Sexually Transmitted Infections as Occupational Diseases: A Crucial Debate for Sex Workers

Sexually transmitted infections (STIs) pose a significant occupational risk for sex workers in Belgium, a particularly vulnerable group due to the nature of their work. Yet, their recognition as occupational diseases remains a complex, under-discussed, and controversial issue. Granting this status to STIs could transform the health and social care provided to sex workers while strengthening their rights. This article explores why recognizing STIs as occupational diseases is a critical issue in Belgium, the structural, legal, and societal barriers to its implementation, and potential solutions to ensure better protection for these workers.

Why STIs as Occupational Diseases Are a Crucial Issue

1. An Inherent Occupational Risk

Sex workers, by the nature of their profession, face a heightened risk of contracting STIs such as chlamydia, gonorrhea, syphilis, hepatitis B, genital herpes, or the human immunodeficiency virus (HIV). According to the World Health Organization (WHO), over one million new STI cases are recorded daily worldwide, with sex workers being particularly vulnerable due to frequent high-risk physical interactions in their work environment. In Belgium, where prostitution is tolerated in certain areas, such as Antwerp or Brussels, this risk is exacerbated by often precarious working conditions. For more insights on prevention practices, see our article on STI prevention practices among escorts in Belgium. Recognizing STIs as occupational diseases would officially acknowledge these infections as direct consequences of their professional activities. This would pave the way for systematic medical care, appropriate financial compensation, and enhanced social protections for sex workers, who often face economic and health precarity. Such a measure would also legitimize their work as a profession in its own right, with rights comparable to those of other high-risk occupations, such as musculoskeletal disorders for construction workers or respiratory diseases for those exposed to hazardous substances.

2. A Step Forward for Social Protection and Workers’ Rights

In Belgium, an occupational disease is defined by legislation as a condition linked to the exercise of a professional activity, as outlined by the Occupational Diseases Fund (FMP), integrated since 2016 into the Federal Agency for Occupational Risks (Fedris). When a disease is recognized as occupational, it entitles workers to coverage of medical expenses, compensation for temporary or permanent incapacity, and, in some cases, a pension. For sex workers, this recognition would be a major step forward, as many operate as self-employed individuals or in informal settings, excluding them from social protections reserved for salaried workers or self-employed individuals affiliated with specific schemes. Such a measure would ensure equitable access to high-quality medical care without out-of-pocket costs and financial security in case of illness. In Belgium, where the healthcare system is renowned for its quality but access can be limited for marginalized groups, this recognition would reduce inequalities faced by sex workers, while enhancing their dignity and social inclusion.

3. A Lever to Destigmatize Sex Work

The stigmatization of sex workers remains a major barrier to their access to fundamental rights in Belgium. Recognizing STIs as occupational diseases would help dismantle prejudices surrounding this profession by highlighting the specific occupational risks they face, similar to those of other high-risk professions, such as healthcare workers exposed to nosocomial infections or construction workers exposed to asbestos. This measure would legitimize sex work as a profession deserving the same protections as other sectors. To delve deeper into the impact of stigma, read our article on how stigmatization affects the emotional well-being of escorts in Belgium. In Belgium, where sex work is partially regulated in cities like Antwerp, this recognition could foster a broader societal debate on the full decriminalization and regulation of sex work, as seen in countries like the Netherlands. It would also have a positive impact on public health by facilitating access to regular screenings, treatments, and prevention methods, thereby reducing STI prevalence in the general population. To explore public health initiatives, check out our article on public-private partnerships in the fight against STIs in Belgium.

Major Barriers to Recognizing STIs as Occupational Diseases

1. The Absence of STIs on the List of Occupational Diseases

In Belgium, the recognition of occupational diseases relies on two systems: the closed list of occupational diseases established by Fedris, which includes conditions like musculoskeletal disorders or asbestos-related diseases, and the open system, which allows recognition of unlisted diseases if a direct link to the professional activity is proven. STIs are not included on this list, posing a significant barrier to their automatic recognition. In the open system, sex workers must demonstrate that the infection was contracted as part of their professional activities, a complex process requiring medical and administrative evidence that is often difficult to obtain. This process, managed by Fedris, is lengthy and uncertain, particularly for a marginalized profession like sex work. Proving that an STI is exclusively work-related, rather than contracted in private life, presents ethical and practical challenges, particularly regarding confidentiality and the collection of personal data.

2. The Ambiguous Legal Status of Sex Work

In Belgium, prostitution has not been illegal since its partial decriminalization in 2022, but it remains poorly regulated. Sex workers often operate as self-employed individuals or in informal settings, particularly in tolerance zones like the red-light districts of Antwerp or Brussels. This ambiguous legal status deprives them of social protections granted to salaried workers or self-employed individuals affiliated with specific schemes, such as the National Institute for Health and Disability Insurance (INAMI). Without clear recognition of their profession, integrating STIs into the framework of occupational diseases remains a significant challenge.

3. Stigmatization and Lack of Epidemiological Data

Stigmatization of sex work hinders the recognition of STIs as occupational diseases. Societal prejudices and a lack of understanding of the realities of this profession relegate sex workers to social and administrative invisibility. This marginalization limits the collection of reliable epidemiological data on STI prevalence in this population, which is essential for justifying their inclusion on the list of occupational diseases. Unlike conditions like musculoskeletal disorders, which account for a significant portion of cases recognized by Fedris, STIs lack visibility in the professional context. For more on this issue, see our article on how stigmatization affects the emotional well-being of escorts in Belgium. The clandestinity or semi-clandestinity in which some sex workers operate, particularly migrants or those working outside regulated frameworks, further complicates the establishment of reliable statistics. Without such data, convincing health authorities and policymakers of the need to recognize STIs as occupational diseases remains challenging.

4. The Complexity of Proving Causality

In Fedris’s open system, a disease can be recognized as occupational if a direct link to the professional activity is demonstrated. However, proving that an STI was contracted in the context of sex work is extremely complex, as these infections can also be contracted in private life. This ambiguity complicates evaluations by Fedris, which require robust medical and contextual evidence. For sex workers, this requirement represents an additional barrier, especially as they may hesitate to disclose personal information due to stigmatization and the risk of discrimination.

Toward Recognition: Potential Solutions

1. Updating the List of Occupational Diseases

To overcome the barrier of the closed list, revising the occupational diseases recognized by Fedris could include STIs for sex workers. This would require epidemiological studies conducted by institutions like Sciensano to document STI prevalence in this population and establish a clear link to their professional activities. Collaboration with associations like UTSOPI (Union of Sex Workers Organized for Independence) would be essential to define exposure criteria.

2. Full Regulation of Sex Work

The partial decriminalization of sex work in Belgium, effective since 2022, is a first step, but full regulation, as seen in the Netherlands, would allow sex workers to be fully integrated into the social protection system. By granting them a clear legal status, whether as employees or self-employed individuals affiliated with INAMI, they could access occupational disease insurance. This regulation would also reduce stigmatization and facilitate access to healthcare.

3. Strengthening Prevention Measures

Preventing STIs must be a priority to protect sex workers. This includes ensuring easy access to regular screenings, vaccines (such as those for HPV or hepatitis B), and protective measures like condoms. Organizations like Violett in Antwerp or Espace P in Brussels already provide health services, but these initiatives need reinforcement through public funding and targeted awareness campaigns. For more details, read our article on STI prevention practices among escorts in Belgium.

4. Advocacy and Collective Mobilization

Associations like UTSOPI play a key role in this debate. They can advocate for sex workers’ voices with authorities, Fedris, and institutions like Sciensano, pushing for the recognition of STIs as occupational diseases. Awareness campaigns could also mobilize the public and policymakers to support legislative reforms. For more on the role of partnerships, see our article on public-private partnerships in the fight against STIs in Belgium.

5. Public Awareness and Education

To combat stigmatization, educational campaigns could shift public perceptions of sex work. By highlighting the realities of this profession and the risks faced by workers, these initiatives would legitimize their fight for better social protections. A better-informed society would be more likely to support reforms recognizing STIs as occupational diseases. For solutions to address stigma, explore our article on how stigmatization affects the emotional well-being of escorts in Belgium.

Conclusion: A Matter of Social Justice and Public Health

Recognizing STIs as occupational diseases for sex workers is a critical issue in Belgium, touching on public health, human rights, and social justice. By ensuring better social protections, reducing stigmatization, and improving access to healthcare, this measure would benefit not only sex workers but society as a whole. However, numerous barriers remain: the absence of STIs on the list of occupational diseases, the ambiguous legal status of sex work, persistent stigmatization, and the complexity of proving causality. To move forward, a combined approach is necessary: updating the list of occupational diseases, fully regulating sex work, strengthening prevention measures, and mobilizing associations. In 2025, this debate must take center stage in Belgium to ensure effective protection for sex workers and recognize their right to health and dignity. By acting to recognize STIs as occupational diseases, Belgium could set a milestone toward a more inclusive and equitable society.