Sex work and health in London

This thesis comprises 12 publications from two decades of research into sex work and health. The papers report on the risks and determinants of HIV and other sexually transmitted infections (STI) in women selling sex in London. The research combined clinical, epidemiological and anthropological methods in a programme that aimed to inform policies and interventions to reduce STI and HIV risks and improve the health and well-being of sex workers. In the accompanying commentary, chapter 1 places the papers in a broad narrative by describing the context of the work which began with the early days of the AIDS epidemic and continued through new challenges including the impact of globalisation and migration. Chapter 2 is a critical review of the major findings in relation to HIV and STI risk, and includes new tables summarising estimates of effect sizes from across the studies. I then discuss major risk factors, placing the findings in the context of the wider literature, and suggest a conceptual framework linking the determinants. Chapter 3 provides a more detailed description of the ways that different research methods were used to test specific hypotheses. In particular, I show how qualitative work uncovers the importance of structural factors, such as the organisation of flats and the distribution and consumption of drugs, in determining individual and group level behaviours and risks. I provide a brief critique of the use of mixed methods in biomedical research, and stress the importance of grounding both qualitative and quantitative work in appropriate theoretical frameworks. Chapter 4 summarises the thesis and re-asserts the need for a model of causation that incorporates social, economic, behavioural and structural factors. The development of interventions requires a synthesis of evidence from many disciplines, together with the perspective of participants whose agency will be the key to successful implementation.

Name dc:type.qualificationname

phd

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

City University London

Year dc:date.issued

2010

Author dc:creator

• Ward, H.

• R Medicine