Building capacity for critical harm reduction discourse

This is excerpted from the 2020 publication “A Reflection on Sex Work and Harm Reduction Discourse” By T. Santini, A. Klein, Stella, l’amie de Maimie, and Butterfly Asian and Migrant Sex Worker Support Network. We edited the original content for length. 


Currently, harm reduction language is used more and more frequently by people outside of criminalized and affected communities. As a result, narrow and problematic representations of harm reduction are getting more air time and visibility. 


It is important to use harm reduction language in the context of sex work in a way that is nuanced, clear and remains in solidarity with broader communities of people who use drugs. 


What is sex work? Why do people do sex work? 

We use the term sex work to refer to the consensual exchange of a sexual service for money, goods or services (e.g. transportation, housing, drugs, status). Like other kinds of employment, people may do sex work for many different reasons. Although it is commonly understood that people work to make money to support themselves and their families and to fulfill other obligations and ambitions, people have a very difficult time recognizing that sex workers work to make money. 


People decide to work in various sectors – both within and outside of the sex industry – based on their level of privilege and access, and based on the options available to them. Some people have the privilege and opportunity of working in the profession of their dreams, while many others decide to work within a context of limited options and difficult working conditions. Our gender, health, economic, and social status may impact our options and access, as do barriers and inequalities related to racism, restrictive immigration policies, transphobia, etc. 


The stigma, marginalization and criminalization associated with sex work – and more broadly with women’s bodies and sexuality – has consistently led to negative and erroneous assumptions about why people do sex work, even among people involved in harm reduction work. Most people are taught to think of sex work through frameworks that cast it in negative and harmful ways: as crime, vice, gendered violence, human trafficking, sexual exploitation, and a product and driver of inequality. These perspectives and the assumptions that underlie them do not reflect the realities of many sex workers, yet are deeply ingrained in many people’s personal, moral, religious and political values. 


Harm reduction principles require that we recognize, respect and support people’s agency, their understandings of their own experiences, reality and needs, and remain non-judgmental about the types of consensual activities that they engage in. 


*Sex work is not inherently harmful to sex workers or to the broader public/community


Vague or limited harm reduction discourse has the potential to bring people with differing “opinions” of sex work together in some ways, as it may allow people to avoid explicitly identifying the locus of harm to the affected community. However, as the term itself is focused on harm, its use in association with sex work may reinforce the mistaken belief that sex work itself is harmful. These misrepresentations result from a lack of knowledge or careful consideration, misinformation and misunderstanding, and moral, religious and political ideologies. 


When focusing solely on minimizing harms, the term “harm reduction” conceals the numerous ways in which sex work is valuable – as a means of personal and economic advancement, resisting exploitation, finding and building community, exploration and travel, body affirmation, survival and of building the capacity to thrive. This erasure of our experiences makes it easier for others to misrepresent sex work as harmful. 

  1. Equating sex work with harm obscures the real harms that sex workers experience and express. When all sex work is considered harmful, people cannot differentiate between the harm that they perceive as inherent to sex work and the harms that sex workers identify. Thus, people cannot clearly understand what sex workers express as a problem that they want to address. 
  2. The idea that sex work is inherently harmful normalizes and even encourages violence against sex workers. If sex work “is,” “attracts” or “encourages” violence – particularly violence against women – then we should all assume and expect that sex workers will and do experience abuse in the context of their work. 
  3. Positioning sex work as inherently exploitative or violent isolates sex work from other forms of employment and sexual experiences. This frames harms experienced in the context of sex work as being unique to sex work and caused by sex work, rather than as harms and inequalities related to unsafe and inequitable living and working conditions, labour exploitation, precarious immigration status, sexual assault and other forms of violence against women. In these ways, viewing sex work as inherently harmful erases the nuances of lived experiences and prevents actors from offering practical solutions.


Sources of harm to sex workers 

The way people are affected by events in their lives is dependent on their social location (e.g. poverty, network and access, self-identified or perceived racial identity, immigration status). How we are situated in relation to structural factors and forms of oppression (e.g., criminalization, colonization, transphobia) determines which structural sources of harm we must mitigate in our lives and at work. 


To counter the myth that sex work itself is a harmful activity – or must inevitably be connected to harm – sex worker advocates need to adequately identify and articulate both the structural and individual/interpersonal sources of harm that sex workers face. 


Structural and individual/interpersonal sources of harm

  • anti-sex work ideologies 
  • sex work prohibitions (e.g. criminal, immigration, municipal)
  • law enforcement initiatives and surveillance (by police, Canadian Border Services Agency, city inspectors)
  • violence, discrimination, profiling and other human rights violations committed by law enforcement officers (e.g. harassment, unlawful and unwarranted search and seizure, assault) 
  • workplace violence and abuse from managers, clients or co-workers
  • labour exploitation (e.g. poor wages, withheld pay, unsafe working conditions)
  • violence and other abuses by perpetrators (e.g. aggressors, neighbours, landlords) who know that the general public expects and accepts violence against sex workers and that sex workers are not likely to report abuse
  • violence, stigma and discrimination from intimate partners and family members, service providers and other institutions, and other members of the public
  • structural inequalities and systems of oppression (e.g. poverty, racism, racial profiling, colonial borders, displacement, discriminatory immigration policies and practices, sexism, misogyny and violence against women)


*The erasure of sex workers’ agency and human rights


Sex workers refer to their right to agency to as their right and capacity to make decisions about their bodies and their lives. 


Sex workers are incredibly diverse, as are their contexts and decisions. Sex workers exercise their agency within their unique contexts and through their own decision-making processes. 

  • Sex workers make diverse decisions based on the range of available options, their individual and structural realities and their self-determined goals. The range of options differs among individuals and communities depending on our level of privilege and access. 
  • Sex workers may experience many intersecting difficulties. Our options and decisions may be limited by our gender, age, racial or cultural identity, mobility, immigration or health status, and other social, legal, economic, and structural positions. We may experience difficulties related to many issues and systems of oppression such as language barriers, colonialism, poverty, criminalization and other conflicts with the law, racial and social profiling, poor and unsafe working conditions, family issues, etc. These different forms of marginalization and oppression are linked.


Dominant notions of agency and autonomy associated with notions of “free choice” or “free will” obscure, distort and misrepresent marginalized women’s agency.

  • Most people do not live and make decisions in a context of free and unlimited choice. Our understanding of women’s agency and consent must extend beyond the binary notion that women are either free agents who choose or individuals without agency who are forced.
  • Although sex workers’ circumstances may vary, everyone has agency– the capacity to make decisions—at all times, even in extreme situations. We use the language of decision-making rather than the notion of choice because “free choice” does not exist in a context of inequalities, including social, legal and institutional ones.




Santini, T. Santini, Klein, A., Klein, Stella, l’amie de Maimie, and Butterfly Asian and Migrant Sex Worker Support Network. 2020. A Reflection on Sex Work and Harm Reduction Discourse.