The Global Phenomenon of Sex Work, Intimate Partner Violence, and Traumatic Brain Injury

Background/Study Motivation: Sex work, an occupation or trade involving exchange of sexual services for economic compensation, is a highly gendered profession, with 60% to 80% of sex workers identifying as women. The rate of traumatic brain injury (TBI) among persons who experience intimate partner violence (IPV) in the sex worker population is significantly high. According to global estimates, 80% of female sex workers have experienced IPV, with an estimated 95% reporting TBIs, sustained either by being hit in the head with objects and/or having their heads slammed into objects while on the job. Conversely, only 10% of IPV survivors in general populations report TBIs. Despite the high "occupational risk" of TBI in the sex worker population, research on the intersection of IPV-TBI in this population has been scant, heavily focused on sexually transmitted diseases and law enforcement, rather than the occupational hazard of IPV-induced TBI that these women face on a daily basis. Literature on HIV/AIDS specifically in sex workers is very well represented, but there is a research gap on the risk of TBI in female sex workers, leaving one of the most vulnerable groups to TBI underrepresented in research and intervention. Objectives, Methods, and Design: In this commentary, we discuss the intersection of sex work and TBI using a "globalization" lens. Drawing from the literature, clinical, observational, and epidemiological cases from Africa (Kenya), Asia (Vietnam), North America (the US), and Oceania (New Zealand), we explore the evolving definitions of sex work; discuss the occupational hazards of the profession with an emphasis on TBI; advocate for ways forward through using harm reduction as a framework; and implore the TBI research community to identify women and girls who participate in sex work as a TBI high-risk group, so they can receive appropriate care and attention. After all, sex work is the "World's Oldest Profession."