Management of sex workers and other high-risk groups.

Overview of the sex industry 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 off-street 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 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 …