sex tourism in macau

Topics: HIV, Prostitution, Drug addiction Pages: 22 (5391 words) Published: May 18, 2014
Occupational Medicine 2007;57:322–328
doi:10.1093/occmed/kqm045

IN-DEPTH REVIEW

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Management of sex workers and other high-risk
groups
William Spice
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Key words

Drugs; health care; sex workers.

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Commercial sex work is a growth industry. According to
an analysis of data from the National Survey of Sexual
Attitudes and Lifestyles by Ward et al. [1], the proportion
of men who reported paying women for sex more than
doubled from 2.0 to 4.2% between 1990 and 2000.
There has also been a diversification of sexual services,
into areas beyond the traditional exchange of sex for
money. Erotic dancing which entails less direct sexual
contact between worker and client and other private sex
work advertised on the Internet have become increasingly
prevalent [2,3].
The sex industry is diverse in the ethnic origins of sex
workers, many of whom are economic migrants and include women trafficked and coerced into sex work by organized crime networks [4]. There has been a demographic shift in the origin of commercial sex workers (CSW) working in west London between 1985 and

2002, with a reduction in the proportion with British
nationality from 75 to 37%, and a corresponding increase
seen in workers from the transitional economies of Eastern
Europe and Russia (1–20%) and developing countries,
particularly Asia (5–27%) [5]. The Poppy Project, in
a survey of female sex workers across London, identified
93 different ethnic groups among women working in offstreet premises, of whom only 19% were British [6]. This influx of individuals from many countries inevitably generates language and cultural barriers in access to health and other services.

The pathways that lead people into commercial sex
work are also varied. At one end of the spectrum are those
who work autonomously, undertake sex work by choice
and are well organized with respect to their sexual health
and accessing services [7,8]. These workers may have
Department of Sexual Health and HIV, Caldecot Centre, King’s College Hospital, 15-22 Caldecot Road, London SE5 9RS, UK.
Correspondence to: William Spice, Caldecot Centre, Kings College Hospital, London SE5 9RS, UK. Tel: 144 203 299 4535; fax: 144 207 346 3486; e-mail: william.spice@kch.nhs.uk

entered sex work for a specific reason (e.g. to fund higher education costs, pay debts or to cover family expenses),
may be intermittent or opportunistic in their involvement
in sex work [9] and succeed in exiting the industry at
a time of their choice [10]. Others make a career decision
to work in the sex industry and may enjoy a high level of
job satisfaction and independence [11]. In contrast, are
those who are driven into commercial sex work through
drug addiction or coercion, and have little autonomy.
These workers, including women sold for the purposes
of trafficking, are highly vulnerable and have little prospect of leaving the industry unassisted [4,12]. Between these
extremes lie the majority, who work in the industry due to
varying degrees of economic necessity and choice [8].
There are significant differences between indoor work
and street work, in terms of harm and risk to health.
Street sex work is more likely to be linked with drugs
[13,14] and many in the UK have entered the industry
primarily out of the need to maintain expensive drug
addictions to heroine and crack cocaine. In this setting,
sex may either be exchanged directly for...

References: 5. Ward H, Day S, Green A, Cooper K, Weber J. Declining
prevalence of STI in the London sex industry, 1985 to
Office, 2003.
Office, 2004.
Downloaded from http://occmed.oxfordjournals.org/ at Institute for Tourism Studies on March 28, 2014
Conflicts of interest
London: Kegan and Paul, 2004.
London: Kegan and Paul, 2004;33:179–197.
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