What barriers do sex workers face when accessing sexual and reproductive healthcare?

Sex workers are experts in our own sexual health and support each other through effective peer education. However, criminalisation, licensing systems and stigma create many barriers to accessible sexual and reproductive health services.

Fear of criminalisation and police

Fear of police, privacy risks, licensing systems or laws that criminalise sex workers with a sexually transmissible infection (STI) or blood borne virus (BBV), can discourage workers from using health services.

Stigma and discrimination

Sex workers in Australia experience high levels of stigma and discrimination in healthcare settings when disclosing our work, resulting in negative treatment or inappropriate care.

Gaps in clinician training

Many clinicians lack training on sex worker health and can make wrong assumptions about risk. This leads to poor advice and care, and creates health inequities and poor health outcomes for sex workers.

What impact do these barriers have on sex worker health?

These barriers have serious negative health outcomes for sex workers. Sex workers may delay or avoid healthcare, including STI screening and treatment, cervical screening and discussion about contraception. Sex workers who avoid disclosing their work due to stigma or privacy concerns may access multiple services. This creates gaps in medical history, poor continuity of care, and missed opportunities for more holistic sexual and reproductive health support. Laws that criminalise sex workers with STI and BBV, or that require compulsory testing, perpetuate stigma and incorrectly assume that we won’t care for our sexual health unless threatened with criminal punishment. A 2018 global study found any type of sex worker criminalisation and policing was associated with twice the risk of HIV and STI.

Why does sexual and reproductive healthcare matter to sex workers?

Every person has the right to bodily autonomy, health and safety, and economic stability. Sexual and reproductive health rights are especially important for sex workers as our bodies are often part of our work. Our bodies are often politicised, stigmatised, and regulated by governments.

Bodily autonomy

Sex workers have the same right as anyone else to make decisions about our bodies, sexuality, and reproduction. Sex worker affirming sexual and reproductive health means we can access contraception and pregnancy planning, abortion care, STI and BBV prevention and treatment, cervical and reproductive cancer screening and make fertility decisions. Without this, sex workers’ control over our bodies and reproductive health is undermined.

Health and safety

Sexual health is workplace health and safety for sex workers. Sex worker affirming sexual and reproductive health includes regular STI screening, access to condoms and lubricant, pre-exposure prophylaxis (PrEP) and other safer sex tools. It means accessible treatment so sex workers can return to work, and that medical professionals offer advice that is relevant to our needs and not based on assumptions and stigma.

Economic stability

Untreated health problems directly affect anyone’s income. Untreated infections, pain, lack of access to contraception, and pregnancy or reproductive health complications reduce work capacity and create financial stress. Sex workers need affirming sexual and reproductive health so that we can maintain our livelihoods and protect our financial stability.

What are sex workers actually asking for in healthcare settings?

• Access to affirming sexual and reproductive healthcare that protects privacy, including for migrant sex workers regardless of visa status.
• Healthcare organisations must openly support decriminalisation and commit to sex worker-specific training to improve their services.
• Simple, confidential complaints mechanisms in healthcare settings that lead to real training and institutional change for sex workers facing discrimination.
• Removal of all mandatory STI/BBV testing and criminal laws so sex workers can access voluntary, stigma-free health services without fear.
• Peer health navigation programs to support sex workers to access affirming sexual and reproductive health services, including for contraception, abortion and cancer screening.
• Partnerships to deliver sex worker-only clinics and mobile health services that meet workers’ specific needs and schedules.