FOURSOME GOLF WEEK

doi:10.1136/sti.2004.012468 2005;81;201-206 Sex. Transm. Inf. C Harcourt and B Donovan The many faces of sex work http://sti.bmj.com/cgi/content/full/81/3/201 Updated information and services can be found at: These include: References http://sti.bmj.com/cgi/content/full/81/3/201#otherarticles 3 online articles that cite this article can be accessed at: http://sti.bmj.com/cgi/content/full/81/3/201#BIBL This article cites 24 articles, 5 of which can be accessed free at: Rapid responses http://sti.bmj.com/cgi/eletter-submit/81/3/201 You can respond to this article at: service Email alerting top right corner of the article Receive free email alerts when new articles cite this article - sign up in the box at the Topic collections (55 articles) Lesbian, bisexual, gay, transgendered health (1313 articles) Sexually Transmitted Infections (1670 articles) Medicine in Developing Countries (1319 articles) HIV Infection/AIDS Articles on similar topics can be found in the following collections Notes http://www.bmjjournals.com/cgi/reprintform To order reprints of this article go to: http://www.bmjjournals.com/subscriptions/ go to: Sexually Transmitted Infections To subscribe to on 28 February 2007 sti.bmj.com Downloaded from REVIEW The many faces of sex work C Harcourt, B Donovan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . See end of article for authors affiliations . . . . . . . . . . . . . . . . . . . . . . . Correspondence to: Christine Harcourt, Sydney Sexual Health Centre, Sydney Hospital, PO Box 1614, Sydney, NSW 2001, Australia; harcourtc@sesahs.nsw. gov.au Accepted for publication 3 November 2004 . . . . . . . . . . . . . . . . . . . . . . . Sex Transm Infect 2005;81:201206. doi: 10.1136/sti.2004.012468 Objective: To compile a global typography of commercial sex work. Methods: A Medline search and review of 681 prostitution articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more
than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work.
Results: At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of direct and
indirect prostitution, with the latter group less likely to be perceived or to perceive themselves as sex
workers. In general, policing sex work can change its typology and location but its prevalence is rarely
affected. The public health implications of sex work vary widely.
Conclusion: Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing
appropriate and targeted programmes. S ex 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 workershealth education, screening, and treatment for
sexually transmitted infections, and condom supplyare the
most cost effective HIV control strategy. 1 Developing appro- priate 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 19962004 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 workers 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 of sex work
Only in the most extreme social situations, such as the
Cultural Revolution in 1960s China 3 and the Taliban regime in Afghanistan, has commercial sex probably been quantita-
tively suppressed. Typically social and legal sanctions against
sex workers merely succeed in displacing the activity into
other localities 4 5 or into a different kind of working arrangement. 6 7 Every country, and every region within those countries, has a different composition to its sex industry
shaped by history, social and economic factors, legal frame-
work, and policing practices. The reasons why people take money or gifts for sex are very varied. In some ancient traditions prostitution was recog-
nised as the hereditary calling of particular subgroups or
castes. In these cases women were born into prostitution.
There are echoes of this practice in India and Nepal where
descendents of temple dancers (Devadasis) and female
court musicians (Nautch girls) still follow their heredi-
tary calling, although their ritual significance is greatly
diminished. 8 9 Currently most sex work has a strong economic basis, primarily as a source of income for sex workers, but also for
dependent kin and associates including pimps, managers,
and ancillary workers. 10 Individual sex workers have very different levels of need ranging from survival, 11 debt, 12 drug dependency, 13 coercion, 14 and social connection, 15 to desire for wealth and social mobility. 15 16 These underlying motives affect the sex workers autonomy and ability to respond to
health promotion messages. 17 For example, a refugee with dependent children in a war zone is less empowered to insist
that a passing soldier uses a condom than an escort in a
wealthy country, who may be supplementing her income to
buy a better car. Direct prostitution
Table 1 lists a variety of sexual services widely recognised as
prostitution because it is clear that the primary purpose of
the interaction is to exchange sex for a fee. These services are
referred to as direct prostitution, though there is great
variety in the social context and possible harms associated
with these transactions. 201 www.stijournal.com on 28 February 2007 sti.bmj.com Downloaded from Street or other public place sex work is probably the most widespread type of prostitution globally. Large numbers of
street based sex workers can be an indicator of socioeconomic
breakdown 10 in developing and war torn countries. 11 In wealthy countries sex workers are more likely to solicit
publicly if legislation denies them access to indoor venues,
they are drug dependent, or there is an employment crisis. 29 Many sex workers regard street work as undesirable because of the danger of violence and other forms of social
hostility. 18 Nevertheless some prefer the relative autonomy and unregulated conditions of outdoor work. 18 In a minority of settings street work is more lucrative and therefore more
prized by sex workers. 16 30 Sometimes the lack of privacy limits services to providing oral sex or hand relief, thus
reducing associated health risks. 31 Instead of waiting for passing trade, some sex workers actively seek their clients in male dominated venues such as
pubs, clubs, hostels or hotels. 25 Others frequent transport hubs, servicing travellers and crew for cash or intercity
travel. 10 26 In an extension of street work, some sex workers in the United States drive their own cars on interstate highways
soliciting truck drivers via CB radio. 27 Between soliciting in public and indoor sex work are doorway and window prostitution. The red light areas of
Hamburg and Amsterdam are well known for their shop
window sex workers. 23 More commonly sex workers in poorer European suburbs, and many parts of the developing world,
solicit passing trade from the doorways of small brothels or
their own homes. 24 Indoor sex work is typified by brothel prostitution. Brothels vary enormously in their size and de

Comments