Sex workers are not only acted upon by medical, moral and legal discourses due to the risk they present to their own health but also due to the perceived risk they pose to the health of others. The diverse settings and different ways in which sex can be sold, combined with previous life experiences contribute to the wide variation in need and risk. This thesis investigates the differential understandings of need, risk, access to and provision of health care between sex workers and health care service providers. Simultaneously it offers an explanation for the continuation of need when health care provision exists. Four discursive themes directed the research: need, risk, access and provision. Data was obtained from semi-structured interviews with street and non-street sex workers and service providers. Discourse analysis was performed to ascertain the conditions, rules and authority under which statements in relation to the discursive themes are constructed. Thematic indexing enabled the analysis of the discursive themes within the empirical data, considering the inter-relationship with discursive constructs (i.e. stigma, safety, pollution, rights and power) identified within previous moral, medical and legal discourse. Sex workers and service providers identified need and risk as problematic drug use, damaged mental health, STIs and violence, but categorise and prioritise differently. Complex constructions were identified, suggesting underlying influences that direct them. Contradictions and tensions exist within the differential construction of the discursive themes, made more problematic by the chaotic lifestyle of many sex workers. The differential understandings must be recognised or the sex worker will continue to be 'maintained' within the complex and interlinked relationships of prostitution, damaged mental health and problematic drug use, the latter two made worse by prostitution but not solely a result of prostituting.

L’objectif de cette thèse est de comprendre d’une part, le parcours migratoire de femmes d’Afrique subsaharienne vers l’Europe et, d’autre part, leur entrée dans la prostitution, c’est-à-dire les raisons et les facteurs qui les poussent à prendre la décision d’exercer la prostitution. Dans ce travail, j’ai mené une étude empirique avec une méthodologie qualitative basée sur la rencontre, l’échange et la coproduction de savoirs. Des récits de vie ont été réalisés avec des femmes venant principalement de l’Afrique subsaharienne, exerçant ou ayant exercé dans le milieu de la prostitution durant leur parcours migratoire en Allemagne ou en France. Dans l'ensemble, il s'agit d'analyser les tendances qui émergent à partir de cette enquête. / The objective of this thesis is to understand, on the one hand, the migratory trajectory of women from sub-Saharan Africa to Europe and, on the other hand, their entry into prostitution, that is to say, the reasons and factors that were responsible for them making the decision go into prostitution. For this study, I carried out an empirical project using a qualitative methodology based on the encounter, exchange and co-production of knowledge. Individual life stories were shared by women mainly from sub-Saharan Africa, working or having worked in the field of prostitution during their migratory journeys to Germany or to France. Overall, the goal is to analyze the trends that emerge from this study.