Male sex work in Australia: impact of legalization, criminalization, and peer support in community and public health
Denton Callander; Ryan DeVeau, Garrett Prestage, Juliet Richters, and Basil Donovan
For decades, the epicenter of male sex work in Australia could be found along a stretch of road in Sydney’s “gayest” district, Darlinghurst. Along “The Wall” (Figure 37.1)—a beautiful sandstone structure built by Australian convicts in the 1820s and a stones throw from the hospital where Australia’s first case of AIDS was diagnosed—men would buy and sell sex only blocks from Sydney’s locales of sex work for both cisgender and trans women. Today, hustling is left to the numerous parking meters along the Wall’s tree-lined street. Yet the Wall remains a powerful symbol of a business that in Australia now mainly operates in a virtual world.
This chapter is the story of male sex work in Australia, which, like so much of sex in the twenty-first century, finds itself written increasingly online. Each year seems to spawn new types of sex-work connection and communication, demanding multifaceted methods of selfpromotion across many platforms (Callander & DeVeau, 2019). The digital age has reshaped not just sex work itselfbut also the systems of support and outreach that have underpinned Australia’s community-driven approach to sex work for over three decades. Peer support and social advocacy have been at the heart of how the Australian sex industry—male and female—has organized for some time, and the Internet has allowed these same tenets to be enacted through diverse digital spaces.
While there is no question that the Internet has significantly changed male sex work in Australia, the reality is that (at least for now) it still requires flesh-and-blood participants, real people who buy sex in either online or offline environments. In this chapter, we sketch a picture of who these people are, using research conducted with male sex workers and their clients. The Australian male sex industry is among the most studied anywhere in the world, with dozens of high-quality social studies conducted over several decades. We spend some time describing the services provided by the community groups that support sex workers in Australia, with a special focus on publicly funded sexual health clinics. By attending to these organizations and what they symbolize, we can get some sense not just of past and present male sex work in Australia, but possibly its future as well.
Figure 37.1 The Wall, Darlinghurst, Sydney, Australia.
The history of male sex work in Australia
It is useful to start by looking at the history of male sex work in Australia, which for a long period was largely undocumented. By not fitting into the heavily gendered analyses of “prostitution” that featured in Australian discourse during the nineteenth and much of the twentieth century, male sex work was rendered invisible in the public imagination. Indeed, it was often conflated with legal and psychiatric arguments around homosexuality in Australia, a common theme in the histories of male sex work told around the world (Friedman, 2014). While some early books on homosexuality included references to sex work (French, 1993; Wotherspoon, 2016'), these were largely brief and in passing.
In 1977, a report from Australia’s Royal Commission on Human Relationships acknowledged that “prostitution is not exclusively confined to the activities of women engaged in commercial sexual transactions” but then went on to describe related issues relevant only to women as the sellers of sex. Similarly 35 years later, the sections on prostitution in Frank Bongiorno s The Sex Lives of Australians: A History (2012) concern only female prostitution before the midtwentieth century. Only when discussing sex in postwar Australia did male sex work garner a reference from Bongiorno: “There was also a substantial, if little known, trade in male prostitution. In the larger cities, men bought sex from street boys or transvestites” (p. 213). He also included male sex workers when discussing Australia’s liberalization of sex work in the 1990s but otherwise referred to sex workers exclusively as women.
It took a combination of gay community activism in the 1970s and research funds made available in response to the AIDS crisis in the 1980s to shed light on commercial sex between men. Some of the first published empirical research on gay male sex work in Australia was presented in Perkins and Bennett’s Being a Prostitute, which reported on three small survey and interview studies with respondents recruited in gay venues in Sydney. This work was groundbreaking because of its sociological (rather than psychological or criminological) approach and its sympathy with the workers’ point of view. The interviewees included gay men who had chosen—at least for a while—to make money from their youth and beauty while having sex they largely enjoyed and also men who did not necessarily identify as gay or bisexual, especially in street work. This early study illuminated the often informal and opportunistic nature of male sex work of the time, opportunities for sex that occasionally blurred the lines between “free” and (explicitly) paid sex. Some of the interviewees described their first experience of being paid for sex as coming about through a man offering them money when they were newly exploring the gay scene. Interestingly, as we explore later in this chapter, casual and opportunistic organization of sex work among men remains one of its defining features in Australia.
A significant component of past (and, indeed, present) male sex work in Australia is its legal status. From the 1970s through the 1990s, strong and effective social organization by (mainly female) sex workers and their allies resulted, over time, in the decriminalization of sex work in one Australian state (New South Wales) (Frances, 1994), which remains one of only two places in the world to have granted this legislative freedom (the other is the country of New Zealand). Although as of 2019, no other Australian jurisdiction had decriminalized sex work, it was a legal practice in several jurisdictions—Victoria, Queensland, and the Australian Capital Territory— but subject to regulation. As is often the case with legalized sex work, the exact details of such regulation differed over time and between jurisdictions, but broadly speaking, within these three jurisdictions, private, independent sex work and (licensed) brothels were permitted. In the remaining parts of Australia (Western Australia, Tasmania, South Australia, and the Northern Territory), independent sex work was legal as of 2019 (with restrictions), but brothels and other forms of collective sex work were not. It is important to recognize that these laws are not static; they have faced and continue to face many challenges and revisions. In 2018, for example, sex worker activists and their allies came together to advocate for sex work decriminalization in the South Australia, an ongoing movement that enjoyed the support of the state s attorney-general but also faced considerable community opposition (Boisvert, 2018).
Generally speaking, Australia enjoys some of the most liberal sex work laws in the world. Nevertheless, there are significant differences between jurisdictions, and these differences can introduce uncertainty among male sex workers traveling between different states and territories: what is permissible in one place may be illegal in others. Furthermore, in jurisdictions with more restrictive laws, it is easy to find examples of their use to stigmatize and harass sex workers, especially when such laws have been applied inconsistently. (Such inconsistency is something of a hallmark for how sex work laws tend to be enforced around the world.) For example, in Adelaide, the capital city of South Australia, in 2017, police conducted sudden raids on several female brothels that had been operating in plain sight for several years (Jones, 2017). It is not clear what sparked this sudden attention to these sex-work establishments, and while male sex workers in Australia may largely avoid the attention of police because they mainly operate independently, highly publicized actions like raiding a brothel likely foster anxiety among sex worker communities. Further, they serve as a powerful reminder of the disparate legislative attitudes that have shaped and continue to shape male sex work in Australia.
Australia's male sex workers and male sex work clients
What is known about male sex workers in Australia today? When a representative sample of men in Australia was surveyed in 2012—2013, 1.3% reported that they had been paid for sex at least once in their lives (Richters, de Visser et al., 2014). Of course, selling sex once or twice does not a sex worker make, and it seems clear that there is a subset of men in Australia for whom sex work is a casual or contextual experience, something they engage in once or twice or maybe something they dip in and out of as need or opportunity arises (McLean, 2015). This phenomenon has been observed in other countries, suggesting that it is not unique to Australia. It is notable, however, just how sizeable this group ot men is; in one survey of gay and bisexual male sex workers in Sydney and Melbourne, 77% reported that they had sold sex only once or twice in the previous six months (pers. comm, Professor Martin Holt, Centre for Social Research in Health, 2016).
At the other end of the spectrum there is a (smaller) contingent of men for whom sex work is ongoing and regular. In the same survey of men in Sydney and Melbourne, 15% reported selling sex at least weekly, while the remaining 8% of men were somewhere in the middle, selling sex every few weeks or monthly. These differences reveal that sex work is not uniformly practiced among men in Australia and that it is useful to think of it as a continuum, ranging from the least to most invested in terms ot frequency and time commitments. Ultimately, sex work is a not a full-time job for most men who sell sex in Australia: Only one in ten report sex work as their main source of income (Prestage et al., 2015).
Beyond helping us describe the nature of sex work among men in Australia, these proportional estimates also allow us to get some sense of the total population size. Estimating population size has important applications in epidemiology (for calculating the incidence of infection), healthcare (outlining the nature of the population requiring care), and support service delivery (by helping to gauge the scope and scale of required services). Describing the size of sex work populations is often hampered by unreliable data confounded by social stigma against those who buy and sell sex. But using information from surveys allows us to make some informed estimates about the breadth and depth of Australia’s male sex work population.
It is helpful to think about three different categories of current sex work among men in Australia. The first, as we have discussed, comprises those who do so casually. These men make up the majority of male sex workers in Australia. The second category is composed of those men for whom sex work is more serious, which is to say they sell sex on an ongoing and regular basis but more as a side job than as a main source of income. Third, there is the “core” group of male sex workers who regularly sell sex and who do so as their primary or only source of income. As Figure 37.2 shows, when applied against national population estimates of gay and bisexual men
Figure 37.2 The estimated population sizes of casual, semi-regular, and regular male sex workers in Australia with 95% confidence intervals.
in Australia (Richters, Altman et al., 2014), we start to get a clearer picture ot Australia’s male sex work population. While there may be nearly 10,000 male sex workers currently working in Australia, only around 1,300 of those sell sex as a steady, ongoing job. Notably, these estimates do not include men who sell sex exclusively to women, a necessary omission given the lack of available information on this topic. While it seems likely that this group is a relatively small one (Caldwell, 2018), future efforts must endeavor to more completely account for the diverse kinds of male sex workers who operate in Australia.
Beyond the population size, characterizing men who sell sex in Australia is not straightforward, at least in part because sex workers rarely form a neatly homogenous group. What information we do have comes predominantly from two studies of male sex workers, one conducted in the late 1990s and the other in 2014 (Minichiello et al., 2002; Prestage et al., 2015). Consistent with much international evidence, men who sell sex in Australia tend to be mainly but not exclusively in their 20s and 30s and to identify as gay or bisexual. Around a quarter were born outside Australia. Nothing empirical is known about transgender male or transmasculine sex workers in Australia.
As is so often the case with sex work research, it is difficult to say much about the representativeness of these estimates. Recruiting a truly representative sample of sex workers to research is made difficult by the (often unclear) boundaries of what constitutes “sex work” and the enduring social stigma that permeates these practices. Previously, we have used information collected from online profiles to describe the demographics and practices of sex workers in Australia and elsewhere (Callander, Moreira et al., in press), which has proven to be a useful approach but one limited to only those men who engage in sex work on a regular basis. It is plausible that casual and contextual workers—those who make up the majority of male sex workers in Australia— are unlikely to maintain formal profiles of this kind and therefore are likely be excluded from that kind of analysis. In spite of the inconsistencies and uncertainties, one thing that does seem clear is that male sex workers in Australia tend to work on their own or through agencies: In 2018, across the entire country, there was only one male brothel in operation.
Another question we might ask is: Why do men sell sex in Australia? The most commonly reported consideration is financial, particularly among young people engaged in full- or part- time study (Prestage, Jin, Bavinton, & Hurley, 2014; Prestage et al., 2015; Minichiello et al., 2002) On its own, however, financial need is an unsatisfying explanation tor sex work, particularly given the large proportion of men in similar circumstances who do not sell sex. One possible reason for this disparity' comes from Prestage et al.’s (2014) survey study, which found that men who sold sex tended to be more sexually adventurous than their non-sex-working peers. Thus, for some men, an already outgoing sexual nature may be part of what facilitates their entry to sex work.
If it is difficult to describe male sex workers in Australia, then their clients are even more mysterious. This mystery is due, in part, to a paucity of data on sex workers’ clients and the tact that clients rarely form anything resembling a community or even a network. Older research found that most male clients of male sex workers were middle class and middle aged, with a minority self-identifying as gay (Minichiello et al., 1999). Men who paid for sex with other men also tended to be older, educated, and employed. While not terribly illuminating, characteristics such as these remain the limit of what is known about male sex work clients in Australia.
Beyond men hiring male sex workers, the Australian public—including researchers—has recently started to ask questions about women who buy sex. In 2016, researchers drawing upon a digital archive ot male sex work profiles (described in more detail by Kumar, Minichiello, Scott, & Harrington, 2017) found that a quarter advertised to female clients (Minichiello, Scott, Callander, & Harrington, 2018). When surveyed in 2012—2013, 0.3% of women aged 16—69
in Australia reported ever having paid for sex (Richters, de Visser et al., 2014), and while it is not safe to assume that all of this business has flown to men, what little research that does exist suggests that the majority of women who pay for sex do so with male sex workers (Caldwell, 2018). As research continues to expand in this area, new questions will be asked about how the experiences of male sex workers’ male clients and female clients converge and diverge.
Peer-led support of male sex work in Australia
The size and nature of the male sex worker market is only one part of its story in Australia. One cannot properly account for male sex work in Australia without attending to the collection of community-run sex work organizations that seek to support and assist male sex workers and the sex industry more broadly. Generally speaking, each of Australia’s eight states and territories is supported by at least one local organization, many of which are coordinated nationally by a peak body known as Scarlet Alliance. Formed in 1989, Scarlet Alliance state as its mission the achievement of:
equality, social, legal, political, cultural and economic justice tor past and present sex workers in order for sex workers to be self-determining agents, building their own alliances and choosing where and how they live and work.
(Scarlet Alliance, 2018)
Funding for this organization comes from their member organizations and from Australia’s peak HIV organization, the Australian Federation of AIDS Organisations. Importantly, since 2002, Scarlet Alliance has included a “male sex worker representative” dedicated to issues relevant to male sex workers. This voluntary two-year position is filled by election from the organization’s membership, and its primary responsibilities include providing advice to Scarlet Alliance on issues affecting male sex workers in Australia, promoting involvement of male sex workers, and maintaining an email list to distribute content to male sex workers. As a peer-run organization, Scarlet Alliance stipulates that whoever fills this position must have some experience as a sex worker.
At a more local level, individual states and territories also host community-run sex work organizations. The role, influence, and offerings of these organizations are directly related to the size of their constituencies, with the most active organizations for male sex workers based in the largest Australian states of New South Wales, Victoria, and Queensland. The Sex Workers Outreach Project in New South Wales (SWOP NSW), for example, hosts a program dedicated specifically to male sex workers. SWOPmale provides a unique array of services, including postal safer sex packet distribution, outreach in sex venues, in-person support services, and traveling outreach to the state’s rural and regional areas. Such efforts are coordinated by one paid position, SWOP NSW’s male support officer.
While some states and territories have comprehensive and targeted peer support tor male sex workers, others have much less or none at all. Smaller jurisdictions like Tasmania and the Northern Territory have much smaller sex worker organizations than other places, and it may not be efficient or possible for them to dedicate resources exclusively to men selling sex. But the size of the jurisdiction does not entirely explain the availability of services for male sex workers. South Australia, for example, is one of the smallest states but boasts a dedicated (volunteer) male sex work officer and a suite of digital offerings. Interestingly, that state also has some of the most restrictive sex work laws found anywhere in Australia. Generally, it is difficult to say what produces different levels of community support and organization between jurisdictions—quite likely it is a combination of funding, local will, and the number of male sex workers who live there—but it is important to recognize that peer and community support for male sex workers is not uniformly distributed across Australia. Accepting that these programs are mainly positive influences on the lives of male sex workers, it is necessary to consider the issues that may arise when men cannot access this kind of support.
Digital channels offer one way to overcome the geographic specificity ot traditional support and outreach. In recent years, many Australian support programs tor male sex workers have expanded to include different forms of digital outreach and support. Typically, this support ranges from the very simple, such as including a male sex work-specific section on an organizational website to something far more comprehensive. SWOPmale in New South Wales, for example, has for several years hosted several different social media accounts and groups, a dedicated resource section on their website, and an e-newsletter available to sex workers only. The male support officer also provides digital outreach through email and instant messaging.
Borrowing from models of online outreach developed in the United Kingdom (Mowlabo- cus, Dasgupta, Haslop, & Harbottle, 2018) and introduced in Australia for gay men generally (Casey & Cook, 2017), SWOPmale also maintains a number of outreach profiles on websites popular with male sex workers, which serve as connection points for male sex workers and clients “in the field.” This approach to outreach and support reflects the changing nature ot the industry, and, as noted, may help to overcome spatial barriers to support provision beyond Australia’s cities. Given that half of male sex workers surveyed in Australia reported that they used the Internet as source ot information on sex work (Prestage et al., 2015), digital approaches are vital.
Overall, Australia boasts a world-class network of peer support tor sex workers, including programs tailored to the specific needs ot men. While certainly not perfect, this network has been and continues to be a key part of maintaining the health and well-being of male sex workers while advocating for their rights across Australia’s diverse legislative frameworks. In spite of its successes, this model of support faces ongoing challenges, namely funding. Public sympathy—and by extension funding—tor sex work rarely abounds, and there exists a perception that because of the very low rates of HIV and other sexually transmissible infections (STls) among sex workers in Australia, funding is not needed. This contention was highlighted by the chief executive officer of SWOP NSW, Cameron Cox, during a 2014 event in Sydney to mark World AIDS Day:
Sex worker health is only a small part of overall HIV funding. Some people believe funding is low because of sex worker successes in HIV transmission reduction, but that success was built on a great and continuous 30-year effort, often unfunded and unpaid, and it would be dangerous [to decrease funding further] especially in the current volatile, changing, and often problematic HIV prevention landscape.
Indeed, funding for sex worker organizations is slight when compared to the funding received by Australian organizations representing other populations deemed to be a priority tor the prevention HIV and STIs. As Cox suggests, successes in support and advocacy for male and other sex workers have likely happened in Australia in spite of funding, not because ot it. Nonetheless, Australia is internationally rather unique in providing some public funding to organizations that directly support male sex workers.
Service delivery, health, infection, and regulation
The third part of our story turns to Australia’s large and comprehensive network of publicly funded sexual health clinics, which operate in every state and territory. The first of these clinics opened in the 1920s, and there are now more than 60 such clinics across Australia, 40% of which are in urban centers, 50% in regional areas, and the remaining 10% in remote parts of the country. There is no charge for attending these clinics, which provide a full service of diagnostic testing, treatment, and management ot HIV and other STIs. No identification is required. Some even provide additional services like psychologists and sex-worker-specific programs.
The significance of these clinics cannot be overstated. They provide a local, anonymous, and free way for male sex workers to access testing without judgment. It seems likely that these clinics have played a significant part in maintaining low levels of infection among male sex workers in Australia.
Globally, STI rates among male sex workers range from less than 1% in some countries to 60% in others, while HIV prevalence ranges from less than 1% to 50% (Minichiello, Scott, & Callander, 2015). These wide intervals highlight just how essential local context is for interpreting infection rates among any population. In 2016, some of us conducted a study of male sex workers attending Australian sexual health clinics in order to estimate the prevalence of chlamydia, gonorrhea, infectious syphilis, and HIV. We found that these infections among male sex workers in Australia were on the lower end of this global scale and sometimes significantly lower than countries we might consider socially, economically, and ideologically comparable (Callander et al. 2016). In 2011, tor example, 25% of male sex workers attending a men’s health clinic in the United Kingdom were diagnosed with chlamydia (compared with 13% in Australia) and 3% with syphilis (compared with 0.5% in Australia) (McGrath-Lone, Marsh, Hughes, & Ward, 2014). Similarly, one study from the United States estimated a 26% prevalence of HIV among male sex workers in the country (Timpson, Ross, Williams, & Atkinson, 2007), compared with 6% in Australia.
Comparing infection rates between countries is rarely straightforward and should be done with caution. A slightly more direct way to assess the impact of peer support and education is through condom use, which globally is as varied as infection rates. Of note, while in some countries only 15% of male sex workers reported consistently using condoms for anal intercourse with clients, this proportion ranged from 59% to 95% among different samples of sex workers in Australia (Minichiello et al., 2015; Prestage et al., 2015). With the introduction of biomedical forms of HIV prevention, however, it is unclear how condom use will change among male sex workers in Australia.
Regarding infection and risk, the most pertinent question is whether male sex workers have higher rates ot infection than their peers who do not sell sex. When all things are equal, does sex work pose a risk to the sexual health of men in Australia? While globally, male sex workers appear to be at a greater risk for HIV than their non-sex-working peers (Baral et al., 2015), a similar association has not been observed in Australia, including for other STIs (Callander et al. 2016). While it is difficult to draw direct associations, this (non)relationship is another piece of evidence supporting the efficacy of peer support and publicly funded sexual health clinics.
Male sex workers in Australia have also demonstrated a high degree ot sexual health service access and uptake. When surveyed in 2014, 84% of male sex workers in New South Wales and Victoria reported a sexual health screen within the six months prior to participation, and no men reported that they had never been tested (Prestage et al., 2015). Similarly writing to the New South Wales Ministry of Health we reported that, on average, male sex workers had nearly two full sexual health screens per year (Callander, Cox et al. 2016). In some states, however, governments mandate quarterly testing as a prerequisite tor sex work among both men and women. For women, this policy has been found to be highly cost ineffective, with one analysis suggesting that it costs nearly A$90,000 (US$68,000) to avert just one chlamydia infection (Wilson et al„ 2010).
Analyzing the costs and benefits of highly frequent STI testing among male sex workers is likely to yield somewhat different results, owing to the generally higher incidence of STls among gay, bisexual, and other men who have sex with men in Australia. A better question might be whether mandatory testing produces its desired outcome, which is frequent testing among male sex workers. This question can be answered by calculating the average number of sexual health tests that male sex workers have in a year and comparing that number between jurisdictions with mandatory testing and those with voluntary testing. This analysis is possible through the use of routine health data extracted from Australia’s publicly funded sexual health clinics (Callander, Harrington et ah, in press).
When comparing jurisdictions with mandated sexual health testing and those where it is voluntary, test frequency is indistinguishable (Figure 37.3). While testing rates have increased among male sex workers across Australia, it would seem that laws mandating testing fail to achieve more frequent sexual health screening among a group of people who already have highly frequent testing regimens. Male sex workers, it would seem, are quite able and willing to regulate their own sexual health testing without edicts from governments.
As noted earlier, male sex workers in Australia work within some of the most liberal legislative frameworks found internationally. This point is especially important when considered alongside a growing scientific consensus that legalizing and decriminalizing sex work supports greater health—including sexual health—among men and women who sell sex (Platt et ah, 2018). A similar effect has been observed specifically within Australia (Harcourt et ah, 2010), suggesting that Australia’s legislative approach, its publicly funded sexual health clinics, and its world-leading peer support have produced exceptional uptake of sexual health services and some of the lowest infection rates found anywhere in the world.
Figure 37.3 Average number of sexual health screens per patient per year (with 95% confidence intervals) among male sex workers attending Australian publicly funded sexual health clinics, stratified by jurisdictions with mandatory or voluntary testing, 2013-2017.
Digitally driven changes to the sex industry are well documented, and they have played out profoundly in Australia. The impact on individual well-being is not entirely clear, and some have pointed out that online sex work might increase feelings ofisolation and loneliness (Jones, 2015). To offset these potential challenges, Australia’s network of peer support for men doing sex work will need to continue to innovate and develop against an ever-evolving backdrop. Their innovation thus tar is exciting and a hopeful sign of their impact and relevance into the future.
Proposed changes and the occasional challenge to sex work laws in Australia continue and seem unlikely to abate anytime soon. Support for and opposition to decriminalization plays out in many areas, and even states with more progressive laws face periodic challenges from mainly conservative political players. Promisingly, these challenges produce consistent outcomes: an evidence-based assessment that the laws (or their absence) work to protect individuals, maintain public order, and sustain public health (NSW Parliamentary Research Service, 2015).
What comes next for male sex work in Australia is difficult to predict, but it will likely involve closer integration of more innovative technologies. As noted, biomedical technologies of HIV prevention are increasingly central to sex in Australia, and it seems that male sex workers have started to adopt them as well. Studies of HIV pre-exposure prophylaxis have found that 5—6% of men accessing that drug in New South Wales and Victoria have engaged in sex work (pers. comm, Ms. Stefanie Vacher, The Kirby Institute; Mr. Michael Traeger, The Burnet Institute, 2018), while among those in a large national cohort of gay men, 44% of sex workers and 33% of non-sex workers report PrEP use (pers. comm, Mr. Mo Hammoud, The Kirby Institute, 2018). These data suggest that male sex workers are accessing PrEP at a similar or possibly higher rate than their peers, but it is unclear if or how their use of PrEP has changed the sex they have with clients. While anecdotal evidence abounds of condomless sex sold at a premium, it remains to be seen how antiretroviral-driven HIV prevention will reshape male sex work for workers and clients in Australia.
It seems that technology is and will remain a central theme in Australia’s male sex industry. Digital and health technologies may offer new ways to engage with sex work clients, who remain largely outside of support and advocacy efforts, as well as those who sell sex infrequently and may not identify with the label “sex worker.” If Australia’s past is any indication, through the combined efforts of many different players—community advocates, peers, lawmakers, clinicians, researchers, and, of course, sex workers themselves—it is entirely feasible that male sex workers and their clients will continue to enjoy, tor the most part, what appear to be healthy, quality sexual-professional experiences.
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Decriminalization as a goal