Decriminalisation improves sex workers’ health and wellbeing, says a 2022 scoping review

10 Mar 2023 19:03:42

In her final blog post, ESWA Intern Hanna Nyman presents the findings of The health and well-being of sex workers in decriminalised contexts: a scoping review. This 2022 review identified and reviewed academic and grey literature to evaluate the health and wellbeing of sex workers in New Zealand and New South Wales, Australia.

Sex work has been decriminalised in the Australian state of New South Wales (NSW) and in New Zealand for two decades and published research on sex workers’ health and well-being under the new legislation has grown during this time. The scoping review identified and reviewed academic and grey literature from these two jurisdictions and discussed the findings of a total of fifty-two research papers, including over thirty peer-reviewed articles. Together, these research papers include data collected through interviewing and surveying thousands of diverse sex workers. This blog post summarises the findings of the review.

The review shows clear improvements in the health and well-being of diverse sex workers in NSW and New Zealand after the decriminalisation of sex work, including improvements in sexual health, rates of sexual health testing, access to health services as well as in avoiding work relations of exploitative nature.

In NSW, positive outcomes in sexual health and practices were attributed to the increased peer education, community, services and access to information that the decriminalisation of sex work had enabled. The decriminalisation of sex work was found to facilitate the work of outreach organisations and to improve migrant sex workers’ access to sexual health and outreach services. State-funded peer-based health promotion programmes that employed gender diverse as well as culturally and linguistically diverse (CALD) peer staff with diverse ethnic, language and national backgrounds, such as the Aotearoa New Zealand Sex Workers’ Collective (NZPC) and the Sex Worker Outreach Project (SWOP) in NSW, were shown to be especially successful in reaching particularly stigmatised populations of sex workers and key to the improvements of diverse sex workers’ health and well-being.

In New Zealand, the NZPC was found to have a central role in providing peer support, advocacy, health promotion for all sex workers, including particularly marginalised and criminalised sex workers, as well as in promoting best practices in service provision. Stigma associated with sex work was still widespread in both New Zealand and NSW, demonstrating the importance of addressing stigma in conjunction with decriminalisation. Recent studies recommended initiatives to tackle stigma such as mental health services developed specifically by and for sex workers, which were found to be insufficient or lacking in both jurisdictions.  Notably, the size of the sex industry had not increased in neither New Zealand nor NSW since decriminalisation.

While the decriminalisation of sex work brought clear benefits to sex workers’ health and well-being, some groups of sex workers continued to experience harm due to inadequacies of the implemented decriminalisation models. In New Zealand, migrant sex workers holding temporary visas are excluded from the decriminalisation model and continue to experience the threat of deportation and increased risk of exploitation. The NZPC continues to oppose this bylaw, backed by research. In NSW on the other hand, where all migrants with valid visas can legally work in the commercial sex industry, migrant sex workers experienced improved sexual health and decreased incidence of exploitation and trafficking.

Shortcomings in NSW were highlighted, however. Street-based sex workers face criminal sanctions if found to work in certain locations due to laws that prohibit street-based sex work in proximity to churches, hospitals, schools or dwellings. In New Zealand, where no such laws are in place, street-based sex workers experienced great improvements in working conditions, access to health and justice after decriminalisation.

In NSW, local councils were found to engage in biased land use planning by restricting sex work premises to industrial areas and denying authorisation to many, resulting in a number of massage parlors providing sexual services without authorisation. The review pointed out that these premises were subject to council compliance visits that targeted majority migrant premises and could lead to workers’ distress, risky behaviours and workplace closures. Local councils and Safework NSW were unsuccessful in ensuring adherence to health and safety measures in sex work premises and where training of councils on these matters was found to be insufficient – although it was mentioned that local councils are currently addressing these issues by collaborating with SWOP NSW and the Ministry of Health.

The review concluded that the full decriminalisation of sex work, without any exception due to visa status or work location, is necessary to improve the health and well-being of all sex workers, including migrant sex workers. Peer-based services for and by diverse sex workers must be funded and promoted to achieve real improvements, as well as the continued collaboration with sex worker organisations in policy making. Further efforts to achieve social justice and address structural inequalities must go hand in hand with legislative change in order to ensure good health and well-being for all populations of sex workers.

This post concludes the two series of blog posts on sex workers’ health and the end of my internship with ESWA. I am grateful for this experience and everything that I have learned about sex workers’ health and the sex workers’ rights movement during this time. The experience has sparked discussions about sex work with the people around me, exposing deeply held views about the nature and morality of sex work. Challenging stigmatising perceptions of sex work quickly breaks through claims of protecting sex workers and reveals the structural violence and oppression hiding underneath. Victimising sex workers and denying sex workers of their agency is rooted in racism, sexism, transphobia and other systems of oppression. The public health field needs to actively challenge these systems and reject the idea that sex workers need to be rescued. Instead, it needs to recognise sex workers as equal partners and to stand in solidarity with the sex workers’ rights movement. I will take everything that I have experienced during the past few months with me as my future career in public health begins to take shape and thank ESWA for the opportunity.


Macioti, P.G., Power, J. & Bourne, A. (2022). The health and well-being of sex workers in decriminalised contexts: a scoping review. Sexuality Research and Social Policy.

A full copy of the article is available upon request through ResearchGate

Written by Hanna Nyman
February 10, 2023