University of North Carolina at Chapel Hill, United States
Introduction: Sex workers face inequities that lead to greater vulnerabilities to HIV, sexually transmitted infections (STI), and violence. These inequities result from many factors that span across individual stressors, interpersonal violence, and structural discrimination. With the premise that sex work is legitimate work that should be decriminalised, we present an occupational health and safety framework to holistically describe the factors needed to ensure safe work environments for sex workers. Method: A qualitative study involving focus group discussions (FGDs) and semi-structured in-depth interviews (IDIs) were adopted. Four FGDs were conducted (n=14), where peer interviewers (n=3) were identified and trained to lead interviews alongside a qualitative researcher. Subsequently, IDIs were conducted among 53 sex workers in Singapore. Interviews explored themes around sex work experiences, support structures, and recommendations for policymakers. Data were analyzed through inductive thematic analysis. Results: We adopted the World Health Organization Healthy Workplace Framework and Model to frame our findings. Physical work environments revealed varying risks and support structures. Types of sex work venues shaped specific risks, including exposure to violence from clients or increased surveillance from police. The availability of emergency support also differed across locations. Psychosocial work environments revealed occupational hazards around trauma, fears, and stigma. Sex workers face heightened risks of trauma because of violence, substance use to cope with the demands of sex work, and fears of getting caught by the police, having their professions inadvertently exposed to their friends and family, and encountering stigma associated with sex work. Personal health resources involved the lack of sexual and reproductive health empowerment (e.g., HIV/STI testing and treatment, vaccinations), lack of awareness and resource to fully exercise legal or their human rights, and resources to exit or retire from sex work. Enterprise community involvement included relationships with other sex workers that differed across networks, some of which characterized by strong support while others by competition. Conclusion: An occupational health and safety framework identified holistic factors that shape inequities that sex workers face, which place them at disproportionate risks of HIV/STI acquisition and violence. Efforts to integrate such a framework is urgently needed to equalize health outcomes for sex workers.
