International Journal of Drug Policy 17 (2006) 3–11
Widening the harm reduction agenda: From drug use to sex work
Institute for Applied Social and Health Research, University of Paisley, The Gardner Building, Paisley PA1 2BE, United Kingdom
Received 27 May 2005; received in revised form 3 November 2005; accepted 6 December 2005
Harmreductionemergedinthe1980sasapublichealthresponsetoHIVandinjectingdruguse.Thispaperreviewstheliteraturetostructurethe harms associated with sex work and expand the domains of harm reduction. Sex work-related harms are often rooted in debates wheremoral arguments and health and criminal justice policies compete for priority. Like drug users, sex workers have a social history in whichthey have been stigmatised, criminalised, pathologised, and on occasion, celebrated. Yet, by focusing on drug-related harm speciﬁcally, the‘harm reduction movement’ is missing opportunities to better promote health among sex workers. Harms associated with sex work include:the vulnerabilities that may lead to sex work; harms that are introduced by sex work; and mutually reinforcing harms such as problematicdrug use. These harms are overwhelmingly concentrated in street sex markets and where sex workers’ pre-existing vulnerabilities can bemost exploited. They include predation and victimisation, violence and child abuse, trafﬁcking and slavery, stigma, sanctions and penalties,STIs, exposure to mutually reinforcing harms and public nuisance. Existing interventions and policy developments to reduce these harms arediscussed.© 2005 Elsevier B.V. All rights reserved.
Sex work; Prostitution; Harm reduction; Literature review
Applied to drug use, harm reduction principles aim toreduce individual, community and societal harms includ-ing harms to health, social and economic functioning(Newcombe, 1992).Largely developed to prevent the spread
of HIV and AIDS, harm reduction is contrasted with druguse prevention and prohibition characterised as the ‘war ondrugs’.Riley et al. (1999)describe harm reduction princi-ples as pragmatic, value neutral and focused on prioritisingachievable goals.Lenton and Single (1998)deﬁne a harmreduction policy or programme as one: ‘(1) where the pri-mary goal is the reduction of drug related harm rather thandrug use per se; (2) where abstinence-oriented strategies areincluded, strategies are also included to reduce the harmto those who continue to use drugs; and (3) strategies areincluded which aim to demonstrate that, on the balance of probabilities, it is likely to result in a net reduction in drugrelated harm’. Harm reduction principles are thus synony-
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mous with the reduction of drug-related harm but it may bepossible to apply these principles more widely. AsMyers,Aggleton, and Kippax (2004, p. 325)argue, ‘public healthseeks critical understanding of issues and promotes the useofcommunityempowermentapproachesthatarewellbeyondtraditionalones,andharmreductioncannotbeconstructedinisolationfromanunderstandingofthemanysocialprocessesthat affect health today.’At present, harm reduction is a feature of sex work inter-ventions mainly where sex workers are a sub-set of prob-lematic drug users (Rogers & Rueﬂi, 2004). As a result, sexworkers who are not problematic drug users are relativelyneglected by harm reductionists and the wider problems of sex work fall outside their remits. Those interested in sexwork as an area for harm reduction in its own right willneverthelessbeabletolearnmuchfromexistingharmreduc-tionists. Drug users and sex workers after all, share similarsocial and political histories of being stigmatised, crimi-nalised, pathologised and occasionally celebrated (Sloan &Wahab, 2000).Aliteraturereviewofsexworkharmsfoundthreetypesof association: factors thought to predict, explain or cause sex
0955-3959/$ – see front matter © 2005 Elsevier B.V. All rights reserved.doi:10.1016/j.drugpo.2005.12.002