VUB research sex work: decriminalisation has little impact on access to healthcare
The health needs of sex workers go beyond classic topics such as sexually transmitted diseases and contraception
Headaches, back pain, mental stress and persistent stigma: these are striking health problems that emerge from new research by the Free University of Brussels on sex workers' access to healthcare. Although Belgium has officially decriminalised sex work since 2022, many sex workers still experience barriers when seeking medical help. "A change in the law alone is not enough. It must be accompanied by targeted interventions that eliminate stigma and discrimination", says VUB researcher Lara Vesentini.
Vesentini holds a PhD in Social Health Sciences at VUB and is affiliated with the MENT research group. She investigated how sex workers today find their way to healthcare and what obstacles they face in doing so. The study came in response to the 2022 sexual criminal law reform, which made Belgium the first European country to decriminalise sex work.
The study shows that sex workers' health needs are much broader than classic topics such as sexually transmitted diseases and contraception. Physical complaints such as headaches and back pain were particularly common. According to Vesentini, these are directly related to working conditions. "Think of an erotic masseuse who has to stand up for long periods and perform repetitive actions", she says.
In addition, mental health problems play an important role. The constant fear of being "exposed", the double life some lead and the negative social image create stress and mental pressure. Unsafe or unhygienic working conditions and difficult clients also weigh on the well-being of sex workers. As a result, the step to regular healthcare remains difficult for many sex workers. Especially with GPs, they still regularly encounter misunderstanding and prejudice. "Many sex workers do not find it easy to be open about their profession", says Vesentini. "They report that doctors sometimes react negatively or have no idea what their work entails."
Sex workers are often not believed to do their job voluntarily. Prejudices about their mental health are also persistent. In addition, they face practical obstacles in the healthcare system, such as long waiting times for medical results. According to Vesentini, decriminalisation has, for now, had little visible impact on access to care. The interviews for the study took place in summer 2023, about a year after the new law was introduced. "Change takes time", she says. "It remains important to make healthcare providers more familiar with the profession of sex workers as well as to make it clear to them that people can choose that job voluntarily."
However, she does see positive evolutions. Decriminalisation paved the way for a new labour law in 2024, allowing sex workers to work under official employment contracts, with rights such as sick leave, maternity leave, pension accrual and protection against dismissal if they refuse clients or certain acts. A crucial role in health care for sex workers today is played by specialised sex work organisations. These work with experts by experience, adopt a low-threshold approach and actively seek out sex workers for medical checks or tests. Especially for undocumented sex workers, they are an essential gateway to care. Yet gaps remain. Psychological counselling is often not in the offer and waiting times in regular mental health care remain long. There too, sex work organisations can play an important bridging role towards mainstream care. "They can help healthcare providers better understand how to support sex workers so that there is a better interaction", says Vesentini.
According to the researcher, better care starts above all with an open attitude without prejudice. "Don't assume that someone has mental problems or is not doing the work voluntarily", she says. "You may of course inquire about that, but don't start from that assumption."
What particularly struck her during the study were the stories of sex workers who eventually dared to name their occupation to their doctor. "Respondents told how that gave them a tremendously liberating feeling and made them feel more powerful", says Vesentini. Experienced sex workers in particular appear to find it easier to be open about their profession, while younger sex workers often still struggle with this.
Still, Vesentini stresses that important voices are still missing from the debate. In the study, only sex workers with Belgian nationality could be interviewed. Undocumented sex workers, who often live in even more vulnerable conditions and have less access to healthcare, remain largely under the radar. "Our results perhaps paint too rosy a picture of reality," she says. "They definitely need to be heard in future research."
For Vesentini, the research is more than an academic exercise. "Sex workers remain a group in a vulnerable position that receives too little attention", she says. "I take it for granted that sex workers are entitled to social protection and safe working conditions. By communicating about this, I hope to further normalise sex work. Why can't it be a profession you can be proud of?"
Read more:
Lara Vesentini: lara.vesentini@vub.be
https://www.tandfonline.com/eprint/Q9ICJMAE338Y8QEFVWWC/full?target=10.1080/13691058.2026.2636214
Frans Steenhoudt
