A Need for Conversation about Sex Worker Health Care

By Niresha Velmurugiah——

I recently attended a workshop by Vancouver-based sex worker support and advocacy agency, PACE, on providing health care for sex workers. PACE is a sex-worker driven organization, and the guidelines at the workshop are based on firsthand experiences with service providers. I left the session content with the progressive care for workers in such a marginalized profession. Then my friend remarked, “Isn’t it messed up that treating people with respect has to be such a revolutionary idea?”

The advice from the workshop was a sad reflection on the status quo. Don’t treat sex workers like they’re dirty. Acknowledge the interplay between sex work and drug use, and how intertwined the two often go. Don’t brush off sex work as illegitimate. Don’t talk down to sex workers or treat them like they need saving. Respect the terms sex workers use to describe their profession. The underlying themes of respect and sensitivity to the context of a person’s life are basics of health care provision. There is, however, a discrepancy between theory and practice, because current health care fails sex workers.

Studies have explored the obstacles that sex workers face when seeking health care. In areas as varied as Miami, Bristol, and Chennai, India, previous experiences with stigmatization from health care providers are common barriers to access. Female sex workers in the Miami study note that judgment is often “associated with…poor hygiene and appearance, and/or drug use.” For this and other reasons, including fear of legal repercussions, many sex workers do not disclose sex work or drug use to health care providers. Sex workers also report the rarity of health care providers who understand and have the knowledge to help with their health problems. Participants in the Chennai study report blame, ostracism, and inadequate counseling from health care providers after HIV diagnoses. Some research has addressed sex worker barriers to accessing health care, such as no health insurance and illegal residence. However access problems are secondary when the service itself is inadequate.

Over the past few decades, sex workers worldwide have bolstered weak public supports with self-run social and health programs. In Bangladesh, street sex workers responded to social ostracism and police brutality by creating the Durjoy Nari Shongho group in 1998. This organization offers drop-in centers where sex workers can receive health care, shelter, food, and childcare. Since 1992, the Brazilian sex worker activist group Davida has promoted HIV prevention so successfully that they now collaborate with the Brazilian Health Ministry.  The Montreal-based organization Stella offers free health clinics, mobile vaccination, and sexual health programs for sex workers. PACE in Vancouver provides educational support for health care workers and other service providers, as well as crisis counseling and other health and social supports for sex workers. With these initiatives, sex workers in some areas find sanctuaries in a mire of stigma. As a Davida anti-stigma ad frankly states, “Don’t be ashamed, girl. You have a profession.”

Despite these movements toward better sex worker health care, a fundamental problem remains. Why is it that sex workers can receive comprehensive, respectful care only in these self-run pockets of society? The growth of sex worker-specific services does not reflect the particularities of sex worker needs, but rather the limitations of conventional health care practices. Health care providers must specifically address the tradition of bigotry that has distanced sex workers. Change will come when health care providers seek education from sex worker advocacy organizations, and then actively promote their services as sex worker-friendly. The mobilization of sex workers in the fight for health, social support, and respect has been inspiring and fruitful. Now health care providers have the responsibility to create a world where these things come without a fight.

Niresha Velmurugiah is a medical student at the University of Alberta and a student contributor to the Akili Initiative.  Her current projects include creating an education program for high school students on sexual violence and organizing learning forums for reproductive and sexual health at her medical school.