers protection act serves the intended purpose may be doubted. The city of Dresden has made an attempt to counteract the negative consequences of the law by implementing clear structures and internal standards.

MATCH: A New Approach for Differentiating & Linking Series of Sex Worker Homicides and Sexual Assaults.

Sex workers as a group are one of the more common targets in serial homicide, yet the most likely to go unsolved. Part of the reason for this is the difficulty in linking individual crime scenes to a series, especially in those series where offenders not only target sex worker victims but also target non-sex worker victims. Inconsistencies in both victim targeting and behaviors engaged in across series add to the difficulties of linking and solvability in these types of crimes. The current study aimed to add to the current body of literature on serial crime linkage by examining not only the most salient behavioral indicators useful for crime scene classification of serial homicides that involve sex worker victims but also examine the trajectories of behavioral change that can help link apparently inconsistent crime scenes and proposes the new Model for the Analysis of Trajectories and Consistency in Homicide (MATCH). The study examines 83 homicide series, including 44 (53%) series where all victims were sex workers and 39 (47%) series that included a mix of sex workers and non-sex worker victims. Using the MATCH system allowed for the majority of series to be classified to a dominant trajectory pattern, over half as many as a traditional consistency analysis that focusses on behavioral similarity matching. Results further showed that Sex Worker Victim series were almost three times more consistent across their series than Mixed-Victim series, not only in victim selection but also in the overall behavioral patterns. Findings are discussed in line with theoretical and psychological issues relating to understanding the nature of behavioral consistency and the importance of going beyond simple matching toward a model that allows for the identification of consistency in seemingly inconsistent series, as well as investigative implications relating to linking serial crimes.

Sex Worker Homicide Series: Profiling the Crime Scene.

Contrary to popular misconceptions, offenders who kill sex workers as part of their series exhibit substantial variability in their victim selection and behavioral patterns, thus creating additional issues for the investigation of these crimes. This article first aims to outline differences in the demographics of crime scene actions present in homicide series with exclusively sex worker victims and series that includes both sex worker and non-sex worker victims, with the aim of understanding the crime scene aetiology of these two different types of series. Second, the research aims to determine between-series differences of victimology as well as crime scene action between sex worker series and mixed-victim series. Third, the research focuses on mixed-victim series and aims to determine the within-series similarities of victimology and crime scene actions, that is, what factors link sex worker victims and non-sex worker victims in the same series. Data were collected through a large-scale review of international media sources to identify solved serial homicide cases that have included at least one sex worker. Of the 83 series looked at, 44 (53%) included sex worker victims only, and 39 (47%) of the series included both sex worker and non-sex worker victims. The findings highlight the challenges that these types of crime present for investigation and the implications they have on current crime analysis research and practice, and results are discussed in line with theoretical and psychological issues relating to understanding differentiation and similarity, as well as investigative implications relating to linkage blindness and linking of serial crimes.

"The Prostitution Problem": Claims, Evidence, and Policy Outcomes.

Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.

Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies.

BACKGROUND: Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur. METHODS AND FINDINGS: We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. CONCLUSIONS: Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.

[Sex workers and public health: intersections, vulnerabilities and resistance]. / Trabajadores del sexo y salud pública: intersecciones, vulnerabilidades y resistencia.

Since the 19th century with syphilis and most recently with AIDS, sex workers have been seen as a means for disease transmission and a public health problem that requires intervention. However, researchers have shown that in Western countries, HIV rates in people involved in commercial sex are low, except for in specific groups, such as intravenous drug users. Moreover, the risks faced by sex workers due to stigmatization and other forms of violence have been put into evidence. Based on an urban ethnography with street sex workers carried out in Porto (Portugal), between 2004 and 2005, this article discusses the social, labor, and legal vulnerabilities affecting people involved in commercial sex and how these interfere with their health. Focus is placed on the strategies used by sex workers to minimize health risks and their discourses of resistance in fighting vulnerabilities.

Effects of implementing the act of prohibition on sex trafficking on female sex workers' sexually transmitted infections.

This study investigated the effect of implementing the act of prohibition on sex trafficking (PST) on sexually transmitted disease (STD) infections among South Korean female sex workers (FSWs) working at prostitution blocks. Research data were collected twice through the Korean government-sanctioned survey for female sex workers (1st wave = 1,083; 2nd wave = 926). We examined the associations among health behavior, working conditions, and the effect of PST act via hierarchical logistic regression analyses using propensity score matching. After adjusted covariates, the risk probability was 0.288 times lower among FSWs who had remained in prostitute blocks after the PST act enforcement compared to FSWs who had worked before the PST. Similarly, the risk probability for a gonorrhea infection was 0.219 times lower among FSWs who had remained in prostitute blocks after the PST act compared to FSWs who had worked before the PST. Therefore, this study showed that, besides already known factors, the implementation and establishment of the PST Act was a strong factor that suppressed STD infections among FSWs.

Key populations and human rights in the context of HIV services rendition in Ghana.

BACKGROUND: In line with its half century old penal code, Ghana currently criminalizes and penalizes behaviors of some key populations - populations deemed to be at higher risk of acquiring or transmitting Human Immunodeficiency Virus (HIV). Men who have sex with men (MSM), and sex workers (SWs) fit into this categorization. This paper provides an analysis of how enactment and implementation of rights-limiting laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. The paper derives from a project that assessed the ethics sensitivity of key documents guiding Ghana's response to its HIV epidemic. Assessment was guided by leading frameworks from public health ethics, and relevant articles from the international bill of rights. DISCUSSION: Ghana's response to her HIV epidemic does not adequately address the rights and needs of key populations. Even though the national response has achieved some public health successes, palpable efforts to address rights issues remain nascent. Ghana's guiding documents for HIV response include no advocacy for decriminalization, depenalization or harm reduction approaches for these key populations. The impact of rights-restricting codes on the nation's HIV epidemic is real: criminalization impedes key populations' access to HIV prevention and treatment services. Given that they are bridging populations, whatever affects the Ghanaian key populations directly, affects the general population indirectly. The right to the highest attainable standard of health, without qualification, is generally acknowledged as a fundamental human right. Unfortunately, this right currently eludes the Ghanaian SW and MSM. The paper endorses decriminalization as a means of promoting this right. In the face of opposition to decriminalization, the paper proposes specific harm reduction strategies as approaches to promote health and uplift the diminished rights of key populations. Thus the authors call on Ghana to remove impediments to public health services provision to these populations. Doing so will require political will and sufficient planning toward prioritizing HIV prevention, care and treatment programming for key populations.

Sex Work Criminalization Is Barking Up the Wrong Tree.

There is a notable shift toward more repression and criminalization in sex work policies, in Europe and elsewhere. So-called neo-abolitionism reduces sex work to trafficking, with increased policing and persecution as a result. Punitive "demand reduction" strategies are progressively more popular. These developments call for a review of what we know about the effects of punishing and repressive regimes vis-à-vis sex work. From the evidence presented, sex work repression and criminalization are branded as "waterbed politics" that push and shove sex workers around with an overload of controls and regulations that in the end only make things worse. It is illustrated how criminalization and repression make it less likely that commercial sex is worker-controlled, non-abusive, and non-exploitative. Criminalization is seriously at odds with human rights and public health principles. It is concluded that sex work criminalization is barking up the wrong tree because it is fighting sex instead of crime and it is not offering any solution for the structural conditions that sex work (its ugly sides included) is rooted in. Sex work repression travels a dead-end street and holds no promises whatsoever for a better future. To fight poverty and gendered inequalities, the criminal justice system simply is not the right instrument. The reasons for the persistent stigma on sex work as well as for its present revival are considered.

Trabajadores del sexo y salud pública: intersecciones, vulnerabilidades y resistencia / Sex workers and public health: intersections, vulnerabilities and resistance

RESUMEN Desde el siglo XIX, con la sífilis y, más recientemente, con el sida, lxs trabajadorxs del sexo pasaron a ser vistos como medios de transmisión de enfermedades y como un problema de salud pública que requiere intervención. Sin embargo, las investigaciones han demostrado que, en los países occidentales, la tasa de VIH en personas involucradas con la venta de sexo es baja, con excepción de grupos específicos, como los consumidores de drogas por vía inyectable. Además, se han puesto en evidencia los riesgos a los que están sometidos lxs trabajadorxs del sexo, por vía de la estigmatización o de otras formas de violencia. En este artículo, a partir de una etnografía urbana con trabajadorxs del sexo de calle, llevada a cabo en la ciudad de Porto (Portugal) entre 2004 y 2005, discutimos las vulnerabilidades sociales, laborales y jurídicas que afectan a las personas involucradas en el comercio del sexo y cómo interfieren en su salud. Nos centraremos en las estrategias de lxs trabajadorxs del sexo para minimizar los riesgos para la salud y el discurso de resistencia en el combate a las vulnerabilidades.

ABSTRACT Since the 19th century with syphilis and most recently with AIDS, sex workers have been seen as a means for disease transmission and a public health problem that requires intervention. However, researchers have shown that in Western countries, HIV rates in people involved in commercial sex are low, except for in specific groups, such as intravenous drug users. Moreover, the risks faced by sex workers due to stigmatization and other forms of violence have been put into evidence. Based on an urban ethnography with street sex workers carried out in Porto (Portugal), between 2004 and 2005, this article discusses the social, labor, and legal vulnerabilities affecting people involved in commercial sex and how these interfere with their health. Focus is placed on the strategies used by sex workers to minimize health risks and their discourses of resistance in fighting vulnerabilities.

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting.

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p < 0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.

Sodomy's Penumbra.

This article advocates a sodomitical approach to sodomy. Its approach is framed alongside and against three historical glosses on sodomy law: first, that sodomy law instantiates homophobia; second, that sodomy law targets sexual violence against boys; third, that sodomy law reaches assaultive sex against women that did not register as assaultive enough to qualify as "rape" by sexist juries. The first story of sodomy law is mostly wrong. The other two glosses pivot on protection: protection of boys or protection of girls and women. These accounts, tethered to identitarianism, underplay sodomy law's multiplicity, as a source and symptom of our conflicted understandings of when sex is sex and when sexual violence is rape. The first part of the article explains my choice of sodomitical sites. The second part complicates the story of sodomy as phobic. The third part complements the historiography of sodomy as protective against boys. The fourth part argues that the gloss on sodomy law as a corrective to disbelieved women is appealing but untrue. The final part makes the case that fellatio matters. The prevalence of forcible oral sex in sodomy cases intimates a cultural pluripotence of oral sex, as well as shifting definitions-in law and life-of sex and rape. This last story of sodomy law remains undetected under an identitarian radar.

Should US Physicians Support the Decriminalization of Commercial Sex?

According to the World Health Organization, "commercial sex" is the exchange of money or goods for sexual services, and this term can be applied to both consensual and nonconsensual exchanges. Some nonconsensual exchanges qualify as human trafficking. Whether the form of commercial sex that is also known as prostitution should be decriminalized is being debated contentiously around the world, in part because the percentage of commercial sex exchanges that are consensual as opposed to nonconsensual, or trafficked, is unknown. This paper explores the question of decriminalization of commercial sex with reference to the bioethical principles of beneficence, nonmaleficence, and respect for autonomy. It concludes that though there is no perfect policy solution to the various ethical problems associated with commercial sex that can arise under either criminalized or decriminalized conditions, the Nordic model offers several potential advantages. This model criminalizes the buying of sex and third-party brokering of sex (i.e., pimping) but exempts sex sellers (i.e., prostitutes, sex workers) from criminal penalties. However, ongoing support for this type of policy should be contingent upon positive results over time.