The sex industry is a major industry both in developing countries, where it is a major source of foreign currency, and in industrialized countries. The two main divisions of the sex industry are (1) prostitution, which involves the direct exchange of a sexual service for money or other means of economic compensation and (2) pornography, which involves the performance of sex-related tasks, sometimes involving two or more people, for still photographs, in motion pictures and videotapes, or in a theatre or nightclub, but does not include direct sexual activity with the paying client. The line between prostitution and pornography is not very clear, however, as some prostitutes restrict their work to erotic acting and dance for private clients, and some workers in the pornography industry go beyond display to engaging in direct sexual contact with members of the audience, for example, in strip- and lap-dancing clubs.
The legal status of prostitution and pornography varies from one country to another, ranging from complete prohibition of the sex-money exchange and the businesses in which it takes place, as in the United States; to decriminalization of the exchange itself but prohibition of the businesses, as in many European countries; to toleration of both independent and organized prostitution, for example, in the Netherlands; to regulation of the prostitute under public health law, but prohibition for those who fail to comply, as in a number of Latin American and Asian countries. Even where the industry is legal, governments have remained ambivalent and few, if any, have attempted to use occupational safety and health regulations to protect the health of sex workers. However, since the early 1970s, both prostitutes and erotic performers have been organizing in many countries (Delacoste and Alexander 1987; Pheterson 1989), and have increasingly addressed the issue of occupational safety as they attempt to reform the legal context of their work.
A particularly controversial aspect of sex work is the involvement of young adolescents in the industry. There is not enough space to discuss this at any length here, but it is important that solutions to the problems of adolescent prostitution be developed in the context of responses to child labour and poverty, in general, and not as an isolated phenomenon. A second controversy has to do with the extent to which adult sex work is coerced or the result of individual decision. For the vast majority of sex workers, it is a temporary occupation, and the average worklife, worldwide, is from 4 to 6 years, including some who work only for a few days or intermittently (e.g., between other jobs), and others who work for 35 years or more. The primary factor in the decision to do sex work is economics, and in all countries, work in the sex industry pays much better than other work for which extensive training is not required. Indeed, in some countries, the higher-paid prostitutes earn more than some physicians and attorneys. It is the conclusion of the sex workers’ rights movement that it is difficult to establish issues like consent and coercion when the work itself is illegal and heavily stigmatized. The important thing is to support sex workers’ ability to organize on their own behalf, for example, in trade unions, professional associations, self-help projects and political advocacy organizations.
Hazards and Precautions
Sexually transmitted diseases (STDs). The most obvious occupational hazard for sex workers, and the one which has received the most attention historically, is STDs, including syphilis and gonorrhoea, chlamydia, genital ulcer disease, trichomonas and herpes, and, more recently, the human immunodeficiency virus (HIV) and AIDS.
In all countries, the risk of infection with HIV and other STDs is greatest among the lowest-income sex workers, whether on the street in the industrial countries, in low-income brothels in Asia and Latin America or in residential compounds in impoverished communities in Africa.
In industrialized countries, studies have found HIV infection among female prostitutes to be associated with injecting drug use by either the prostitute or her ongoing personal partner, or with the prostitute’s use of “crack”, a smokeable form of cocaine—not with the number of clients or with prostitution per se. There have been few if any studies of pornography workers, but it is likely to be similar. In developing countries, the primary factors are less clear, but may include a higher prevalence of untreated conventional STDs, which some researchers think facilitate transmission of HIV, and a reliance on informal street vendors or poorly equipped clinics for treatment of STDs, if treatment involves injections with unsterile needles. Injection of recreational drugs is also associated with HIV infection in some developing countries (Estébanez, Fitch and Nájera 1993). Among male prostitutes, HIV infection is more often associated with homosexual activity, but is also associated with injecting drug use and sex in the context of drug dealing.
Precautions involve the consistent use of latex or polyurethane condoms for fellatio and vaginal or anal intercourse, where possible with lubricants (water-based for latex condoms, water or oil-based for polyurethane condoms), latex or polyurethane barriers for cunnilingus and oral-anal contact and gloves for hand-genital contact. While condom use has been increasing among prostitutes in most countries, it is still the exception in the pornography industry. Women performers sometimes use spermicides to protect themselves. However, while the spermicide nonoxynol-9 has been shown to kill HIV in the laboratory, and reduces the incidence of conventional STD in some populations, its efficacy for HIV prevention in actual use is far less clear. Moreover, the use of nonoxynol-9 more than once a day has been associated with significant rates of vaginal epithelial disruption (which could increase the female sex worker’s vulnerability to HIV infection) and sometimes an increase in vaginal yeast infections. No one has studied its use for anal sex.
Access to sex worker–sensitive health care is also important, including care for other health problems, not just STDs. Traditional public health approaches that involve mandatory licensing or registration, and regular health examinations, have not been effective in reducing the risk of infection for the workers, and are contrary to World Health Organization policies that oppose mandatory testing.
Injuries. Although there have not been any formal studies of other occupational hazards, anecdotal evidence suggests that repetitive stress injuries involving the wrist and shoulder are common among prostitutes who do “hand jobs”, and jaw pain is sometimes associated with performing fellatio. In addition, street prostitutes and erotic dancers may develop foot, knee and back problems related to working in high heels. Some prostitutes have reported chronic bladder and kidney infections, due to working with a full bladder or not knowing how to position oneself to prevent deep penetration during vaginal intercourse. Finally, some groups of prostitutes are very vulnerable to violence, especially in countries where the laws against prostitution are heavily enforced. The violence includes rape and other sexual assault, physical assault and murder, and is committed by police, clients, sex work business managers and domestic partners. The risk of injury is greatest among younger, less experienced prostitutes, especially those who begin working during adolescence.
Precautions include ensuring that sex workers are trained in the least stressful way to perform different sexual acts to prevent repetitive stress injuries and bladder infections, and self-defence training to reduce vulnerability to violence. This is particularly important for young sex workers. In the case of violence, another important remedy is to increase the willingness of police and prosecuting attorneys to enforce the laws against rape and other violence when the victims are sex workers.
Alcohol and drug use. When prostitutes work in bars and nightclubs, they are often required by management to encourage clients to drink, as well as to drink with clients, which can be a serious hazard for individuals who are vulnerable to alcohol addiction. In addition, some begin to use drugs (e.g., heroin, amphetamines and cocaine) to help deal with the stress of their work, while others used drugs prior to beginning sex work, and turned to sex work in order to pay for their drugs. With injecting drug use, vulnerability to HIV infection, hepatitis and a range of bacterial infections increases if drug users share needles.
Precautions include workplace regulations to ensure that prostitutes can drink non-alcoholic beverages when with clients, the provision of sterile injection equipment and, where possible, legal drugs to sex workers who inject drugs, and increasing access to drug and alcohol addiction treatment programmes.