Doctors Could Do Better, Especially for Sex Workers

People of color, poor, queer, trans, fat, disabled, and otherwise marginalized folks frequently struggle to adequately access healthcare. This is also true for sex workers, who are disproportionately from these marginalized backgrounds.

When accessing health care, sex workers also have to grapple with the stigma around disclosing their job status, with the very real possibility that they may be discriminated against or harassed because of it. The barriers sex workers face in accessing adequate and appropriate health care shines a light on the shortcomings of our health system at large.

For this reason, among others, we would do well to heed to the oft-cited sex workers’ rights mantra, “Listen to sex workers,” who in this case can tell us where those shortcomings are. For this reason, we interviewed four sex workers—and one doctor—about barriers to medical access for sex workers.

Ember Fiéra, an Asian trans sex worker, believes that doctors have too much power in deciding who deserves their care. “[Doctors] get to judge us—whether we are worthy of receiving this treatment or that treatment.” This power to refuse care to those who fall outside of their interest has often meant that sex workers have had to turn to each other for the care that they aren’t getting from doctors. “It’s ridiculous that we’re providing medical care—advice—to each other,” she says.

“[Doctors] get to judge us—whether we are worthy of receiving this treatment or that treatment.”

Former escort and freelance writer/photographer Adrie Rose agrees. “I mean, [discrimination against sex workers is] pretty prevalent, but it grates a little bit more when it’s coming from a medical professional—someone who’s supposed to be objective.”

Director of Reproductive and Infectious Disease at Allegheny Health Network, Dr. Yasaswi Kislovskiy, began to understand this reality when, as part of her fellowship research, she interviewed people who exchange sex. “I think it's really important to convey how much they immediately knew that the system was not for them,” she says of her interviewees. “From the person who checks [them] in at registration [to] the phone call it takes to make [their] appointment.”

Read: The Erasure of Sex Work From the Common Internet

Most sex workers quickly recognize stigma when they see it coming from their health care providers. For this reason, many are reluctant to disclose their jobs, even when it is relevant to their care. “Because sex work is criminalized, because it's so stigmatized, I don’t think it's really good for a lot of patients to disclose,” Fiéra comments.

While Bryan Knight has to negotiate healthcare based on his status as a gay sex worker, he recognizes that as a white cis-man, his interactions with doctors have been easier. Unlike some of the other sex workers we interviewed, doctors don't scold him for engaging in the sex trades. “There’s definitely a race and gender presenting factor in who gets the talk versus who doesn’t get the talk,” he says.

"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.