The many faces of sex work

Correspondence to:
 Christine Harcourt
 Sydney Sexual Health Centre, Sydney Hospital, PO Box 1614, Sydney, NSW 2001, Australia; [email protected]

Sex work, or prostitution, is the provision of sexual services for money or its equivalent. Sex workers may be male, female, or transgendered, and the boundaries of sex work are vague, ranging from erotic displays without physical contact with the client, through to high risk unprotected sexual intercourse with numerous clients. Individuals may occasionally and opportunistically exact a fee or gift for a sexual favour without perceiving themselves to be sex workers, or they may engage more or less full time in the explicitly commercial provision of sex services. This variability results in a spectrum of implications for public health and health service provision; yet sex work is typically stigmatised and often criminalised.

Particularly in developing countries, interventions with sex workers—health education, screening, and treatment for sexually transmitted infections, and condom supply—are the most cost effective HIV control strategy.¹ Developing appropriate interventions requires a comprehensive picture of the shape and location of local sex industries.² To aid programme managers in this task, we sought to develop a typology of sex work that can be used as a checklist for situation assessments.

METHODS

A Medline search and review of 681 “prostitution” articles published in English from 1996–2004 was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs on sex work, as well as observations in more than 15 countries, particularly in the Asia-Pacific region and Latin America. These included direct field notes, conference presentations, government and non-government inquiries, national HIV programme assessments, and advice from key local informants.

The broad grouping of “direct” and “indirect” sex workers was used because it is already in general usage, particularly in Asia. The narrower categories were arbitrarily based on worksite, mode of soliciting clients, or type of sexual services provided. The broad categories of “high class” and “low class,” reflecting the sex worker’s income, was considered but not used in the main typology because income is a continuum and different “classes” of sex worker can be found in any one type of sex work. Our initial aim was to illustrate the variety of social contexts in which prostitution occurs.

RESULTS

Types and social contexts...