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The third finding was that although many women were aware of the damage caused by prostitution, and constructed techniques to manage the threat to emotional wellbeing, it was certainly not the case that all of the women I encountered in the sex industry were proficient in avoiding psychological damage. Those who did not adopt separating strategies left their emotions and identity exposed: ‘I do get down. It is hard and you get low days. Some days I hate what I do, I try and block it out. It is hard sometimes. . . . I don’t talk to anyone about it, it is better that way. The less I talk about it the less real it is’ (Louise, street). Strong negative emotions that are not managed can have dangerous consequences especially in relation to substance misuse and self-esteem: ‘Last year I did go through a bad patch when I was drinking a lot just to get away’ (Kelly, sauna). Others told of their spiral of selling sex to buy drugs while at the same time depending on drugs to get them through the emotional trauma of having sex with a stranger for £10.
Discussion and conclusions.
The traditional empirical focus on sexual behaviour and drug use in commercial sex uncovers the complex issues that expose sex workers to health risks. Risks to health, however, cannot be considered in isolation but must be contextualised as one hazard on a continuum of risks that sex workers engage in and are exposed to. The findings from this study regarding the strict use of condoms amongst indoor sex workers supports the general trend that establishes a high rate of condom use (Cusick 1998, Day and Ward 1990, McKeganey et al. 1992, Ward et al. 1999) and offers an alternative view to the suggestion that sex workers are misinformed about the health risks in prostitution to the extent that ‘sexual risk-taking with clients [is also] associated with off-street forms of prostitution’ (Kinnell 1991: 91). Comprehensive awareness of health issues could be explained by the intense health-promotion work that has taken place with sex workers over the past decade, that continues in over 90 projects in Britain (see Cooper et al. 2001). It may indeed be the case, as suggested by Gysels et al. (2002) from a study of sex workers in a Ugandan trading town, that women who are entrepreneurial are more skilled in negotiating safe sex and therefore have a different risk profile to those who are dependent on drugs and work from unsafe, unregulated street markets.
An important rationalisation amongst sex workers in my study was that taking care of health risks was a point of individual responsibility, and while there was an ever-present chance that a condom could break or a client could force unprotected sex, this was an unusual event. This meant that sex workers understood health risks as a controllable feature of their work and, armed with the correct scientific information, and tools such as condoms, caps, contraceptive pills, regular health checks and so forth, health risks were less of a worry. Instead, because indoor sex workers considered condom use an integral practice of their work, other more subtle risks were given more attention and strategic intervention.
Violence from clients was considered to be a hazard that was less predictable, more prevalent and therefore increasingly risky compared to health-related risks. Assessing the likelihood of physical harm from clients was a difficult judgement call and therefore minimising violence was a more pressing concern. Reducing the likelihood of physical risks was prioritised through a complex system of precautions, screening, deterrents and remedial protection. These mechanisms were evident at both an individual level as well as through rules and systems in establishments. The awareness and effort owners, managers and workers put into reducing violence, while at the same time maximising profit, meant that violence usually scored a higher priority than the risks related to health, but was still not the most preoccupying hazard for sex workers. This study found that sex workers constructed their understanding of risk not only on the basis of tangible harms. Often women said that they could recover from physical injuries but there were other kinds of occupational dangers that would bring irreparable damage to their private sphere.
Sex workers considered the emotional and psychological consequences of selling sex as a hazard equal to that of physical violence and health-related concerns. One reason for this is that unlike physical harm, the emotional consequences of selling sex do not stop when a woman leaves the sauna or street. Emotional risks are not confined to the place or hours of work, but are to be guarded against always; at home, in private and even when women are no longer involved in prostitution. The emotional consequences of selling sex require sustained psychological processes throughout a woman’s social relationships. Another reason why emotional risks were prioritised was because the risks relating to ‘being discovered’ were considered to be somewhat out of their control. The chances of a family member witnessing a sex worker in an environment such as a sauna or hotel could be minimised by choosing specific geographical locations and types of markets carefully, but much of whether women were ‘found out’ was left to chance. Women felt that often they had little control over the emotional risks in prostitution, and therefore these pitfalls were to be guarded against over what has been considered in the literature to be more obvious harms.

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