"When you add in things like being Black, being overweight or obese, being a sex worker, people just take you a lot less seriously.”
Rose agrees that the problem is compounded by race, commenting, “As a Black woman, it’s really hard to get competent healthcare, and with being a sex worker, I think it would only be worse.” And Rose has been taken less seriously. She reports, “When you add in things like being Black, being overweight or obese, being a sex worker, people just take you a lot less seriously.”
When seeking hormone treatment, Fiéra was told by the front desk staff that her doctor was “not accepting those kinds of patients anymore.”
The criminalization of some forms of sex work only makes the problem worse. Sex worker Ava Adore comments, “[Sex workers] are not gonna say why something is happening when it’s related to a job that is illegal.” She continues, “You’re gonna be less honest with your doctor, which is going to affect your care significantly.”
The consequences of criminalization are far-reaching. “I think that a huge part of the issue with receiving healthcare and getting criminalized people to seek out medical assistance when it's necessary is that they can’t trust that the information is going to stay where it’s supposed to,” Rose says. “Not to doubt their integrity, but I can’t take that chance,” she explains. As a child of immigrant parents, she didn't feel like she could trust that information about her job wouldn’t put her or her parents at risk of deportation.
Read: Sex Workers and Advocates Speak on Legalized Sex Work
Adore, who suffers from chronic pain, added that information about criminalized labor can adversely impact accessing disability benefits. She says, “For one, [information you share with doctors] goes in your medical record and those are accessible in things like disability cases.” This is problematic because courts and case administrators tend to view sex workers unsympathetically; also because receiving already meager disability benefits is contingent on a determination that you are unable to work.
Sex work, as under the table income, is often good for people on disability because it doesn’t count against their benefits, like babysitting, housekeeping, or other ways people supplement the payments that fail to amount to a living wage. But if you tell your doctor you do sex work, you're admitting you have a source of income. That could tip the judge off that you’re violating your eligibility.
In other words, if you tell your doctor that you are a sex worker and the judge reads your medical charts where you admitted to working, (sex work is a job!) the judge can determine that you are not qualified for disability benefits—where one of the main stipulations for qualification is your inability to work.
"You have to have your guard up and you just can’t trust that they have your best interest at heart.”
In addition to the legal issues, Fiéra has experienced fetishization from doctors after disclosing her work in the industry. She says, “You have to protect yourself, especially when you are a sex worker, when you are trans, you have to have your guard up and you just can’t trust that they have your best interest at heart.” She continues, “They treat you like a fetish object, you know?” Indeed, she recounts a story of a doctor chasing her down the halls of the hospital to ask her for dates and acting in other inappropriate and highly sexualized ways.
Read: Reproductive Healthcare for Trans People
While something as enormous as the healthcare system can’t be changed overnight, it is obvious that the stigma that sex workers face within it is detrimental to their health. In this regard, individual doctors and practices can take steps to create safe spaces for sex workers, thus improving their health outcomes.
Through her research, Dr. Kislovkiy learned a tremendous amount about how to better serve sex workers and encourages others to do better. She says, “I find myself asking the people around me, ‘If you feel like you’re getting that feeling like "I don't want to give this person my time of day," I would really implore that you investigate why you think that that person just doesn’t deserve your time of day.’ And that then that's a really good signal to understand your own bias and work against it.”
To Adore, it’s simple, “Treat us like fucking human beings because so often we don’t even get that respect, especially street level and survival workers.”
“Treat us like fucking human beings because so often we don’t even get that respect, especially street level and survival workers.”
Rose commented with a similar sentiment regarding doctors listening to their sex working patients, “I think the most important thing is believing people.”
Beyond those intangibles, Knight suggests that doctors can signal solidarity by displaying sex worker symbols. He says, “I mean, having the red umbrella [the recognized symbol for sex worker solidarity] definitely is like, ‘okay, this is a safe space.'”
Fiéra would compile information on all the doctors in her area to give to other trans sex workers, “Literally I had a list of doctors, and I had people contact me and whenever someone would see a doctor I’d be like, ‘how was it?’ you know, 'did you get what you wanted?' and stuff like that, so I was actually keeping this whole list and sending it out to different people in the community.”
Knight takes it upon himself to interview doctors about what their experience treating sex workers has been, while Adore has advocated for her friends in the sex trades when they have trouble navigating the medical establishment.
The fact that sex workers fear disclosing information that would help doctors serve them better, points to a broken medical system that doesn’t serve the most marginalized and vulnerable people in our society.
Dr. Kislovkiy points out, “People’s identities are intersectional; they aren't just Black women, they're many parts of themselves. I think the same is true here for people who exchange sex, they have many identities that they’re presenting forward, so if there are overlapping identities that have experienced marginalization, I think those are also associated with stigma.”