Feature: Sex Work and Public Health in the Age of Trump

by Stephanie Kaylor.

Photograph of an individual on a sidewalk from the knees down going through a series of protest signs. The two visible signs read "Human Rights" and "Support Sex Workers." Photo by PJ Starr.
Photo by PJ Starr. Used with permission.

While it seems that every day of Donald J. Trump’s presidency comes with a new threat to human rights that advocacy groups are quick to denounce and organize against, one such threat has received little attention from social justice advocates: on February 23, 2017, Trump declared that the problem of human trafficking was one that he would commit to combatting through the “full force and weight” of the U.S. government. Though some progressive advocates may interpret this to be a rare instance of a concern for women’s rights at best, or an empty promise at worst, the ramifications for those involved in or suspected of being in the commercial sex trade are quite severe.  “Anti-trafficking” efforts have historically been used to grant government and law enforcement agencies increased permissions to surveil, intimidate, arrest, and deport these individuals even as they have been characterized by feminist rhetoric and support. The repercussions of the policing of sex workers has led to their further marginalization, including impediments upon their ability to practice safe reproductive healthcare practices or consult with health care practitioners.

The issue of sex workers’ rights has historically been a controversial one even amongst feminist advocates. Within this debate, some argue in favor of the so-called “Nordic model” as a means to abolishing the industry, as it would increase penalties for procurers and patrons of sexual services with (allegedly) no repercussions for sex workers themselves. According to testimonies from workers in regions where this policy has been implemented and advocates of decriminalization, however, this approach still leads to the marginalization of and violence against sex workers. As documented in a 2015 study by the Global Network of Sex Work Projects, the “Nordic model” has not eliminated the problem of police surveillance and harassment of workers as they target sex workers in order to locate their clientele. Additionally, the 2015 study notes that sex workers continue to face housing discrimination and loss of child custody over their involvement in the trade. These issues resulting from the policy implementation, combined with the need to work longer hours as fewer clients are willing to pay for sexual services, have led to the disenfranchisement of sex workers as they migrate to less visible work environments which often means working apart from one another.

Though the stereotype of the sex worker as a vessel of disease is one that  many have challenged, “anti-trafficking” measures nevertheless infringe upon the bodily autonomy of both those who work and those who are suspected of working in the commercial sex trade. In New York City, for example, condoms have been used by police as evidence of the crime of prostitution, since the early 1990’s [1], leading workers to skip using or reuse condoms. Though it may seem senseless for a key instrument of public health to be criminalized, one defense of this practice was that there may be cases in which police would encounter trafficking victims whose involvement in the commercial sex trade was apparent but nevertheless there was a lack of evidence through which a raid or arrest of traffickers would be warranted; if police found an unusually high number of condoms in the possession of the alleged trafficker(s) and traffickee(s), they could promptly intervene in this situation without requiring a lengthy investigation.

The actual implementation of the use of condoms as evidence of prostitution-related crime, however, has only caused further harm to those working in the commercial sex trade. Sex workers and transwomen alike reportedly halted their use of condoms in fear of police harassment or arrest, often seen as a more dangerous alternative to putting one’s sexual and reproductive health at risk. In 2014 a compromised policy was enacted, ending the practice of confiscating condoms as evidence of particular sex work related crimes; this measure, however, did not end the use of condoms as evidence of all crimes, and included a loophole in which condoms can still be confiscated for vague reasons; therefore, the same fear of intimidation and police harassment that caused this public health problem is nevertheless unresolved at this time.

Though sex workers come from a heterogeneity of backgrounds beyond the stereotypes of students, drug users, and undocumented immigrants, the latter (as well as the documented) do turn to the industry due to a limitation of other job opportunities, particularly during the off-season of farm work. The threats to their health are compounded by their immigration status. As there already exists a fear of arrest and abuse (including but not limited to deportation) on the part of undocumented immigrants, one can only imagine this to be further compounded by Trump’s commitment to both a xenophobic nationalism and the “anti-trafficking” platform. Though they may pose less of an immediate threat, doctors and even educators are also viewed with this same fear and intimidation [2]; this would be compounded by any dialogue that may suggest criminal or deviant behavior, such as routine questions during a physical exam about the number of sexual partners one has recently engaged with. In addition to safety concerns, immigrant women have reported that they simply do not know about available healthcare services, believing that without papers or a high income they are precluded from STD screenings and treatment. Though anti-immigration measures and xenophobia have maintained a bipartisan hold, the heightened nature of these ideologies in the age of Trump bring with them the threat of widening the distance between these workers and their needed resources.

On a more immediate level, healthcare services can be a pivotal arena in which sex workers’ needs are met or denied. Anonymous and confidential STD testing services are relatively common in urban centers, but without an explicit openness to serving sex workers, many of sex workers’ general concerns related to being harassed, being subjected to disrespectful behavior, or perceiving a need to provide inaccurate information related to their sexual activity remain present. While these antagonistic behaviors are generally not permissible among medical professionals, negative experiences such as those with  police highlighted above are common enough to instill a fear of hostility or punitive measures from even those who claim to work for the general public. Organizations and initiatives such as St. James Infirmary in San Francisco, however, provide a model that stands as a requisite for aims of inclusivity in public health. In addition to assurances of confidentiality,  St. James Infirmary explicitly states their commitment to serving individuals who have worked or currently work in the commercial sex trade, alongside intravenous drug users and those traditionally “othered” by hegemonic healthcare rhetoric and practice.

Though sex workers represent a range of demographics, their specific healthcare needs are nonetheless impacted by the additional intersection of oppression that comes from working in a stigmatized and criminalized trade, and initiatives toward public health will not be inclusive or sufficient until this is explicitly addressed. While decriminalization of the commercial sex trade would resolve these concerns as well as many related to surveillance, the threat of a criminal record, and the inability to report assaults on the job to police, this goal does not appear to be achievable in the imminent future. As there is currently bipartisan support for a measure that would allow for individuals who placed advertisements as sex workers to face felony charges, Democratic support or coalition-building against Trump’s “anti-trafficking” agenda does not appear viable. While sex workers and their allies continue to advocate for decriminalization through contesting such policy measures, consciousness-raising, and various other forms of protest, it is imperative that those in the sphere of public health address the reality that some of their clients are sex workers with immediate needs that can and must be accommodated.

Stephanie Kaylor is a MA student in the department of Philosophy, Art, and Critical Thought at European Graduate School where she is finishing her thesis on the intersections of nationalism and hegemonic campaigns against sex trafficking. Stephanie holds a MA in Women’s, Gender, and Sexuality Studies from the University at Albany, where she is currently working as a Lecturer, and is Managing Editor of Five:2:One Magazine and Reviews Editor of Glass: A Journal of Poetry.

[1] Shields, Acacia. Criminalizing condoms: how policing practices put sex workers and HIV services at risk in Kenya, Namibia, Russia, South Africa, the United States, and Zimbabwe (Open Society Foundations, 2012), 13.

[2] Villalón, Roberta. Violence against Latina immigrants: citizenship, inequality, and community. New York: New York Univ. Press, 2010.

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