Pregnancy prevention and contraceptive preferences of online sex workers in the UK

Abstract

Objectives: The internet has changed the organisation of sex work. The risk of sexually transmitted infections has frequently been a research focus, but less is known about sex workers’ use of contraception for pregnancy prevention. The aim of this research was to gain a better understanding of contraceptive preferences and provider interactions of online sex workers.

Methods: Data were obtained from a multi-methods study of sex workers in the UK who advertise on the internet and have sexual contact with clients, particularly in the Birmingham and Solihull areas. The study comprised an online survey among 67 participants and eight qualitative interviews.

Results: Reported high rates of condom use with clients led to sex workers considering pregnancy prevention to be a personal rather than an occupational issue. Disclosure of sex working to health professionals is often seen as unnecessary and/or undesirable due to concerns about stigma. A clear distinction between contraceptive needs for commercial and non-commercial partners was evident.

Conclusion: Service providers need to take account of both personal and commercial needs during contraceptive consultations and avoid making assumptions based on homogeneous understandings of sex work. Encouraging disclosure of sex work to facilitate appropriate discussions may need new approaches to combat privacy and stigma concerns.

Keywords:

• Contraception
• disclosure
• internet
• pregnancy
• sex work
• stigma

Author contributions

PL was the principal investigator of the project and, with KP, contributed to the research concept, study design and data collection, analysis and reporting. HP and CR contributed to the study design and data reporting. JDCR contributed to the research concept, study design and data analysis and reporting. VW contributed to the study design and data collection, analysis and reporting. All authors commented on and approved this paper.

Disclosure statement

JDCR reports personal fees from GSK Pharma, Hologic Diagnostics, Mycovia and Janssen Pharma, as well as ownership of shares in GSK Pharma and AstraZeneca Pharma. He is author of the UK and European guidelines on pelvic inflammatory disease; a member of the European sexually transmitted infections guidelines editorial board; a member of the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Commissioning Board; and a past member of the NIHR HTA Primary Care, Community and Preventive Interventions Panel (2013-2016). He is an NIHR journals editor and associate editor of Sexually Transmitted Infections journal. He is an officer of the British Association for Sexual Health and HIV (vice-president) and of the International Union against Sexually Transmitted Infections (treasurer). CR is a member of the Clinical Governance Committee and Adolescent Special Interest Group for the British Association for Sexual Health and HIV. VW is an employee of Taylor and Francis.

Data availability

No data are available. Additional unpublished data from this study are unavailable, as they may identify participants.

Additional information

Funding

This work was supported by Umbrella partnership/University Hospitals Birmingham NHS Foundation Trust and Birmingham City Council.