Better health for sex workers: which legal model causes least harm?BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2609 (Published 20 June 2018) Cite this as: BMJ 2018;361:k2609
- Sally Howard, journalist, London, UK
An estimated 60 000-80 000 sex workers live in the UK.1 Around 80% are women, working on the streets or in various indoor environments, and prostitution may be increasing in response to austerity policies and benefit cuts. Three quarters of indoor sex workers say they do it to support children.1 Surveys indicate as many as 9% of British men have admitted ever paying for sex.2
Sex worker populations present unique health challenges. Stigma, fear of authorities, and sometimes chaotic living patterns may be serious barriers to accessing healthcare. Street workers have a high risk of health problems, including sexually transmitted infections, long term conditions such as diabetes and back pain,3 mental illness, and drug and alcohol dependency disorders. The estimated 17 000 migrant women working in prostitution in England and Wales face further barriers to accessing care, including language and fear of data reaching immigration officials.4
Worldwide, 45-75% of sex workers have experienced workplace violence, although indoor working is generally safer.5
Amnesty International, the United Nations, and the World Health Organization have called for the full decriminalisation of all aspects of consensual sex work for both sellers and purchasers, as in New Zealand.678 This could enable interventions to reduce harm among these populations, such as actions to reduce the spread of HIV.
UK advocates for full decriminalisation (box 1), which include the sex worker organisation English Collective of Prostitutes and the BMA Junior Doctors Committee, were encouraged by an interim report on prostitution in 2016 from the Commons’ home affairs select committee. This …