New Belgian Legislation on Occupational Diseases: Recognition of Sexually Transmitted Infections for Sex Workers

18 August 2025 – The Royal Decree promulgated by King Philippe amends the Royal Decree of 28 March 1969, which establishes the list of occupational diseases eligible for compensation in Belgium. This reform, effective as of 18 August 2025, introduces specific provisions for sex workers, in line with the law of 3 May 2024 regulating sex work under an employment contract. This article explores this legislative advancement in detail, its implications for sex workers, and establishes connections with relevant articles on our blog Bunniz.be. Through an in-depth analysis of the legal, medical, and social aspects, this article provides clear and accessible information. Context and Scope of the Royal Decree The Royal Decree of 18 August 2025 is based on the coordinated laws of 3 June 1970 concerning the prevention of occupational diseases and the compensation for damages resulting from them. These laws, amended by several texts, notably those of 21 December 1994, 13 July 2006, and 23 November 2017, ensure social protection for workers exposed to occupational risks. The reform introduces code 1.404.06 to the list of occupational diseases, specifically targeting sexually transmitted infections (STIs) contracted by sex workers in the course of their professional activities. Objectives of the Reform - Recognition of Occupational Risks: Identifying STIs as occupational diseases for sex workers, thereby strengthening their social protection. - Facilitation of Compensation: Providing financial compensation for damages caused by these diseases. - Enhancement of Prevention: Encouraging early screening and management of STIs in a professional context. To explore the rights of sex workers in addressing occupational risks further, consult our article on sexually transmitted infections as occupational diseases. List of Recognized Occupational Diseases (Code 1.404.06) The Royal Decree details seven sexually transmitted infections recognized as occupational diseases for sex workers under contract, with precise diagnostic criteria to ensure medical objectivity. Below is a comprehensive analysis, with links to relevant articles on Bunniz.be: 1. Acquired Immunodeficiency Syndrome (AIDS): - Diagnosis: Confirmed by fourth-generation serology (IgM and IgG antibodies, p24 antigen, positive Elisa test), a positive Western blot or ImmunoBlot, and/or a positive viral load test. - Context: This recognition marks a significant advancement for sex workers, who are often exposed to high risks due to their activities. To learn more about public health efforts, read our article on [public-private partnerships in the fight against STIs in Belgium](https://www.bunniz.be/fr/blog/les-partenariats-public-prive-dans-la-lutte-contre-les-ist-en-belgique-les-contributions-des-escorts). 2. Hepatitis B: - Diagnosis: - Acute hepatitis: Detection of the surface antigen (HBsAg) and IgM anti-HBc antibodies. - Chronic hepatitis: Persistence of HBsAg for more than six months. - Occult hepatitis: PCR test confirming the presence of HBV DNA in patients who are HBsAg-negative but anti-HBc-positive. - Context: Hepatitis B can have severe long-term consequences. Discover the challenges related to preventing infectious diseases in our article on the challenges of STI prevention for escorts in Belgium. 3. Syphilis: - Diagnosis: Positive specific treponemal test combined with a non-treponemal test (VDRL or RPR ≥ 1). - Context: Although treatable, syphilis requires early screening to avoid complications. For more information, consult our article on sexually transmitted infections as occupational diseases. 4. Human Papillomavirus (HPV): - Diagnosis: Presence of cellular dysplasias, neoplasias, warts, condylomata acuminata, or papillomatoses, confirmed by cytology or histopathology. An expert opinion is required for non-ano-genital areas. - Context: HPV is a major issue due to its link to certain cancers. Explore prevention strategies in our article on the challenges of STI prevention for escorts in Belgium. 5. Chlamydia: - Diagnosis: Positive PCR test. - Context: This common bacterial infection can be asymptomatic, making screening crucial. Our article on public-private partnerships in the fight against STIs in Belgium explores initiatives to improve access to screening. 6. Gonorrhea: - Diagnosis: Positive PCR test. - Context: Gonorrhea can lead to serious complications if untreated. For more information on infectious risks, consult our article on sexually transmitted infections as occupational diseases. 7. Trichomoniasis: - Diagnosis: Positive PCR test or vaginal pH analysis with microscopic confirmation. - Context: Less common, trichomoniasis can affect quality of life. Learn about reproductive health issues in our article on the challenges of STI prevention for escorts in Belgium. Criteria for Occupational Risk Exposure The decree specifies the minimum periods of professional exposure required for these diseases to be recognized as occupational: - AIDS: Exposure at least 10 days before diagnosis. - Hepatitis B: Exposure at least 28 days before diagnosis. - Syphilis: Exposure at least 21 days before diagnosis. - Chlamydia: Exposure at least 5 days before diagnosis. - Gonorrhea: Exposure at least 3 days before diagnosis. - Trichomoniasis: Exposure at least 4 days before diagnosis. These criteria ensure a direct link between professional activity and the contraction of the disease. Workers must be employed under the legal framework of the law of 3 May 2024. For more information on the rights of workers under contract, consult our article on sexually transmitted infections as occupational diseases. Importance of Exposure Criteria - Traceability: Establishing a clear link between professional exposure and the disease. - Equity: Ensuring that only cases related to professional activity are compensated. - Prevention: Encouraging employers to strengthen protective measures, such as access to condoms and vaccines. Implications for Sex Workers This reform is a historic step forward for sex workers in Belgium, a group often marginalized. By recognizing STIs as occupational diseases, the decree provides: 1. Enhanced Social Protection: Sex workers benefit from coverage comparable to that of other high-risk professions, such as healthcare workers or those exposed to hazardous substances. For a comparison, read our article on public-private partnerships in the fight against STIs in Belgium. 2. Access to Compensation: Damages caused by these diseases can be compensated through Fedris. 3. Legitimization of the Profession: This measure helps destigmatize sex work and integrate it into the social protection system. 4. Prevention and Public Health: Regular screening reduces the spread of STIs, a key public health issue. For more details, consult our article on the challenges of STI prevention for escorts in Belgium. Legislative Process and Validation The development of the decree involved several entities: - Scientific Council: Opinions issued on 6 February 2024 and 28 May 2024, ensuring the medical validity of the criteria. - Fedris: Opinions from the Occupational Diseases Management Committee on 13 March 2024 and 11 September 2024. - Inspector of Finances: Validation on 26 November 2024. - Minister of Budget: Agreement granted on 24 June 2025. - Council of State: No response within the allotted time, allowing the adoption of the decree. Signed in Nantes on 18 August 2025 by King Philippe and the Minister of Social Affairs, Frank Vandenbroucke, this decree reflects a consensus among scientific, administrative, and political stakeholders. How to Access Compensation To be eligible for compensation, sex workers must: 1. Prove their professional status: Provide an employment contract compliant with the law of 3 May 2024. 2. Present a medical diagnosis: Meet the diagnostic criteria specified in the decree. 3. Demonstrate professional exposure: Comply with the specified exposure periods. 4. Submit a request to Fedris: The agency will assess eligibility and determine compensation. For more details on the administrative process, consult our article on sexually transmitted infections as occupational diseases. Issues and Perspectives This reform is part of a broader movement to recognize the rights of sex workers. It raises several issues: - Public Health: Regular screening helps reduce the prevalence of STIs. - Equal Rights: Sex workers are placed on an equal footing with other high-risk professions. - Risk Prevention: Employers will need to strengthen protective measures, such as access to preventive equipment. To explore public health initiatives, read our article on public-private partnerships in the fight against STIs in Belgium. Conclusion The Royal Decree of 18 August 2025 marks a decisive step in protecting sex workers in Belgium. By recognizing sexually transmitted infections as occupational diseases, it ensures better management of the risks associated with this profession and strengthens their social inclusion. For more information, contact Fedris or consult a labor law expert. Stay informed by exploring other articles on our blog Bunniz.be, including: - sexually transmitted infections as occupational diseases - public-private partnerships in the fight against STIs in Belgium - the challenges of STI prevention for escorts in Belgium