Intersecting stigma as a fundamental barrier to the health and wellbeing of sex workers.

Abstract

Sex workers face compounding social and health inequities driven by multiple stigmas-social processes of devaluation that reduce access to power, resources, and opportunities. In this Series paper, we review the evidence and report that structural, interpersonal, and internalised stigma profoundly shape sex workers' health by undermining access to health and human rights, with well documented impacts on sexual health, mental wellbeing, safety, and access to justice. Furthermore, stigma within communities and health, social, workplace, and legal systems often intersect to drive health inequities, social exclusion, and legal harms experienced by diverse sex workers globally. Despite these challenges, sex workers actively negotiate and resist the effects of stigma through peer support, advocacy, and community building, highlighting their agency and resilience. Decriminalisation, community mobilisation and empowerment, and rights-affirming health care are evidence-based strategies to reduce stigma and promote the health, safety, and rights that are urgently needed to optimise health and wellbeing for sex workers across the globe.