Commercial sexual exploitation (CSE) includes a wide range of often linked sexual activities which typically men profit, or buy, from women and which objectify and harm women. CSE primarily affects women, and it can involve activities such as:

  • selling or exchanging sex, including street prostitution and “Sex for Rent”
  • escorting
  • stripping, lap dancing
  • phone sex, internet sex, webcamming
  • pornography
  • trafficking.

These can be in exchange for things such as:

  • money
  • drugs
  • food
  • shelter
  • protection

Coping with the consequences of CSE and exposure to violence and other forms of abuse can have a profound impact on physical, sexual and mental health and the adoption of negative health behaviours.

Physical assault, rape, attempted rape and sexual assault are commonly reported by those involved in prostitution, as are high levels of alcohol and/or drug use as a common coping strategy among women involved in selling or exchanging sex.

We have created guidance and information that explains the nature of CSE, its impact on health, and how staff can respond to those who have experienced it.

View our guidance on CSE for health workers

Commercial sexual exploitation and health inequalities

The Scottish Government Equally Safe Strategy includes prostitution, pornography and other forms of involvement in the sex industry within its definition of violence against women. The exploitation of women in such ways legitimises negative attitudes towards women and is inextricably linked to gender inequality and sexual violence.

For many of those who become involved in CSE, it is through a lack of choice and a need for survival in response to their social and economic environment. They may:

  • come from vulnerable backgrounds
  • live in poverty or with financial difficulties
  • feel they have few realistic or viable alternatives
  • have addiction or substance misuse issues
  • experience other forms of violence or abuse.

Based on a lack of alternatives and often on coercion, such activities are rarely a free or vocational choice

While women and girls are at the greatest risk of being abused through CSE, men are also affected and can become involved in prostitution for similar reasons to women. Often the adverse impact of male prostitution is belittled or overlooked since it is more likely to be wrongly considered consensual, rather than recognised as exploitative.

Tackling commercial sexual exploitation

Prostitution – Challenging and deterring Men’s Demand: a strategic approach, published in 2024, is the national strategy for working with the wider public and third sector to challenge and deter men’s demands for prostitution and support those with experience of it.

The strategic approach was informed by Lived Experience research and is underpinned by six policy principles developed in 2022, to support policy and practice in this area. The principles are:

  • take a national consistent approach
  • treat women involved as victims of exploitation, not criminals
  • promote social inclusion and address stigma
  • adopt a preventative approach to tackle the circumstances that foster sexual exploitation
  • support recovery and sustainable exit
  • learning from lived experience.

A key component of the strategic approach is improving access to support and tackling stigma - with mainstream services having a wider awareness of CSE and its impacts on those involved. An improved awareness of CSE across mainstream services forms part of a preventative and early intervention approach.

A new multi-agency group to help support the implementation of the strategic approach and to consider CSE policy more broadly was launched in March 2024. Health is a key agency which most people use, meaning health staff are well-placed to recognise, ask, and respond to abuse. Some services are more likely to have contact with people involved in selling or exchanging sex such as sexual health services and could signpost to further support.

National CSE Lead

The Women’s Support Project is the national development lead for CSE. Its role involves capacity building and delivery of training via local violence against women-partnerships. Violence Against Women partnerships is a collection of local agencies working together to tackle violence against women and girls.

Encompass Network

The Women’s Support Project manages the Encompass Network, which is made up of agencies across Scotland that work with women, girls and vulnerable men who are currently involved, have exited or are at risk of involvement in commercial sexual exploitation.

CSE Aware

The Women’s Support Project and Encompass Network have developed CSE Aware for frontline staff working in services across Scotland to increase and share their knowledge and skills around commercial sexual exploitation.

It aims to break the stigma surrounding CSE and ensure that women involved in selling or exchanging sex receive comprehensive, non-judgmental support that understands how CSE can impact them.

Access Turas for more information on CSE Aware and learning resources

Local contacts

Each local NHS Board has an Executive Lead and Operational Lead for gender-based violence (GBV). You can contact your local lead for information on local policies, training opportunities and support for staff.

Support services for the public

Members of the public can be directed towards Scotland's Service Directory on NHS Inform which provides information on:

Last updated: 22 October 2024
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