Health and Sex work in the EU

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To legalise prostitution is to deny civil and human rights

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Feminists and sex workers often take exception to the fact that prostitutes are often seen as the source of STDs, whereas the it is clients who are responsible for the spread of diseases. This is particularly true as most clients also have a long term sexual relationship in which other forms of contraception than condoms are used, thus STDs affect wider society as a whole. As described in the paragraphs below, STDs are not the only health risk sex workers run.

Violence is a constant threat, Farley reports One woman as saying of her health: "I’ve had three broken arms, nose broken twice, [and] I’m partially deaf in one ear….I have a small fragment of a bone floating in my head that gives me migraines. I’ve had a fractured skull. My legs ain’t worth shit no more; my toes have been broken. My feet, bottom of my feet, have been burned; they've been whopped with a hot iron and clothes hanger… the hair on my pussy had been burned off at one time…I have scars. I’ve been cut with a knife, beat with guns, two by fours. There hasn’t been a place on my body that hasn’t been bruised somehow, some way, some big, some small."   But violence is not the only threat: In one study, 75% of women in escort prostitution had attempted suicide. Prostituted women comprised 15% of all completed suicides reported by hospitals. (Letter from Susan Kay Hunter, Council for Prostitution Alternatives, Jan 6, 1993, cited by Melissa Farley. Like combat veterans, women in prostitution suffer from posttraumatic stress disorder (PTSD), a psychological reaction to extreme physical and emotional trauma. Symptoms are acute anxiety, depression, insomnia, irritability, flashbacks, emotional numbing, and being in a state of emotional and physical hyperalertness. 67% of those in prostitution from five countries met criteria for a diagnosis of PTSD – a rate similar to that of battered women, rape victims, and state-sponsored torture survivors.

Presenting at a recent conference [link to europap page on presentations], Sophie Day of Imperial College London reported on a study of the long term health implications of sex work in women in London. Interviewing 131 women who had been in contact with a health project in 1985 (the average age at the time of the study being 37) among those women still working it found:


55% had been violently assaulted

55% had a drugs problem

54% suffered from mental health problems

Among those women no longer working:

31% had been violently assaulted

69% suffered from mental health problems


Since the study was carried out, 6 of the 131 women interviewed have died (as of January 2002): one from AIDS, one as a result of liver problems and none as a direct result of sex work.

Interestingly the study also probed former sex workers’ psychological health, finding that the majority of them found the stigma attached to prostitution weighed most heavily on them once they had stopped working in the sex industry. Day explains this partly with family and other social implications, partly as once out of the industry, sex workers lose their peer support networks.

On the other hand 72% of women felt better off than before they began sex work, 68% thought they had earned more than they would have in another job and 64% said they were better off than their sisters. Overall 50% of the women interviewed had stopped selling sex, and the majority said they had achieved their life-long goals. Sophie Day concluded her presentation by observing that there are severe long-term health implications for sex workers in the form of infections (such as hepatitis C), alcohol and drugs abuse, vulnerability to violence, concerns about reproductive health and most significantly, mental health problems.


Health risks in sex work

The following is a summary from a Europap publication ‘Hustling for Health’ providing information for health project volunteers.


Although HIV prevalence varies greatly across Europe, "Rates among sex workers tend to reflect rates in the general population"

Other STDs

STDs left untreated can lead to increased likelihood of HIV transmission, infertility, ectopic pregnancy, increased likelihood of cerveical cancer. Across Europe 50% of sex workers use no other method of contraception than condoms.

Cervical Cancer

Associated with early sexual intercourse, multiple partners, some STDs, smoking - high mobility & insecure living environments of sex workers "make this a difficult group to follow up when abnormalities are detected."

Reproductive Health

50% of sex workers use no other contraception than condoms – there is particularly low uptake of mainstream contraception services among migrant prostitutes.

Drug use

IV drugs increase the likelihood of the spread of HIV; All drugs including alcohol may affect decision making and therefore condom use.


The violence or threat of violence is often used to coerce prostitutes into unprotected sex. Rape rarely includes the use of condoms, may include anal penetration and is more likely to cause internal injury than consensual intercourse.


Affects sex workers access to mainstream health services


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