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It has been argued that norms of occupational health have weakened with diversification in the sex industry. We explore this issue in walk-in flats in London, focusing on relationships between managers (maids) and sex workers. Today, most maids are local and most sex workers are ‘migrants’. We collected data on 117 maids and sex workers, and carried out intensive fieldwork with seven maids and 17 sex workers. Managers take prime responsibility for educating and inducting new workers. Authoritarian management has been considered bad for health both in these walk-in flats and in the ‘100 per cent condom use programme’ criticized by sex workers’ projects. Yet, we found that maids acted as friends and managers, which helped settle new sex workers. Over time, however, migrants were more affected by issues of isolation and exploitation than local workers. Alternative models of health promotion such as peer education must be seen in a wider legal context where the lack of rights makes it difficult to appeal against exploitation, or to become mobile. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: We hypothesised that changes in the London sex industry will have weakened health and safety norms. Methods: Baseline data were collected on sex workers at St Mary's Hospital and grouped into four time periods: 1985-88; 1989-92; 1993-96; 1997-2000. Results: 1217 new patients were enrolled. The following changes were seen: women were older (median age increased from 25 to 27) less likely to have been born in the UK (declined from 80% to 39%), were older when they began sex work (median age increased from 21 to 24 years), and had been working for less time (median of 3 years declined to 1 year). The proportion working on the streets declined from 22% to 2%, while the proportion working in flats increased from 15% to 35%. Condom use at work rose from 80% to 99% for vaginal and from 50% to 81% for oral sex. Condom use with non-paying partners rose from 11% to 31%. There was a decline in the proportion reporting a past STI from 86% to 31%, and in the prevalence of most STI at first visit chlamydia declined from 8.2% to 3.9%, and gonorrhoea from 3% to 1%. The only increase was in hepatitis B core antibody from 6.6% to 10.1%. Discussion: We have documented significant changes in the London sex industry but these have not been associated with increased risk behaviour or risk of STI. This finding is all the more surprising given increasing migration from higher prevalence areas and increasing STI in the UK. [ABSTRACT FROM AUTHOR]

Assesses the risks of infection of prostitute women with HIV in London, England. Role of prostitute women in models of heterosexual transmission of HIV; Debates on public health initiatives; Performance of a cohort analysis.