Open Access Highly Accessed Research article

Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator

Michele R Decker12*, Erin Pearson1, Samantha L Illangasekare1, Erin Clark1 and Susan G Sherman23

Author Affiliations

1 Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E4142, Baltimore, MD 21205, USA

2 Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

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BMC Public Health 2013, 13:876  doi:10.1186/1471-2458-13-876

Published: 23 September 2013



Physical and sexual violence heighten STI/HIV risk for women in sex work. Against this backdrop, we describe the nature of abuse against women in sex work, and its STI/HIV implications, across perpetrators.


Adult women involved in sex work (n = 35) in Baltimore, MD participated in an in-depth interview and brief survey.


Physical and sexual violence were prevalent, with 43% reporting past-month abuse. Clients were the primary perpetrators; their violence was severe, compromised women’s condom and sexual negotiation, and included forced and coerced anal intercourse. Sex work was a factor in intimate partner violence. Police abuse was largely an exploitation of power imbalances for coerced sex.


Findings affirm the need to address physical and sexual violence, particularly that perpetrated by clients, as a social determinant of health for women in sex work, as well as a threat to safety and wellbeing, and a contextual barrier to HIV risk reduction.

Violence; HIV risk; Sex work