What happens to women who sell sex? Report of a unique occupational cohort

Abstract

Background/objectives: Sex work has been seen as both a health and a social problem. However, there is a paucity of evidence on the longer term impact on health. We explored the health and career paths over a period of 15 years among women who have worked in the sex industry. Design: A longitudinal study of sex workers recruited between 1986 and 1993 and followed for 15 years. Outcome data were obtained through interview, clinic records, or third parties. Setting: Clinic and community settings in London. Participants: We obtained outcome data on 130 (37%) of the original cohort of 354 women, with a combined follow up of 1247 years. Main outcome measures: Vital status, most recent occupation, duration of sex work, sexually transmitted infections (STI), major health problems. Results: The majority (73/124, 59%) were still in the sex industry and had sold sex for a mean of 13.6 years. There were six deaths, a mortality of 4.8 per 1000 person years. Surviving women had a high cumulative risk (110 of 118, 93%) of STI. Past gonorrhoea was associated with pelvic inflammatory disease (RR 2.28, 95% CI 1.12 to 4.66) and infertility (RR 10.9, 95% CI 1.5 to 77.3). Other outcomes included mental health problems (38 of 97, 40%) and addiction (46 of 72, 64%). There were no significant differences in health outcomes between women who were still in the sex industry and those who had stopped. There was a high level of occupational mobility, and 31 women (of 84, 37%) had completed vocational or higher education, including eight to postgraduate level. Conclusions: Sex work is associated with excess mortality and morbidity including the sequelae of STI, mental health problems, and substance misuse. The relation between these health problems and sex work is complex.