Sex work is a dangerous profession and sex workers are exposed to serious risks.1
Beyond sex workers' own risk of sexually transmitted disease (STD)/HIV acquisition, in the absence of condom use sex workers may play an important part in the spread of sexually transmitted infections (STI) into the general population.2
Differences in the social context3
and social organisation of sex work4,5
may have important implications for sex workers' risk of acquiring and transmitting STI and for the delivery of clinical and social services. Understanding the social context and social organisation of sex work is also necessary for planning and implementing effective STD/HIV interventions targeting sex workers.1
Societal collapse, poverty, war, and globalisation have all been associated with changes in the volume and societal patterning of sex work.3,6
It is important to describe and understand the underlying patterns and dynamics that govern sex work in societies, its heterogeneity across populations, and its evolution through time.4,5,6,7
In several previous studies, we described organisational patterns of sex work in several Russian locales, noting marked diversity in the organisation and marketing of sexual services in different Russian cities.4,5,7
This report describes the results of a rapid assessment in Tallinn, Estonia, which attained independence from the former USSR in 1991.
Tallinn, Estonia, is a particularly interesting city for the study of sex work because of its historical and demographic characteristics. Following 50 years of occupation by the Soviet Union, Estonia gained its independence in 1991. The transition from Soviet occupation to autonomy brought about major societal upheaval economically and socially. Many men and women lost their jobs, positions, and security as Soviet factories and military installations closed, creating substantial unemployment, especially in the north eastern region of Ida‐Virumaa abutting Russia but also in Tallinn. Many of the unemployed were ethnic Russians who were originally imported from the Soviet Union to control the military, industry, and governance in Estonia. As ethnic Estonians emerged into social, economic, and political prominence with independence, ethnic Russians found themselves without the status and privilege they formerly enjoyed. As in most transitional societies, sex work has expanded into an important mode of coping with the economic inequality and societal unrest of the past 15 years.
Estonia is a small country with a population of 1.4 million and the capital city of Tallinn has 400
000 residents. The small population size has implications for the practice of sex work since, unlike more populated cities, both sex workers and clients express concern about being recognised. Consequently, observable street sex work is limited in Tallinn. Conversely, there are demographic pressures that increase both the demand for and supply of sexual services. Like many other European countries, Estonia has undergone the second demographic transition and Estonians now spend a larger portion of their adult lives childless and unmarried.8
The fertility rate in Estonia declined steadily from 2.02 in 1980 to 1.37 in 2003. Fertility in Estonia has remained below replacement levels since independence in 1991. The mean age at first marriage increased from 24.4 and 22.6 in 1980 to 28.2 and 25.7 in 2003 for men and women, respectively and marriages per 1000 declined from 8.78 in 1980 to 4.21 in 2003.9
In light of the massive sociopolitical changes in Estonian society since 1991, it is not surprising that the unemployment rate has been high in Estonia. Average annual unemployment has varied from 6.5% and 6.6% in 1993 to 10.4% and 8.9% in 2004 for men and women 15–74 years of age, respectively. During this period the maximum unemployment rate peaked at 16.5% and 12.6% in 2000 for men and women, respectively. Employment disparities have been considerable across geographic regions and remain high; in 2004 the unemployment rate was 10% in Tallinn, but 17.9% in Ida‐Virumaa. High and heterogeneous unemployment rates often are important predictors of the volume and spatial patterning of sex work.5
A similar pattern of disparities is also observed in average monthly net wages and in the gross domestic product per capita.10
Interestingly, as of 2003, ethnic Estonians were the majority population of Tallinn but only a small minority of the population in Ida‐Virumaa which remains predominantly Russian. Ida‐Virumaa is at the easternmost border with Russia and its Soviet industrial base suffered after independence, leaving this region with the highest unemployment rates in the country. A sizable majority of the region's Russian speaking population was not eligible for Estonia citizenship after independence and the area has experienced considerable political dissent since independence regarding potential secession from Estonia and many of its residents and leaders do not speak Estonian, which places them at a disadvantage for entering universities and competing for jobs, all of which now require fluency with the Estonian language.
Organised crime is a notable component of the social context in modern Estonia. The police conceptualise the history of crime in the recent past as being composed of two distinct periods. The first era (1991–1996/7) was marked by intense struggle and competition for primacy among different organised crime groups and experienced 400 murders per year. The second era (1996/7–present) is marked by a dynamic equilibrium of power among a smaller number of surviving organised crime cartels and 70–80 murders per year. (Law enforcement officials in Tallinn, personal communication May 2005.)
Following independence, the Estonian Parliament debated whether prostitution should be criminalised or legalised and concluded that neither option would prevail. Currently, adult exchanges of sex for money are not punishable under Estonia's criminal code so long as they take place within one's own residence and involve only adults, but acting as the middleman (pimp or procurer) is criminalised.11
As in other places, bacterial sexually transmitted diseases (STD) are on the decline in Estonia while viral STI incidence is increasing (Anneli Uusküla, unpublished data). Syphilis, gonorrhoea, Chlamydia trachomatis
, trichomoniasis, and genital herpes simplex virus (HSV) infections are all reportable in Estonia,12
but misdiagnoses and under‐reporting are frequent.16
The population of Estonia is concentrated in Tallinn and the majority of STD are reported from Tallinn. Following independence, bacterial STDs and syphilis increased markedly in the country.13
Trichomoniasis and chlamydial infection are the most frequently reported STDs.14
Underscoring the importance of social context, in a recent study changes in syphilis incidence rate were correlated with concurrent changes in the unemployment rate and tuberculosis incidence.15
Similarly, underscoring the importance of health system parameters, adherence to treatment guidelines seems to be less than perfect.16
Seroprevalence of HSV‐2 among low risk populations is considerable.17
The HIV epidemic was slow to start in Estonia and began to develop only after it entered into the drug injecting community.18
Substantial public attention, a recent scholarly conference, and a number of commissioned reports address trafficking of Estonian women for sex work abroad although few reports consider sex work within Estonia.19
Despite the absence of any statistics on the trafficking of women in Estonia, several articles in the popular press and multiple reports estimate this is a considerable problem for Estonian women.
A rapid assessment was conducted in Tallinn in May 2005, to describe the socioeconomic and cultural determinants of sex work; assess the magnitude of sex work and trafficking; describe the organisational structure and distinct categories of sex work; depict the spatial patterning of sex work in Tallinn, and identify recent temporal changes in sex work patterns. In this article we describe the patterns of interaction we observed among sex workers, taxi drivers, organised crime, and the general population. We discuss the implications of our findings for the spatial and social dispersion of sex work; the effect of population size on sex work; and the impact of globalisation on sex work. Finally, we discuss the implications of our findings for public health programmes, policy formation, and future research.