This paper reports findings from a qualitative study of female sex workers who were identified as particularly vulnerable to risks to their sexual health and physical safety. In-depth interviews were conducted with 24 women to explore issues of safe sex and risk management in relation to their work, health and private lives. The main risks identified were client violence and client resistance to condom use. Non-use of condoms with private partners also placed many of these women at risk of STDs and HIV. Various approaches to avoidance or management of risk are described. The degree of control individual women were able to exert during sexual encounters with clients was affected not only by the legal context of sex work but also by the age, experience, self-esteem and self-confidence of the women and by their drug use at the time of the encounter. For some of these women, problems associated with homelessness, drug use and extreme social isolation far outweighed the risks associated with sex work.