Sex worker health equity drives new Lancet public health series

A new four-paper series in The Lancet Public Health makes sex worker health equity the center of a broader research and policy agenda. San Diego State University said the collection argues that health programs for sex workers should look beyond HIV and sexually transmitted infection prevention to include mental health, violence, stigma, health care access and workplace safety.

The series grew out of a two-year collaboration involving researchers at San Diego State University, the Johns Hopkins Bloomberg School of Public Health, the Global Network of Sex Work Projects and sex workers from a range of geographic settings, according to the university. SDSU described the collection as the most comprehensive synthesis of evidence on sex workers’ health in more than 10 years.

Shira Goldenberg, an associate professor at San Diego State University, said the papers show why research, programs and policies should be broadened and developed with sex workers. She said meaningful partnership with sex workers is needed to improve evidence, policy and health equity.

What does the Lancet series say about sex workers' health?

The papers examine how social, legal and workplace conditions shape sex workers’ health globally, according to San Diego State University. They synthesize evidence on mental health, sexual and reproductive health, violence, stigma and discrimination, occupational safety, health care access and broader social determinants of health.

Health equity, in this context, means focusing on preventable differences in health and access to services that are tied to social and structural conditions. The series says these inequities are not inherent to sex work itself, according to SDSU, but are shaped by conditions including stigma, discrimination, violence and legal environments.

The work builds on earlier collections published in 2014 and updated in 2018. San Diego State University said those earlier reviews documented the disproportionate burden of HIV and other sexually transmitted infections among sex workers and showed how laws and structural conditions affect health.

Stefan Baral, a professor at the Johns Hopkins Bloomberg School of Public Health, said sex work occurs in every country and that an occupational health framing can support safer work and better health for sex workers and clients.

Three priorities identified by the papers

• Move beyond HIV alone. The series says sex workers face inequities across multiple areas of health and well-being, and that policies should address those wider conditions.

• Treat stigma, discrimination and violence as health factors. The papers describe these forces as structural determinants that operate through health systems, legal settings and social institutions.

• Use an occupational health and safety approach. The series points to safer working conditions, violence prevention, labor protections, social protections and reduced workplace hazards as part of the health agenda.

The Global Network of Sex Work Projects, described by SDSU as the world’s largest network of sex worker rights organizations, was a central partner in the project. The network works with regional groups advocating for the rights of female, male and transgender sex workers.

According to San Diego State University, sex workers and representatives of sex worker-led organizations served as authors and collaborators. Their expertise and lived experience informed the research, interpretation and recommendations.

Anna Shapiro, acting global coordinator of the Global Network of Sex Work Projects and a collaborator and co-author on the series, said the project showed the need to center sex workers’ lived experience when producing evidence. The publication details list Katherine Rucinski and colleagues’ paper, “Health inequities faced by sex workers,” in The Lancet Public Health, with DOI 10.1016/s2468-2667(25)00307-x.

This story draws on original reporting from Medical Xpress.