A new four-paper Series in The Lancet Public Health reflects a two-year collaboration among researchers at San Diego State University and the Johns Hopkins Bloomberg School of Public Health, the Global Network of Sex Work Projects (NSWP) , and sex workers from diverse geographic settings. Developed through meaningful community partnership, the collection provides the most comprehensive synthesis of evidence on sex workers' health in more than a decade and offers a contemporary approach to inform future research, policy and practice.
Published July 24, the collection represents a sustained international effort to examine the factors that shape the health and well-being of sex workers globally and to identify priorities for future research, policy and practice.
“This series highlights the importance of broadening research, programs and policies with sex workers to address health equity, as most past work has been focused on the prevention of HIV and sexually transmitted infections. Our work also shows that it is critical for these efforts to meaningfully engage and partner with sex workers to build stronger evidence, better policies, and promote health equity," said Shira Goldenberg, associate professor at San Diego State University.
A defining strength of the series is its partnership with the Global Network of Sex Work Projects (NSWP), the world's largest global network of sex worker rights organizations. NSWP works to advance the voices of sex workers globally and connect regional networks advocating for the rights of female, male and transgender sex workers.
Researchers partnered with sex workers and representatives of sex worker-led organizations as authors and collaborators. Community expertise and lived experience informed the research, interpretation of findings and recommendations, reflecting a shared commitment to producing evidence that is relevant, rigorous and responsive to the priorities of the communities most directly affected.
Building on influential collections published in 2014 and updated in 2018, the series reflects how the evidence base has evolved over the past decade. Earlier collections documented the disproportionate burden of HIV and other sexually transmitted infections among sex workers and demonstrated how legal and structural environments influence health. The collection expands that foundation by presenting a broader understanding of health and 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 professor at The Johns Hopkins Bloomberg School of Public Health.
Across four papers, the series synthesizes evidence related to mental health, sexual and reproductive health, violence, stigma and discrimination, occupational safety, access to health care, and the social and structural determinants of health. Collectively, the papers position health equity and occupational health and safety as central frameworks for understanding and addressing the health and well-being of sex workers globally.
The series identifies three major advances for research, policy and practice:
Broadening the focus from HIV to health equity. The evidence demonstrates that sex workers experience inequities across multiple domains of health and well-being. The papers emphasize that these inequities are shaped by broader social and structural conditions rather than being inherent to sex work itself.
Recognizing stigma, discrimination and violence as structural determinants of health. The series highlights how intersecting forms of stigma, discrimination and violence influence health through health care systems, legal environments and broader social institutions. The findings underscore the importance of addressing structural barriers alongside individual-level interventions.
Advancing an occupational health and safety framework. The series proposes occupational health and safety as a practical framework for understanding and addressing many of the health, safety and rights-related challenges documented across the collection. This perspective shifts attention toward safe working environments, violence prevention, labor protections, access to social protections and reducing occupational hazards.
Across the four papers, the findings point to the importance of moving beyond disease-specific approaches to address the broader determinants of health, including stigma, discrimination, violence, occupational health and safety, legal environments, and access to responsive health and social services.
The series also underscores the importance of meaningful engagement with sex workers and sex worker-led organizations throughout the research process. Community expertise informed the development of the Series and emerged as an essential consideration for future research, policy development, implementation and evaluation.
“This collaboration has demonstrated how it is not only possible, but necessary, to center sex workers’ lived experiences when generating evidence. We hope it will serve as a basis for future partnerships and advocacy efforts,” said Anna Shapiro, NSWP Acting Global Coordinator and series collaborator and co-author.
Together, the papers provide a contemporary framework for understanding the health and well-being of sex workers and offer evidence to inform future research, policy and practice aimed at reducing longstanding and preventable health inequities.
The series demonstrates that advancing health equity depends not only on strengthening the evidence base, but also on meaningful partnerships with the communities whose expertise is essential to generating that evidence.
The Lancet Public Health
People
Advancing Health Equity for Sex Workers
24-Jul-2026
Zahra Stardust, PhD was a paid presenter at a Respect (Queensland, Australia) Roundtable on sex work and online content moderation in April, 2025. All other authors declare no competing interests.