This paper was commissioned for the Inclusion Health programme and is one of a series of reports from the programme examining health and exclusion.
Social exclusion is commonly defined as a series of linked and/or mutually reinforcing processes, such as low income, poverty, debt, unemployment, poor education, health problems, housing problems, crime, lack of social support and other adverse life events (Bradshaw et al., 2004). Experience of these can lead to vulnerability and exclusion from enjoying the rights of employment, health care, secure housing and a decent standard of living (Popay, Povall and Mathieson, 2012). As well as affecting individuals, social exclusion affects groups of people such as migrants, disabled people, homeless people, and those suffering from mental illness; often as a result of impoverishment, discrimination and lack of adequate public services. Many people who engage in sex work are subject to high levels of social exclusion – in some cases chronic exclusion, and begin sex work as a result of experiencing many of the processes leading to exclusion.
Government policies to address sex work (and its consequences) have tended to focus on the law, the criminal justice system and punitive measures to tackle and reduce sex work activities at the expense of health and safety (Cusick and Berney, 2005; Hubbard, Matthews and Scoular, 2007). This approach has been criticised for its failure to adequately address sex worker health issues, including the wider determinants of health, and promote positive physical and mental health which has the potential to reduce the numbers of people engaging in sex work through the improvement of health and life options (Sander, 2007; Jeal and Salisbury, 2013).
This paper aims to review the existing evidence on sex workers in the UK paying particular attention to health alongside wider issues of social exclusion, such as poverty, homelessness and substance misuse. There are no studies which we are aware of that focus specifically on social exclusion and sex work in England and the UK. The paper is structured around three main themes. The first theme examines the driving factors which cause vulnerability, social exclusion and involvement in sex work. The second theme looks at how processes of exclusion affect the lives of sex workers and considers the different levels of social exclusion experienced by certain groups of sex workers. Sex workers face significant risks and ill-health; in particular, on-street, off-street, migrant and trafficked sex workers. Finally, the third theme explores the barriers which prevent greater social inclusion and the stabilisation of sex workers’ lives. Many of these barriers relate to broader issues of social exclusion beyond sex work itself.