Stigma and Sex Work

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A painting of a mother and child with Syphilis. Syphilis Mother and Child, Unkown artist, 2016,




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Woman inflicted with syphilis. Sylphilide pustuleuse en grappe, Jean Louis-Marie Alibert, 1833,


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PSA about HIV stigma. HIV Stigma PSA, Unknown, 08/20/14, 

Stigma presents barriers to the ability for sex workers to pursue safer sex supplies and other health care needs. This page explores the the stigma attached to sex work, the stigma associated with sexually transmitted infections, and how these intersect to limit public health access. The inherent risk of outing oneself as a sex worker makes it difficult for sex workers to have a voice in the public health policies that affect them the most. Therefore, stigma and public health are inherently related.


Sex workers were blamed for the transmission of syphilis in a similar way to the way they were later scapegoated for HIV. In Quetel’s “History of Syphilis,” Quetel lays out how the public responded to the disease with harsh policy interventions on sex workers, including mandatory health interventions that ultimately had adverse health outcomes.[1]

An old police file from France in the 1880s illustrates the way that syphilis was associated with sex work; “A compensation of three francs will also be granted for the capture of a girl that is recognized at the clinic as having a contagious disease and is designated for the hospital, would not have returned to the prefecture by the indicated time, or who would have evaded the hospital that which she would have been treated for a contagious illness.”[2] In this quote we can see how the police offered compensation for women with syphilis, assuming that all women who have syphilis are sex workers. The disease and the identity of sex workers were considered synonymous. This also illustrates how stigma and scapegoating of sex workers at this time fueled the criminalization of sex work, and therefore makes accessing health resources a risky action for the workers themselves. 

The pictures on this page display artistic representations of Syphilis, and show how women with syphilis were thought of as dirty, devious, and manipulative. The painting to the left entitled “Poeme en Quatre Chants” illustrates a woman afflicted with Syphilis attempting to entice a man into her disease. This shows the way that men with Syphilis were thought of as victims while women with Syphilis, especially sex workers, were thought of as perpetrators. The photo of the woman with a child diseased with Syphilis again shows the way that women were specifically scapegoated for the disease. The photo below this showing a stoic woman with an infection on her face again displays the way women with Syphilis were not sympathetic figures, and since Syphilis was associated with sex work, these women were especially stigmatized.


Stigma exists and persists today for sex workers throughout the world, and creates barriers to pursuing compassionate care for fear of judgement and care denial. Because of the lack of understanding by people outside the industry, an important public health tactic for sex workers is crowdsourcing information within the sex work community. This means workers can share experiences and information about safety, payment, and health, and share tips for negotiating safer situations and turning down unsafe work.

The HIV/AIDS crisis and the reaction to the virus amplified the stigma sex workers already had to deal with. The public panic around sexuality during and following the AIDS crisis moved gay life into the private sphere, and took sex work with it. Policing sexuality on the street increased, posing risks to street based sex work. Therefore, stigma affected the ability for sex workers to negotiate safety with clients.  The AIDS crisis also increased the stigma against sex workers as carriers of disease. Sex workers were quickly blamed for the spread of the virus. Laws against HIV positive people entering the US and HIV criminalization laws disproportionality affected sex workers ability to live safely without fear of arrest..[3] 

What is different:

Although a lot of stigma exists today in the discourse around sex work, there has been a significant effort on the part of sex worker led organizations to destigmatize sex work and support the sex worker community. Several non profit groups have been started, including CAL PEP and SJ. These groups have been able to promote their message through technology, and advocate from a sex worker perspective. [4]

What has stayed the same: 

Historical sex workers have been targeted for the spread of both HIV and Syphilis which has made for negative health outcomes for these groups. Both of these diseases were not well understood, caused widespread panic about sex and sexuality. In addition, stigma creates barriers to health access. In the cases of both Syphilis and HIV, public health remedies have failed to fully address the blaming of sex workers by the general public, and the adverse affect stigma has on health access for sex workers.


[1]Quétel, Claude. History of Syphilis. Baltimore: Johns Hopkins University Press, 1990.

[2] Translation of Parent-Duchatelet Composite File, 2013. Translation by GreggorMattson, PhD, 2016. Translation by Noëlle Marty ’17, 2016.

[3]Grant, Melissa Gira. Playing the Whore: The Work of Sex Work. New York: Verso Books, 2014.

[4] Majic, Samantha. American Governance : Politics, Policy, and Public Law : Sex Work Politics : From Protest to Service Provision. Philadelphia, PA, USA: University of Pennsylvania Press, 2013. ProQuest ebrary. Web. 2 March 2016.

Stigma and Sex Work