On the game, in the line, in business, working – synonyms for commercial sex mostly refer more or less directly to the economic transaction on which it centres. A word search on ‘prostitution’, by contrast, offers up the definition ‘whoredom’, glossed as ‘adultery, fornication, harlotry, hustling, whoring’; and ‘prostitution’ in turn appears among the synonyms for ‘disgrace’, ‘misuse’, ‘ill repute’, ‘misapplication’ and ‘misappropriation’ (www.Thesaurus.com). The tension between the selling of sex by women as an economic activity and the pervasive social stigma attached to this particular way of earning a living is at the heart of Sophie Day’s illuminating study.

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Her analysis of the London lives of female sex workers at the close of the 20th century is not a conventional ethnography, though it draws on ethnographic material. It offers what at first seems a curiously old-fashioned kind of anthropology, setting out some classic binaries – public and private, time and space, naming and classification, market and state – but then gradually dismantling them through a biographical analysis, illustrated by individual case studies, that counterposes conventional expectations of the life course with discussion of the very different conditions shaping lives in sex work. On the game initially surveys the historical development of sex work and the policy and legislative labyrinth surrounding it to develop a political economic analysis of a highly particular occupation whose conditions are uniquely circumscribed by its semi-illegality. Day rapidly establishes that there is a complex problem to be addressed in analysing a form of labour which provides the core metaphor for moral degradation but that cannot – in classical Marxist terms – be alienated from the worker performing it. Yet these initial rather theory-dense chapters are less compelling than the later sections where the lives of real women begin to emerge.

Day begins by characterising prostitutes as ‘public women’ who are forced to create for themselves an entirely discrete ‘private’ identity in order to separate themselves from the stigma and putative immorality associated with sex work. To render a subtle and compelling argument in bald terms, selling access to one’s body for sexual services is kept distinct from the necessary implication that this constitutes selling one’s self. A fascinating chapter details how selling sex is described by sex workers as ‘simply work’. Since sex is meant to be a private activity, ‘work’ is carefully segregated from unpaid sexual encounters. Condoms, spermicides, towels, disinfectant, washing and other procedures of cleansing and separation seem to create an absolute segregation between occupational activities and private sexual life. When asked in the clinic (Day’s primary fieldwork location) about their last sexual encounter, some informants would only report their most recent sexual act with a boyfriend or husband, never with a client. In this light, Day’s interpretation of sex workers’ views sometimes appears shaky, as when she argues that her informants ‘refute[d] popular notions of sexual activity as a purely private property of the person.’ Her material suggests, rather, that far from disputing the popular premise that sex is part of private life, sex workers strive to sustain it, even to the extent of reclassifying commercial sex as not sex at all but ‘simply work’.

The phrase ‘public women’ was one instance (‘stickiness’ as a metaphor for the enduring stigma of sex work was another) when it was difficult to discern whether a concept being invoked was inductively derived or drawn from secondary sources (the epithet for a later chapter from Lacquer refers to ‘public women’). Gradually however the rhetorical purpose of invoking this specific opposition becomes clear over the course of the book, as the instability of a normative segregation into public and private becomes clearly apparent. At least among those women who moved from what to start with was ‘simply working’ into becoming successful entrepreneurs through their time ‘on the game’, life inside and outside work turns out to be almost entirely interwoven; clients are friends, friends become business contacts, and business trips abroad double up as holidays. Day shows that although in the clinic environment women talked as though their lives were separated into public and private, the activities of each domain were profoundly interconnected and mutually determining, so that only the careful concealment of information functioned to maintain segregation between and among those in sex work and those outside it. The multiple names and identities adopted by those who work in the sex trade (in part to maintain safety and privacy as well as to avoid the law) caused Day and her co-researchers extreme difficulty in piecing together a coherent picture of the social world in which sex workers lived. Day argues that this fragmentary view turned out to be shared by sex workers themselves, although it seems likely to have been exacerbated by the positioning of the research in a clinical location (medical records being yet another likely site for alternate identities). Day and her clinical collaborator set up an occupational health project for sex workers in a west London hospital in the mid-1980s and the primary material discussed in this book was gathered mostly in this setting, which provided the health-related services that first drew informants into the research project of recruiting, surveying and following up a cohort of sex workers over a 14-year period.

The secrecy and concealment surrounding work in the sex industry is not just a response to stigma but is produced by the peculiarly vindictive apparatus of the state which, for example, forces sex workers to represent working environments as domestic settings so as to circumvent laws that criminalise brothel-keeping, and to risk turning friends and relatives into pimps if they share their earnings. A certain aura of circumlocution seems almost to pervade the study, so that in its early chapters the subjects of the book remain strangely intangible and the reality of their lives elusive. In a laudable attempt to avoid the sort of objectification produced by the many studies that typologise sex workers according to their level of earnings and type of work environment, the grounds for selecting those informants described in the book are left unclear and no detailed socio-demographic or health information on the overall cohort from which they were drawn is provided until the final chapter. Nor, apart from a brief description of one of the flats where most of Day’s informants saw clients and a couple of passing references to meetings in a restaurant or on a street, is there any descriptive detail to provide context to the quoted interview excerpts.

Day’s determination to provide a respectful, sober and resolutely untitillating account is, nonetheless, facilitated by her eventual focus on a number of women who seem to have become highly skilled in their chosen occupation (doubtless in part because those who are successful are more likely to remain in sex work, while those who are not dropped out of the game and often, out of the research). For those familiar with the public health literature on sex work, references to resolutely independent informants who worked abroad, spent substantial sums of money on beauty treatments and designer clothes and used their expertise to set up a variety of other business enterprises may come as a surprise. Day points out that these interlocutors’ preoccupation with business achievement as a marker of occupational success was entirely consonant with mainstream free market values in the Thatcher era of the 1980s and 1990s. Although undoubtedly a part of Day’s purpose is to demonstrate that many sex workers do not conform even remotely to common stereotype, the focus on relatively affluent, autonomous entrepreneurs made me wonder how ‘typical’ of the overall cohort such women were. For instance, Day notes that 19% of the cohort followed up to 2000 had a history of injecting drugs and around another third (I estimate) used non prescription drugs, but she discusses the ‘addictive’ character of money from sex work without ever referring to the possible reverse causation that keeps women working in order to support more literal (chemical) forms of addiction, despite the prominence of this issue in other studies of female prostitution in the UK. This may in part be due to temporal changes in the profile of sex workers; marked increases in migration to the UK and heavy policing and legislative changes at the turn of the century that have driven sex work off the streets hint that this portrait of sex work in London may to an extent be historical.

Day does not speculate on the ‘representativeness’ of her portrayal, but she does explain that she sought to avoid the exploitative effect of the many accounts of sex work that intrude on the privacy of female sex workers’ lives; and in this she has succeeded to an extraordinary extent. Her account highlights the insidious effects of continuing repression and exclusion by the state and legal institutions, the constant threats to safety and security from sexual violence and personal exploitation, without turning the subjects of her enquiry into ciphers of degradation. Equally, it acknowledges the pleasures and freedoms that her informants report from being able to earn easy money without accountability to an employer or time clock, while circumventing popular stereotypes that associate ‘working girls’ with fecklessness, drug addiction, perversion or straightforward rapaciousness. The necessary reliance on narrative accounts over participant observation also bears fruit in later sections of the book, when women’s struggles with fertility and the desire for motherhood are presented through extended case studies. Although a high proportion of the women in the cohort had a history of sexually transmitted infections that can produce infertility, Day makes a persuasive and poignant case that the longing for children, and the repeated (often then terminated) pregnancies, came from a need to demonstrate fertility and the possibility of a (continually deferred) private future beyond sex work in response to the public and sterile character of the work itself.

Health issues are not a particular focus of this book but some of its most acute analytic insights concern key concepts in medical anthropology and sociology. The research vehicle of a cohort study, with its temporal tracking of biographical trajectories through the ‘life course’ (a concept central to longitudinal studies in epidemiology as well as to medical sociology), provides the grounds for a fundamental contribution to sociological understanding of biography. Day critiques the concept of ‘biographical disruption’ which has been prominent in analyses of the effects of chronic illness, arguing that while illness has been seen as disrupting individual biographies, the preponderance of mental as well as reproductive health problems reported by sex workers suggests conversely that these may be symptoms of lives that do not conform to normative biographical trajectories. The very concept of an undisrupted, predictable, life course towards personal maturity and social integration is thereby revealed as a social fiction.

The power of this fiction is evident in the recent growth in the social sciences and humanities and in clinical medicine alike of a focus on ‘illness narrative’. Not just a conceptual approach to the analysis of interview material, it has been advocated as a powerful therapeutic tool, with a growing number of courses and books on ‘narrative medicine’. The requirement to produce a coherent story of one’s illness, however, risks privileging the articulate, educated and naturally reflexive over those who are unable or simply disinclined to ‘co-construct’ such a narrative with their health provider or research interlocutor. The cheery presumption that narratively constructing one’s own life as story is a basic human trait and thus a universal good may conceal the same kind of adverse potential found in some extreme forms of alternative therapy, in which patients who do not recover essentially become culpable for their ‘failure’ to heal themselves. The conceit of narrative metaphor harnessed for healing is, incidentally, exposed with exquisite precision in ‘Grand Rounds’, a short story written by a former clinician that appeared in the last issue of Granta (Adrian 2012). Describing in particular detail one close informant who consistently refused to construct any kind of temporally coherent autobiographical account, Day concludes that this refusal may be read as a political response to dominant definitions of progressive time, revealing how biographical conventions depend on the ‘material architecture of public and private’ and on assumptions about social reproduction that bear little relation to the reality of sex workers’ lives. This discussion of ‘refusal’ is reminiscent of Edwin Ardener’s early contribution to gender studies, in which he argued that what anthropologists represent as general societal structures are dominant models communicated by male informants, in comparison to whom women seem inarticulate or ‘muted’: ‘…they giggle when young, snort when old, reject the question, laugh at the topic and the like’ (Ardener 1975: 2). While the notion of generic ‘female’ and ‘male’ linguistically encoded conceptual models now seems simplistic, there surely are many subaltern ‘muted groups’ who are unable or unwilling to conform narratively and, perhaps, experientially to lives shaped according to a dominant societal template. In the case of sex workers, Day suggests that the exclusion and discontinuities entailed in life ‘on the game’ suited those who, for reasons of sexuality or a dislike of more regulated working patterns, already considered themselves misfits.

Another stalwart of medical social theory has been the concept of ‘medicalisation’, generally treated as the oppressive encompassment of elements of the social by biomedical hegemony. In a chapter on the politics of rights Day observes that the process of ‘medicalisation’ has for sex workers sometimes been beneficial; the threat of HIV/AIDS and the focus on sex work this has generated allowed sex workers to make a case for their role as public health workers in the wider community and opened a route to better service provision and strengthening of political support for decriminalisation. Certainly many public health initiatives focused on sex workers in the wake of HIV have had transformative effects, particularly in impoverished and marginalised communities in the majority world. Over the past decade or so the argument that reducing vulnerability to HIV requires attention to its underlying structural determinants has gradually gained sway in international public health. Externally imposed attempts to prevent HIV in marginalised high-risk populations through purely biomedical means (condom distribution, heath education, treatment for sexually transmitted infections) have seemed less successful than those which involve the ‘targeted’ communities themselves and address sex workers’ own more immediate concerns and needs – legal rights, poverty, children’s education and so forth. In this way the public health ‘problem’ of HIV prevention becomes a vehicle through which to initiate social change and direct financial resources to stigmatised groups on ethical and human rights grounds. All this often requires a certain sleight of hand to elide health and other social ‘goods’, since actually demonstrating measurable reductions in HIV prevalence as a direct consequence of ‘community mobilization’ activities is methodologically tricky and hard evidence for specific health benefits of these kinds of ‘structural interventions’ remains patchy (Lambert 2012).

Although Day makes no claims to its broader import, other insights that emerged from the Praed Street Project similarly repay comparison in a broader cross-cultural perspective than that attempted in the book (where the frame of reference does not extend beyond Europe). Finding out that sex workers in the UK by and large adhere religiously to condom-protected sex was of particular significance in the early days of the HIV epidemic, when sex workers were prominently stigmatised as ‘reservoirs of infection’ liable to spread the virus to successive clients. By implication, high rates of sexually transmitted infection amongst sex workers are almost certainly linked to contact with non-paying sexual partners with whom, as Day discusses, the non-use of condoms is an expression of intimacy and trust. Recent studies in several Indian states have replicated this observation precisely, demonstrating the limits of prevention programmes that emphasise the need for safer sex with clients alone (Dandona and Benotsch 2011). Other striking similarities in certain characteristics of sex work – across north India a sex worker is referred to simply as ‘working woman’ (dhandhavali), whereas the term for ‘prostitute’ (rand) also means ‘widow’ and is so offensive as to be unutterable except as a swear word – suggest that Day’s initial proviso to analyse prostitution ‘as a key phenomenon of industrial capitalism’ that is locally shaped by ‘specific Christian precepts of heterosexuality and monogamy’ may be unduly modest.

Justifying her continuing use of the term ‘prostitute’, which has become mostly unacceptable in academic and policy circles as a descriptor for those who sell sex and is, she acknowledges, offensive to many of her informants, Day notes its retention as a means of conveying the occupation’s ‘negative moral connotations’ and of specifying the nature of this activity (involving bodily contact) in contrast to other forms of work in the sex industry, ‘such as telephone sex, acting or reception work’. The casual reference to acting as a sex industry job took me by surprise. Was this an allusion to a leftist political reading of prostitution – qua the English Collective of Prostitutes, a workers’ rights organisation that campaigns for the decriminalisation of sex work and is briefly referred to in the volume – as simply another form of women’s labour that should rightly be paid, like housework?^[1] Or, perhaps, a reference to the historical stigmatisation of female actors as sexually suspect in the days when acting was a deeply disreputable occupation for women? Then again, perhaps it should be read as a way of understanding sex work that has gained recent currency in some quarters; a campaign recently adopted by Durbar Mahila Samanwaya Committee, a prominent sex workers’ organisation in West Bengal (http://www.durbar.org), aims to unionise sex workers along with a range of other allied occupations as ‘entertainment workers’. These reflections on a single footnote illustrate the way in which possibilities for reconceiving the very nature of prostitution are opened up by this rich and thought-provoking account, which contributes to a long tradition in the social sciences of illuminating mainstream social institutions by exploring the marginal worlds that seem to deviate from them. In an age of Facebook and Twitter, home working, blogs, 24-hour reality shows and public anthropology, maybe soon we shall all be entertainment workers.

REFERENCES

Adrian, Chris (2012), Grand rounds, Granta 120:7-24

Ardener, Edwin (1975), ‘Belief and the Problem of Women’, in S. Ardener (ed.) Perceiving Women. London: Malaby Press, 1-17.

Dandona, Lalit & Benotsch, Eric (2011) Evaluation of the Avahan HIV prevention initiative in India. BMC Public Health 11(Suppl 6):11

Lambert, Helen (2012), Balancing community mobilisation and measurement needs in the evaluation of targeted interventions for HIV prevention. Journal of Epidemiology and Community Health, 66:ii3-ii4 doi:10.1136/jech-2012-201566.

1. ^[1]http://prostitutescollective.net/2012/06/08/our-first-spokeswoman-selma-james-profiled-in-the-guardian/↩