Protecting the Healthcare of Sex Workers
Sarah Jahangeer
Spring 2021
Sex workers, adults who exchange consensual sex for compensation, face numerous human rights violations. Under the United States’ legal system, sex work is criminalized in all states except for Nevada. Though it is predominantly illegal, the market for sexual trade is present across the country. Without regulations, injustice prevails; sex workers do not feel safe seeking aid from the authorities without fear of incarceration. The criminalization of sex work has many adverse affects on the already marginalized community, such as underrepresentaion in medical research, high health risks, and the unacknowledgement of structural barriers that hinder their health and well being. By decriminalizing sex work, the United States can offer more legal protection of healthcare to the vulnerable sex workers.
The stigma and legal repercussions surrounding sex work often leads to fear in disclosing their work; however, this can impede health care providers in their pursuits to offer the most appropriate care. Sex workers that attended a targeted health clinic in San Francisco reported that 70 percent of them had never disclosed their work related behavior to their health care providers (Cohan, 2006). Whether this is due to fear of facing stigma from their healthcare provider or of being directed to diversion programs which restrict their autonomy, the failure of sex workers to open up about their work adds to their underrepresentation in medical research, which leads to an inaccurate picture of sex workers and their medical needs.
In an attempt to address this, the American College of Obstetricians and Gynecologists offers recommendations to adapt under the current legal framework of the U.S. by encouraging health care providers to incorporate sex work-inclusive lines of questioning during routine check ups. For example, if a patient discloses behavior indicative of sex work, such as having multiple sexual partners or engaging in substance abuse, then the health care provider should follow up by asking if the patient has engaged in the exchange of sex for goods. Acknowledged sex workers should receive proper cancer screenings and vaccinations. Additionally, they should be counseled by the healthcare provider on possible health risks like sexually transmitted infections/ HIV, etc. The healthcare field, especially obstetrics and gynecologists, can also cater towards sex workers by expanding their studies to include this population in order to fight against their underrepresentation in medical research. (“Improving” 2017). Ignoring the medical needs of sex workers will not help solve them.
Among existing research on sex workers, it has been found that health risks are prevalent and heightened under a legal framework that disregards their safety. Sex workers are more susceptible to violence, including rape, assault, and murder. In a study with cis female sex workers that were open abouttheir occupation and hadaccess to services at a family planning clinic, 40% reported that they were offered more money for unprotected sex and 30% reported a history of client condom refusal. These health risks can lead to STDs, unintended pregnancies with inadequate family planning resources, mental health trauma and drug abuse (“Improving” 2017). Consumers tend to take advantage of sex workers since they are unlikely to receive help from law enforcement, due to the criminalization of their work. Interestingly, when law enforcement is involved, sex workers are further endangered. Abolitonists cite instances reported by the Human Rights Watch that report that “police officers harass sex workers, extort bribes, and physically and verbally abuse sex workers, or even rape or coerce sex from them” (“Why” 2020). Decriminalization will allow sex workers to receive proper legal protection needed to ensure access to health care and justice.
Current reforms to the U.S.’s legal system are underway, such as nationwide adopted Prostitution Diversion Projects. Though these programs aim to funnel convicted sex workers away fromincaceration and towards habilitative measures, these programs often fail to address institutional, systemic issues that cultivate sex work. Without instating changes at the state and federal level, socioeconomic factors that influence the prevalence of sex workers prevail. Yale conducted a critical analysis of PDPs across the country in efforts to reform or create a new framework for aiding sex workers access healthcare and justice. Researchers found that these programs tend to provide short term, unsustainable resources. By focusing on immediate issues like providing mental health aid, the programs forego their responsibility to invest in long term factors that affect sex workers like housing assistance, childcare support, economic opportunitites, immigration status and healthcare services (Un-Meetable, 2018). These programs will have more success in addressing deeper issues that endanger sex issues by providing meaningful counseling, education and social and medical services.
Decriminalizing sex work will offer protection to sex workers in many regards including access to specialized healthcare, legal protection of health and healthcare justice. By criminalizing it, the U.S government has marginalized a population that is vulnerable as is. By decriminalizing sex work, medical literacy on the topic will flourish, and sex workers will have better access to proper healthcare services and protection from the legal system, if that healthcare fails to help them.
Works Cited
Cohan D, Lutnick A, Davidson P, Cloniger C, Herlyn A, Breyer J, et al. Sex worker health: San Francisco style. Sex Transm Infect 2006;82:418–22.
“Improving Awareness of and Screening for Health Risks Among Sex Workers.” ACOG,
American College of Obstetricians and Gynecologists,
“Why Sex Work Should Be Decriminalized.” Human Rights Watch, 28 Oct. 2020,
www.hrw.org/news/2019/08/07/why-sex-work-should-be-decriminalized.
Un-Meetable Promises - Yale Law School. Sept. 2018,