This entry received 3rd prize in an AY2024/2025 op-ed competition by Bridging GAP (Gender and Policy), a student group at the Lee Kuan Yew School of Public Policy which aims to enhance awareness of the importance of gender among public policy students.
When a global health crisis hits, the headlines scream about overwhelmed hospitals, economic downturns, and political turmoil. But beneath the surface lies a tragic and overlooked story, one of women forced to bear the brunt of systemic neglect, societal stigma, and invisible suffering. Nowhere is this more evident than in Japan’s sprawling yet shadowed sex industry. These women, already living on society’s margins, become the hidden victims of health crises, facing the dual scourge of venereal diseases and a near-total absence of aid.
A Billion-Dollar Industry Built on Precarity
The Japanese sex industry is as vast as it is controversial. Known colloquially as the “fuzoku” and “mizu shobai,” it encompasses hostess clubs, escort services, massage parlours, and beyond. (Japanese Online, 2018; FromJapan, 2021) This sector, while technically operating in a legal grey zone, is undeniably integral to Japan’s culture and economy. (Zhu, 2023) Yet, the women who form its backbone are treated as expendable, invisible, and undeserving of the protections afforded to others.
Many of these women enter the industry out of desperation: single mothers struggling to feed their children, survivors of domestic abuse seeking a way out, and young women drowning in debt. (Tanaka et al, 2019; JapanToday, 2009) They are society’s safety net — unseen, undervalued, and utterly abandoned when crises strike.
A Venereal Time Bomb
Venereal diseases, the grim, unspoken shadow of the sex industry, become an epidemic within an epidemic during global health crises. Syphilis, gonorrhoea, and chlamydia are not just health risks; they are ticking time bombs. For women in the sex industry, the danger is amplified by several brutal realities:
- Shame and Silence: Seeking medical help is an exercise in humiliation. The stigma surrounding sex work ensures that many women avoid clinics altogether, fearing judgment, exposure, or worse. This is compounded by a lack of health insurance and uncertain legal status. (Ryall, 2024)
- Risky Deals for Survival: When global crises crush incomes, desperate women are forced into even riskier practices. Clients demand unprotected services, and saying no is not an option when rent is due. (JapanToday, 2022)
The impact of these diseases is devastating. Untreated venereal diseases can cause chronic pain, infertility, and complications during pregnancy, a particularly cruel blow to women who may already struggle with maternal health due to lack of access to care. Syphilis, if untreated, can progress to late stages, causing neurological damage, blindness, and even death. Gonorrhoea and chlamydia can lead to pelvic inflammatory disease, leaving women in excruciating pain and at risk of ectopic pregnancies. These conditions are not just medical issues; they are life-altering crises that trap women in cycles of poverty and despair.
The psychological toll is equally harrowing. Living with untreated diseases fosters a profound sense of shame and isolation. (Okunuki, 2022) Many women report feelings of worthlessness and despair, compounded by the societal stigma they face. Their physical suffering is mirrored by an emotional burden that few can truly fathom.
COVID-19: The Crisis That Exposed the Cracks
If there was ever a moment that laid bare the systemic failure to protect these women, it was the COVID-19 pandemic. Lockdowns wiped out incomes overnight. Clubs and parlours shuttered their doors. Clients disappeared. For women in the sex industry, the pandemic didn’t just bring economic ruin, it brought hunger, homelessness, and hopelessness.
The situation worsened as venereal diseases spread unchecked. With clinics prioritizing COVID-19 patients, many sex workers found their access to treatment reduced significantly. (Yamaguchi et al, 2022) Others avoided healthcare facilities altogether, fearing exposure to the virus or the judgmental gaze of medical professionals. As a result, preventable conditions worsened, leading to long-term health consequences that could have been avoided with timely intervention.
Yet, when the Japanese government rolled out financial relief packages, these women were left out in the cold. (Osaki, 2020) The informal nature of their work disqualified them from aid, and bureaucratic red tape ensured that even those eligible to access help were stonewalled. (Yeung et al, 2020) Public health campaigns ignored them. Protective equipment? Testing? Treatment? Not for them.
What Can Be Done?
The tragedy is not inevitable. Society’s indifference is the real disease, and it’s one we can cure. Here’s how:
- Legalise and Protect: Recognise sex work for what it is, work. Legal protections would give these women proper and regular access to healthcare, financial aid, and safer working conditions. Remember, these women are not criminals, they too are people in need of aid.
- Inclusive Aid Programmes: Governments must design relief measures that account for informal workers. Simplify applications. Ensure anonymity. Stop making survival conditional on societal approval and government whims.
- Targeted Health Services and Pop-up Clinics: Establish more clinics that cater specifically to sex workers. Provide confidential testing, affordable treatment, and no-questions-asked care with the help of AI-assisted applications that ensure complete anonymity and provide locations of pop-up clinics that would cater to those in need. These services must be a given, not a privilege.
- Eradicate Stigma: Change starts with awareness. Public campaigns should humanise, not demonise, the women in this industry. These women contribute much to the economic and cultural health of the nation. Their health is thus public health. Their dignity is thus the responsibility of the nation. Strive to bring people up, not down.
The Cost of Ignorance
To ignore this crisis is to tacitly accept a society where some lives are worth less than others. It is to let women, namely mothers, daughters, and sisters suffer in silence while we turn a blind eye. Global health crises will come and go, but the shame of our inaction will linger.
Japan’s sex workers are not just casualties of venereal diseases and pandemics; they are casualties of our apathy. It’s time to bring their struggles out of the shadows and into the light. Because in the end, a society is judged not by how it treats its powerful, but by how it treats its most vulnerable. And right now, we are failing.
Let’s stop failing. Let’s start fixing.
Bibliography
“About Mizu Shobai: A Night Entertainment Business in Japan.”
From Japan. Accessed January 26, 2025.
https://fromjapan.info/topics-about-mizu-shobai-a-night-entertainment-business-in-japan/.
“What Is Fuzoku?”
Japanese-Online. Accessed January 26, 2025.
https://japanese-online.com/whatsnew/view/325970/what-is-fuzoku/.
“The Causes of the Sex Industry Within Japan’s Economic Structure?”
ResearchGate. Accessed January 26, 2025.
https://www.researchgate.net/publication/375000115_The_Causes_of_the_Sex_Industry_Within_Japans_Economic_Structure.
“Japan’s Sex Workers Head Overseas in Search of Lucrative Job Opportunities.”
Japan Today. Accessed January 26, 2025.
https://japantoday.com/category/features/kuchikomi/japan’s-sex-workers-head-overseas-in-search-of-lucrative-job-opportunities.
“Single Mothers Squeezed by Recession, Turning to Prostitution as Last Resort.”
Japan Today. Accessed January 26, 2025.
https://japantoday.com/category/features/kuchikomi/single-mothers-squeezed-by-recession-turning-to-prostitution-as-last-resort.
“Japanese Demand Laws Against Tokyo’s Street Prostitution – ‘Internationally Embarrassing.’”
The Star. Accessed January 26, 2025.
https://www.thestar.com.my/aseanplus/aseanplus-news/2024/11/30/japanese-demand-laws-against-tokyos-street-prostitution—internationally-embarrassing.
“Bread & Roses: Do Sex Workers Really Have a Choice?”
Shingetsu News Agency. Last modified April 4, 2022.
https://shingetsunewsagency.com/2022/04/04/bread-roses-do-sex-workers-really-have-a-choice/.
“Sex Industry Coronavirus Aid in Japan.”
The Japan Times. Last modified October 4, 2020.
https://www.japantimes.co.jp/news/2020/10/04/national/sex-industry-coronavirus-aid/.
“Japan’s Sex Workers and Coronavirus.”
CNN. Last modified April 19, 2020.
https://edition.cnn.com/2020/04/19/asia/japan-sex-workers-coronavirus-intl-hnk/index.html.
PMC. “A Discussion on the Challenges Faced by Sex Workers in Japan.”
National Center for Biotechnology Information (NCBI). Accessed January 26, 2025.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6892673/.
PMC. “Analysis of Japan’s Sex Industry Amid Economic Changes.”
National Center for Biotechnology Information (NCBI). Accessed January 26, 2025.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9058318/.