What can put women who sell sex at risk of early death?
When thinking about the risk of early death for women involved in selling sex, violence may immediately come to mind. Yet, in reality there is no single answer to this question. As we will explore on this blog, different circumstances in the lives of women can directly or indirectly increase their risk of dying early. Here, we will focus on three main aspects: their personal context, direct violence from people in their lives, and the systems that fail to prevent women’s early deaths.
Women’s personal context
Health, homelessness and substance use are among some of the main preventable factors that can put any person at risk of early death. Yet, for women involved in selling sex, these can be the exact circumstances that pushed them to become start selling or exchanging sex in the first place. These can also be situations that appear or worsen during their involvement. Let’s have a closer look at each of them.
Substance use
The links between substance use and early mortality are well known, from long-term health problems (such as liver damage due to drinking alcohol) to life-threatening situations (like a drug overdose). However, to truly understand the root causes and impacts of substance dependency, it is essential to contextualise it within individuals’ lives.
For many women, substance use is closely tied to selling sex. While we may hear that prostitution is a means to fund substance use, this frequently overlooks the fact that women often use substances to cope with seeing punters. A study in Wales, for example, found that 80.6% of women increased their drug use as a result of selling sex.
Recently, a specialist service for those involved in the sex trade shared with us that they lost two supported women. Women’s deaths were recorded in national statistics as drug-related, but this explanation fails to capture the broader circumstances surrounding the lives of these women. Their drug use was reinforced by their involvement in selling and exchanging sex. At this point, one might wonder: how many lives of women lost to drug-related deaths could have been saved if we had focused on how selling sex contributes to and increases their drug use?
Homelessness
The negative impacts of homelessness on people’s health are well documented. People who sleep rough are at a greater risk of contracting illnesses and diseases. And exposure to the elements can also mean health conditions worsen quicker. There is also the stress and reality of living homeless, which can impact a person’s mental health and ability to look after themselves.
In Scotland, shockingly the average age of death for homeless women is 45. At the same time, in 2024, Encompass Services, which specialise in supporting women involved in selling sex, reported that 60% of supported women had experienced homelessness at some point in their lives.
The dynamics of homelessness are also different for women compared to men. Domestic abuse, poverty and trauma are among the reasons that can leave women homeless. And very often women face what is known as hidden homelessness, meaning they will sofa surf, stay with family and friends or pay for a night in a hostel or hotel to avoid rough sleeping, in many cases due to concerns for their safety. Yet, to have access to a place to stay, some women may be asked for sexual ‘favours’. And even when women seek formal support, they can face the risk of exploitation, particularly in mixed-sex temporary shelters.
In essence, many women are confronted with a double set of risks. In an attempt to avoid rough sleeping, which can affecter their overall health and safety, some start selling sex. Yet their involvement in selling sex comes with the additional risks we discuss here, such as potential for substance use, direct violence, risk of sexual infections and stigma which can become a huge barrier to accessing services.
Health
Women involved in the sex trade are exposed to physical and mental health risks which can shorten their lives. A recent report highlighted that women in the sex trade face significant risk to sexual health infections such as gonorrhea, chlamydia, human papillomavirus (HPV), syphilis, hepatitis, and HIV. Many of these infections can lead to health complications and result in a lower life expectancy.
Mental health is another crucial factor to consider. At CSE Aware we have long argued that experiencing physical and sexual abuse, neglect, and household dysfunction—such as substance abuse— at an early age can lead individuals into the sex industry. One study supports this idea, suggesting that the likelihood of selling sex increases with the number of adverse childhood experiences (ACEs). ACEs are also linked to a higher risk of premature mortality; for instance, experiencing six or more ACEs can reduce life expectancy by up to 20 years.
While there has been extensive research on women’s mental health, one area that has lacked attention—especially in the UK—is women's self-harm and suicidal ideation. The latest Encompass Snapshot indicated that 41% of supported women with experience of the sex industry have had suicidal ideation or attempted suicide, while 26% have harmed themselves. Although selling sex may not be the sole reason behind these coping strategies, the high prevalence of suicide and suicidal thoughts in this group is concerning and should not be ignored.
Other psychological factors such as loneliness also play a significant role. For some women, the stigma surrounding the sale of sex and concerns about disclosing their involvement to others (even to the closes people in their lives) can result in social isolation. Although there is no direct research exploring the connection between loneliness, selling sex, and early death, many studies have identified loneliness as a risk factor for premature mortality.
Substance use
The links between substance use and early mortality are well known, from long-term health problems (such as liver damage due to drinking alcohol) to life-threatening situations (like a drug overdose). However, to truly understand the root causes and impacts of substance dependency, it is essential to contextualise it within individuals’ lives.
For many women, substance use is closely tied to selling sex. While we may hear that prostitution is a means to fund substance use, this frequently overlooks the fact that women often use substances to cope with seeing punters. A study in Wales, for example, found that 80.6% of women increased their drug use as a result of selling sex.
Recently, a specialist service for those involved in the sex trade shared with us that they lost two supported women. Women’s deaths were recorded in national statistics as drug-related, but this explanation fails to capture the broader circumstances surrounding the lives of these women. Their drug use was reinforced by their involvement in selling and exchanging sex. At this point, one might wonder: how many lives of women lost to drug-related deaths could have been saved if we had focused on how selling sex contributes to and increases their drug use?
Homelessness
The negative impacts of homelessness on people’s health are well documented. People who sleep rough are at a greater risk of contracting illnesses and diseases. And exposure to the elements can also mean health conditions worsen quicker. There is also the stress and reality of living homeless, which can impact a person’s mental health and ability to look after themselves.
In Scotland, shockingly the average age of death for homeless women is 45. At the same time, in 2024, Encompass Services, which specialise in supporting women involved in selling sex, reported that 60% of supported women had experienced homelessness at some point in their lives.
The dynamics of homelessness are also different for women compared to men. Domestic abuse, poverty and trauma are among the reasons that can leave women homeless. And very often women face what is known as hidden homelessness, meaning they will sofa surf, stay with family and friends or pay for a night in a hostel or hotel to avoid rough sleeping, in many cases due to concerns for their safety. Yet, to have access to a place to stay, some women may be asked for sexual ‘favours’. And even when women seek formal support, they can face the risk of exploitation, particularly in mixed-sex temporary shelters.
In essence, many women are confronted with a double set of risks. In an attempt to avoid rough sleeping, which can affecter their overall health and safety, some start selling sex. Yet their involvement in selling sex comes with the additional risks we discuss here, such as potential for substance use, direct violence, risk of sexual infections and stigma which can become a huge barrier to accessing services.
Health
Women involved in the sex trade are exposed to physical and mental health risks which can shorten their lives. A recent report highlighted that women in the sex trade face significant risk to sexual health infections such as gonorrhea, chlamydia, human papillomavirus (HPV), syphilis, hepatitis, and HIV. Many of these infections can lead to health complications and result in a lower life expectancy.
Mental health is another crucial factor to consider. At CSE Aware we have long argued that experiencing physical and sexual abuse, neglect, and household dysfunction—such as substance abuse— at an early age can lead individuals into the sex industry. One study supports this idea, suggesting that the likelihood of selling sex increases with the number of adverse childhood experiences (ACEs). ACEs are also linked to a higher risk of premature mortality; for instance, experiencing six or more ACEs can reduce life expectancy by up to 20 years.
While there has been extensive research on women’s mental health, one area that has lacked attention—especially in the UK—is women's self-harm and suicidal ideation. The latest Encompass Snapshot indicated that 41% of supported women with experience of the sex industry have had suicidal ideation or attempted suicide, while 26% have harmed themselves. Although selling sex may not be the sole reason behind these coping strategies, the high prevalence of suicide and suicidal thoughts in this group is concerning and should not be ignored.
Other psychological factors such as loneliness also play a significant role. For some women, the stigma surrounding the sale of sex and concerns about disclosing their involvement to others (even to the closes people in their lives) can result in social isolation. Although there is no direct research exploring the connection between loneliness, selling sex, and early death, many studies have identified loneliness as a risk factor for premature mortality.
Direct violence
As we explored in our Safety insights, violence can be a constant reality for many women involved in selling sex. It can be perpetrated by pimps, controllers, sex buyers, partners and members of the public. A study in London revealed that the mortality rate among women selling sex was twelve times higher than that of women in the general population, with murder identified as one of the leading causes of death. Additionally, an analysis of the UK murder database from 1990 to 2016 concluded that individuals involved in selling sex are, by a significant margin, the group most at risk of homicide.
The threat of murder can come in different ways for women. Some may be experiencing abuse from a partner which may well escalate into homicide. In some cases, pimps and controllers will use violence to control women which can end up in murder. Finally, women are at risk of death from violent sex buyers who target women specifically for violence. On the other hand, sex buyers may also request and push for sex involving violent acts such as strangulation, which can result in women’s death.
The heightened risk of violence in the sex industry means women who sell sex are already exposed to a higher risk of murder. We also mustn’t forget that around the world women in the sex industry have often been the overlooked victims of femicide, something to which we will return in our final blog in this series.
The threat of murder can come in different ways for women. Some may be experiencing abuse from a partner which may well escalate into homicide. In some cases, pimps and controllers will use violence to control women which can end up in murder. Finally, women are at risk of death from violent sex buyers who target women specifically for violence. On the other hand, sex buyers may also request and push for sex involving violent acts such as strangulation, which can result in women’s death.
The heightened risk of violence in the sex industry means women who sell sex are already exposed to a higher risk of murder. We also mustn’t forget that around the world women in the sex industry have often been the overlooked victims of femicide, something to which we will return in our final blog in this series.
A system that fails to prevent early death
While the above circumstances can put women directly at risk of dying early, systems that hinder women’s efforts to access necessary support can indirectly lead to women’s early deaths. Take, for example, Emma Cadwell’s case: it took nearly two decades to bring her killer to justice. In the end, he was convicted of 11 additional rapes and multiple sexual assaults, affecting a total of 22 women. The absence of justice—despite being named in the police investigation early on—contributed to further assaults and put other women at risk of murder. As one woman who encountered the killer said, "Hundreds of women reported him, but they [the police] wouldn't listen."
More than a decade later, the lack of trust in the police remains significant. Fear of criminalisation, stigmatisation, or the risk of being outed are just a few reasons that prevent women from engaging with the justice system. This lack of trust means that their concerns and experiences of violence remain unaddressed while the perpetrator stays around, with the potential to escalate his actions.
These barriers also exist in areas like healthcare, social work, housing, and employment. Some women decide not to access essential services due to the fear of being judged for their involvement, which means their emotional, practical, and health needs are not addressed. Even when women engage with services and choose to disclose their circumstances, they often encounter a lack of understanding regarding their needs, leaving many without adequate support. For instance, research conducted by National Ugly Mugs revealed significant gaps within the healthcare system, including services related to vaccination, testing, and treatment. This accumulation of barriers across different settings can ultimately affect women’s health and quality of life.
The relationship between selling sex and early death is complex and multifaceted. Yet, it is important to remember that early death is preventable. We hope this blog will encourage you to consider the experiences of the women you support from a different perspective.
This is the second part in our series of blogs exploring the early deaths of women involved in the sex industry. You can find our previous and future blogs on this page.
More than a decade later, the lack of trust in the police remains significant. Fear of criminalisation, stigmatisation, or the risk of being outed are just a few reasons that prevent women from engaging with the justice system. This lack of trust means that their concerns and experiences of violence remain unaddressed while the perpetrator stays around, with the potential to escalate his actions.
These barriers also exist in areas like healthcare, social work, housing, and employment. Some women decide not to access essential services due to the fear of being judged for their involvement, which means their emotional, practical, and health needs are not addressed. Even when women engage with services and choose to disclose their circumstances, they often encounter a lack of understanding regarding their needs, leaving many without adequate support. For instance, research conducted by National Ugly Mugs revealed significant gaps within the healthcare system, including services related to vaccination, testing, and treatment. This accumulation of barriers across different settings can ultimately affect women’s health and quality of life.
The relationship between selling sex and early death is complex and multifaceted. Yet, it is important to remember that early death is preventable. We hope this blog will encourage you to consider the experiences of the women you support from a different perspective.
This is the second part in our series of blogs exploring the early deaths of women involved in the sex industry. You can find our previous and future blogs on this page.
