This article considers the terms prostitution, sex work, transactional sex, and survival sex, the logic of their deployment and utility to research concerned with people who are paid for sex, and HIV. The various names for paid sex in HIV research are invested in strategically differentiated positionings of people who receive payment and emphasize varying degrees of choice. The terminologies that seek to distinguish a range of economically motivated paid sex practices from sex work are characterized by an emphasis on the local and the particular, efforts to evade the stigma attached to the labels sex worker and prostitute, and an analytic prioritizing of culture. This works to bestow cultural legitimacy on some locally specific forms of paid sex and positions those practices as artifacts of culture rather than economy. This article contends that, in HIV research in particular, it is necessary to be cognizant of ways the deployment of alternative paid sex categories relocates and reinscribes stigma elsewhere. While local identity categories may be appropriate for program implementation, a global category is necessary for planning and funding purposes and offers a purview beyond that of isolated local phenomena. We argue that “sex work” is the most useful global term for use in research into economically motivated paid sex and HIV, primarily because it positions paid sex as a matter of labor, not culture or morality.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
For this reason, this article focuses on how terminology positions those who provide sexual services, rather than the other actors in paid sex whose roles are also relevant to HIV prevention.
For the purposes of this article, paid sex refers only to sexual exchanges between consenting adults, to avoid confounding the issue with sex trafficking or child sexual exploitation.
Wardlow (2004) suggests that objections to paid sex reflect concerns about the commodification of intimacy and affection, perhaps referring to the manner in which sex for money destabilizes boundaries between the “public” sphere of business and the “private” sphere of domestic relationships. Tabet (2012) also, but differently, examines this through references to a continuum of sexual-economic exchange.
A tendency to view engagement in sex work or prostitution as an individual pathology is also evident in the mass of research seeking causes in personal histories of sexual or substance abuse, or in psychological problems (Goldhill, 2015).
Some sex workers and some modes of sex work are more likely to lead to encounters with the justice system than others (Hubbard, Matthews, & Scoular, 2008).
Signing an anti-prostitution pledge became an eligibility requirement for funding from the US President’s Emergency Plan for AIDS Relief in 2003.
Women’s engagement in prostitution in Victorian society has been similarly interpreted as a marker of agency (Walkowitz, 1980).
Yet, it is one that pervades numerous humanitarian efforts targeting those who are paid for sex (see McMillan & Worth, 2016).
Abel, G. (2014). Sex workers’ utilisation of health services in a decriminalised environment. New Zealand Medical Journal, 127, 30–37.
Agustín, L. (2005). The cultural study of commercial sex. Sexualities, 8, 618–631.
Armstrong, D. (1995). The rise of surveillance medicine. Sociology of Health & Illness, 17, 393–404.
Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A. L., Decker, M. R., … Kerrigan, D. (2012). Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Infectious Diseases, 12, 538–549.
Bindman, J., & Doezema, J. (1997). Redefining prostitution as sex work on the international agenda. Retrieved from http://www.walnet.org/csis/papers/redefining.html.
Bobashev, G. V., Zule, W. A., Osilla, K. C., Kline, T. L., & Wechsberg, W. M. (2009). Transactional sex among men and women in the south at high risk for HIV and other STI. Journal of Urban Health, 86, 532–547.
Braun, Y. A. (2010). Gender, development, and sex work in Lesotho. Equality, Diversity and Inclusion, 29, 78–96.
Brouard, P., & Crewe, M. (2012). Sweetening the deal? Sugar daddies, sugar mummies, sugar babies and HIV in contemporary South Africa. Agenda, 26(4), 48–56.
Chatterji, M., Murray, N., London, D., & Anglewicz, P. (2005). The factors influencing transactional sex among young men and women in 12 sub-Saharan African countries. Biodemography and Social Biology, 52, 56–72.
Chen, Y., Li, X., Zhou, Y., Zhang, C., Wen, X., & Guo, W. (2012). Alcohol consumption in relation to work environment and key sociodemographic characteristics among female sex workers in China. Substance Use and Misuse, 47, 1086–1099.
Cluver, L., Orkin, M., Boyes, M., Gardiner, F., & Meinck, F. (2011). Transactional sex amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty. Journal of Acquired Immune Deficiency Syndromes, 58, 336–343.
Decker, M. R., Crago, A. L., Chu, S. K., Sherman, S. G., Seshu, M. S., Buthelezi, K., … Beyrer, C. (2015). Human rights violations against sex workers: Burden and effect on HIV. Lancet, 385, 186–199.
Dewey, S. (2011). Neon wasteland: On love, motherhood, and sex work in a rust belt town. Berkeley: University of California Press.
Donovan, B., Harcourt, C., Egger, S., Watchirs Smith, L., Schneider, K., Kaldor, J. M., … Tabrizi, S., (2012). The sex industry in New South Wales: A report to the NSW Ministry of Health. Sydney: Kirby Institute, University of New South Wales.
Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntyre, J. A., & Harlow, S. D. (2004). Transactional sex among women in Soweto, South Africa: Prevalence, risk factors, and association with HIV infection. Social Science and Medicine, 59, 1581–1592.
Dunkle, K. L., Wingood, G. M., Camp, C. M., & DiClemente, R. J. (2010). Economically motivated relationships and transactional sex among unmarried African American and white women: Results from a US national telephone survey. Public Health Reports, 125(Suppl. 4), 90–100.
Epstein, H., & Halperin, D. (2007). Letter. Lancet, 369, 9561.
Galldin, K., Robertson, L., & Wiseman, C. (2011). Bedford v. Canada: A paradigmatic case toward ensuring the human and health rights of sex workers. HIV/AIDS Policy & Law Review, 15(3), 1–5.
Ghose, T., Swendeman, D., George, S., & Chowdhury, D. (2008). Mobilizing collective identity to reduce HIV risk among sex workers in Sonagachi, India: The boundaries, consciousness, negotiation framework. Social Science and Medicine, 67, 311–320.
Ghys, P., Jenkins, C., & Pisani, E. (2001). HIV surveillance among female sex workers. AIDS, 15(Suppl. 3), 33–40.
Godwin, J. (2012). Sex work and the law in Asia and the Pacific. Bangkok: United Nations Development Programme.
Goldhill, S. (2015). The imperialism of historical arrogance: Where is the past in DSM’s idea of sexuality? Archives of Sexual Behavior, 44, 1099–1108.
Greene, J. M., Ennett, S. T., & Ringwalt, C. L. (1999). Prevalence and correlates of survival sex among runaway and homeless youth. American Journal of Public Health, 89, 1406–1409.
Halperin, D., & Epstein, H. (2004). Concurrent sexual partnerships help to explain HIV prevalence: Implications for prevention. Lancet, 363, 4–6.
Helleringer, S., & Kohler, H. P. (2007). Sexual network structure and the spread of HIV in Africa: Evidence for Likoma, Malawi. AIDS, 21, 2323–2332.
Hubbard, P., Matthews, R., & Scoular, J. (2008). Regulating sex work in the EU: Prostitute women and the new spaces of exclusion. Gender, Place & Culture, 15, 137–152.
Hubbard, P., & Sanders, T. (2003). Making space for sex work: Female street prostitution and the production of urban space. International Journal of Urban and Regional Research, 27, 75–89.
Hunter, M. (2002). The materiality of everyday sex: Thinking beyond ‘prostitution’. African Studies, 61, 99–120.
Jenkins, C., & Buchanan-Aruwafu, H. (2007). Culture and contexts matter: Understanding and preventing HIV in the Pacific. Manila: Asian Development Bank.
Jewkes, R., Morrell, R., Sikweyiya, Y., Dunkle, K., & Penn-Kekana, L. (2012). Men, prostitution and the provider role: Understanding the intersections of economic exchange, sex, crime and violence in South Africa. PLoS ONE, 7, e40821. https://doi.org/10.1371/journal.pone.0040821.
Kaufman, C., & Stavrou, S. (2004). ‘Bus fare please’: The economics of sex and gifts among young people in urban South Africa. Culture, Health and Sexuality, 6, 377–391.
Kerrigan, D., Kennedy, C., & Morgan-Thomas, R. (2014). A community empowerment approach to the HIV response among sex workers: Effectiveness, challenges, and considerations for implementation and scale-up. Lancet, 385, 172–185.
Kerrigan, D., Wirtz, A., Baral, S., Stanciole, A., Butler, J., Oelrichs, R., & Beyer, C. (2013). The global HIV epidemics among sex workers. Washington, DC: World Bank.
Kippax, S. (2012). Effective HIV prevention: The indispensable role of social science. Journal of the International AIDS Society, 15(2), 17357.
Kirby Institute. (2011). HIV/AIDS, viral hepatitis, and sexually transmissible infections in Australia Annual Surveillance Report 2011. Sydney: Kirby Institute, UNSW.
Kwena, Z. A., Shisanya, C. A., Bukusi, E. A., Turan, J. M., Dworkin, S. L., Rota, G. A., & Mwanzo, I. J. (2017). Jaboya (“Sex for Fish”): A qualitative analysis of contextual risk factors for extramarital partnerships in the fishing communities in Western Kenya. Archives of Sexual Behavior, 46, 1877–1890.
Leclerc-Madlala, S. (2003). Transactional sex and the pursuit of modernity. Social Dynamics, 29, 213–233.
Levine, P. (2003). Prostitution, race and politics: Policing venereal disease in the British empire. London: Routledge.
Longfield, K. (2004). Rich fools, spare tyres and boyfriends: Partner categories, relationship dynamics and Ivorian women’s risk for STIs and HIV. Culture, Health and Sexuality, 6, 483–500.
Luke, N. (2005). Confronting the sugar daddy stereotype: Age and economic asymmetries and risky sexual behavior in urban Kenya. International Family Planning Perspectives, 31, 6–14.
Maganja, R. K., Maman, S., Groves, A., & Mbwambo, J. K. (2007). Skinning the goat and pulling the load: Transactional sex among youth in Dar es Salaam, Tanzania. AIDS Care, 19, 974–981.
Masvawure, T. (2010). ‘I just need to be flashy on campus’: Female students and transactional sex at a university in Zimbabwe. Culture, Health and Sexuality, 12, 857–870.
McMillan, K., & Worth, H. (2011). Sex workers and HIV prevention in Fiji—After the Fiji Crimes Decree. Sydney: International HIV Research Group, UNSW.
McMillan, K., & Worth, H. (2015). Problematics of empowerment: Sex worker HIV prevention in the Pacific. Health Promotion International, 31, 946–953. https://doi.org/10.1093/heapro/dav069.
McMillan, K., & Worth, H. (2016). Patrulhando as periferias: Trabalho sexual, protoclos sobre tráfico humano e prevenção do VIH no Pacífico. In O. Sacramento & F. Ribeiro (Eds.), Planeta sida: Diversidade, políticas e respostas sociais (pp. 277–300). Ribeirão: Húmus.
Miller, C. L., Fielden, S. J., Tyndall, M. W., Zhang, R., Gibson, K., & Shannon, K. (2011). Individual and structural vulnerability among female youth who exchange sex for survival. Journal of Adolescent Health, 49, 36–41.
Morris, M., & Kretzschmar, M. (1997). Concurrent partnerships and the spread of HIV. AIDS, 11, 641–648.
Pando, M., Coloccini, R., Reynaga, E., Fermepin, M., Vaulet, L., Kochel, T., … Avila, M. (2013). Violence as a barrier for HIV prevention among female sex workers in Argentina. PLoS ONE, 8, e54147. https://doi.org/10.1371/journal.pone.0054147.
Plumridge, L., & Abel, G. (2001). A ‘segmented’ sex industry in New Zealand: Sexual and personal safety of female sex workers. Australian and New Zealand Journal of Public Health, 25, 78–83.
Poulin, M. (2007). Sex, money, and premarital partnership in southern Malawi. Social Science and Medicine, 65, 2383–2393.
Pyett, P., & Warr, D. (1997). Vulnerability on the streets: Female sex workers and HIV risk. AIDS Care, 9, 539–547.
Rojanapithayakorn, W. (2006). The 100% condom use programme in Asia. Reproductive Health Matters, 14, 41–52.
Shannon, K., & Csete, J. (2010). Violence, condom negotiation and HIV risk among sex workers. Journal of the American Medical Association, 304, 573–574.
Shannon, K., Kerr, T., Marshall, B., Li, K., Zhang, R., Strathdee, S. A., … Wood, E. (2010). Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a Canadian setting. Archives of Pediatrics & Adolescent Medicine, 164, 61–65.
Shannon, K., & Montaner, J. (2012). The politics and policies of HIV prevention in sex work. Lancet Infectious Diseases, 12, 500–502. https://doi.org/10.1016/S1473-3099(12)70065-8.
Shannon, K., Strathdee, S., Goldenberg, S., Duff, P., Mwangi, P., Rusakova, M., … Boily, M. (2015). Global epidemiology of HIV among female sex workers: Influence of structural determinants. Lancet, 385, 55–71.
Shannon, K., Strathdee, S., Shoveller, J., Rusch, M., Kerr, T., … Tyndall, M. (2009). Structural and environmental barriers to condom use negotiation with clients among female sex workers: Implications for HIV-prevention strategies and policy. American Journal of Public Health, 99, 659–665.
Shaver, F., Lewis, J., & Maticka-Tyndale, E. (2011). Rising to the challenge: Addressing the concerns of people working in the sex industry. Canadian Review of Sociology/Revue canadienne de sociologie, 48, 47–65.
Shorter Oxford English Dictionary. (3rd ed.). (1959). New York: Oxford University Press.
Simic, M., & Rhodes, T. (2010). Violence, dignity and HIV vulnerability: Street sex work in Serbia. Sociology of Health & Illness, 31, 1–16.
Tabet, P. (2012). Through the looking-glass: Sexual-economic exchange. In F. Omokaro, & F. Reysoo (Eds.). Chic, chèque, choc. Transactions autour des corps and stratégies amoureuses contemporaines (pp. 39–51). Genève: Open Edition Books.
Todd, J., Cremin, I., McGrath, N., Bwanika, J., Wringe, A., Marston, M., … Żaba, B. (2009). Reported number of sexual partners: Comparison of data from four African longitudinal studies. Sexually Transmitted Infections, 85(Suppl. 1), i72–i80.
Turshen, M. (1998). The political ecology of AIDS in Africa. In M. Singer (Ed.), The political economy of AIDS (pp. 167–182). New York: Baywood.
Vanwesenbeeck, I. (2001). Another decade of social scientific work on sex work: A review of research 1990–2000. Annual Review of Sex Research, 12, 242–289.
Vanwesenbeeck, I. (2017). Sex work criminalization is barking up the wrong tree. Archives of Sexual Behavior, 46, 1631–1640.
Vuylsteke, B., Das, A., Dallabetta, G., & Laga, M. (2002). Preventing HIV among sex workers. In K. Mayer & H. Pizer (Eds.), HIV prevention: A comprehensive approach (pp. 376–406). Amsterdam: Elsevier.
Walkowitz, J. (1980). Prostitution and victorian society: Women, class and the state. New York: Cambridge University Press.
Walls, N., & Bell, S. (2011). Correlates of engaging in survival sex among homeless youth and young adults. Journal of Sex Research, 48, 423–436.
Wardlow, H. (2004). Anger, economy, and female agency: Problematizing ‘prostitution’ and ‘sex work’ among Huli of Papua New Guinea. Signs, 29, 1017–1040.
Wardlow, H. (2006). Wayward women: Sexuality and agency in a New Guinea Society. Berkeley: University of California Press.
Watson, J. (2011). Understanding survival sex: Young women, homelessness and intimate relationships. Journal of Youth Studies, 14, 639–655.
Wojcicki, J. (2002a). Commercial sex work or Ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal, South Africa. Culture, Medicine and Psychiatry, 26, 339–370.
Wojcicki, J. (2002b). ‘She drank his money’: Survival sex and the problem of violence in taverns in Gauteng Province, South Africa. Medical Anthropology Quarterly, 16, 267–293.
Worth, H., Patton, C., & Goldstein, D. (2005). Reckless vectors: The infecting ‘other’ in HIV/AIDS law. Sexuality Research and Social Policy, 2, 3–4.
Zheng, T. (2009). Red lights: The lives of sex workers in postsocialist China. Minneapolis: University of Minnesota Press.
About this article
Cite this article
McMillan, K., Worth, H. & Rawstorne, P. Usage of the Terms Prostitution, Sex Work, Transactional Sex, and Survival Sex: Their Utility in HIV Prevention Research. Arch Sex Behav 47, 1517–1527 (2018) doi:10.1007/s10508-017-1140-0
- Sex work
- Transactional sex
- Survival sex
- HIV research