SEX WORKERS AND THE CONTROL OF SEXUALLY-TRANSMITTED DISEASE

Objectives: To describe and assess measures to control sexually transm itted diseases (STDs) among sex workers and their partners. Methods: A review of medical, historical and social literature, focusing on sele cted cases. Results: Measures to control disease in sex workers today are often prompted by concerns about HIV transmission. However, the li terature shows that prostitution varies from one place and time to ano ther, together with the risk of sexually transmitted disease. A broad social definition of prostitution rather than a narrow reference to le vels of sexual activity is important for effective disease control, as an understanding of the relation between social disadvantage and sexu al activity enables the provision of occupational services that sex wo rkers actually want and use. Social prejudice and legal sanctions caus e some sex workers and their partners to avoid even the most appropria te and accessible specialist services. Therefore targeted programmes c an only complement, and not replace, general measures to control STDs, which are developed for other social groups or the local population a s a whole. Conclusions: Sex workers and sex work differ from one place to another and so a single model for STD control is inappropriate. No ne the less, occupational health risks suggest a general need for spec ialist services. Where these do not compound the disadvantages that se x workers already suffer, medical services are likely to offer signifi cant benefits in prevention, early diagnosis, and treatment of STDs. A s the stigma of prostitution leads many people to remain invisible to services, a general health infrastructure and anti-discriminatory meas ures will be equally important to effective disease control.