Ending Violence Against Sex Workers Requires Ending Discrimination in the Medical and Legal Systems

Published in

UCI CARE

6 min readDec 1, 2022

December 17th is the International Day to End Violence Against Sex Workers. Initially started in 2003, this observance began in response to the murders of seventy-one women, many of whom were sex workers, by Gary Ridgway, the Green River Killer, in the 1980s and 1990s.¹ Since its creation, this observance has allowed workers and allies from across the world to commemorate those lost to violence and organize to promote the rights and well-being of the sex worker community.

Sex work is an umbrella term that encompasses many different types of work, including prostitution, erotic dancing, dom/sub work, webcam work, adult film, and being a sugar baby.² Importantly, sex work is distinct from human trafficking; while individuals who are being trafficked may be subject to sexual exploitation, sex work is a consensual form of employment choice.

When discussing violence against sex workers, it is essential to recognize that in addition to more overt forms of violence, such as physical violence from a client, sex workers are also impacted by biases and discrimination within the medical and police systems. Due to these biases, these systems can also perpetuate cycles of violence affecting sex workers by creating additional barriers for victims of violence who are seeking support.

First, in addition to the criminalization of sex work within the United States, which classifies sex work as a misdemeanor, sex workers are also often the victims of police brutality. Because sex work is criminalized, folks who participate in sex work may fear reporting acts of violence due to potential legal consequences. Additionally, police officers are in a position of power that allows them to abuse sex workers or use coercion or threat of arrest to obtain sexual favors.³ Moreover, as a United Nations report on the United States noted, “sex work that occurs in public spaces is also often policed under legislation prohibiting loitering, public nuisance, trespassing or ‘failure to obey’ a police officer’s directive to move along.”⁴ Notably, the criminalization of sex work also intersects with police abuse of BIPOC and LGBTQ+ communities. Actual or perceived involvement in the sex trade results in approximately 30,000 arrests annually, and in 2015, 40% of those arrested were Black individuals.⁵ Police disproportionately target sex workers who are people of color⁵, and transgender or gender-nonconforming folks are regularly profiled, targeted, and/or falsely arrested as sex workers simply for walking around outside.⁶ In a 2012 survey, 75% of transgender women and nonbinary folks in New York City reported that they did not carry condoms because they feared being arrested under the assumption that they were sex workers.⁷ Finally, when sex workers do come to the police to seek help and report acts of physical or sexual violence, they are often blamed for their assaults and not escorted to or referred to medical services.⁴

Though many sex workers are hesitant to seek medical treatment due to the fear of legal consequences or mistreatment by healthcare workers, when sex workers do choose to interact with medical professionals, they are often impacted by the stigmatization of sex work. Many sex workers have experienced rude or dismissive treatment at the hands of medical professionals and as a result, are unlikely to disclose that they participate in sex work. In one interview-based study, sex workers reported feeling “written off,” having their symptoms dismissed (sometimes resulting in trips to urgent care or the emergency room), or being viewed as “disease-ridden” if they disclosed their line of work or HIV+ status.⁸ Unfortunately, this also creates a barrier to accessing the proper care, as sex workers have unique occupational health needs⁸ as well as general health needs shared with the rest of the population. Additionally, like other marginalized populations, sex workers may face logistical barriers to accessing healthcare, such as the availability and affordability of medical visits, testing, and treatment.⁸ Much of the medical literature on sex workers focuses on STI and HIV prevention — and with good reason, as there are many structural barriers that have created sexual health disparities for this population. For example, because condom possession can be considered evidence of sex work in some cases (and thus a legal liability), and because police may confiscate condoms from sex workers, they may not be able to use safe-sex practices in their work.³ However, health needs of sex workers extend beyond just considering sexual and reproductive health. For instance, because of the nature of their work, sex workers may be at increased risk for repetitive stress injuries; infectious diseases such as pneumonia or bronchitis; increased alcohol or drug use; or stress, anxiety and depression due to the fear of legal consequences or experiences of power-based personal violence.⁹ Utilizing a whole-person approach is necessary to provide sex workers with the healthcare that they need.

In order to promote improved medical and legal experiences for the sex worker community, it is necessary to not only invest in breaking down stigma among healthcare workers and police officers — such as bias trainings at each level of education, including pre-employment training such as police academies or medical, nursing, and other health professional schools— but also to promote policies that consider sex work as a legal service. When considering improved legal protections for sex workers, there are three main options: legalization, depenalization, and decriminalization.¹⁰

Legalization is the introduction of laws which govern sex work. These often include specific regulations, such as work hour limits, restrictions on work locations, mandated HIV/STI testing, and mandatory registration or licensure. In effect, this means that each sex worker would need to obtain documentation in order to work, and that police would need to enforce these policies. Unfortunately, in countries where this type of model is used, sex workers and sex work businesses have sometimes faced excessive fines, increased surveillance, raids, prosecution, and criminal sanctions for non-compliance. In addition, undocumented sex workers face more barriers under this system because they cannot obtain a license to work, and thus would need to evade law enforcement and accept potentially exploitative working conditions.¹⁰

Depenalization is similar to legalization, but functions through public order laws rather than criminal laws. Public order laws regulate the use of public space, so under a depenalization model, sex work businesses may be required to obtain and display licenses, including workers’ full names; may be limited to specific zones, as other parts of a city or area may be designated as “prostitution-free”; and sex workers may be subject to sex-work-specific public order offenses or general offenses such as loitering, public indecency or public dress codes. Under this model, there may also be mandatory HIV/STI testing or mandated rehabilitation.¹⁰

Finally, the decriminalization model removes all laws related to sex work as well as associated laws that often impact sex workers, such as laws against vagrancy, obscenity, or loitering. The decriminalization model removes all legal barriers to accessing care, because sex workers cannot be prosecuted for their work, and could potentially improve healthcare outcomes and criminal justice utilization for this population due to reduced stigma. This model is the one most commonly supported by sex worker advocacy groups.¹⁰ Importantly, partial decriminalization models — which prohibit the purchase of sex, but not the sale — have gained increasing popularity in the European Union, but have had the negative consequences of increasing the power imbalance between workers and potential clients. As with other forms of criminalization, because there is still a potential legal penalty, there is an increased risk of violence toward sex workers, and they are less likely to have their boundaries respected.¹¹

All three models have varying benefits; for more information and case studies regarding these models, please see this Global Network of Sex Work Projects report.

Trying to tackle society-wide problems such as the stigma and violence impacting sex workers can feel overwhelming, but one of the best and most accessible ways to begin this work in our own lives is to begin educating ourselves and unpacking our biases. By reading this article, you’ve already begun your educational journey. This December 17th, in honor of the International Day to End Violence Against Sex Workers, consider learning more about the sex worker community (and ways to get involved!) via one of these resources:

Global Network of Sex Work Projects: https://www.nswp.org
Sex Worker Outreach Project USA: https://swopusa.org
Red Umbrella Fund: https://www.redumbrellafund.org

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Written by Abbey Houchin