Annotation and Responses
Some Health Agencies Consider This Term Inappropriate
20 Dec 2006 at 21:17 GMT
There is currently a debate within the public health community about whether the term "prostitute" is still appropriate. Within many public health organizations (including the health-related UN agencies), the term "prostitute" is generally avoided and the term "sex worker" is considered more appropriate. UNESCO, for example, in its "Guidelines on Language and Content in HIV- and AIDS-related Materials," states that the term prostitute is considered disparaging "and does not reflect the fact that sex work is a form of employment for a sex worker and not a way of life" [1]. Similarly, Unicef states in its guidance that the term prostitute "has a negative connotation" and "does
not accurately describe situations in which
women may be forced into exchanging sex for
money or food due to gender inequality and lack
of alternative economic opportunity" [2]. In the global fight to prevent and control HIV, the health community must clearly engage with sex workers worldwide, and it seems important for us to "get the language right" so as not to further stigmatize an already marginalized and stigmatized group.
References
[1]: unesdoc.unesco.org/images/0014/001447/144725e.pdf
[2]:
http://www.unicef.org/malaysia/Guidelines_for_Reporting_on_AIDS_-_language.pdf
Rationale for using the term “prostitute” in scientific research
We thank Dr. Yamey for noting the diversity of terms used to describe prostitution and those involved in it.
The Compact Oxford English Dictionary (http://www.askoxford.com/dictionaries/) defines a “prostitute” as “a person, typically a woman, who engages in sexual activity for payment.” Nothing in this long-held definition implies that prostitution is not work, especially when compared to definitions of other activities that people perform in exchange for money, goods, or services.
The term “sex worker” (or its redundant expanded form, “commercial sex worker”) is a much broader term more recently invented by advocates and adopted by some in public health to refer to prostitutes. However, as used in the literature, this term also includes many roles beyond that of prostitute, such as those involved with striptease, pornography, paid telephone sex, etc. Consequently, “sex worker” is an imprecise label that obscures the referent’s actual behavior.
The term “sex worker” is often employed by those with a political agenda to decriminalize or legalize prostitution. In contrast, we take no political position on the legal status of prostitution. We study prostitution in the legal context in which it currently exists in the USA, has existed for many decades, and is likely to exist for some time to come.
In our experience, prostitute women sometimes refer to themselves with the term “prostitute,” but more often use terms that public health officials, advocates, and the general public typically find vulgar and offensive, such as “working girl,” “wh*re [full term filtered by PLoS One],” “hooker,” or simply “ho.” Over the past 30 years [1-14], we have successfully engaged prostitute women on their turf, in our clinics, and other settings, as we strived to address their health and social problems with evidence-based strategies. We treated these women with respect and kindness, and they reciprocated with steadfast cooperation in our studies. Our colleague, Donald Woodhouse (personal communication), informally canvassed prostitute women in Colorado Springs in the early 1990s about the term “commercial sex worker” and encountered universal disdain for it. One woman said, “I’m no commercial sex worker, I’m a ho.” The debate over “appropriate” terminology has otherwise never surfaced in our interactions with prostitute women, and the use of the term “prostitute” in scientific forums certainly has not hindered our work with them.
Prostitute women have been disproportionately affected by the HIV epidemic. However, the empirical record indicates that blood exposures—not specific to prostitution—may be the primary routes of HIV transmission in prostitute women (e.g., injection drug use [5,15-20] and unhygienic health care [21, Gisselquist D, unpublished data]). By focusing HIV preventive interventions exclusively on prostitution and sex, and not also on the blood exposures frequently encountered by prostitute women and others, public health officials may be missing opportunities to prevent HIV transmission more effectively.
Prostitute women are stigmatized and marginalized, but the terms used to refer to them neither cause nor alleviate their low status. Abandoning a widely understood, specific, descriptive term for a vague one, though, can impede clear scientific discourse.
References
1. Potterat JJ, Rothenberg R, Bross DC. (1979) Gonorrhea in street prostitutes: epidemiologic and legal implications. Sex Transm Dis 6: 58-63.
2. Potterat JJ, Woodhouse DE, Muth JB, Muth SQ. (1990) Estimating the prevalence and career longevity of prostitute women. J Sex Res 27: 233-243.
3. Potterat JJ, Phillips L, Rothenberg RB, Darrow WW. (1984) On becoming a prostitute: an exploratory case-comparison study. J Sex Res 20: 329-335.
4. Potterat JJ, Muth SQ, Bethea RP. (1996) Chronicle of a gang STD outbreak foretold. Free Inquiry in Creative Sociol 24: 11-16.
5. Potterat JJ, Brewer DD, Muth SQ, Rothenberg RB, Woodhouse DE, et al. (2004) Mortality in a long-term open cohort of prostitute women. Am J Epidemiol 159: 778-785.
6. Potterat J, Rothenberg RB, Muth SQ, Darrow WW, Plummer L. (1998) Pathways to prostitution: The chronology of sexual and drug abuse milestones. J Sex Res 35: 1-21.
7. Klovdahl AS. (1985) Social networks and the spread of infectious diseases: the AIDS example. Soc Sci Med 21: 1203-1216.
8. Plummer L, Potterat JJ, Muth SQ, Muth JB, Darrow WW. (1996) Providing support and assistance for low-income or homeless women. JAMA 276: 1874-1875.
9. Woodhouse DE, Rothenberg RB, Potterat JJ, Darrow WW, Muth SQ, et al. (1994) Mapping a social network of heterosexuals at high risk for HIV infection. AIDS 8: 1331-1336.
10. Centers for Disease Control. (1992) Street outreach for STD/HIV prevention -- Colorado Springs, CO, 1987-1991. MMWR 41: 94-101.
11. Brewer DD, Garrett SB, Kulasingam S. (1999) Forgetting as a cause of incomplete reporting of sexual and drug injection partners. Sex Transm Dis 26: 166-176.
12. Brewer DD, Garrett SB. (2001) Evaluation of interviewing techniques to enhance recall of sexual and drug injection partners. Sex Transm Dis 28: 666-677.
13. Potterat JJ, Rothenberg RB, Muth JB, Woodhouse DE, Muth SQ. (1999) Invoking, monitoring, and relinquishing a public health power. Sex Transm Dis 26: 345-349.
14. Khabbaz RF, Darrow WW, Hartley TM, Witte J, Cohen JB, et al. (1990) Seroprevalence and risk factors for HTLV-I/II infection among female prostitutes in the United States. JAMA 263: 60-64.
15. Darrow W, Centers for Disease Control Collaborative Group for the Study of HIV-I in Selected Women. (1990) Prostitution, intravenous drug use, and HIV-I in the United States. In: Plant M, editor. AIDS, drugs, and prostitution. London, England: Tavistock/Routledge. pp. 18-40.
16. Modan B, Goldschmidt R, Rubinstein E, Vonsover A, Zinn M, et al. (1992) Prevalence of HIV antibodies in transsexual and female prostitutes. Am J Public Health 82: 590-592.
17. Nguyen AT, Nguyen TH, Pham KC, Le TG, Bui DT, et al. (2004) Intravenous drug use among street-based sex workers: a high-risk behavior for HIV transmission. Sex Transm Dis 31: 15-19.
18. van den Hoek A, Yuliang F, Dukers NH, Zhiheng C, Jiangting F, et al. (2001) High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV. AIDS 15: 753-759.
19. Ding Y, Detels R, Zhao Z, Zhu Y, Zhu G, et al. (2005) HIV infection and sexually transmitted diseases in female commercial sex workers in China. J Acquir Immune Defic Syndr 38: 314-319.
20. Chen XS, Yin YP, Liang GJ, Gong XD, Li HS, et al. (2005) Sexually transmitted infections among female sex workers in Yunnan, China. AIDS Patient Care STDS 19: 853-860.
21. Gisselquist D, Correa M. (2006) How much does heterosexual commercial sex contribute to India's HIV epidemic? Int J STD AIDS 17: 736-742.