Sex workers have very diverse working conditions and experiences (Weitzer, 2007). Decriminalization and legalization of sex work significantly improves the health and safety of sex workers, but most sex workers across the world operate under the disadvan­tages of criminal legal statutes. Sex workers can develop physical and mental health prob­lems as a result of violence, chronic stress, exposure to sexually transmitted diseases, and a lack of control over their working conditions (Ward & Day, 2006; Wong et al., 2006). At the worst, women in the sex trade are murdered by their customers (Pelisek, 2011). The research in this section pertains to countries where prostitution is not decriminalized.

Two thirds of the sex workers in a nine-country study met diagnostic criteria for posttraumatic stress disorder (PTSD), which develops when an individual experiences overwhelming trauma. Some of the symptoms include recurrent nightmares, emotional numbness or fear, difficulty sleeping and concentrating, and flashbacks (feelings of reliv­ing the original traumatic experience). According to this research, it is a misconception that sex workers enter the business to support their drug habits. Various studies have reported that prostitution precedes drug and alcohol abuse for 39-60% of individuals. Sex workers often began to abuse drugs and alcohol to try to cope with overwhelming negative feelings while working (Farley, 2004).

HIV/AIDS is another danger sex workers and their customers face. There is strong evidence that the number of infected prostitutes correlates with the HIV prevalence in a country (Talbott, 2007). Customers often pressure sex workers not to use condoms, and those in the United States who face the greatest pressures not to use condoms are younger than 18, are under the influence of drugs or alcohol, service customers in cars or public spaces, are the most desperate for money, and are in the country illegally (Akarro, 2008; Shannon et al., 2009). A study in Mexico found that prostitutes receive a pre­mium of between 23% and 46% for unprotected sex—an increase from over $14,000 to $51,000 in income per year (Gertler et al., 2005). Programs that provide safe sex educa­tion or give female condoms to sex workers have seen an increase in the numbers of sex workers practicing safe sex (Hoke et al., 2007).