Usage of the Terms Prostitution, Sex Work, Transactional Sex, and Survival Sex: Their Utility in HIV Prevention Research


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.

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  1. 1.

    The surveillance, in the interests of public health, however, of women who sell sex predates the emergence of HIV (see Armstrong, 1995; Levine, 2003).

  2. 2.

    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.

  3. 3.

    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.

  4. 4.

    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.

  5. 5.

    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).

  6. 6.

    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).

  7. 7.

    Signing an anti-prostitution pledge became an eligibility requirement for funding from the US President’s Emergency Plan for AIDS Relief in 2003.

  8. 8.

    Women’s engagement in prostitution in Victorian society has been similarly interpreted as a marker of agency (Walkowitz, 1980).

  9. 9.

    Yet, it is one that pervades numerous humanitarian efforts targeting those who are paid for sex (see McMillan & Worth, 2016).


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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

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  • Prostitution
  • Sex work
  • Transactional sex
  • Survival sex
  • HIV research