Commentary: Sex Work, Health Policy and the Need for a Grassroots Social Movement Perspective

February 2015Kate Horton

Sex workers face very real health risks, including violence and sexually transmitted diseases, but the reasons for the risks are largely misunderstood. A growing body of research has shown that the work itself is not always inherently risky; rather, the health risks emerge from sex work’s moral and social stigmatization and its criminalization in most countries in the world.

Criminalization undermines attempts to get accurate health data, because it prevents sex workers from accessing the health care and prevention services they need. It also drives sex work underground, away from any protection that may be offered by law enforcement, thus allowing people to commit violence towards sex workers without fear of reprisal, which in turn perpetuates the health risks that society perceives as inherent.

Even laws and policies designed to protect sex workers or give them access to health services are created without engaging sex workers themselves, perhaps because too many policymakers and health professionals continue to view sex workers as social pariahs, criminals or victims.

Fed up with being stigmatized, marginalized and criminalized, many sex workers are advocating for change. And while changing deeply embedded social norms will take time, it is both possible and incredibly important that sex workers’ voices be prioritized in the generation of policies aimed at reducing the health inequalities associated with sex work.

The Sex Workers’ Rights Movement

The sex workers’ rights movement (SWRM) is a global movement, manifested as local groups of activists and advocates working towards improving the safety and human rights of sex workers. Although the focus is largely on prostitution, the movement also includes others selling sexual and erotic services (such as erotic massage, dance and fetish work), phone sex and webcam performers, those working in the adult film industry and those who work with sex workers to campaign for their rights.

The SWRM advocates a human rights framework, with decriminalization of sex work as an essential step towards affording sex workers equality in health and human rights – a position supported by a 2014 series of articles published in The Lancet after the 20th International AIDS Conference in Melbourne. The increased recognition of sex workers’ human rights illustrates the value and importance of a homegrown movement that empowers a group to forge its own arguments and get those arguments onto the policy agenda.

It’s critically important that researchers, health professionals and policymakers continue to seek and engage with the arguments that come from the SWRM, precisely because it provides an essential avenue of representation for sex workers when all others are blocked. If we are truly interested in the health of sex workers as equal members of society, we must take our lead from the people experiencing and confronting the harmful beliefs that have become entrenched within the social and political fabric of our society.

Kate Horton is a fourth-year health policy doctoral candidate in the Department of Social and Behavioral Sciences at UCSF School of Nursing and winner of the 15th Annual Ann Klobas Award for Outstanding Policy Paper. Her dissertation work explores the role of sex worker activism in health policy. Her faculty advisers are Shari Dworkin and Ruth Malone.



I would think that ending sex trafficking and slavery globally would be the most important first step. Wish your efforts were focused on that.

I certainly agree with the above comment. From Silicon Valley to Sacramento to Mombasa sex trafficking includes our children and youth who of are victims of a hellish life.

Not every sex worker is involved in human trafficking nor sexual slavery. Perhaps a good first step would be to recognize the differences and focus on empowering those that choose to be involved by decreasing the stigma and marginalization.

Sex slavery is a critical issue that deserves way more focus. So does sex working to obtain drugs for addiction. It is hard to believe that if sex workers had equal access to education and economic stability that they wouldn't choose another occupation or profession. How about researching that?

It’s great that research at UCSF is, thankfully, not based on our moralistic judgement. When you do your PhD, how about you research “sex slavery” and maybe you, too, will realize that there are a lot of people who chose sex work as an occupation/profession. I, for one, am glad that this research is being done.

I’m so glad to see people engaging in this issue! I would agree that sex trafficking is something that needs to be addressed. However, it is estimated that of all people trafficked globally, 22% are forced into sexual exploitation, compared to 68% forced into other forms of labor such as agriculture, construction, domestic work, and manufacturing. Addressing trafficking and slavery globally requires addressing global inequalities and capitalism, and holding ourselves and multinational corporations accountable for the labor practices that all industries employ, rather than focusing on sex trafficking in particular. It is a widely held assumption that sex work and sex trafficking are the same, or that the former drives the latter. However, there are many accounts of people engaging in sex work as a rewarding and fulfilling occupation, as well as people making a decision to do it when few other options present themselves. Neither of these constitute trafficking or slavery, nor is there evidence that they perpetuate it. However, policy efforts to address sex trafficking are also often built on these assumptions, and in the wake of trying to reduce sex trafficking, they impact the health and human rights of all sex workers. As such, sex workers also have a huge stake in addressing sex trafficking, and policymakers should be building partnerships with sex workers in order to address these issues too. I hope this helps to clarify some of the issues raised in this important conversation. Kate Horton.

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