Research Project on sex workers´ health needs

Topic and goals

Backgrounds and questions

Globally, sex workers have an increased risk of acquiring HIV[1]. Among the reasons for this are the persistent (often multiple) stigmatization and discrimination, criminalization and experiences of violence. At the same time, many people in sex work have inadequate or no access to health services, for example if they are not health insured. So far, there is little scientifically knowledge about the situation in Germany.

With the qualitative study "Sexual Health and HIV/STI Prevention Strategies and Needs of Sex Workers”, Deutsche Aidshilfe wants to improve the understanding of the health needs of sex workers in Germany. For this purpose, sex workers with different (e.g. biographical, socio-economic or socio-cultural) backgrounds, with different gender identities and from different living and working contexts are to be questioned within focus groups on the following topics:

1. Which health risks (especially with regard to HIV and sexually transmitted infections/STIs) do sex workers perceive and what strategies do they use to protect their own health? How do or did sex workers deal with the structural changes brought about by the ProstituiertenSchutzGesetz, which came into force in July 2017 and, among other things, introduced mandatory health counseling as a condition for legally engaging in sex work, as well as with the changes brought about by the Covid pandemic (specifically occupational bans and the reduction of prevention services)?
2. Which prevention, testing and care services do sex workers use and how do they use them? What are barriers to accessing these services? Which needs are not (sufficiently) covered by the existing services?
3. What are the needs and barriers among different groups of sex workers regarding the use of HIV pre-exposure prophylaxis (PrEP) as a safer sex method?

The study should incorporate the experiences of a high diversity of people in sex work in order to capture different needs and requirements of sex workers.

Benefits of the project

The results as well as recommendations for action from the project are to be published in scientific articles and in a brochure as well as online. The research findings should have a positive impact on several levels:

1. Sex workers can learn more about the different needs of their communities and will be able to articulate and substantiate their demands better.
2.  Prevention services for sex workers can be improved according to the identified needs of the different target groups. In addition, the development of new services can be supported by the project results.
3.  Evidence-based recommendations to policy makers should contribute to the development of structures that improve the health as well as living and working conditions of sex workers. At the same time, the results can provide an important contribution to the evaluation of the Prostituiertenschutzgesetz.

The Focus Groups

The study follows a qualitative research design and the data is collected through focus group interviews. Focus groups are small groups, which are stimulated to discuss specific topics by an information input and an open moderation.

The Peer researchers

Peer researchers are collaborating on the project. They play a crucial role in the acquisition of the focus group participants, the moderation of the focus groups and the on-site connection. Right now they are participating in the evaluation of the focus groups. They are sex workers themselves and/or they are involved in social work with a local group of sex workers and have a special connection to the group members, for example, because of their native language. They participate in a preparation and training weekend and an evaluation workshop . The focus group interview guideline has been developed participatively with the Peer researchers and the members of the advisory board.

Composition and procedure of the focus groups

From October 2022 to March 2023, the group discussions took place at different locations in Germany. In order to fully incorporate the diverse experiences of migrant sex workers into the project, the focus groups were conducted in different languages. Here are the focus groups that took place:

• Female Escorts
• BIPoC sex worker
• Trans* sex worker
• Trans* women from Latin America
• Male* sex worker
• Bulgarian sex worker
• Thai sex worker
• Sex worker with illegalized substance use
• Sex worker with disability or chronic illness
• Young bulgarian male* sex worker

The conversations were recorded acoustically, transcribed and the transcripts were translated into German. The evaluation of the data preserves the anonymity of the individuals. Participants in the focus groups received an expense allowance of 100€.

The focus groups are now being analyzed in a participatory manner with the peer researchers and the members of the advisory board. Based on the results, recommendations for action will be developed and further research needs will be formulated.

The project advisory board

An advisory board with community representatives, scientists and practitioners, is actively involved in the further development of the research design and will provide methodological and technical support for the entire duration of the project. The members are:

• Maia Ceres, sex worker, Health Advisor of the Berufsverbandes erotische und sexuelle Dienstleistungen e.V. (BesD)
• Dr. Johanna Claass, Head of the health consultation for sex workers after §19 IfSG as well as of the consultation after §10 ProstSchG in Hamburg
• Giovanna Gilges, Executive Board of the Gesellschaft für Sexarbeits- und Prostitutionsforschung (GSPF)
• Gudrun Greb, CEO of ragazza e.V. and Executive Board of BufaS e.V.
• Olivia Green, sex worker, Co-Coordinator of The Black Sex Workers Collective, Member of FAU Sexworker Section (Union)
• Dr. Klaus Jansen, Deputy Head of the division HIV/AIDS and other blood borne infections, Robert Koch-Institut
• Stefanie Klee, sex worker and Executive Board of Bundesverbandes Sexuelle Dienstleistungen e.V. (BSD)
• Ursula Probst,Social and cultural anthropologist, research assistant (post-doc) at the Institute for Social and Cultural Anthropology, Freie Universität Berlin
• Navina Sarma, Research associate in the Department of Infectious Disease Epidemiology at the Robert Koch Institute
• Caspar Tate, Member of Trans*Sexworks
• Nadja Zillken, Referent for Women and Female Sexwork at Deutsche Aidshilfe and advisory board member of BufaS e.V.

Funding and duration

The project is funded by the German Federal Ministry of Health. It has started on the 1st of April 2022 and will end on the 31st of March 2024.

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