When people talk about adult work in Moscow, the conversation often jumps to legality, safety, or stigma. But behind the headlines are real people navigating a system that rarely considers their health. Public health isn’t about cracking down or moralizing-it’s about reducing harm, preventing disease, and keeping people alive. In Moscow, where adult work exists in a legal gray zone, the public health response has been patchy at best. And the consequences are visible in rising STI rates, limited access to care, and deep distrust between workers and authorities.
What Adult Work Looks Like in Moscow Today
Adult work in Moscow isn’t one thing. It includes independent escorts, online performers, street-based workers, and those operating through agencies-some legal, many not. A 2024 survey by a Moscow-based NGO found that 68% of adult workers in the city worked alone, mostly through apps or messaging platforms. Only 12% reported using an agency that provided any kind of health support. Most don’t have formal contracts, insurance, or access to workplace protections.
Unlike in countries where sex work is decriminalized and regulated, Moscow’s laws don’t criminalize selling sex itself-but they punish related activities: advertising, soliciting in public, or renting space for work. This creates a paradox: workers are forced underground to avoid police attention, making it harder to reach them with health services. Many avoid clinics because they fear being reported, fined, or detained under vague public order laws.
Public Health Gaps: No Testing, No Trust
STI rates in Moscow have climbed steadily over the past five years. In 2023, gonorrhea cases among adults aged 20-35 rose by 27% compared to 2019. Chlamydia increased by 19%. These numbers don’t reflect just adult workers-they reflect entire communities where prevention tools are out of reach.
Condoms are rarely distributed by authorities. Free testing is available at public clinics, but few workers feel safe using them. One worker, who asked not to be named, said: “I went to a clinic last year for an STI check. The nurse asked if I was a sex worker. When I said yes, she stopped writing. Told me to come back with a friend. I never went again.”
There are no dedicated outreach programs in Moscow that offer on-site testing, PrEP, or mental health support for adult workers. The few NGOs that try to help-like the Moscow Sex Workers’ Collective-operate on tiny budgets and rely on volunteers. They hand out condoms and lube at metro stations and parks, but they can’t reach everyone. And they’re constantly under pressure from local officials who see them as enabling illegal activity.
Why Harm Reduction Works-And Why It’s Blocked
Public health experts agree: harm reduction saves lives. Needle exchange programs cut HIV transmission by over 50% in cities like St. Petersburg. Peer-led outreach reduced overdose deaths in Berlin by 40%. But in Moscow, these models are ignored for adult work.
Why? Because the official stance still treats adult work as a moral failure, not a public health issue. The city’s 2022 Health Strategy mentions “socially vulnerable groups” but doesn’t name adult workers. No budget line exists for their health needs. Even when workers try to access care, they’re often met with judgment, not services.
Compare this to Amsterdam or New Zealand, where sex workers are consulted in policy design. In Amsterdam, all registered sex workers get free quarterly STI screenings and mental health check-ins. In New Zealand, since decriminalization in 2003, workplace safety has improved, and STI rates have dropped. Moscow could learn from this-but only if it stops seeing adult work as a crime to punish and starts seeing it as a health issue to manage.
The Role of Technology and Isolation
More adult workers in Moscow are moving online. Apps like Telegram and VKontakte are now the main way clients are found. This reduces street-based risks-but creates new ones. Workers can’t verify clients easily. They can’t negotiate safety terms in person. Many don’t know how to screen for scams or violent behavior.
Online work also means less social support. Many workers are isolated, living alone, far from family. Mental health issues like depression and anxiety are common, but there’s zero public funding for counseling tailored to their experiences. A 2023 study by the Russian Institute of Social Health found that 61% of adult workers in Moscow reported symptoms of clinical depression-twice the rate of the general population. Yet only 8% had ever sought professional help.
Even basic tools-like emergency buttons, safety check-ins, or peer support networks-are rare. Workers who try to build these systems themselves risk being labeled as “organizers,” which can lead to criminal charges under Russia’s anti-extremism laws.
What Could Change
Change doesn’t require legalizing adult work. It requires recognizing that health rights are human rights.
- Mobile clinics that visit known gathering spots-like metro exits, parks, or hostels-could offer free testing, condoms, and referrals without asking for ID or reporting to police.
- Peer educators trained by public health experts could distribute supplies and info through trusted networks. Workers know who’s safe to talk to. Let them lead.
- Anonymous reporting tools for violence or coercion could be built into apps workers already use. No names. No police. Just a way to get help.
- Training for healthcare workers to stop stigmatizing language. A simple “I’m here to help” can make the difference between someone getting care-or walking away forever.
These aren’t radical ideas. They’re standard practice in cities that care about public health. In Moscow, they’re treated as political acts.
The Cost of Doing Nothing
Every time a worker avoids a clinic because she’s afraid of being judged, the whole community pays. STIs spread. Mental health crises go untreated. Violence goes unreported. Children lose parents to preventable illness. Families fracture.
Public health isn’t about approving or disapproving of adult work. It’s about keeping people alive. In Moscow, that means breaking the silence. It means listening to workers-not about morality, but about what they need to stay safe. It means funding services that don’t ask for papers, don’t call the police, and don’t make people feel ashamed.
The tools are there. The knowledge is there. What’s missing is the will.
Is adult work legal in Moscow?
Selling sexual services isn’t explicitly illegal in Moscow, but related activities are. Advertising, operating from a fixed location, or organizing work through agencies can lead to fines or detention under public order or anti-extremism laws. This legal gray zone forces workers into isolation and makes it harder to access health services safely.
Are STI rates higher among adult workers in Moscow?
Yes. While official data doesn’t always separate adult workers from the general population, studies by independent health NGOs show significantly higher rates of gonorrhea and chlamydia among those who report sex work. Limited access to testing, inconsistent condom use due to client pressure, and fear of clinics contribute to this gap.
Can adult workers get free healthcare in Moscow?
Technically, yes-Russia’s public health system offers free testing and treatment for STIs. But in practice, many adult workers avoid clinics due to fear of judgment, discrimination, or being reported to authorities. Clinics rarely offer confidential or worker-friendly services, and staff are often untrained in trauma-informed care.
Do any organizations support adult workers’ health in Moscow?
A few small NGOs, like the Moscow Sex Workers’ Collective, provide condoms, lube, and basic health info. They operate on donations and volunteer work. They’re not funded by the government and face constant pressure from local authorities. Their reach is limited, but they’re often the only lifeline for workers.
Why doesn’t Moscow have harm reduction programs for adult workers?
The government views adult work as a moral or criminal issue, not a public health one. There’s no political will to fund outreach, testing, or peer support programs. Even when evidence shows harm reduction works-like in other countries-it’s dismissed as condoning illegal activity. This mindset keeps workers at risk and the public health system blind to real needs.
What Comes Next
If you’re someone who works in adult work in Moscow-or know someone who does-your health matters. You don’t need permission to protect yourself. Use apps that let you share your location with a trusted contact. Carry condoms and lube. Learn how to screen clients using simple questions. Find a peer you can talk to. If you’re in Moscow, reach out to the Moscow Sex Workers’ Collective. They don’t ask for papers. They don’t judge. They just help.
And if you’re a policymaker, a doctor, or a citizen who cares about public health-ask yourself: Why are we letting people die because of stigma? The answer isn’t more policing. It’s more compassion. More access. More listening.
