“We are already naked”: an ethnographic study of migrant sex-workers’ marginalisation under medical surveillance in Singapore

Singapore’s pragmatic governance of sex work, combining criminalisation and toleration, is exemplified by the Medical Surveillance Scheme (MSS) introduced in 1976 to manage STIs/HIV among registered sex-workers. While the MSS provides conditional healthcare access, it excludes undocumented migrant sex-workers, leaving them vulnerable to health inequalities, precarity, and state violence. Drawing on an ethnography-informed conducted between March 2022 and July 2023 in collaboration with Singapore’s sex-worker community, this study examines how migrant sex-worker bodies are regulated and marginalised under entangled logics of biopolitical inclusion (via medical surveillance) and sovereign exclusion (via consistent policing and moralisation). We argue that public health governance of migrant sex-workers functions not only for disease control but also as a mechanism of social ordering, sustaining the structure of violence tied to sexuality, mobility, and nation-building. By centring migrant sex-workers’ lived experiences, we challenge dominant epidemiological framings that reduce them to "risk categories," instead unpacking how state interventions enact coercion, fear and danger. The study calls for a reorientation of public health policy from punitive regulation towards grounding in dignity, equality and justice. • Ethnographic study developed in collaboration with Singapore’s sex work community • Migrant sex-workers are regulated and marginalised under entangled logics of powers • Migrant sex-workers’ narratives challenge dominant biomedical framings of "risk categories.” • Health governance produces vulnerability and precarity • Health governance further sustains the structures of violence tied to sexuality, mobility, and nation-building