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What are sex work settings?

Sex work settings are places or social networks in which sexual services are exchanged for money or goods.

There is a wide diversity of sex work settings, ranging from well-established and visible brothel-based red-light areas to a looser collection of venues such as bars, hotels, marketplaces or roadside areas. The stakeholders involved are also very diverse. They may include male, female or trans-gender sex workers, their clients and regular partners, business owners and third-party intermediaries, such as taxi drivers. Sex work settings may involve either transient migrant and mobile populations of both sex workers and clients or more permanent local communities.

The nature, visibility and extent of sex work in different localities is influenced by a range of other groups, for example the police, religious institutions, NGOs and community groups, and by local and national laws, policies and attitudes to sex work. In many countries, sex work occupies an ambiguous social and legal status, and sex workers may be severely stigmatized, marginalized or criminalized. Violence, exploitation and the abuse of sex workers’ human rights are common in many parts of the world.

Why is it important to target sex work settings with HIV prevention and care initiatives?

In many places, sex work settings are characterized by high rates of partner change, low rates of condom use, unsafe sex and high rates of sexually transmitted infections (STIs). Consequently, the risk of HIV infection is often high and the virus can quickly spread through sexual networks encompassing sex workers, clients, regular partners and associated lovers, spouses and children. Furthermore, some sex workers or clients may be involved in additional types of risky behavior, such as injecting drug use.

In many places, underlying economic and socio-cultural factors cause vulnerability to HIV.

These factors may operate indirectly, related to the low status of women, a lack of educational or economic opportunities, and local attitudes to sex and sexuality which create a market for sex work whilst simultaneously stigmatizing those involved in it. Alternatively, such factors may operate more directly, as in the case of laws and policies that criminalize sex work. Here, the social and legal status of sex work can create situations in which sex workers have little control over the conditions in which they work, and presents barriers to the use of health and social welfare services. At the same time, the stigma and fear commonly associated with HIV contribute to a reluctance to come forward for HIV-related services.

The internal structure of the sex industry may also increase vulnerability to HIV and hinder sex workers’ ability to protect themselves. Sex work can be competitive and isolated, making it difficult to maintain social or family links. Working conditions can be highly exploitative, leaving individual sex workers with limited power over their lives. Vulnerability is highest where sex workers are isolated from mainstream society and where they lack internal solidarity and their own social support networks. In such circumstances the capacity for community action around health and other issues may be low.