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Occupational health and safety among commercial sex workers

Review : Ross, Crisp, Månsson and Hawkes have published “Occupational Health and Safety Among Commercial Sex Workers” in the latest ‘online first’ edition of the Scandinavian Journal of Work Environment and Health. At first look the article  appears to be a welcome contribution to efforts to place sex work within the realm of labour and outside what the piece itself terms “moral discourses that ignore, devalue, or condemn commercial sex workers” (page 1). However it also disappoints in fundamental respects. Its contribution to strategies for improving sex worker OHS is limited and the suggestions for legal reform seem to betray the authors’ ambivalence about the existence of the industry itself.

The article is based on a literature review of various OHS problems facing sex workers (“violence”; “alcohol and drug use”; “immigration”; “repetitive strain injury” etc). It draws on studies from many different regions, and thus very different industries. It also discusses the stratification within these industries and how they affect the conditions/risks that sex workers face. It correctly focuses on men, as well as women, and transgender sex workers too. 

But is is problematic that there is little engagement with, or discussion of, sex worker perspectives, or literature from sex workers on how the  negative aspects of the industry the article raises are actually negotiated by sex workers in practice.  

The second problem, which goes to ambivalence, is that the authors acknowledge how important the legal/regulatory environment is to the lived reality of many sex workers in the industry.  Thus it is said “[w]here some or all aspects of sex work or sexual behaviours … are illegal it is almost impossible to provide basic health and safety for sex workers. Such legal barriers encourage poor workplace safety, violence, lack of screening for STI, blackmail and extortion” (page 11). Yet, perhaps because of the journal in which it is published, it does not criticise (and in parts seems to endorse the practical and symbolic implications of the “Swedish model”, saying (without citation) that the model has not prevented sex workers’ access to health services. The authors then say, without any hint of irony that “[s]ocial stigma and discrimination create an environment that perpetuates a culture of violence” (at page 12) before mentioning “partial criminalization of clients” as one of “various legal options” (at page 12) (my emphasis). 

Regulations of the kind that “protect” sex workers from the individuals that pay their wages are both stigmatizing and discriminatory. Such laws suggest that the industry is intrinsically (not sometimes, or in certain conditions) violent and that sex workers are always victims that need greater assistance than workers in other difficult sectors or industries. It is the great contribution of many sex worker activists, particularly in responding to the global proliferation of anti-trafficking laws, to unpack that assumption and identify the  ‘real life’ risks and strategies

Research that seeks to improve the labour conditions of sex workers should do at least two things: engage with what sex workers say about addressing OSH challenges and avoid recommending reforms that can have unintended consequences such as entrenching the very stigma that so many authors repeat — almost like a mantra – that sex work is damaging to health and wellbeing and the best that can be hoped for is harm minimisation. Sex workers say that sex work is an occupation that can be made safe by the same mechanisms as make other industries and occupations safe (or safer).


Human Rights and Law application-pdf-9571212Occupational Health and Safety.pdf


Ross MW, Crisp BR, Månsson S-A, Hawkes S.