Global changes in migration, health, employment, and public policy are having a major impact on the sex industry. As editors of this themed issue on sex work have put together papers to document some of these changes, revisit the epidemiological and social understanding of the role of sex work in relation to sexually transmitted infections, and assess interventions that can reduce the burden of disease and of stigma on participants in the industry.
Major drivers of change in the sex industry are economic, demographic, ideological, and technological. Globalisation is the umbrella term used to express many of these changes, which include increased economic interdependence of different countries through trade, the extension of the world market to areas of the world previously isolated, increased movement of people and of capital, and the rapid spread of new technologies and media across wide sections of the globe.
Each of these aspects has had an impact on the sex industry.1
For example, countries of the former Soviet Union have seen a massive economic transition with an increase in unemployment and radical restructuring of employment.2,3
More people are seeking paid work and many cannot find it in the formal sector and look to alternatives, one of which is the sex industry.4
Some people move to urban centres, others to different countries in the hope of finding a better living. Some individuals, mainly women, are coerced into migrating for sex work or other forms of informal or unregulated labour. It is difficult to quantify the actual numbers of people selling sex but there are many reports of a widespread increase in numbers of sex workers.5,6
This greater potential supply of sex workers seems to be matched by increased demand in many parts of the world. In the United Kingdom, for example, the proportion of men who reported paying for sex doubled in the decade from 1990 to 2000.7
Global estimates again are difficult to provide but one review found that in half of the countries studied at least 9% of men reported paying for sex in the previous 12 months.8
Opportunities and demand for commercial sex are likely to expand as divorce rates rise, people travel more, and in many countries adults spend a greater proportion of their lives living alone.9
These demographic changes link to other economic factors, the most important being poverty and inequality. Women earn less than men, foreigners earn less than locals, young workers earn less than older people. These inequalities mean that some people are in much greater, often desperate, need of money while others have growing disposable incomes. In many western countries such as the United States and the United Kingdom such unequal distribution of wealth has led to an increase in many personal services, including domestic work, child care, etc, where one individual earns enough to employ another person.10
The inequalities also lead to relative deprivations; individuals who are not deprived in the absolute sense of the term may feel deprived in comparison with the very rich and seek to supplement their income through sex work.
…the organisation and conditions of sex work are highly diverse
There are many ideological influences on the sex industry and these vary by country and culture, but the growth of sex as a commodity is reflected in the increased use of sexual images in advertising, the rapid growth of the adult entertainment industry, virtual and real, and the widespread availability of pornography on the internet. This growing market in sex continues despite the actions of many governments, faiths, and social movements to try and regulate or abolish it. It appears that stressing the sanctity of sexual relations within marriage is no match for the advertising power of business.
These major changes appear to have led to an increase in the size of the sex industry. Alongside this has been a transformation in its organisation. Communication technologies allow sex work businesses to advertise on the internet, no longer bounded by national borders in terms of advertising or indeed regulations. Internet enabled mobile phones mean that clients can find a sex worker almost anywhere in the world instantly, and they can also read online reviews of individual sex workers that are regularly posted on punters' websites. Elsewhere, sex workers are based in more traditional brothels and bars, but may also come into contact with a wider range of clients owing to the expansion in international travel for work and recreation.
Against this changing backdrop, regulations have also been evolving.11
In some countries, including New Zealand, the Netherlands, and Australia, aspects of sex work have been decriminalised, while in others—for example, Sweden, men who pay for sex have been criminalised. Increasing concern over international mobility of sex workers, whether voluntary or coerced in the form of trafficking, has led to a raft of new legislation and increased surveillance of the industry.
These broad changes have had different effects. In the United Kingdom and much of western Europe there has been a rapid increase in migrants, women and men, selling sex.12,13
This has altered some of the previous structures of the sex industry, with a shift to less visible forms of work to reduce the risk of arrest and deportation. In London, sex workers now work mainly from private addresses, although these are still part of a network with key people, managers or “maids,” facilitating negotiations and providing health advice for new workers.14
In Russia many sex workers are migrants from other parts of the Russian Federation.15
It is not new for sex workers to move location in order to work, but the scale and range of migration presents challenges for the workers themselves. Working in a strange environment, often not knowing the local language, being unaware of their rights, they are very vulnerable to exploitation and abuse. Old norms of solidarity and support between sex workers may be broken up, and the peer values, including those that determine health and safety norms, may be disrupted with this mobility. In a different way, new technology has also disrupted previous norms of organisation. The ubiquitous mobile phone and internet advertising can also break up communities of workers into isolated individuals. Another effect of the broad changes involves the socioeconomic background composition of sex workers. Men and women who exchange sex for money come from increasingly diverse backgrounds; some are from high educational and socioeconomic status brackets.16,17
Sex workers have always been at risk of sexually transmitted infections (STI), and are frequent targets of control programmes. Some of these interventions have been helpful in providing resources and health care, but many actually reinforce stigma and a culture of blaming sex workers for spreading disease. There has been considerable research on sex workers over the two decades since HIV was recognised as an STI, and this body of work shows that sex work is diverse, and that simple models suggesting that it has a central role in the spread of disease are false. In many countries of the global north, many, but not all, sex workers are at a relatively low risk of HIV. They work carefully, professionally, and manage to have multiple sexual partners without acquiring HIV or other STI. In contrast, in many countries of the global south, some, but not all, sex workers are at high risk of acquiring HIV. Thus, a unified approach to sex workers in the context of STI and HIV prevention would be unwise. Interventions should be based on good information about the local organisation of the sex industry, the health risks involved, and the input from sex workers about the most effective way of reaching their peers.