SDSU leads international research collaboration to broaden understanding of sex workers’ health
The series was published in The Lancet Public Health and expands the evidence on sex workers’ well-being and occupational safety
By Zoe Glotzer
Monday, August 3, 2026
San Diego State University led an international collaboration published in The Lancet Public Health, one of the world’s leading public health journals, that offers the most comprehensive synthesis of evidence on sex workers’ health in more than a decade
Published July 24, the four-paper series brings together two years of research and collaboration among SDSU, Johns Hopkins Bloomberg School of Public Health, the Global Network of Sex Work Projects (NSWP) and sex workers from diverse geographic settings. Together, the partners developed a body of evidence to inform future research, policy and practice while advancing health equity
The collection expands how researchers understand sex workers’ health by examining not only HIV and sexually transmitted infections, but also mental health, reproductive health, violence, stigma, discrimination, workplace safety, access to healthcare and the broader social conditions and structural determinants such as laws and policies that can influence health.
“This landmark international collaboration demonstrates the power of research to reshape an entire field,” said Amy Bonomi, dean of SDSU’s College of Health and Human Services. “By challenging conventional approaches to understanding health among sex workers, Dr. Goldenberg and her colleagues have created a framework that will influence future research, inform policy, and strengthen public health practice around the world to improve the health and lives of sex workers.”
Led by Shira Goldenberg, associate professor in the Division of Epidemiology and Biostatistics in the School of Public Health and co-director of the SDSU/UCSD Joint Doctoral Program in Public Health, the project represents a sustained international effort to better understand the factors that shape the health and well-being of sex workers around the world. A defining feature of the work was its partnership with NSWP, an advocacy group for the rights of female, male, and transgender sex workers with member organizations in five continents.
Researchers from SDSU, Johns Hopkins, and other academic institutions from around the world worked alongside sex workers and representatives of sex worker-led organizations as authors and collaborators, ensuring that community expertise and lived experience informed the research, interpretation of findings and recommendations.
“This collaboration has demonstrated how it is not only possible, but necessary, to center sex workers’ lived experiences when generating evidence. We hope it will serve as a basis for future partnerships and advocacy efforts,” said Anna Shapiro, acting global coordinator of NSWP and a collaborator and co-author on the series
The series builds on influential collections published in 2014 and updated in 2018, which documented the disproportionate burden of HIV and other sexually transmitted infections among sex workers and demonstrated how legal and structural environments influence health. The new collection broadens that foundation by examining health more holistically.
The health inequities faced by sex workers are rooted in interconnected social and structural factors such as the criminalization of sex work and in various repressive laws, policies, and practices that restrict sex workers’access to vital health services. The findings of the series position health equity and occupational health and safety as essential frameworks for understanding and improving sex workers’ health worldwide
“This series highlights the importance of broadening research, programs and policies with sex workers to address health equity, as most past work has been focused on the prevention of HIV and sexually transmitted infections,” Goldenberg said. “Our work also shows that it is critical for these efforts to meaningfully engage and partner with sex workers to build stronger evidence, better policies, and promote health equity.”
The research identifies three key advances for research, policy and practice:
- Broadening the focus to health equity. The evidence demonstrates that sex workers experience inequities across multiple domains of health and well-being. The papers emphasize that these inequities are shaped by broader social and structural conditions rather than being inherent to sex work itself.
- Recognizing stigma, discrimination and violence as structural determinants of health. The series highlights how intersecting forms of stigma, discrimination and violence influence health through healthcare systems, legal environments and broader social institutions. The findings underscore the importance of addressing structural barriers alongside individual-level interventions.
- Advancing an occupational health and safety framework. The series proposes occupational health and safety as a practical framework for understanding and addressing many of the health, safety and rights-related challenges documented across the collection. This perspective shifts attention toward safe working environments, violence prevention, labor protections, access to social protections and reducing occupational hazards.
“Sex work is practiced in every country in the world,” said Stefan Baral, professor at the Johns Hopkins Bloomberg School of Public Health. “Leveraging an occupational health framing to sex work advances opportunities for sex work to be safe and sex workers and their clients to be healthy.”
The series highlights the importance of centering leadership of sex workers and sex worker-led organizations throughout the research process. Demonstrating how meaningful collaboration with communities can strengthen research and can contribute to more responsive public health evidence. Community expertise informed every stage of the work, from interpreting evidence to developing recommendations
Together, the four papers provide a framework for understanding the health and well-being of sex workers and offer evidence to inform future work aimed at reducing longstanding and preventable health inequities.
Depicted in photo at top, from left: Sofia Gruskin (University of Southern California, panelist), Carmen Logie (Factor-Inwentash Faculty of Social Work, University of Toronto and first author), Shira Goldenberg (San Diego State University, Series Lead), Karina Bravo ( Latin American Platform of People who do Sex Work (PLAPERTS), co-author), Fairy Abdulghani (Organisasi Perubahan Sosial Indonesia (OPSI)/Asia Pacific Network of Sex Workers (APNSW), co-author), Anna Shapiro (NSWP Acting Global Coordinator and co-author), Kaitlyn Atkins (Johns Hopkins Bloomberg School of Public Health, co-author), Stefan Baral (Johns Hopkins Bloomberg School of Public Health, Series Co-Lead).
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