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Sex work has been seen as both a health and a social problem. However, there is a paucity of evidence on the longer term impact on health. Outcome data were obtained through interview, clinic records, or third parties. Vital status, most recent occupation, duration of sex work, sexually transmitted infections STI , major health problems.
There were six deaths, a mortality of 4. Past gonorrhoea was associated with pelvic inflammatory disease RR 2. There were no significant differences in health outcomes between women who were still in the sex industry and those who had stopped. Sex work is associated with excess mortality and morbidity including the sequelae of STI, mental health problems, and substance misuse. The relation between these health problems and sex work is complex. Sex work has been seen as a problem: a threat to public health, public order, decency, the formal economy, the integrity of borders, and women's rights.
Most policy debates share the premise that the sex industry is harmful to participants; its workers are considered to be socially excluded and vulnerable. This belief underpins recent policy changes in the United Kingdom. Unfortunately there is little evidence to support such policies. While the short term impact of sex work on health has been studied extensively in recent decades, 4 , 5 , 6 prompted by concerns about the risks of HIV, little is known about the longer term impact.
In common with others, we have conducted short term studies and found that sex workers in the United Kingdom face increased risks of HIV and other sexually transmitted diseases and blood borne viruses. We established a cohort of sex workers in London between and Detailed methods, baseline findings, and initial follow up data have been reported elsewhere.
While it was not possible to establish whether the study was strictly representative of the local sex industry, methods of recruitment were as inclusive as possible including women attending the clinic, their colleagues and friends, plus direct recruitment through outreach to local streets, escort agencies, flats, and saunas. For the purposes of this paper we refer to an initial cohort of women recruited between and who were interviewed at least twice and consented to ongoing research.