PrEPing for Sex Work

Sex continues to be a taboo subject for most people I know in my community in the United States. There's a lot of shame and embarrassment surrounding a topic that many consider to be very personal. However, sex can be a very beautiful and fulfilling act. Sex can also be business as usual. For some, though, “Sex work is work.”

Sex work in the United States

Sex workers are some of the most under-appreciated and demonized people in our society. Sex work is illegal in many municipalities in the United States. It is seen as exploitative and immoral. However, for a society to make this broad judgment is contradictory. There is a market for sex work in many forms, from street sex workers to online webcam performers and people consume this service every day.

Why aren't sex workers valued in our society?

Yet, the people who participate in this work aren’t valued by our society and receive very little protection from public health and government agencies. In many cases, sex workers are a population of people who are most at-risk for exposure to sexually transmitted infections; yet, they are not provided the resources they need to protect themselves.

Sex work and HIV: where is the research?

There is a lack of research among populations of sex workers even on the prevalence or “commonness” of HIV among sex workers. In 2016, researchers wanted to review all the science journals for studies that looked at the prevalence of HIV among female sex workers. With their search criteria, they found 14 studies that included at least 50 participants and the dates of those articles published ranged from 1987 to 2013.¹ What was really shocking was the fact that only 2 studies had been conducted in the last ten years.¹

The need for accurate data and representation

This lack of research shows a lack of response by the scientific and public health community to overcome the barriers to reach this population and collect accurate data in the United States. Especially disappointing is that voices of female-identified sex workers are silenced and ignored. Even with new PrEP drugs like Descovy, studies on their effectiveness in women always take a back seat.

Sex workers experience barriers to accessing HIV prevention

PrEP or pre-exposure prophylaxis is a relatively new method that can prevent the spread of HIV and could be used as a primary tool in any sex worker’s tool kit for protection. Yet many people in this industry lack access to options for PrEP.

Discrimination by healthcare providers

There are many factors that prevent access to PrEP and being open with healthcare providers tends to be one of the biggest barriers. Health care providers don’t actually situate themselves within communities of sex workers in most cases and so the burden tends to be on the patient to disclose a part of their work-life that is open to stigma and judgment by many in American society. In fact, people have been discriminated against in doctor’s offices because of their work.

When patients don’t feel comfortable with the medical community they don’t utilize it. When the medical community does not integrate into the high-risk communities, the goal of ending HIV is unattainable. PrEP requires a prescription; it’s time that our health partners make large efforts to listen to sex workers and their needs and adapt.