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This paper has argued that some sex workers, particularly those who work from indoor markets, construct their understanding of risk in relation to their personal situation and prioritise risks depending on the perceived consequences or outcomes. I suggest that sex workers use a continuum of risk that gives increasing attention and strategic planning to emotional risks, followed by the risk of violence from clients and finally, health-related risks. This continuum can be understood first, in relation to the level of control sex workers perceive they have over the likelihood of a particular risk happening and second, the severity of the consequences of the risks.
Sex workers rationalise the outcomes relating to non-condom use by relying on the excellent health care services available, their knowledge of what to do should such an occasion arise, and peer support. Equally, being robbed would mean inconvenient material loss, but the physical injuries are minimised despite the high incidence of severe, even fatal, physical harm experienced by some sex workers. However, the consequences of emotional risks such as being discovered working as ‘a prostitute’ could mean the end of a relationship, family breakdown, stigmatisation and irreparable emotional distress.
The level of control sex workers feel they have over the likelihood of a risk occurring determines the ranking of harms. For instance, practical systems of personal safety, collective rules and shared codes of conduct inform the management of health risks and violence. However, although sex workers make concise decisions about where to work, how to hide their money-making activities and design secrecy strategies, the chances of being ‘found out’ present risks to their emotional wellbeing over which they have minimal control.
Understanding how sex workers construct profiles of risk regarding the occupational hazards they face in prostitution is essential for health policymakers. At a local level, some of these findings can be used to influence health-related policy and projects specifically designed for sex workers. Although Romans et al. (2001) found no evidence that sex work increases psychiatric morbidity, the stigmatised nature of prostitution renders mainstream public health strategies less effective. Specialist services, as described by Cooper et al. (2001), engage those who work in the sex industry at a local level to promote the safety of women in prostitution. Such projects are ideally placed to challenge assumptions that risks for sex workers are only health related. For instance, Rickard and Growney (2001) facilitated a health promotion aid by recording sex workers’ experiences. A tape was created with the specific aim of using stories to share occupational safety tips. Such a practical tool could be devised concentrating on the emotional strategies that sex workers use to protect themselves and keep their private relationships free from interference from their jobs. Such policy initiatives would address the points raised in Making it Happen. A Guide to Delivering Mental Health Promotion (Department of Health 2001) that highlight the importance of health services taking an integrated approach to physical and mental health needs. The connections between mental health and physical wellbeing have been established through rigorous research and should be considered vital amongst populations who use their bodies as sites of economic labour.
These findings also have wider policy implications regarding the social organisation of the sex industry in Britain. The legalities around selling sex place women’s mental as well as physical wellbeing at risk. Pressure to hide their work, live a ‘double life’, fabricate stories to their families and partners in order to avoid stigma and marginalisation result in significant psychological stress. By legitimating sex work as a profession the structural inequalities that leave many women vulnerable could be addressed, enabling women to organise themselves in public and private without fear of committing an offence. Protective relationships with the police could also be established and resources could move away from criminalisation, fines, arrests, court appearances, probation and imprisonment through anti-social behaviour orders.
My argument does not intend to diminish or deny the seriousness or prevalence of violence or the established health risks in prostitution, but instead draws attention to how sex workers construct profiles of risk that place forms of harm on a continuum. Risk behaviour in prostitution cannot only be understood from a medical or epidemiological viewpoint as the wider social and cultural circumstances of sex workers’ lives are as important to their wellbeing in their understanding of what is a risky outcome. Issues of secrecy, privacy, maintaining familial and personal intimate relationships, self-esteem and identity are at the core of what sex workers consider to be consequences of their work. These perceptions inform how sex work is practised and ultimately how prostitution is organised.

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