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Sex workers: a glimpse into public health perspectives.

Few issues have the potential to cause as much debate among public health professionals as commercial sex work. Commercial sex work is a broad term that includes street prostitution, massage parlors, brothels, escort services, strip clubs, phone sex lines, and pornography. The term sex workers can refer to anyone who sells sexual services for money.

Historically, public health has focused on sex workers as disease vectors--those who would spread sexually transmitted diseases (STDs), and more recently HIV, to the wider population. Interventions, therefore, focused not on the health of sex workers but on their role in shaping the health of society.

Many, including the World Health Organization (WHO), however, suggest that this approach is problematic. They argue that this approach increases the marginalization and stigma already faced by these individuals and as such can breed resentment amongst the target audience, drive commercial sex work further underground, and undermine success.

The WHO believes that interventions can have a positive impact on both the course of epidemics and the lives of those involved in commercial sex work. However, it and others in the public health field are calling for an approach that has as its primary goal the health and well-being of sex workers.

According to the WHO such an approach would follow certain key principles including adopting a nonjudgmental attitude, respecting sex workers' human rights, involving sex workers in program development, and recognizing that sex workers are part of the solution. (1)

Harm reduction models such as this are often controversial as they seek to improve conditions and health without necessarily eliminating potentially harmful behavior. At the center of this argument as it concerns sex workers is the question of free will. Commercial sex work does not operate in a vacuum but is instead inextricably linked with social and economic issues including poverty, race, class, lack of education, and the low status of women in many societies. By its nature, this harm reduction approach suggests that we respect the choices of individuals who become involved in sex work and focus our efforts on preventing heath risks.

Here the public health approach becomes even more mired in the political debate and questions of whether current practices in which most countries make selling sex for money illegal are helping or hurting sex workers and societies.


It is against this backdrop of ongoing debate that we present this SIECUS Report. It is not designed to settle any of these arguments--no 30 pages could do that. Instead, it provides many first-hand accounts of the issues sex workers face and some interventions that follow a rights-based, harm reduction model.

Two articles, one by Juhu Thukral and the other by Julie Stachowiak and colleagues, present detailed data of studies with sex workers in New York and Moscow respectively. The women surveyed discuss, in their own words, working conditions, relationships with law enforcement, violence, and efforts to minimize health risks.

We then switch to the educators point-of-view as both Esther Corona and Maxwell Ciardullo provide us with first-hand accounts of interventions in which they have participated. Corona explains that she was initially reluctant to become involved but that the program she helped to create was an extraordinary experience for both the sex workers and educators who attended.

And, in her first hand account of efforts to unionize exotic dancers at San Fransisco's Lusty Lady, Siobhan Brooks reminds us that sex work is, by its nature, linked to issues of race and social class.

Finally, Melissa Dittmore, looks into a new policy put forth by the Bush Administration that may bring an end to many harm reduction programs by withholding funds from any international organization that does explicitly condemn prostitution and sex trafficking.


Most topics seem smaller or more manageable to me by the time I have finished editing an issue of the SIECUS Report. I cannot say the same thing about commercial sex work. It is truly the crossroads of public health, public policy, and human rights and touches on such equally large issues as race, gender, and socio-economic status. Nonetheless I am pleased to be able to provide readers with this small glimpse into such a vast issue. I have learned a great deal and I hope you do as well.


1. Sex Work Toolkit: Targeted HIV/AIDS Prevention and Care in Sex Work Settings (Geneva, World Health Organization, 2004), accessed 22 June 2005, <>.

Martha E. Kempner, M.A.

Director of Public Information
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Article Details
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Title Annotation:FROM THE EDITOR
Author:Kempner, Martha E.
Publication:SIECUS Report
Article Type:Editorial
Date:Mar 22, 2005
Previous Article:Saying "I don't".
Next Article:Behind closed doors: an analysis of indoor sex work in New York City.

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