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Official websites use. Share sensitive information only on official, secure websites. There is significant debate regarding the regulation of the sex industry, with a complex range of cultural, political and social factors influencing regulatory models which vary considerably between and within countries. This systematic review examined the available evidence on the relationship between different approaches to sex industry regulation in high-income countries, and associated effects on sex worker health status.
Objectives included identification of sex worker health outcomes, including sexual health, substance use and experience of stigma and violence. A search was performed electronically in eight scholarly databases which yielded 95 articles which met the criteria for inclusion.
Findings suggested that sex workers in legalised and decriminalized countries demonstrated greater health outcomes, including awareness of health conditions and risk factors. Sex workers are a priority population for public health [ 1 ] and there is growing support for occupational health and safety approaches to support sex worker health [ 2 , 3 , 4 ]. Sex workers may experience vulnerability for a number of health issues, including those related to mental health, sexual health, substance use and interpersonal violence [ 5 ].
A recent study found higher rates of alcohol use, illicit drug use, and experiences of violence amongst sex workers compared to the general population [ 5 ]. Similar outcomes have been noted in other research, with concerns raised for the human rights of sex workers in response to increasing rates of violence [ 6 , 7 ] alcohol [ 8 , 9 ] and drug use [ 10 ].
Health issues in this population are exacerbated by the experience of discrimination and stigma, leading to reduced health service seeking behaviour [ 11 , 12 ]. Regulatory models for sex work are varied; shaped by social, cultural and political influences [ 13 , 14 , 15 ]. Historically, criminalisation was the favoured regulatory model in many high-income countries [ 16 ]. More recently, societal perspectives towards the sex industry have shifted, resulting in regulation that is increasingly diverse within and between countries [ 17 ].