Annotation and Responses

Some Health Agencies Consider This Term Inappropriate

Gavin Yamey

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.


Rationale for using the term “prostitute” in scientific research

Devon D. Brewer, John J. Potterat, Stephen Q. Muth, and John M. Roberts, Jr.

21 Dec 2006 at 21:19 GMT

We thank Dr. Yamey for noting the diversity of terms used to describe prostitution and those involved in it.

The Compact Oxford English Dictionary ( 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.


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