Understanding Resilience Among People in Sex Work

1. Introduction

The concept of resilience, the capacity to withstand or overcome major stress or hardship despite difficult circumstances [1], is becoming increasingly prevalent in research that focuses on structurally-disadvantaged groups, including people with marginalised identities [2], underprivileged youth [3] and, the focus in this editorial, sex workers [4].

Our Special Issue adopts a sociological approach to resilience. An encompassing sociological approach focuses on the macro-level economic, social and political systems that shape emotional and individual experiences at the micro-level [5]. A sociological approach also centres macro-level concepts, such as economic precarity and social inequities, and meso-level concepts, including health and social care systems, and examines how they result in decreased life chances for people in marginalised circumstances. This Special Issue additionally highlights structural forces linked to stigma and criminalisation which (1) frame the unequal opportunities and limited life chances people in sex work have to contend with [6] and (2) accent the important role collective action can play in challenging stigmatisers and improving sex workers’ access to non-judgmental services and supportive communities [7].

The specific impetus behind this Special Issue emerged from a lingering problem in many studies of adults in sex work, which tend to present them in an unrealistic one dimensional fashion, overlooking their different lived realities, complex experiences, individual capabilities, and strategies to thrive in the face of adversity [8,9]. However, like other stigmatised groups who are structurally marginalised, people in sex work challenge normative models of physical, mental, emotional and social resilience, thus pushing back against stereotypes and other tools of oppression.

For our Special Issue, we called for research papers that address some of the following: the application of different models and frameworks of resilience that are specific to people in sex work; ways that resilience influences structural, social, and individual determinants of health for people in sex work; strategies of resilience employed by sex workers at individual, organisational, and/or community levels; and models of resilience which integrate with intersectional frameworks and are specifically related to people in sex work and/or when conducting research with people in sex work.

2. Overview of Included Papers

We are delighted to present an overview of the eight papers that have been published online as part of our Special Issue. The papers are diverse along a number of fronts: their geographical reach, ranging from Australia and New Zealand, three Pacific Island States (Fiji, Kiribati and Palau), South Africa, India, Brussels and Canada. Additionally, one paper is global in reach. The sex worker populations investigated are also varied in their identities and life experiences, identifying with different genders, sexual orientations and from different racial backgrounds. The sex work workplaces studied likewise vary: street, escort agencies, brothels, massage parlours, nightclubs/bars, online/Internet and international fishing boats. Finally, the studies adopt a range of methodologies, from multisensory and arts-based ethnographic fieldwork, qualitative meta-synthesis, scoping review approach and in-depth interviews. Despite this multiplicity, all papers successfully engage extant research on resiliency among sex workers and call for nuance to better capture the ways resiliency plays out at different levels of analysis.

2.1. Conceptualising Resilience

Two papers address the concept of resilience head on. The first contribution, “Sex Work and the Problem of Resilience,” understands resilience as a crucial resource for sex workers as they struggle against structural forces limiting their life chances. The authors define resilience among sex workers as “the ability to connect, reconnect, and resist disconnection in response to hardships, adversities, and trauma” (p. 1). Rather than keeping the focus at the micro level, which is how the concept tends to be understood in extant studies, the authors call for examination of sex workers’ resilience, which sometimes takes the form of resistance, at the level of the ‘political economy’ where people in the sex industry are confronted with occupational, race and gender inequities, stigmatisation, violence, and other issues related to their work. The authors thus focus their analytic lens to shed light on the ways economic and social inequities are experienced and sometimes challenged by sex workers within and across nation states tied together by global capitalism. The authors’ research findings on three Pacific Island States (Fiji, Kiribati and Palau) reveal that sex workers there do not simply accept their situation but rather struggle for their rights, even when circumstances are stacked against them. In doing so, the authors lay bare the structures of inequity that buttress sex work under global capitalism, as well as reveal the need for changes in labour markets and justice systems to better support the current resistance efforts practiced by sex workers in their workplaces and communities.

The second contribution, “Ecological Contexts of Resilience in Sex Work: Managing a Precarious, Stigmatised, and Criminalised Occupation in One Canadian City,” speaks to the benefits of conceptualising resilience using Michael Ungar’s ecological interpretation [10] that considers four principles—decentrality, complexity, atypicality, and cultural relativity. This approach draws attention to the environmental factors and available resources that shape resiliency, as well as interventions that promote well-being among groups that experience structural environments that restrict resilience-promoting processes. The authors test the utility of the social ecology of resilience model to understand how sex workers in one Canadian city cultivate resilience in their workplaces. The authors’ qualitative findings from a cross-section of active sex workers from Victoria, Canada, reveal a complex set of strategies to foster resilience at work. In particular, the authors were interested in how their participants kept safe at work, what resources they accessed and what other resources they wish they could access to improve their safety. The authors found numerous structural factors—job precarity, stigma, and criminalisation—challenged sex workers’ experiences at work and beyond. Nevertheless, participants also reported an assortment of well-thought-out strategies they employed to keep safe at work. The authors found resilience among sex workers in their study was possible due to a complex array of factors, including the advantages they had access by virtue of their social locations, as well as particular characteristics of their immediate workplaces and social networks.

2.2. Resilience Across Workplaces and Spaces

Three papers highlight how resilience plays out in sex workers’ workplace contexts. This Special Issue’s third contribution, “Experiencing, Negotiating and Challenging Stigma in Sex Work: Examining Responses from Brothel-Based and Transient Sex Workers in Kolkata, India,” examines resilience among brothel and transient street-based sex workers in Kolkata, in eastern India. In this contribution, the author shows resilience is experienced differently by transient sex workers compared to brothel-based sex workers located in several neighbourhoods in the red-light district of Sonagachi in Kolkata. While both transient and brothel-based workers are required to register as sex workers and thus open themselves up to stigma by the public, the latter, brothel-based workers, largely do not accept the label. Their resistance is due to their belief that sex work is a legitimate and honourable form of employment. Moreover, they tend to have access to community organisations and unions that promote educational, violence-reduction and other structural interventions, as well as opportunities to be part of development projects. So even in a country such as India where sex work is criminalised and stigmatised at the national level, access to health care knowledge and other supports at the local level creates variation in sex workers’ occupational resiliency. Alternatively, transient people in sex work (who were more likely to identify as transgendered) did not want to be part of the brothel-based system nor self-identify as a sex worker. While they were better able to hide their sex work identity and escape public stigma, they also were less likely to challenge the popular misperceptions surrounding sex work, access social and economic supports, and advocate for decriminalisation of their profession and improved working conditions.

A related paper, the fourth contribution, “Carefully Curated/For Heart and Soul”: Sensing Place Identity in Sex Workplaces,” explores experiences of place identity—a concept that aims to illuminate how our physical environments shape our self-identities and, in turn, how we shape our physical environments. Responding to a call for research to reduce sex work stigma in workplaces, the author used multisensory and arts-based ethnographic fieldwork to research how sex workers engage in place-based identity processes, despite working in a highly stigmatised occupation that is criminalised at the federal level. The research took place in Calgary, Canada. The data sources included multisensory art, recording of interviews, co-researchers’ observations, audio notes, interviews and music. All workplaces examined were located off-street, such as participants’ own homes, rented apartments/studios and hotel rooms. The research findings illuminate a variety of ways participants (co-researchers) engaged in place-identity processes within their workplaces, at different times using music, colour and visual art that intertwined with their sense of self and brought personal rewards. The author shows that such workplaces enhanced participants’ resiliency in their workplaces, “fostering workplace comfort, control, and empowerment” (p. 487), despite society-wide sex work stigma and criminalisation.

The fifth contribution, “Sex Workers’ Online Humor as Evidence of Resilience,” illuminates how sex workers in their communities and workplaces practice resilience by drawing upon humour, an interpersonal resource used naturally to release tension and sometimes used by workers in their other occupations to “negotiate, manage, and resist stigma” (p. 312). While often the brunt of sexist jokes within and across countries perpetuated by members of the public and the media, studies show sex workers are sometimes able to employ humour at work to effectively negotiate safe sex practices, including condom use and challenge stigmatising behaviours. The author focuses on the use of humour as a resistance tool in online settings, some of which may be client-facing, but most of which are directed at others in their professional networks. The data examined were online postings from peer-led organisations and interchanges between sex workers that were posted on their social media sites. The bulk of the postings were from Australia but the author also studied news media texts published during the first COVID-19 lockdown in New Zealand. Three dominant themes emerged from the author’s textual analysis: (1) sex workers and their support organisations actively employ ‘backstage’ humour, often as memes related to client interactions or misunderstandings (e.g., the nature of the worker-client relationship), which contribute to in-group solidarity and camaraderie between colleagues, or, when posted on client-facing social media, are used to enforce respectful and healthy boundaries; (2) humour can be used as a tool to resist stigma and discrimination and sometimes reframe interactions and create alternative narratives about sex work to the benefit of workers; and, (3) humour was sometimes employed as a mechanism to build bonds among sex workers and their support organisations, regularly in the form of ‘gallows’ or ironical humour, with the hope of raising awareness of the harms of criminalisation and bringing about positive social and political change. The findings indicate that humour can serve as an embedded form of resilience among people in sex work, can foster their physical and emotional health vis-à-vis their clients, and can expand and strengthen sex workers’ support networks. The author challenges the deplatforming (i.e., deletion of social media accounts or posts) of sex workers from online spaces by governments under the guise of controlling sex trafficking.

2.3. Context, Resilience, and Public Health Promotion

Finally, three papers in our Special Issue focus on strategies to improve resilience among highly disadvantaged sex work groups. Contribution six, “Mapping Evidence on Strategies Used That Encourage Pre-Exposure Prophylaxis (PrEP) Uptake and Adherence Amongst Female Sex Workers in South Africa”, used the scoping review framework to examine the published literature to discover what HIV prevention interventions are in place that promote PrEP uptake and adherence among sex workers in one geographical region—female sex workers (FSWs) in different communities in South Africa. Such directed health promotion efforts, especially those that are peer-led and provide easy and rapid access to PrEP, were identified as having multiple positive outcomes, including reducing stigma attached to HIV and sex work, improving health, and furthering resilience among one marginalised population. The authors categorised the scoping review results under three main themes, reflective of a three-prong approach to improve PrEP acceptance and adherence among FSWs in South African communities: (1) PrEP is heavily promoted and widely distributed; (2) counselling and relevant educational resources are made available in communities and (3) employment of instant “messaging” (e.g., two-way texting) and a loyalty reward system. The authors’ scoping review analysis also reported that PrEP use promotion should not be a stand-alone programme, which many FSWs find stigmatising, but instead be embedded in other sexual health programmes that are targeted to the entire population, thereby normalising PrEP use. Importantly, the authors highlight how the effectiveness of health promotion initiatives related to PrEP uptake in South Africa varied between communities, recommending contextual factors specific to locations be taken into consideration when designing health interventions.

The seventh contribution of this Special Issue, “The Lived Experiences of Male Sex Workers: A Global Qualitative Meta-Synthesis,” examines an understudied population engaged in sex work—cisgender men—from a global perspective. The research that exists indicates that male sex workers (MSWs), some who identify as gay but many who do not, share some similarities with women in sex work, including their experience of work-related stigma, but also diverge in other respects. These divergent areas can include cismen’s relative higher social privilege compared to women and unique vulnerabilities, including gay or queer-identifying dual-criminalised status in places/countries where sexual minorities are targeted. The authors note there is a paucity of qualitative and mixed methods studies of MSWs that shed light on how they create their sex work experiences, including with each other at work, their clients and romantic partners. Employing qualitative meta-synthesis, the authors reviewed relevant studies and report nine meta-themes from the papers that fit their research purpose. Results show important similarities in the work experiences of MSWs and FSWs, including economic motivations as the most common reason for initial and ongoing sex work involvement, stigma associated with selling one’s sexual services, and engaging with a wider community of sex workers where they may find formal and informal supports to sustain and build their resilience. Other meta-themes focus on complexities MSWs experience when negotiating their sexual identities and commercial sex lives, and the complexities of MSWs’ developing a work identity that may or may not have been congruent with their sexual identity. Heterosexual and bisexual MSWs were more likely than queer MSWs to experience depression and/or anxiety at work and in their personal relationships, and experience areas of privilege and discrimination unique to their lived experiences. The review results point to the need for intervention programmes that are responsive to MSWs and geared to issues they face unique to their sexual orientations and genders.

The eighth and final contribution, “Stakeholders’ Perceptions Regarding the Impact of the Working Environment on the Occupational Safety, Health, and Well-Being of Street-Based Sex Workers in Brussels”, focusses on resilience and the structural challenges to experiencing it among sex workers in street-based work environments. The authors’ theoretical focus is on work environments which “can significantly bolster well-being, health outcomes, resilience, and life standards or precipitate and exacerbate work-related injuries and illnesses, affecting physical and psychological health” (p. 702). The authors note that, despite Belgium decriminalising sex work in 2022—a positive development to enhance sex workers’ health and safety—the occupation remains highly stigmatised in the country. The authors’ qualitative study involved interviews with stakeholders who were in both direct and indirect contact with street-based sex workers and were all interested in improving their health and well-being. The stakeholders included sex worker lobbyers, a vice squad inspector, social workers, sex worker organisation volunteers, and a researcher. At the formal level, the 2022 legal reform in Brussels provided sex workers, including those who are street-based, the same formal rights as other workers. However, stakeholders identified numerous challenges to health and safety specifically for street-based sex workers in Brussels, even in a decriminalised environment. Structural barriers—including sex work stigma—restricted workers’ agency and left them marginalised and working in unsafe conditions, which often led to limited access to crucial resources of living. Stakeholders also highlighted the diversity of sex workers within the street-based community and, in particular, the relative poorer health outcomes of those from more disadvantaged backgrounds (e.g., migrants/non-legal status, poor, transgender, etc.). Moreover, stakeholders reported that sex workers’ ability to exercise resilience was influenced by events outside of their control, including the COVID-19 pandemic, economic crises, and the persistence of stigma and anti-sex work campaigns led by municipal leaders. The findings suggest more research is needed to better understand how resilience operates among street-based sex workers, including engaging in efforts directly with sex workers, understanding the role various community stakeholders play in enhancing or challenging their resilience, and how structural forces can enhance or diminish the activation of resilience in their workplaces and occupational communities.3. Concluding Remarks

This Special Issue adds to our understanding of resilience experienced among sex workers from different backgrounds, work locations and geographical regions. This collection of eight articles demonstrates that resilience among sex workers, much like any population, is complex and operates simultaneously at micro, meso, and macro levels. At the micro level, evidence shows that one’s ability to draw on a sense of humour to cope with day-to-day challenges of clientele or broader challenges of criminalisation can help to cultivate solidarity among sex worker peer groups. Moreover, we learned how self-expression and creativity in one’s workplace can contribute to sex worker empowerment and enhance their ability to exercise autonomy and control in this work environment. Other studies show implementing public health policies at both meso and macro levels can support sex workers’ resiliency. Yet to be successful, interventions must be attuned to and with diverse experiences of sex workers. This includes not only across workplaces and jurisdictions but also in ways that consider intersectional factors such as sex, gender, sexuality, race, ethnicity and socio-economic status. Finally, we learned that while macro-level interventions, such as (de)criminalisation of sex work, can positively impact resilience across numerous dimensions of sex worker health and well-being (e.g., reduced fear of police intervention, allowance of third-party support, etc.), decriminalisation alone will be limited in its impact without continued efforts to destigmatise sex work across sex industry sectors.

In summary, this Special Issue demonstrates that resilience—embodied, enacted, and influenced—is both a tool and a strategy that sex workers across the globe and their networks of support draw upon in the face of ongoing stigmatisation. Importantly, as this Issue’s first contribution highlights, the continued enactment and embodiment of resilience among sex workers must not be seen as a strategy to live with a diminished social status in perpetuity. Rather, resilience can help sex workers and their allies adapt to dynamic environments that continue to evolve across physical, social, digital, and political landscapes, while still striving for equitable and decriminalised workplaces. The persistence of sex work stigma, as shown in this collection and much of the empirical literature [6] is often the root cause of harmful health policies, criminalised legislation, and marginalisation of sex workers in their communities. Yet, as this Special Issue shows, resilience persists among workers and their allies at different levels, including at the sociological/macro level—often serving to educate, normalise, and destigmatise people in their workplaces and communities. Going forward and called for by many of the authors in this collection, we recommend taking a systems level and intersectional approach in future research on resiliency in sex work that reflects the diversity and heterogeneity of workers in the sex industry. We also recommend more studies on how resiliency is currently enacted (or not) in different geographical locations and under different legal environments.