Editor—Church et al report that violence by clients was strongly associated with street prostitution in three British cities.1 Although they say that violence in sex work has seldom been the focus of public and academic interest, it has been extensively documented in much of the historical and contemporary literature.2–3 Moreover, they simplify the situation by focusing exclusively on violence by clients. In a survey we conducted in London (1989-91), 112 (58%) out of 193 women reported previous assault; these women worked in all sectors of the industry, including 57% of indoor and 68% of street workers. Women reported that 40% of recent assaults were by clients.
Survey data are defined by the pre-existing knowledge and concerns of the investigators. We interpreted material from our survey in the light of prospective research to avoid replicating our own perceptions about violence. This study design also enabled measurement of incident violence and estimates of mortality. Different types of violence were experienced from the state, family, strangers, and clients. The most harrowing entailed the occasional removal of prostitutes' children by the state, and domestic violence. But in addition, everyday arrests, imprisonment, fines, and police raids led women to move within the industry to minimise their risks. Thus, some women reported a positive choice to work in saunas or on streets after experiencing violence in other work sectors because of the apparent protection of operating in a public place with colleagues.4
Prospective research showed, therefore, that London street workers could not be readily differentiated from others over time. Church et al discuss the service implications of excessive mortality but cannot provide relevant data from their survey methods; nor do they cite any. We have previously reported a death rate 12 times higher than expected in London.5 Two women were murdered; neither worked on streets, and the one case that was resolved implicated a boyfriend, not a client. As we concluded, the two murders provide extreme examples of common experiences among prostitutes, who face high rates of violent assault in their personal and their professional lives. The health risks of this occupation are both direct and indirect; occupational studies of, and services for, prostitutes cannot be confined to the risks posed directly by exchanges with customers.