The Real Source of Violence Against Sex Workers

by Cecilia Gentili and Zil Goldstein

When we talk about violence against sex workers, what do we mean? The rare media story that addresses this topic — often coinciding with the annual obligatory mention of International Day to End Violence Against Sex Workers — typically conjures images of physical violence at the hands of an individual perpetrator. But what do WE mean when we talk about violence against sex workers? We’re talking about the systems that create violence — criminalization and incarceration, hostile healthcare settings, economic exclusion, and the racist, transphobic, and misogynist legislation that allows these systems to thrive. To prevent violence and harm, sex workers need protection and support, specifically spaces that have been designed to end violence.

Much of the violence perpetrated against sex workers — including trafficking — originates in the criminalization of consensual sex work. We know that criminalization of sex work increases the risk of poorer social and health outcomes. Attempting to solve the problem of violence against sex workers by using increased criminalization and policing results in the exact opposite of the desired effect. Sex workers regularly report being harassed and assaulted by law enforcement officers, as well as by correctional officers in sites of incarceration. In addition to this violence, even a brief time spent in jail can have potentially deadly consequences for sex workers with HIV, as they are all too frequently denied the medications they need to manage their condition and stay alive. If sex workers cannot seek healthcare, earn a living wage, or report crimes against them without fear of further violence or incarceration, how are we to survive?

The COIN Clinic at Callen-Lorde Community Health Center in New York City aims to change the narrative for sex workers’ health. Callen-Lorde has an over 50-year history of providing primary care and sexual health care to people living on the margins — including LGBTQ+ people, people who use drugs, and people engaged in sex work. COIN — Cecilia’s Occupational Inclusions Network — is a program at Callen-Lorde designed specifically by sex workers, for sex workers, provides a fast-track to health care in a safe, affirming environment, free of financial barriers.

Funded by the New York City Council, the COIN Clinic at Callen-Lorde is open to anyone who identifies as a sex worker. Primary care, behavioral health care, medications, and labs are all provided free of charge. Sex workers are encouraged to discuss their health needs openly without fear of repercussion. We believe the COIN Clinic is a model for affirming the rights and dignity of sex workers and would love to see similar programs in cities across the country.

But what makes it special? The COIN clinic highlights the power of putting the most impacted at the heart of shaping solutions to the problems faced in their daily lives. First and foremost, the clinic recognizes the massive financial barrier that many sex workers face in attempting to access healthcare. Without the possibility of employer-sponsored insurance, sex workers are forced to either purchase individual plans (often an impossible financial burden), attempt to navigate Medicaid, or simply go without insurance. Far too many opt to forgo insurance and put off medical care for as long as possible, resulting in worse health outcomes and often hospitalization with devastatingly large medical bills. The COIN clinic provides service that is truly, 100% free of charge. This is inclusive of not only care, but also labs and medications as well. This creates a bridge to overcome the financial barrier and help to improve immediate and long-term health outcomes for sex workers.

In addition to facing financial obstacles, many sex workers also fear the possibility of criminalization when visiting a medical provider. This can result in individuals choosing not to disclose their occupation to a healthcare provider, and sometimes not fully expressing their healthcare needs. Once again this has been shown to result in worse healthcare outcomes for sex workers. COIN was designed with this concern in mind and ensures that nothing on a patient’s chart will indicate that they have enrolled in a sex worker program. To instill confidence, the providers work with their patients to make sure that they are comfortable with everything that gets written down or recorded during a visit.

Sex workers, and particularly sex workers who are living with HIV, frequently report encountering stigma and discrimination in healthcare settings. This can result in inadequate treatment, as well as discouraging sex workers from seeking healthcare in the future. To ensure a safe and positive environment for sex workers, the entire staff of Callen-Lorde was trained by Trans Equity Consulting on working with people in the sex trades. The providers also received additional specific training on the best ways to care for sex workers.

The possibility of a project like the COIN Clinic was made possible by the tireless organizing work of sex worker-led organizations. Organizations like SWP, Decrim NY, BSWC, SWOP, and Red Canary Song — to name a few — have worked for decades to destigmatize, protect, and affirm sex workers. The COIN Clinic, and Callen-Lorde Community Health Center as a whole, is proud to work alongside these organizations to provide direct health care services while working in a coalition to advocate for legislation to decriminalize sex work.

The COIN Clinic represents a single model of how to address part of the structural violence faced by sex workers. It is a program that could be replicated and adapted to serve the specific needs of sex worker communities around the world. There are also many brilliant, bold experiments in improving the lives of sex workers being carried out in cities all across the country. From mutual aid programs like the Brave Space Alliance’s Sex Worker Mutual Aid and Advocacy Group or SWOP Brooklyn’s COVID Relief Fund, to housing projects like Destination Tomorrow’s SWITCH Housing.

So when we discuss violence against sex workers, let us forgo the focus on individual acts of violence, and instead look at the structures that render sex workers vulnerable in the first place. We should look to the impact of criminalization on sex workers, as a driving force behind the manufactured economic precarity, housing insecurity, and inadequate healthcare that pervade the lives of sex workers. We should uplift the ingenuity of sex worker-led projects as models to resource and scale-up to solve these problems, and stop the violence at the source.

Learn more about how we can support you on these issues: https://www.reframehealthandjustice.com/services

‍