Sex work: health and safety

Framing

This article treats sex work as work, and provides occupational health and safety information. That framing is the position of WHO, UNAIDS, Amnesty International, the Global Commission on HIV and the Law, and Human Rights Watch, on the evidence that criminalisation increases violence and reduces access to health services.

Sex work and trafficking are distinct. Trafficking is coerced and is a serious crime; conflating the two has been shown to harm both groups by diverting resources and by making consensual workers unwilling to report crimes committed against them.

What the evidence says about legal models

Platt et al. (2018, PLoS Medicine), systematically reviewing 134 studies across 33 countries, found that criminalisation — including client criminalisation under the Nordic model — was associated with increased risk of violence, HIV and other STIs, and reduced access to health services. Workers under criminalised regimes reported rushed negotiations, less time to screen clients, displacement to isolated areas, and reluctance to report violence to police.

Decriminalisation, as implemented in New Zealand since 2003, has been associated in government review and subsequent research with improved ability to refuse clients, better condom negotiation, and greater willingness to report violence — without the increase in the size of the industry that was predicted.

This is a matter of public health evidence, and it is separate from questions of morality or personal preference.

Screening and safety practice

• Screen before meeting: verified references from other workers, employment or identity verification, deposits, and a phone call rather than text only.
• Tell someone: location, client details, start and expected end time, with an agreed check-in and an explicit plan for a missed check-in.
• Use a buddy or a checking service. Peer safety networks are the most consistently reported protective factor in the research.
• Control the environment where possible. Know the exits, do not be positioned away from them, and avoid unfamiliar private locations for first meetings.
• Take payment upfront. Disputes about payment are a common precursor to violence.
• Keep a bad-date list and share it through peer networks. National bad-date reporting schemes exist in several countries.
• Do not work impaired. Judgement, memory and the ability to leave all depend on it.
• Trust the instinct to leave. Leaving early costs a booking; the alternative can cost much more.

Health

• Barriers for all penetrative and oral contact; carry your own and check them.
• Regular STI screening at all exposed sites, typically every three months or more often. Many countries have services specifically for sex workers, which are usually free and confidential.
• PrEP where HIV exposure risk exists.
• Vaccination: hepatitis A, hepatitis B, HPV, and mpox where offered.
• Doxy-PEP where clinically indicated.
• Plenty of good lubricant — friction injury over many encounters is a cumulative occupational injury and increases infection risk.
• Physical health: repetitive strain, jaw and neck pain, back pain, and skin irritation are common occupational issues and are treatable.
• Mental health: stigma, secrecy from family, client behaviour and the risk environment all take a toll. Find a non-judgemental practitioner; several directories list sex-worker-friendly clinicians.

Boundaries

Setting and holding boundaries is professional practice, not rudeness. Decide in advance what services you offer and at what price, what you will not do at any price, and what your rules are on kissing, condomless anything, filming, and drugs. Stealthing — a client removing a condom without agreement — is a sexual offence, not an occupational hazard to be absorbed.

A client who negotiates a boundary after it has been stated, who pressures at the door, or who arrives intoxicated has given information worth acting on.

Digital safety

Separate work identity: separate phone, separate email, separate payment details, separate social media. Strip metadata from images. Consider face-obscured advertising images. Be aware of reverse image search — using an image anywhere else links the identities. Payment processors frequently close accounts without notice, so do not keep all funds in one place.

Some jurisdictions criminalise advertising or third-party involvement even where the work itself is legal; know the specific law where you are.

If something happens

Violence against sex workers is a crime and is prosecutable. Reporting is harder where the work is criminalised, and in several countries specialist third-party reporting schemes exist that allow reporting without direct police contact — National Ugly Mugs in the UK is the best-established. Sexual assault referral centres provide care regardless of occupation and regardless of whether you report.

Support organisations

English Collective of Prostitutes, National Ugly Mugs, SWARM and SWOP in the UK; SWOP-USA and Red Canary Song in the US; Scarlet Alliance in Australia; NSWP internationally. Peer-led organisations consistently provide the most practical safety information in this field.

Sources

• Platt L et al. "Associations between sex work laws and sex workers' health: a systematic review and meta-analysis of quantitative and qualitative studies." PLoS Medicine, 2018.
• WHO. "Implementing comprehensive HIV/STI programmes with sex workers" (the SWIT), 2013.
• Amnesty International. Policy on state obligations to respect, protect and fulfil the human rights of sex workers, 2016.
• New Zealand Prostitution Law Review Committee. Report on the operation of the Prostitution Reform Act 2003, 2008.
• Deering KN et al. "A systematic review of the correlates of violence against sex workers." American Journal of Public Health, 2014.
• UNAIDS. Guidance note on HIV and sex work, current edition.

Last reviewed: August 2026.