Barriers To Healthcare: Sex Work and Stigma
Due to social stigma, discrimination, and intersecting marginalized identities amongst workers, sex work tends to be a dangerous job both physically and mentally. Women involved with sex work are at a disproportionate risk of sexual violence, impacted mental health, poor reproductive care, and general physical harm. Despite this, sex workers often face grueling obstacles when seeking healthcare, with upwards of one-fourth of sex workers being denied health care due to their line of work (Kirkegaard, 2021). Additionally, the heavy crossover of marginalized identities within sex work further limits access to proper health care. The barriers in healthcare for sex workers can be understood by the compromised social position of sex workers, as well as the legal power dynamics between sex workers and physicians.
In relation to the general public, sex workers are discriminated against and stigmatized into a highly oppressed social position. This is further reinforced by the lack of healthcare resources available, as well as additional obstacles faced by women of intersecting identities. Women of color, LGBTQ+ women, and women in poverty have less choice, control, and access to social resources. This extends to healthcare and often manifests as the inability to be approved for insurance, facing stigma from physicians, and having health concerns reduced to being byproducts of their work. These combine to create both systemic and mental blocks in seeking out healthcare. In a qualitative study, I. Spirkovska took account of the lived experiences of prominent sex workers regarding social position and healthcare. Narratives were gathered via interview, and those interviewed were chosen due to being leading figures in various sex work-based communities across the United States. According to Spirkovska, “almost a quarter of young sex workers have been denied health services because of their occupation.” Equally concerning, more than 63% of sex workers cannot receive healthcare without being accompanied by another person due to the fear and mistrust of the health system. The concerning statistics surrounding access and opinions of sex workers towards healthcare providers further demonstrate the weight of the problem. The highly stigmatized social position harms and alienates sex workers from receiving necessary health services.
To further emphasize the role of social position in this issue, researchers Benoit, C., et al. gathered data and interviews to examine the causes of macro, meso, and micro-levels of stigma faced by sex workers. Commonly, sex workers receive a lack of attention, lesser care, and judgment from healthcare providers, contributing to unmet health needs. Reports of insensitive or abusive language, disrespect, humiliation, and the outright denial of care are not scarcities for sex workers. With the overarching societal view of sex workers as deviant social others, these abuses become fully normalized within healthcare. Prejudiced physicians are unable to meet the needs of sex workers, and often are not inclined to try. Even the most well-seasoned healthcare providers can often be paragons of social discrimination, and lack empathy for sex workers. To make matters worse, the criminalization of sex work further lowers one’s social position. Potential breaches of confidentiality and consequent threats of arrest play a major factor in preventing sex workers from being properly cared for. Sex workers, like all individuals, are deserving of adequate general healthcare, non-discriminatory mental health treatment, and being viewed independently from their profession regardless of their social position. The stigma contributes to poor health outcomes and further represses the social mobility and safety of sex workers.
Additionally, sex workers are often the victims of being on the exploited-end of social power dynamics. Within healthcare, physicians hold the power of arrest and withdrawal of care over sex workers. This is due to the criminalization of sex work, as the innate power dynamic creates tension between physicians and sex-working patients. Often, other intersecting marginalized identities further reinforce the power dynamic. Racism, homophobia, and classism all intersect with the lived experiences of sex workers and are all potential avenues of discrimination from physicians. Furthermore, the fear of arrest and discrimination strengthens this barrier by eliminating transparency and full disclosure between patients and physicians. This increases when intersecting marginalized identities (i.e. race, homelessness, sexuality) are present. It is especially harmful due to the increased violence faced by marginalized sex workers. In a 2021 research study by Goldenberg, et al., interview-style narratives from American sex workers and research data provided by the Global Network of Sex Work Projects were synthesized to illustrate the oppressive living conditions of marginalized sex workers. Interviewees had been selected by reaching out to prominent sex workers within activist groups and other sex work-based communities. The research demonstrated the lack of primary care and sexual health services available to sex workers—especially marginalized workers—and the connection between physicians and criminalization.
Moreover, Platt, L., et al. researched the ways in which criminalization promotes dangerous working conditions and contributes to the denial of healthcare. The research team synthesized bibliographic databases between January 1990 and May 2018 to compile 40 quantitative and 94 qualitative studies relating to sex work legislation, health, and policing. To specialize the findings further, they conducted a meta-analysis to find measured associations between violent outcomes, access to healthcare or health services, and policing. The criminalization of sex work has been found to increase the risk of sexual and physical violence from clients, condom-less sex, and STI/HIV exposure. This barrier is very clearly damaging to the health of sex workers and create real threats of arrest and police harassment. Additionally, this barrier plays back into lowering the social position of sex workers. The threat of arrest also discouraged sex workers from having their health fully and honestly examined by physicians, disrupted health service access, and limited the sex workers' ability to reduce potential health risks. By denying sex workers the ability to receive healthcare without fear of arrest, sex workers are forced into vulnerable and physically harmful positions. The criminalization of sex work breeds the conditions necessary to promote the physical and medical harm of sex workers. When these two truths pair, sex workers are put in a very powerless and damaging position. The denial of healthcare is caused by and reinforces the unequal power dynamic between physicians and workers.
Despite the bleak outlook, researchers and sex workers have offered strategies to combat this oppression. Implementing medical training manuals for treating sex workers and creating a database of physicians specially trained for treating sex workers is one avenue for change. With training, the physician can create a safer environment than previously expected. In turn, there would be more trust in sex workers seeking out care and adequate treatment. Without this base-level understanding, sex workers will continue to fear seeking healthcare, which promotes worse health outcomes and a lack of access to health resources. Decriminalizing sex work, which would aid in alleviating discrimination even outside of healthcare, is another efficient way to promote health care for sex workers- perhaps even the most efficient. The legal status of sex workers also often compounds poverty and other marginalized identities, which then worsen the consequences (and fears) of arrest. By removing this barrier, sex workers would have full, open, and honest conversations about their health. More importantly, they would receive care that best fits their needs. Overall, working within the healthcare and legal system are crucial outlets for remodeling how sex workers and healthcare interact.
On a broader scale, reshaping the portrayal of sex workers in day-to-day life and popular culture is a crucial component in elevating the social position of sex workers and eliminating the power dynamics impacting them. Without changing the current view of women in sex work, long-term structural and cultural progressive change cannot occur. Instead, sex workers would continue to suffer under the existing social punishments. All social aggressions faced by sex workers circle into health mistreatment and must be acknowledged alongside the structural oppression within healthcare.
*It is important to note that, for the purpose of this research, “sex workers” is defined as any woman under the umbrella of prostitution, pornography, and any other compensated sexual act or performance.
Benoit, Cecilia, et al. “Prostitution Stigma and Its Effect on the Working Conditions, Personal Lives, and Health of Sex Workers.” The Journal of Sex Research, vol. 55, no. 4-5, 2017, pp. 457–471., https://doi.org/10.1080/00224499.2017.1393652.
Goldenberg, Shira M., et al. Sex Work, Health, and Human Rights: Global Inequities, Challenges, and Opportunities for Action. Springer International Publishing AG, 2021.
Platt, Lucy, et al. “Associations between Sex Work Laws and Sex Workers’ Health: A Systematic Review and Meta-Analysis of Quantitative and Qualitative Studies.” PLOS Medicine, vol. 15, no. 12, 2018, https://doi.org/10.1371/journal.pmed.1002680.
Spirkovska, I. (2019, November 30). Sex workers face high HIV risks – and high barriers to care. United Nations Population Fund. Retrieved December 13, 2021, from https://www.unfpa.org/news/sex-workers-face-high-hiv-risks-%E2%80%93-and-high-barriers-care?&_ga=2.213528529.452756663.1634590722-1719679157.1634590722#.