When researchers wanted to understand what keeps sex workers healthy, they did something that does not always happen in public health research: they asked sex workers to help design the study and even co-author the papers.
The result is a new four-paper series published in The Lancet Public Health that reflects two years of collaboration between researchers at San Diego State University and Johns Hopkins Bloomberg School of Public Health, the Global Network of Sex Work Projects (NSWP), and sex workers themselves. The collection represents the most complete review of evidence on sex workers' health in more than a decade, according to the researchers involved.
For years, most research on sex workers focused on preventing HIV and sexually transmitted infections. While that work remains important, the new series expands the conversation to include mental health, violence, stigma, access to health care, and the working conditions that affect overall well-being.
"Sex work is practiced in every country in the world. Leveraging an occupational health framing to sex work advances opportunities for sex work to be safe and sex workers and their clients to be healthy," said Stefan Baral, a professor at Johns Hopkins Bloomberg School of Public Health.
The project builds on earlier collections from 2014 and 2018 that documented the disproportionate burden of HIV among sex workers and showed how laws and social barriers affect health outcomes. This new series goes further by positioning health equity and workplace safety as central ideas for understanding what sex workers need to thrive.
Shira Goldenberg, an associate professor at San Diego State University, said the series demonstrates that health inequities among sex workers stem from social and structural conditions, not from the nature of the work itself. The papers argue that stigma, discrimination, and violence function as structural barriers that shape health through health systems, laws, and community institutions.
A defining strength of the series is its partnership with NSWP, the world's largest network of sex worker rights organizations. Sex workers and representatives from sex worker-led groups participated as authors and collaborators, bringing lived experience to every stage of the research.
The findings point toward practical solutions. By applying an occupational health and safety framework — the same approach used to protect workers in other industries — the researchers argue that policymakers and health officials can better address the challenges documented across the collection.
For Goldenberg, the message is clear: improving health for sex workers requires working alongside them, not for them. "It is critical for these efforts to meaningfully engage and partner with sex workers to build stronger evidence, better policies and promote health equity," she said.
The series offers a roadmap for researchers, policymakers, and health workers seeking to move beyond a single-disease focus and toward a broader vision of health equity for a population that exists in every corner of the globe.