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Health inequalities and

representations of sex workers in health publications in England.

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Article:
Putnis, N. and Burr, J. (2020) Evidence or stereotype? Health inequalities and
representations of sex workers in health publications in England. Health: An
Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 24 (6). pp.
665-683. ISSN 1363-4593

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Putnis, N., & Burr, J. (2019). Evidence or stereotype? Health inequalities and
representations of sex workers in health publications in England. Health. © 2019 The
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This is a repository copy of Evidence or stereotype? Health inequalities and
representations of sex workers in health publications in England.

White Rose Research Online URL for this paper:

[Link]

Version: Submitted Version

Article:
Putnis, N and Burr, J (2019) Evidence or stereotype? Health inequalities and
representations of sex workers in health publications in England. Health: An
Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. ISSN
1363-4593

[Link]

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Health: an interdisciplinary journal for the social study of health, Illness and medicine

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Page 1 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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5 Evidence or Stereotype? Health Inequalities and Representations of Sex Workers in Health
6 Publications in England
7
8
9
10
11 The health of sex workers is considerably influenced by their position in society and by the
12
13 marginalisation and stigmatisation they face worldwide. They are frequently criminalised and
14 labelled as deviant, disordered or ‘vulnerable’: stereotypes that simplify and misrepresent
15
16 their realities. Sex work policies create social and structural barriers, creating dangerous work
17
18 environments and exacerbating significant health inequalities.
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20 Health organisations and their policies play an important role in highlighting inequalities and
21 guiding health systems in reducing them. In this paper, we use a document analysis design to
22
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24
25 national health organisations: National Health Service (NHS) England, Public Health
26 England and the National Institute for Health and Care Excellence, alongside the UK’s
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28 Department of Health.
29
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30 We find that sex workers are largely absent in these documents and, when present, are
31
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depicted not using evidence, but simplistically with moralistic undertones. The dichotomous
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33 constructions: vulnerable yet also criminal ‘prostitute’ reflect wider political and social
34
35 constructions of sex working women. This not only obscures their realities, but homogenises,
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blames and stigmatises, ultimately doing the opposite of what these organisations purport to
37
38 do: it damages their health and wellbeing.
39
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 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 2 of 110

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Page 3 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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21 England. We provide a critical overview of how sex
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25 wellbeing.
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28 Sex work is a term used to describe ‘a range of activities relating to the exchange of money
29
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30 (or its equivalent) for the provision of sexual services’ (Balfour and Allen, 2014: 3). We will
31
32 use this term to avoid the negative connotations of the term ‘prostitute’ and to highlight the
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34 diverse nature of this ‘range of activities’ and of the individuals involved. We will return to
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36 the complexities of terminology later in this paper.

37
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39 Approaches on the ‘management’ of sex work differ worldwide, with various attempts to
40
41 abolish and criminalise sex workers and/or clients or conversely to decriminalise or legalise
42
43 the practice. These policies mirror academic and feminist debate. For the sake of brevity, this
44
45 can be simplified to a polarised ‘sex wars’ between those that regard sex work as patriarchal
46
47
48
violence against women and those that argue this approach runs contrary to sex workers’
49
50 rights, voice and homogenises experiences (Ferguson, 1984; Sanders, 2016). Despite multiple
51
52 perspectives on the legitimacy of sex work, this continuum of views often features violence
53
54 towards sex workers and their perceived wellbeing as central to their arguments.
55
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conditions, substance abuse and poor health in general (Balfour and Allen, 2014; Jeal et al.,
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34 2017; Jeal and Salisbury, 2004, 2007; Mc Grath>Lone et al., 2014). Stigma and
35
marginalisation both lie at the root and exacerbate these issues, with access to healthcare
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38 generally poor (Jeal and Salisbury, 2013; Mastrocola et al., 2015).
39
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41 Importantly, however, not all forms of sex work carry the same risks. Sex work is diverse,
42
43 with different environments, circumstances and associated issues (Harcourt and Donovan,
44
45 2005). For example, the more common ‘indoor’ work is associated with less violence,
46
47 substance use and risk overall than ‘street’ work (Hubbard and Prior, 2013; Jeal and
48
49 Salisbury, 2007; Sanders and Campbell, 2007). Migrant sex workers and men, transgender or
50
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non>heterosexual individuals work in different circumstances and have different needs (Baral
52
53
54
et al. 2015; Platt et al. 2013; Smith and Laing 2012). This diversity is frequently omitted in
55
56 sex work policy. Finally, there lies an important distinction between designating all sex
57
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 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 6 of 110

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39 how this could affect their health and wellbeing.
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In England, national health policies are produced by the Department of Health (DH) and
43
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45 ‘Arm’s Length’s Bodies’ (ALBs). ALBs discussed in this paper: NHS England (NHSE),
46
47 Public Health England (PHE) and the National Institute for Health and Care Excellence
48
49 (NICE) all play key roles in health service provision and access, commissioning, population
50
51 health and standards for care throughout England. They play key roles in reducing health
52
53 inequalities and, alongside the DH, repeatedly state this as a priority. This ‘need to reduce
54
55
[health] inequalities’ is enshrined in law (Health and Social Care Act, 2012). These
56
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Page 7 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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3 # E states, for example, ‘all our work is
4
5 informed by…evidence’ (PHE, 2015: 5). Whilst the debate on the existence or feasibility of
6
7 evidence>based policy is complex (see, for example, Smith, 2013), these organisations make
8
9 a clear mandate to use evidence to reduce inequality.
10
11
12
In this paper, we undertake a document analysis of publications released by the UK
13
14
15 government DH and ALBs: NHSE, PHE and NICE. The absence of an overarching sex
16
17 workers’ health policy means that these documents are not necessarily designated as policy.
18
19 We argue, however, that these documents contain reflections of policy>makers and of those
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21 decisions and non>decisions, action and inaction, perspectives and values that ultimately
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23 constitute policy.
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We are interested in how English national health publications discuss and portray sex
30
31
32 workers. By selecting a systematic search methodology, we aimed to analyse a cross>section
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34 of documents containing every reference to sex work or workers in a 6>year period, from
35
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36 2010 to May 2016. This period has salience due to the UK’s 5>year political cycles, with the
37
38 previous Government taking up post in 2010.
39
40
41 Sex work/workers and synonyms were searched in [Link] (which hosts both DH and PHE
42
43
online platforms); [Link] and [Link]. Synonyms included sex
44
45
46 trade/industry/market; prostitute/ion. Where possible, terms were combined using Boolean
47
48 functions and/or truncation. All resultant publications were screened for relevance.
49
50
51 Systematic searches for grey literature has no ‘gold standard’ with a less standardised
52
53 methodology than academic searches (Godin et al., 2015). To increase trustworthiness,
54
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 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 8 of 110

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development’; ‘patient information’.
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15 Social Care online search ([Link]>[Link]) – advanced search.
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17 Filters: ‘government publication’; ‘legislation’; ‘consultation document’; statutory
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19 guidance’; ‘practice guidance’; ‘practice examples’; ‘standards’.
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21 [Link]
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24 Google Advanced Search.
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27 Inclusion and exclusion criteria were set. Any document containing any search term,
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29 published between 2010 and May 2016 by NHSE, PHE, NICE or DH was included. This
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31 incorporated instances where these terms arose in quotes from individuals, but only when not
32
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33 used for research or illustrative purposes. Exclusion criteria were publications from countries
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35 outside of England and commissioned documents. This latter criterion is critical, as the DH
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commissions documents written by academics or other health organisations. These
38
39
40 documents have been excluded from this study as their status in relation to both policy and
41
42 academia is unclear.
43
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45 We analysed the documents using a combination of content and thematic analyses,
46
47 concurrently assessing the context of the search terms i.e. desired readership and publication
48
49 topic. Whilst content and thematic analysis are sometimes regarded as interchangeable, we
50
51 conceived content analysis as achieving an additional descriptive layer of reliability by
52
53
54
quantitatively assessing terms, document types, repetition and terminologies. We analysed
55
56 the documents using a descriptive search for the frequency of all accounts of sex workers
57
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60 [Link]
Page 9 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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31 Equality Act (2010) and legislation requiring ‘regard to’ health inequalities (Health and
32
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34
35 (EIA). The worth of these documents has been called into question (former British Prime
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37 Minister, David Cameron, called them ‘bureaucratic nonsense’ (Cabinet Office 2012)). Yet, it
38
39 is in these documents or similar that sex workers arise in a third of cases (11/34). In these
40
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42
documents plus in a further ten and therefore in the majority of the texts (21/34) sex workers
43
44 arise solely in lists of groups described as ‘disadvantaged’, ‘marginalised’, ‘socially
45
46 excluded’, ‘hard>to>reach’, ‘vulnerable’, ‘hidden’ and, once even, ‘easy to ignore’. These lists
47
48 include fellow marginalised groups, typically ‘refugees’, ‘homeless’ or ‘traveller
49
50 communities’. Whilst a discussion of sex workers’ vulnerabilities or exclusion is welcomed,
51
52 these lists risk compounding the issue of their absence, as they recognise inequality, yet lack
53
54
this meaningful discussion. These are lists of ‘others’, even designated as such (‘other
55
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 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 12 of 110

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Understanding the vulnerabilities associated with prostitution and sex workers
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36 In only one document, the DH’s Framework for Sexual Health Improvement in England
37
38 (2013), is there a recognition and discussion of structural causes of vulnerability and poor
39
40 health. Sex work is otherwise described as a ‘behaviour’. First in relation to symptoms of
41
42
personality disorder:
43
44
45
46 …impulsivity and self damaging behaviour (substance abuse, prostitution, self$harm
47
48 and suicide attempts) (Motz et al. for NHSE and National Offender Management
49
50 Service 2015: 10)
51
52
53 ...impulsive acts of recklessness…(e.g. substance misuse, prostitution, suicide
54
55 attempts). (p. 139)
56
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60 [Link]
Page 13 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

1
2
3 '
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5
6 behavioural characteristics, for example illicit drug use or commercial sex work…
7
8 )( +E, 2014a: 2)
9
10
11 These highlight individualistic concepts of blame and ‘behaviour’. They also introduce the
12
13
concepts of the sex worker as mentally unwell, and the sex worker as a criminal.
14
15
16
17
$ %
18
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Sex workers are directly associated with mental health or disability in 4 texts, most notably
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20
21
22 learning difficulties or personality disorder. In a further 4 they are listed alongside ‘mental
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24 health issues’ (and other causes of ‘vulnerability’). The conflation of sex work and mental
25
26 health issues raises serious concerns as we will illustrate through the UK Government’s Care
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27
28 Act Statutory Guidance case study of Miss P. Miss P is introduced as a person who does not
29
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have capacity to consent and that:
31
32
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34
Miss P was being coerced into prostitution and physically assaulted (DH, n.d.)
35
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37 The issue of consent, mental illness and ‘prostitution’ as conceptualised in this case study are
38
39 very problematic. We have earlier introduced the ‘sex wars’ debate: put simply, the ‘sex>
40
41 work>as>work’ versus ‘prostitute>as>victim/’prostitution>as>violence>against>women’ debate.
42
43 The sex workers’ rights movements ‘resist accounts that cast them as mere victims’ (Scoular,
44
45 2004: 346), arguing it constructs sex workers as ‘devoid of choice, responsibility or
46
47
accountability’ (Maher, 2000: 1). Sex work is legitimate work, only achievable with consent.
48
49
50 The latter view conceptualises sex work (or prostitution) as inherently a violation against
51
52 women’s rights, and argues that they are always coerced regardless of context (see, for
53
54 example, Jeffreys, 2010). The implication in this case study, is that consent is irrelevant to
55
56 ‘prostitution’ status, which links to this view. Irrespective of these dichotomised views on
57
58
59
60 [Link]
 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 14 of 110

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14 & )+ E) (Crellin, 2015).
15
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17 Despite these issues, this case study does at least imply a recognition of a distinction between
18
19 coerced versus non>coerced ‘prostitution’. This is not always the case in these documents, as
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20
21 we will now discuss.
22
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24 &
25
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27 The conflation of sex work with violence, abuse or trafficking is a common theme in sex
28
29
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work literature (Kempadoo et al., 2015; Lancet, 2015; Weitzer, 2007). Trafficking or CSE are
30
31
32 widely recognised as human rights’ violations requiring global policy and action, however
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34 conflation with sex work ignores the different experiences of those involved. It again
35
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36 misrepresents the difference between consensual sex work and non>consensual abuse, with
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38 potentially damaging effects around sex workers’ ability to report rape or violence (Sanders,
39
40 2016). These conflations and misconceptions are replicated in these documents.
41
42
43
Eight documents associate sex work and violence, recognising that sex workers have an
44
45
46 increased risk of violence, but also depicting sex work as violence. Two documents, both
47
48 from ‘Health & Justice’ (H&J), list the following:
49
50
51 ..advice for sex workers and those who have been subjected to domestic violence and
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53 abuse (Guite et al. for PHE 2014: 6)
54
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Page 15 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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2
3 …support for those who may have been victims of domestic abuse or sex workers
4
5 ) E, 2014b: 17)
6
7
8 A ‘Liaison & Diversion’ (L&D – a service for offenders with issues around mental health,
9
10 learning disability or drugs) document quotes:
11
12
13
…experiences of domestic violence, sexual violence, prostitution and human
14
15
16 trafficking.
17
18
19 ..Understanding the vulnerabilities associated with prostitution and sex workers who
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20
21 put themselves at risk of exploitation, abuse, violence…’ (NHSE, 2014: 8–9)
22
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23
24 Despite not defining sex work as abuse, there is an implicit association between sex work and
25
26 violence in these statements. Going a step further, the EIA accompanying the DH’s
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28 Improving Services for women and child victims of violence explicitly states:
29
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30
31 [Violence against women] includes domestic violence, forced marriage, ‘honour’
32
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34
crimes, , sexual violence, trafficking for sexual exploitation, stalking and
35
female genital mutilation. [emphasis added] (2010c: 5)
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37
38
39 This clearly defines all ‘prostitution’ as violence, putting it in apparent parity with human
40
41 rights’ violations and violent crime.
42
43
44 The final 2 documents discussing sex work in relation to violence (both regarding sexual
45
46 violence) do so in passing, under ‘other services’, in a list of ‘key informants’ and under ‘data
47
48 sharing’ (DH, 2011:13,17; NHSE, 2015i:19). This further underlines the lack of presence in
49
50
51
documents where special attention to sex work is perhaps warranted. In no document is there
52
53 a discussion of the heightened risks of violence for sex workers, the potential health impacts
54
55 or management.
56
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58
59
60 [Link]
 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 16 of 110

1
2
3 $ % '
4
5
6 " ! ! "
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8 $ " A " $ " $
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10 # ! " " @L.$ ! #
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%! ! ! & )H C #$ /013*#
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14
15 " " " cause ! '
16
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18 …prostitution and sex workers…recognising depression, anxiety and personality
19
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20 disorders which may have gone undiagnosed )( E, 2014: 9)
21
22
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23 …with a history of borderline personality disorder and depression…involved in street
24
25 prostitution (NHSE, no date, no page numbers)
26
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27
28 The following two in relation to symptoms of personality disorder:
29
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30
31 impulsive acts of recklessness as a means of emotion regulation (e.g. substance
32
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34
misuse, prostitution, suicide attempts). (Motz et al. for PHE and National Offender
35
Management Service 2015: 139)
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36
37
38
39 impulsivity and self$damaging behaviour (substance abuse, prostitution, self$harm
40
41 and suicide attempts) (10)
42
43
44 The relationship to borderline personality disorder is interesting. Feminist and sociological
45
46 commentators contest this psychiatric diagnosis on the grounds that it is the modern
47
48 ‘hysteria’, disproportionately associated with ‘femininity’ and ‘emotionally unstable’ women
49
50
51
(Rogers and Pilgrim, 2014; Ussher, 2011, 2013). Women deemed ‘mad’ have long been
52
53 associated with ‘promiscuity’ (Chesler, 2005). These accounts of deviance and sexuality
54
55 seem to coalesce both in accounts of sex workers and in accounts of women and ‘madness’,
56
57
58
59
60 [Link]
Page 17 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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28 …drug users are more likely to be involved in crime (such as theft and prostitution)…
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44 ( +E guidance on drug use reports:
45
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47 Many acquisitive crimes...are committed by people whose drug use has become an
48
49 addiction…[who] support their drug use with low$level dealing or prostitution.
50
51 (NICE, 2014b: 2)
52
53
54 A NICE accompanying document for ‘services for pregnant women with complex social
55
56 factors’ii lists:
57
58
59
60 [Link]
 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 18 of 110

1
2
3 …prostitution and criminal activity… )( +E, 2012: 15)
4
5
6 All 5 NICE publications discuss sex work only in relation to drug use. Whilst substance abuse
7
8 and sex work may co>exist and interact to confer health problems, the complexities in this
9
10 discussion is missing from these documents, referring to ‘prostitution’ as merely deviant
11
12
criminal activity as a means to fund a drug problem. This misrepresents the myriad potential
13
14
15 economic motivators behind sex work, which include poverty, debt, childcare or funding
16
17 education (Sanders et al., 2009: 39–40).
18
19
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20 The report ‘crime reduction benefits of drug treatment’ (NHS National Treatment Agency for
21
22 Substance Misuse, 2012)iii repeatedly lists ‘prostitution’ between ‘drug dealing’ and ‘other
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23
24 stealing’, alongside ‘fraud’ and ‘violent theft’. This document also states:
25
26
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27 women involved in street prostitution typically spend over 75% of their income on
28
29
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drugs (p. 22)

30
31
32
This references a UK Home Office document (Hunter et al., 2004) which references another
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33
34
35 (May et al., 1999) which bases its findings on a small sample of sex workers chosen because
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36
37 of their association with both sex and drug markets. This poorly researched statement
38
39 reinforces a simplistic, one>dimensional view of sex work that is easily corroborated with a
40
41 moralistic agenda. This misrepresentation is not an isolated case; as Cusick et al. (2009)
42
43
highlight, the Home Office was criticised in 2009 for the sweeping statement ‘nearly all sex
44
45
46 workers are addicted to drugs or alcohol’ (p. 707).
47
48
49 Sex workers’ needs in these crime>related documents, when they are mentioned, are poorly
50
51 acknowledged. Support for sex workers in prison is both important and lacking (Ahearne,
52
53 2016) yet they arise only 3 times in 2 H&J documents – twice in relation to rehabilitation
54
55 companies, who list sex workers amongst those individuals for whom they provide support.
56
57
58
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60 [Link]
Page 19 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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35 ( E’s ‘Equality Diversity System’ lists ‘women and men involved in prostitution’ (NHS,
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37 2013: 11) and the EIA for the DH’s National Sexual Health Policy lists sex workers under
38
39 ‘gender’, displaying a welcome recognition of diversity:
40
41
42 Sex workers – like the rest of the population – form a diverse group, and their sexual and
43
44 health behaviour will vary greatly. However, sex workers may have particular sexual health
45
46
needs, and these are likely to differ according to their gender and personal circumstances
47
48
49 (2010a: 19)
50
51
52 The case study ‘Billy’ (not a real case, but ‘representative case material’) is a welcome
53
54 example, in presence although not in content, of a male sex worker, in addition to the only
55
56 reference to non>heterosexuality. However, here too there is reference to female sex workers.
57
58
59
60 [Link]
 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 20 of 110

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Page 21 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 22 of 110

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47 ' %! & %
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49 & )Ehrenreich and English, 1976: 14). These conceptions do not truly represent
50
51 women or sex workers. They obscure diversity, agency, reality and are based on ideological
52
53
54
beliefs of womanhood and female sexuality, portraying moralistic undertones. This
55
56
57
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60 [Link]
Page 23 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

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3 " ! $ reinforcing "
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16 ! England clearly demand some focus from
17
18
health organisations > both in relation to human rights and equality but also to cost (and life)>
19
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20
21 saving prevention and early intervention. The absence and construction of sex workers in
22
these documents portrays not an evidence>based perspective, but a lack of interest and/or a
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23
24
25 moralistic point of view – one that is unlikely to be conducive to reducing these inequalities.
26
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27
28 There is more however. In addition to a lack of focus, the moral slant of these constructions
29
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30 risks further exacerbating these inequalities. The way people are defined in public documents
31
32 dictate the strategies and plans for how their needs will be met (or not). The language and
ev

33
34 perspectives used influences how sex workers are envisaged by those reading these
35
iew

36 documents. Whilst we can find no evidence on how widely read these documents are,
37
38
especially given the significant range included in this analysis, it is very likely that many of
39
40
41 these documents are widely read by health service staff, including public health professionals,
42
43 policymakers, managers and frontline staff. In other words: those responsible for organising
44
45 and delivering frontline services. Therefore, the perspectives presented risk exacerbating
46
47 stigma and perpetuating a narrative where sex workers are inferior, deviant and devoid of
48
49 (sensible) choice or agency. They perpetuate a ‘discourse of disposal’ (Lowman, 2000: 1003)
50
51
increasing the risk of violence, abuse and poor health and wellbeing. These documents risk
52
53
54
reinforcing those social and structural norms that create the damaging environment in which
55
56 sex workers currently work and live.
57
58
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60 [Link]
 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 24 of 110

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2
3 " " <
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7 )5 /000*# $ A ! !
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9 " ! "
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" ! ! " #E
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14 " ! . $( E, PHE and NICE publications. These documents thus
15
16 form a disjointed collection, not intended to be read together and thus any conclusion drawn
17
18 from examining their entirety needs to be taken in context. However, any member of the
19
Fo
20 public or healthcare staff searching for discussion or guidance on the care or management of
21
22 sex workers come across a similarly disjointed array. Our findings also suggest how an
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23
24
25
analysis across documents can be as fruitful as an individual policy analysis, the latter
26
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27 deemed to be of utmost importance in understanding the roots and direction of health systems
28
29 (Buse et al., 2012).
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30
31
We have focussed on sex workers as a diverse yet defined group with clear health inequalities
32
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33
34 who are marginalised, stigmatised and subject to myriad social constructions typically
35
defined by people other than themselves. We could however have concentrated on any of the
iew

36
37
38 ‘other vulnerable groups’ so often listed alongside them: homeless people; traveller or
39
40 migrant communities. Our findings have salience across this spectrum, posing the question
41
42 of how balanced the views of health organisations are in relation to marginalised groups
43
44
generally?
45
46
47 Recent high profile publications such as by Amnesty International (2016) and the UK
48
49 Government Home Affairs Committee (2016) recognise and advocate the health benefits of
50
51
decriminalising sex work. The Home Affairs Committee Report states ‘current practice…
52
53
54
ha[s] an adverse impact’ and ‘it is wrong that sex workers…[are]…stigmatised and
55
56
57
58
59
60 [Link]
Page 25 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

1
2
3 & ) /1*# ! " "
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5 ! & #
6
7
8 Evidence from New Zealand, where the 2003 Prostitution Reform Act decriminalised all
9
10 forms of sex work, indicates a positive effect on sex worker’s health and safety (Abel, 2014).
11
12 A comparative analysis of Australian states with differing sex work laws demonstrates
13
14 similar findings (Harcourt et al., 2010). Whilst legislation lies outside the scope of our
15
16 recommendations, research from these countries highlight the importance of governmental
17
18
and health perspectives to the health of this group. They highlight the health benefits of
19
Fo
20
21 opening the conversation about sex worker’s rights, decriminalisation and their health and
22
safety.
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23
24
25
We recommend that UK health policy follow this lead and start considering the root causes of
26
ee

27
28 sex worker’s health inequalities. We recommend they display a balanced, non>partisan view
29
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30 of sex workers and start doing just as they purport to do: use evidence to improve the health
31
32 of this politicised and marginalised group.
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33
34
35
iew

36
37
38
39
40 i
This document also uses the term child ‘prostitution’, as aforementioned contradictory terms (p. 26).
41 ii
Note sex workers are not mentioned in the associated guideline ‘Pregnancy and Complex Social Factors’
42 iii
This agency has been subsumed by PHE and is thus included in this analysis
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60 [Link]
 Health: an interdisciplinary journal for the social study of health, Illness and medicine Page 26 of 110

1
2
3 5
4
5
6 4 ?H )/016* 4 " C ' ! % ! &
7
8 # Criminology&Criminal Justice /6)3*' ;30B3:/#
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11 4 ? )/01=* ' " # Prison
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13 Service Journal )//7*' /6B/:#
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16 4 " 4$ - H$ " 4$ # )/011* + "
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18 G' + $ $ # Global Public Health
19
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20 =) 7*' 732B 7=:#
21
22
4" )/01=* Amnesty International Policy on State Obligations to Respect,
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25 Protect and Fulfil the Human Rights of Sex Workers# 4 "'
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27 '88!!!# " # 8 8 " 8 70860=/8/01=8 8 )4 ( /012*

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29
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5 4 F )/016* A Review of the Literature on Sex Workers and Social

30
31
32 Exclusion By the UCL Institute of Health Equity for Inclusion Health, Department of
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34 Health# 4 "' '88!!!# # 8 " 8 8 > >
35
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36 > > > > > > !> > )4 ( /012*

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39 5 .$ 9 " H $? $ # )/013* H ! ' $ $
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41 G " # The Lancet 7;3)::=6*' /=0B/27#
42
43
5 H )/000* + ' !# '5 H ? ?) *$
44
45
46 Qualitative Researching with text, image and sound$ @ ' 4?E Publications: 131–
47
48 151.
49
50 Benoit C, Mccarthy B and Jansson M (2015) Stigma , sex work , and substance use : a
51
52
53
comparative analysis. Sociology of Health and Illness, 37(3): 437–451.
54
55 Bernstein E (1999) What’s Wrong with Prostitution? What’s Right Sexual Labor. Hasting’s
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Page 27 of 110 Health: an interdisciplinary journal for the social study of health, Illness and medicine

1
2
3 Women Law Journal 10)1*' :1B112#
4
5
6
5 ! - )/016* 5 '% & # ' H
7
8 ) *$ Social policies and social control: New perspectives on the not$so$
9
10 big society$ @ ' ' 7:B3/#
11
12
5 ! - )/016* P G N '+ + !
13
14
15 %G &D # Social Policy and Society 17)7*' 721B7;2#
16
17 5 ! - )/012* " $ $ " '4
18
19
G @ # Social Policy &
Fo
20
21
22 Society, 1=)7*' 1B17#
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23
24 5 -$ H ( ? )/01/* Making Health Policy# @ 'E ,
25
26
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27 + E )/01/* " H & +5 # 4 "'

28
29 '88!!!# # 8 " 8 8 " >" > > > ) F
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30
31 /012*#
32
ev

33
34 + 4 F )/013* 9 " ( ! +
35
iew

36 Engagement and Support Orders and their Policy of Forced Welfarism. Social Policy &
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38 Society 14(1): 103–112.
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41 Carter SM, Ritchie JE and Sainsbury P (2009) Doing good qualitative research in public
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43 health: not as easy as it looks. NSW Public Health Bulletin 20(7–8): 105–111.
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46 Caudwell J (2017) ‘ Does your boyfriend know you’re here?’ The spatiality of homophobia
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48 in men’ s football culture in the UK of homophobia in men’s football culture in the UK.
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50 Leisure Studies 30(2): 123–138.
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Chesler P (2005) Women and Madness: Revised and Updated. Basingstoke: Palgrave
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55 Macmillan
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3 + )/013* 9 " # The Children’s Society#
4
5 4 "' '88!!!# # # 8 !> > 8 > 8 ">
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7 > > > > > M0. ) /6 F /012*#
8
9
10 + @$ - $5 >? 5$ # )/00:* "
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12 Estimating the size of the sex worker population in Britain. Critical Social Policy 29(4):
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14 703–719.
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17 Deering KN, Amin A, Shoveller J, et al. (2014) A systematic review of the correlates of
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19 violence against sex workers. American Journal of Public Health 104(5): 42–55.
Fo
20
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22 DH (2010a) Equality Impact Assessment for National Sexual Health Policy. London:DH
rP
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24 Press
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DH (2010b) Healthy Lives, Healthy People: Our strategy for public health in England.
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London: DH Press
rR

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31 DH (2010c) Improving services for women and child victims of violence: The Department of
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33 Health Action Plan, Equality Impact Assessment. London: DH Press

34
35
iew

36 DH (2011) Response to Sexual Violence Needs Assessments (RSVNA) Toolkit (revised).

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38 London: DH Press
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41 DH (n.d.) Care and Support Statuatory Guidance. no date. Available from:
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43 [Link]
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45 support>statutory>guidance#using>the>care>act>guidance (accessed October 2017).
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48 Dodsworth J (2014) Sex worker and mother: Managing dual and threatened identities. Child
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50 and Family Social Work 19(1): 99–108.
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Ehrenreich B and English D (1976) Complaints and Disorders: the sexual politics of
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55 sickness. 2nd ed. London: Writer&Readers Publishing Cooperative.
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2
3 Equality Act (2010) UK Legislation. Available from:
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5 [Link] (accessed November 2017)
6
7
8 Ferguson A (1984) Sex War: The Debate Between Radical and Libertarian Feminists. Signs:
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10 Journal of Women in Culture and Society 10(1): 106–12.
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12
Godin K, Stapleton J, Kirkpatrick SI, et al. (2015) Applying systematic review search
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15 methods to the grey literature: a case study examining guidelines for school>based
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17 breakfast programs in Canada. Systematic Reviews 4(1): 138.
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19
Grenfell P, Eastham J, Perry G, et al. (2016) Decriminalising sex work in the UK. BMJ 4459:
Fo
20
21
22 i4459.
rP
23
24 Guite H, Kristiansen D, Morrey A, et al.(2014) Health & Justice report 2014. Available at:
25
26
ee

[Link]
27
28
29
ealth_and_justice_report_2014.PDF (accessed Nov. 2017)
rR

30
31 Harcourt C and Donovan B (2005) The many faces of sex work. Sexually Transmitted
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ev

33 Infections 81(3): 201–206.

34
35
iew

36 Harcourt C, O’Connor J, Egger S, et al. (2010) The decriminalisation of prostitution is

37
38 associated with better coverage of health promotion programs for sex workers. Aust NZ
39
40 J Public Health 34(2): 482–6.
41
42
43 Health and Social Care Act (2012) UK Legislation. Available from:
44
45 [Link] (accessed 16 July 2017).
46
47
48 Home Affairs Committee (2016) Prostitution. Third Report of Session 2016$17. Available at:
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50 [Link] {Accessed
51
52 Nov. 2017)
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54
55 Hubbard P and Prior J (2013) Out of sight, out of mind? Prostitution policy and the health,
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1
2
3 ! > " > ! # Critical Social Policy 77)1*' 160B
4
5 13:#
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7
8 ?$ H . . )/006* Solutions and strategies : drug
9
10 problems and street sex market : guidance for partnerships and providers#
11
12 @ ' " E
13
14
15 F ( + )/006* 4 " > ' >
16
17 # Journal of Public Health /=)/*' 162B131#
18
19
F ( + )/002* >
Fo
20
21
22 " ! > '4 > # BJOG 116)2*' ;23B
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23
24 ;;1#
25
26
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F ( + )/017* ! '!
27
28
29
# Postgraduate Medical Journal ;:)1037*' 7=:B20#
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30
31 F ($ H F$ +$ # )/012* ! "
32
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33 ! " " ' # BMJ$ 2)7*' 1B:#

34
35
iew

36 F )/010* The Idea of Prostitution# ? ' #

37
38
39 - F F )/006* . ,-# The
40
41 European Journal of Women’s Studies 11)1*' 22B101#
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43
- " -$ F 5 )/013* Trafficking and Prostitution Reconsidered:
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45
46 New Perspectives on Migration, Sex Work, and Human Rights# @ '
47
48 - )/00;* Violence and Sex Work in Britain# + " ' #
49
50
51 @ )/013* - ! # Lancet$ 7;=):::7*' 306#
52
53
@ !" F )/000* G ! ) * + # Violence
54
55
56 against women$ =):*' :;2B1011#
57
58
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3 H @ )/000* Sexed Work: Gender, Race and Resistance in a Brooklyn Drug Market#$
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5 E 'E , #
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8 H EL, Taylor AK and Chew>Graham C (2015) Access to healthcare for long>term
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10 conditions in women involved in street>based prostitution: a qualitative study. BMC
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12 family practice, 16(1): 118.
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15 May T, Edmunds M, Hough M, et al. (1999) Street Business : The links between sex and drug
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17 markets. Webb B (ed.), Police Research Series London:RDS
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Mc Grath>Lone L, Marsh K, Hughes G, et al. (2014) The sexual health of female sex workers
Fo
20
21
22 compared with other women in England: analysis of cross>sectional data from
rP
23
24 genitourinary medicine clinics. Sexually Transmitted Infections 90(4): 344–350.
25
26
ee

Motz A, Logan C, Bull C, et al. (2015) Working with offenders with personality disorder
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29
Available from: [Link]
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30
31 content/uploads/sites/12/2015/10/work>offndrs>persnlty>disorder>[Link] (Accessed
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33 Nov. 2017)
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35
NHS (2013) A refreshed Equality Delivery System for the NHS. Available from:
iew

36
37
38 [Link] (Accessed
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40 Nov. 2017)
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42
NHS National Treatment Agency for Substance Misuse (2012) Estimating the Crime
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44
45 Reduction Benefits of Drug Treatment and Recovery. Available from:
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47 [Link]
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49 treatment>guidance (Accessed Nov. 2017)
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52 NHSE (2014) Liaison and Diversion Bulletin. Available from:
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54 [Link] (Accessed
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56 Nov.2017)
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1
2
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