Indoor Sex Workers Research Articles

East London Project: a participatory mixed-method evaluation on how removing enforcement could affect sex workers' safety, health and access to services in East London

Background Sex workers’ risk of violence and ill-health is shaped by their work environments, community and structural factors, including criminalisation. Aim We evaluated the impact of removing police enforcement on sex workers’ safety, health and access to services. Design Mixed-methods participatory study comprising qualitative research, a prospective cohort study, mathematical modelling and routine data collation. Setting Three boroughs in London, UK. Participants People aged ≥ 18 years, who provided in-person sexual services. Interventions Simulated removal of police enforcement. Outcomes Primary – recent or past experience of sexual, physical or emotional violence. Secondary – depression/anxiety symptoms, physical health, chlamydia/gonorrhoea, and service access. Results A combination of enforcement by police, local authorities and immigration, being denied justice when reporting violence, and linked cuts to specialist health and support services created harmful conditions for sex workers. This disproportionately affected cisgender and transgender women who work on the streets, use drugs, are migrants and/or women of colour. Among women (n = 197), street-based sex workers experienced higher levels than indoor sex workers of recent violence from clients (73% vs. 36%), police (42% vs. 7%) and others (67% vs. 17%); homelessness (65% vs. 7%); anxiety and depression (71% vs 35%); physical ill-health (57% vs 31%); and recent law enforcement (87% vs. 9%). For street-based sex workers, recent arrest was associated with violence from others (adjusted odds ratio (AOR)) 2.77, 95% confidence interval (CI) 1.11 to 6.94). Displacement by police was associated with client violence (AOR 4.35; 95% CI 1.36 to 13.90) as were financial difficulties (AOR 4.66; CI 1.64 to 13.24). Among indoor sex workers, unstable residency (AOR 3.19; 95% CI 1.36 to 7.49) and financial difficulties (AOR 3.66; 95% CI 1.64 to 8.18) contributed to risk of client violence. Among all genders (n = 288), ethnically and racially minoritised sex workers (26.4%) reported more police encounters than white sex workers, partly linked to increased representation in street settings (51.4% vs. 30.7%; p = 0.002) but associations remained after adjusting for work setting. Simulated removal of police displacement and homelessness was associated with a 71% reduction in violence (95% credible interval 55% to 83%). Participants called for a redirection of funds from enforcement towards respectful, peer-led services. Limitations Restriction to one urban locality prevents generalisability of findings. More interviews with under-represented participants (e.g. trans/non-binary sex workers) may have yielded further insights into inequities. Correlation between different risk factors restricted outcomes of interest for the modelling analyses, which were largely limited to experience of violence. Conclusion Our research adds to international evidence on the harms of criminalisation and enforcement, particularly for women who work on street and/or are racially or ethnically minoritised. Findings add weight to calls to decriminalise sex work, tackle institutionally racist, misogynist and otherwise discriminatory practices against sex workers in police and other agencies, and to (re)commission experience-based, peer-led services by and for sex workers particularly benefiting the most marginalised communities. Future work Realist informed trials, co-produced with sex workers, would provide rigorous evidence on effective approaches to protect sex workers’ health, safety and rights. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/55/58.

The impact of policing and homelessness on violence experienced by women who sell sex in London: a modelling study

Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88–4.43) or displaced (4.79, 1.99–12.11), or of experiencing displacement if homeless (3.60, 1.59–8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53–81%). The effects are non-linear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5–10.3%) or 6.7% (3.7–10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1–11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4–6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9–19.6%) in combination. Violence reduces by 26.5% (22.6–28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.

The impact of policing and homelessness on violence experienced by women who sell sex in London: a modelling study

Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88–4.43) or displaced (4.79, 1.99–12.11), or of experiencing displacement if homeless (3.60, 1.59–8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53–81%). The effects are non-linear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5–10.3%) or 6.7% (3.7–10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1–11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4–6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9–19.6%) in combination. Violence reduces by 26.5% (22.6–28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.

Estimating turnover and industry longevity of Canadian sex workers.

How long indoor sex workers stay employed in collectives is a poorly understood aspect of sex worker agency in industrialized democracies. This study provides estimates of turnover, the rate at which workers leave employment, using a subsample of 76 collectives representing 3545 workers over a one-year period. All the collectives provided data on individual workers via external websites. The collectives were identified in a larger random sample of 783 advertisers from a popular Canadian classifieds site used by sex workers, all of whom provided URLs as part of their ad contact information. Monthly between October 2022 and October 2023, individual workers associated with the subsample of advertisers were identified from web pages maintained by these advertisers and scheduling data was collected where available. Worker turnover was estimated based on whether workers were visible one month to the next. Over the year, estimated turnover ranged from 12.0% to 16.0% (mean 14.2% SD 1.1%). Turnover was not affected by month or number of workers in the collectives. Mean 41.1% workers (SD 23.5%, N = 51 advertisers) were scheduled on any given day. Workers were visible for a mean 5.5 months (SD 4.5) with those visible for one month being the largest single group. Most sex workers in collectives are likely not permanent full time employees, and the extremely brief work histories of many suggest that failure in the industry may be common for this subpopulation.

WITHDRAWN: An OPA-F-Based Single-Valued Neutrosophic Fuzzy MARCOS Approach with Dombi Aggregation Operators for Evaluating Indoor Sex Work Risk in the Economy

The primary risk factor affecting the economy of indoor sex work is examined in this study. Policymakers must thoroughly examine this factor's complex effects since they have a direct bearing on the financial security of employees and the industry's economic dynamics. Interventions can be designed to improve overall economic well-being in the setting of indoor sex work by addressing and mitigating this significant risk. A hybrid multi-criteria decision-making (MCDM) called Fuzzy Ordinal Priority Approach-Single-Valued Neutrosophic Fuzzy Measurement of Alternatives and Ranking according to COmpromise Solution (OPA-F-SVNF-MARCOS) is created to determine the most important parameter in the study. A thorough multi-criteria decision-making (MCDM) system, such as the MARCOS approach, allows for the consideration of a wide range of elements that impact the danger of indoor sex work, such as social dynamics, legal frameworks, economic indicators, and public health concerns. In the suggested method, OPA-F establishes the weights for the criteria, and SVNF-MARCOS assigns a ranking to each option. Furthermore, Dombi aggregation operators capture the interaction between risk variables and the degrees of uncertainty they are linked with. This study helps those involved in this delicate field—policymakers, law enforcement, and social care providers—make decisions that are better informed and grounded in evidence.

AN EVALUATION OF INDOOR SEX WORKERS' PSYCHOSOCIAL OCCUPATIONAL HEALTH AND SAFETY IN METRO VANCOUVER, CANADA.

Criminalization of sex work is linked to increased risk of violence and lack of workplace protections for sex workers. Most jurisdictions globally prohibit some or all aspects of sex work with New Zealand constituting a notable exception, where sex work has been decriminalized and regulated via OHS guidelines. We used the Guide to Occupational Health and Safety in the New Zealand Sex Industry (NZ Guide) as an analytical framework to examine the lived-experiences of psychosocial OHS conditions of indoor sex workers in Metro Vancouver under end-demand criminalization. We drew on 47 semi-structured interviews, conducted in English, Mandarin, and Cantonese in 2017-2018, with indoor sex workers and third parties providing services for them. Participants' narratives were analyzed using a coding framework based on the NZ Guide's psychosocial factors section, including safety and security from violence and complaints processes, which highlighted specific OHS shortcomings in the context of end-demand sex work legislation in indoor sex work environments. Participants identified a significant lack of OHS support, including a lack of safety training, right to refuse services, and access to justice in the context of labour rights violations or fraud, robbery or violence. Our findings emphasize the benefits of full decriminalization of sex work to facilitate sex workers' access to OHS through development and implementation of OHS guidelines designed by and for the indoor sex industry. OHS guidelines should focus on labour rights and protections, including development of sex workers' right to refuse services and access to justice.

Trajectories of Vulnerability and Resistance Among Independent Indoor Sex Workers During Economic Decline

Economic decline, such as we have witnessed in recent years, has disproportionately affected women and evidence demonstrates how financial hardship encourages entry to the sex industry. This worsens the working conditions within sex industry markets but, despite this, evidence documenting the effects of recent austerity measures on the sex industry is lacking. This article draws on qualitative longitudinal research following the 2007–2008 financial crisis to explore work trajectories and experiences of vulnerability through time among independent indoor sex workers in the UK. Participants’ experiences demonstrate worsening conditions in the mainstream labour market, particularly for women and, within this constraining context, sex work represents a choice to mitigate economic vulnerability. Yet this creates increased competition in the sex industry alongside declining demand, which compromises economic security and worker wellbeing. Exploring sex workers’ experiences over time contributes to a deeper understanding of the relationship between women’s work practices and vulnerability during economic decline, which is necessary to inform policy responses.

An Evaluation of Indoor Sex Workers' Sexual Health Access in Metro Vancouver: Applying an Occupational Health & Safety Lens in the Context of Criminalization.

The criminalization of sex work has been consistently shown to undermine workers' Occupational Health and Safety (OHS), including sexual health. Drawing on the 'Guide to OHS in the New Zealand Sex Industry' (the Guide), we assessed barriers to sexual health best practices among indoor sex workers in Metro Vancouver, Canada, in the context of ongoing criminalization. Part of a longstanding community-based study, this analysis drew on 47 qualitative interviews (2017-2018) with indoor sex workers and third parties. Participants' narratives were analyzed drawing on a social determinants of health framework and on the Guide with specific focus on sexual health. Our findings suggest that sex workers and third parties utilize many sexual health strategies, including use of Personal Protective Equipment (PPE) and peer-driven sexual health education. However, participant narratives demonstrate how structural factors such as criminalization, immigration, and stigma limit the accessibility of additional OHS best practices outlined in the Guide and beyond, including access to non-stigmatizing sexual health assessments, and distribution of diverse PPE by third parties. Our current study supports the need for full decriminalization of sex work, including im/migrant sex work, to allow for the uptake of OHS guidelines that support the wellbeing and autonomy of all sex workers.

How client criminalisation under end-demand sex work laws shapes the occupational health and safety of sex workers in Metro Vancouver, Canada: a qualitative study

ObjectivesIn 2014, Canada implemented end-demand sex work legislation that criminalises clients and third parties (eg, managers, security personnel, etc) involved in sex work. The focus of this analysis is to...

Resisting State Violence by Making Room for Police Officers’ Benevolence: Canadian Indoor Sex Workers of Colour Share Their Experiences

Resisting State Violence by Making Room for Police Officers’ Benevolence: Canadian Indoor Sex Workers of Colour Share Their Experiences

“You’re selling a brand”: Marketing commercial sex online

Sex work has undergone a change, with the rise of the internet economy with more ‘middle class’ sex workers coming into the industry. In this paper, I explore the social status hierarchy within online direct-contact commercial sex work in New Zealand. I draw on findings from an in-depth qualitative investigation of online sex work, undertaken between 2017 and 2018. I took a participatory approach, working closely with NZPC – Aotearoa New Zealand Sex Workers’ Collective to provide an understanding of two interrelated issues: the role web platforms play in shaping the social status of sex workers who advertise for clients online; and how sex workers brand and market themselves online. The findings suggest that sex workers strive to represent themselves as authentic in their marketing to enhance social status. Furthermore, the web platform on which over 90% of indoor sex workers in New Zealand advertise has embedded a status system among sex workers through the advertising packages they offer. Social status has thus become the most powerful marketing tool indoor direct-contact sex workers have to stand out from their competitors and attract sufficient clients to make a liveable income.

DEKRIMINALISERING NIE DIE ENIGSTE STRUIKELBLOK IN SEKSWERKERS SE STRYD OM ARBEIDSREGTE

Prostitution is at present still regarded as a criminal offence in South Africa. However, the possibility of the decriminalization of the sex trade enjoys serious consideration by the South African Law Commission. It is generally accepted that the position of sex workers (at present treated as illegal workers) regarding labour rights, will automatically improve with decriminalization. This article focuses mainly on whether indoor sex workers’ access to labour rights will indeed improve. The risk for sex workers of being treated as independent contractors, once decriminalized, in the main enjoys attention and becomes clear from a comparative study with theNetherlands and Victoria (Australia) where sex work has been practised as a legal occupation for several years.

Information and Communication Technologies in Commercial Sex Work: A Double-Edged Sword for Occupational Health and Safety

Over the previous decade, there has been a notable shift within sex work marketplaces, with many aspects of the work now facilitated via the internet. Many providers and clients are also no longer engaging in in-person negotiations, opting instead for communications via technological means, such as through mobile phones, email, and the internet. By analysing the qualitative interviews of indoor-based providers, clients, and agency managers, this paper addresses the occupational health and safety concerns that indoor sex workers experience in the digital age, as well as how technology use can both support and hinder their capacity to promote their health and safety. Using thematic analysis, we arrived at three salient and nuanced themes that pertain to the intersection of sex work, technology use, and occupational health and safety: screening; confidentiality, privacy, and disclosure; and malice. As socio-political context can affect the occupational health and safety concerns that providers experience, as well as their capacity to prevent or mitigate these concerns, we highlight our findings in light of prevailing societal stigma and a lack of legal recognition and protections for sex work in Canada.

Brief Report: Longitudinal Associations Between Place of Sex Work and Client Condom Coercion Among Sex Workers in Baltimore, Maryland.

The sex work environment influences sex workers' control over enforcing condom use. Sex work in outdoor and public spaces, compared with indoor spaces, may inhibit condom negotiation. We examined longitudinal associations between public place of sex work and condom coercion among female sex workers. This cohort study involved 5 data collection points over 1 year among female sex workers (N = 246) in Baltimore, Maryland, recruited by targeted sampling. We conducted bivariate analyses to examine associations between currently conducting any sex work in a public place (PPSW, eg, car, abandoned house, street, park/forest, and public bathroom) vs. exclusively indoor sex work (eg, house, motel, and dance club) with sociodemographic, substance use (eg, injection drug use, crack use), and past 3-month condom coercion (eg, client condom refusal/removal). We used logistic regressions with generalized estimating equations and exchangeable correlation structure to examine longitudinal associations between PPSW and subsequent condom coercion, adjusting for sociodemographic and substance use variables. Among participants (race/ethnicity: White: 67.5%; Black/African American: 22.8%; Latina/other ethnicity: n = 9.8%; age range: 18-61), most reported daily injection drug use (58.5%), daily crack use (62.2%), and homelessness (62.2%). Most (88.6%) reported any PPSW at baseline. Current PPSW was associated with increased odds of past 3-month condom coercion (adjusted odds ratio [aOR]: 1.85, 95% confidence interval: 1.16 to 2.94, P = 0.01) compared with indoor sex work, as was daily crack use (aOR 1.67, 95% confidence interval: 1.18 to 2.37). Public sex work environments were associated with client condom coercion and confer additional sexual health risks in contexts of illegality. Interventions should address risk disparities in social geographies of sex work.

Harms of third party criminalisation under end-demand legislation: undermining sex workers’ safety and rights

After Canada’s laws criminalising sex work were struck down by the Supreme Court for violating sex workers’ rights and new end-demand legislation was passed in 2014. These new laws however continue to criminalise sex work third parties (i.e. venue owners/managers) who gain material benefits, despite evidence that managed in-call venues can provide important protections for sex workers. As part of a longstanding community-based study in Vancouver, this analysis drew on 25 in-depth interviews with third parties who provide services for indoor sex workers. We explored how end-demand third party criminalisation shapes indoor sex workers’ working conditions, health and safety. We found that most third parties were women and current/former sex workers, problematising assumptions of third parties as exploitative male “pimps”. Third parties provided client screening, security and sexual health resources for sex workers, yet end-demand laws restricted condom availability and access to police protections in case of violence, thereby undermining sex workers’ health and safety. Our findings highlight that third party criminalisation under end-demand legislation reproduces the unsafe working conditions under the previous laws deemed unconstitutional by Canada’s highest court. Legislative reforms to decriminalise all aspects of the sex industry, including sex workers’ right to work with third parties, are urgently needed.

Sex work, advertorial news media and conditional acceptance

Media depictions of sex work and workers are a key site where perceptions of the sex industry are established and contested, particularly for audiences who may have little to no direct interaction with it otherwise. The presence of an advertorial framing or function of news media coverage of the sex industry has been identified in previous work. This article analyses news media coverage in New Zealand post-decriminalisation to consider how advertorial frames are used to construct indoor low-volume sex work as acceptable, and identify the conditions which are attached to this acceptability. The advertorial frames often emphasise the respectability and/or desirability of the clientele, potentially indicating to male readers that they may be a client-type man. Simultaneously, this construction of clients as desirable is used to underpin a discourse of authentic pleasure on the part of the workers. These narratives obscure the sexual and emotional labour involved in low-volume sex work, stripping it of its status as work, and positioning work-sex as akin to non-transactional sexual contact. Such renderings often draw meaning and legitimacy by shifting existing stereotypes about the sex industry as dangerous or damaging to other workers: typically those who charge less for their services or who are perceived to see more clients. This article concludes that the establishment of one kind of sex work as more acceptable at the expense of other sectors of the industry may serve to further entrench existing inequalities among people who work in the sex industry.

“It’s like Being an Electrician, You’re Gonna Get Shocked”: Differences in the Perceived Risks of Indoor and Outdoor Sex Work and Its Impact on Exiting

ABSTRACTThis study sought to understand differences in risks of indoor versus outdoor sex work and how perceptions of risk influenced sex workers’ motivation to exit. Among the 19 indoor and outdoor sex workers included in this qualitative study, themes of risks included: violence versus death, discovery, romantic relationships, arrest, health risks, loss, and “the unknown”. Results of this study show that sex workers have a nuanced perception of risks and exiting motivations dependent upon the sex trade market. These results offer suggestions for policy and intervention practices uniquely tailored for indoor and outdoor sex workers.

“If He Looks Clean…”: Condom Use Decisions in Prostitution

ABSTRACTProstitutes engage in sex acts with multiple partners and have higher than average rates of intravenous drug use. For these reasons, unprotected sexual contact with a prostitute constitutes high-risk activity. The present study includes interviews with 34 indoor and outdoor sex workers that explore the factors involved in their condom use decisions. Three themes common to participants’ protective behavior decisions (interpersonal, situational, and personal factors) were elucidated and then analyzed within a rational choice framework. Policy implications include court-ordered sex education programs for women cited for prostitution and the expansion of harm reduction programs.

On the edges of the law: sex workers’ legal consciousness in England

AbstractIn England, sex workers are placed at the edges of the law. How the social and legal status of sex workers impacts on their perception of and interaction with the law in a semi-legal setting has not yet been explored. Drawing on fifty-two qualitative interviews with indoor and outdoor sex workers in England, this study investigates their disposition to the law, legality and the state. The commonalities and discrepancies between the experiences of indoor and outdoor sex workers reveal the influence of the combination of legal framework and social status on sex workers’ legal consciousness. This study finds that, even in a setting of semi-legality, sex workers attempt to avoid contact with state authorities. However, this aversion to the current law does not prevent them from making claims for legal change. Surprisingly, indoor and outdoor sex workers hold opposing views on the appropriate level of regulation and state involvement in the sex industry. Remarkably, although outdoor sex workers have more negative experiences with arbitrators of the law, they desire the law's protection. In contrast, indoor sex workers’ main grievance is for sex work to be a legitimate industry that can operate with only minimal state control. These differences in outdoor and indoor workers’ legal claims are explicable by sharp cleavages in social status, vulnerability and degree of criminalisation. These findings demonstrate that intra-group differences in the legal consciousness of marginalised groups are key to understanding the role of social and legal status in shaping legal claims.

Harms of Workplace Inspections for Im/Migrant Sex Workers in In-Call Establishments: Enhanced Barriers to Health Access in a Canadian Setting.

Given shifting sex work criminalization and enforcement in Canada, this study examined worrying about workplace inspections by authorities amongst indoor sex workers in Vancouver (2014-2017). Data were drawn from acommunity-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate factors associated with worry about inspections. 23.9% of participants experienced workplace inspections; 51.6% worried about inspections. In multivariable analyses, worrying about inspections was associated with recent im/migration [adjusted odds ratio (AOR) 3.13; 95% confidence interval (CI) 1.77-5.53], police harassment (AOR 3.49; 95% CI 1.92-6.34), and workplace violence (AOR 1.66, 95% CI 1.09-2.51). In a multivariable confounder model, worry was independently associated with barriers to health access (AOR 1.45, 95% CI 1.06-1.98). Im/migrant indoor workers are disproportionately impacted by concerns about workplace inspections, which was independently linked to enhanced barriers to health access. Current criminalization measures may exacerbate health inequities among im/migrant sex workers.