Meet the Pittsburgh sex workers and doctors looking to eliminate whorephobia in medical care

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CP Illustration: Jeff Schrekengost

In their poignant essay “Once You Have Made Pornography,” porn star Lorelei Lee (they/them) brilliantly outlines the long-term consequences of sex work stigma for porn stars, yet what they describe is more broadly applicable to sex workers of all kinds.

Indeed, they warn sex workers that the longer they work in the sex industry, the harder it will be to relate to those outside of it. “It will be civilians [in this context — those who do not work in the sex industry] for whom the knowledge that you’ve been naked for money will be a kind of flattening,” they say. “A thing they cannot see around.”

Such stigma negatively impacts most aspects of sex workers’ lives: from banking discrimination, to interpersonal violence, to child custody battles, to criminalization. Access to compassionate and appropriate health care, unfortunately, is no exception.

Though in theory, doctors are bound by the Hippocratic Oath to “do no harm,” sex workers will tell you that whorephobia runs deep and that it has deleterious effects on their medical care.

Lee gives a few such examples, presumably from their own experience. “You’ll be in a doctor’s office for something else entirely and later you’ll learn they’ve tested you for HIV without your consent — they will do this even after you tell them you were tested just a week ago,” they say. And more, “A nurse will be drawing your blood and while the needle is in your arm she’ll tell you that you disgust her.”

Former Pittsburgh-based sex worker Jey Martina, MPH (she/her) was on the Sex Workers Outreach Project (SWOP) Pittsburgh’s steering committee when she realized that sex workers were not getting the health care they need and deserve. She tells me in an email that her experience in SWOP motivated her to go to grad school for public health and to focus on healthcare professionals’ influence on the care of marginalized folks, sex workers in particular. “I wanted to understand why researchers only looked at population health trends among people who’ve done sex work and not the behavioral patterns of the health professionals working for them,” she says.

Turning the research lens to the behavior of the health care professionals instead of the communities they serve is exactly what Martina did. In collaboration with Yasaswi Kislovskiy, MD, Director of Reproductive Infectious Disease at Allegheny Health Network, they interviewed people currently and formerly engaged in sex work, asking them what should be included in health care specific to those involved in the sex trades.

This change in perspective brings into focus the radical (not to mention, true) notion that sex workers are experts in their own experience, and that they know what they need.

The voices of the sex workers in this study were then shared with the medical professionals who wanted to understand how to combat the whore stigma that negatively impacted the care they provided. Martina explains, “These findings were taken to a closed-door group of administrators and health care providers who were invested in creating a sex-worker-only health clinic.”

The outcome of these interviews generated a list of 22 ranked suggestions for healthcare professionals on how to better serve sex workers. “The most voted-on suggestion was for healthcare spaces to have in-house resources or connections to mental health and quality of life resources, with a direct referral link to places that offer temporary housing,” Martina wrote in a summary. The second, going back to Lee’s point about civilians, was “having a healthcare space teeming with providers who have experience not only working with the community, but experience from working in the sex industry themselves.” Specifically, Martina notes, “providers who are trans, Black, or BIPOC; providers who receive mental healthcare; providers who are not coercive, judgmental, or infantilizing.”

“Essentially, the group wanted to be seen,” Martina wrote.

This desire is only natural given a long history of being underserved by the medical community. Ken Ho, MD (he/him), an infectious disease specialist and assistant professor at the University of Pittsburgh Medical School, tells me in an email, “Many of these [sex working] folks I think have been left behind by the medical institution throughout history, and trust between these communities and the medical institution has suffered as a result.” When patients do not trust their doctors, their ability to get adequate care from them is certainly limited. Ho believes that it is up to the doctors to regain this trust. He says, “I think learning how to provide care that includes these populations at all levels is necessary in order to regain that trust.”

Certainly, the research that Martina and Kislovskiy brought to established doctors and administrators is an important step toward undoing some of the pre-existing harm that sex workers have suffered at the hands of medical providers; sex workers are begging for this. But another strategy is to start at the level of medical training.

To this end, about 6 or 7 years ago, Ho started teaching a seminar on sexual health history-taking at the University of Pittsburgh’s medical school. He began doing this when a group of medical students approached him and a few of his colleagues who also worked with LGBTQ+ patients. The students wanted their standard curriculum supplemented with more sex-positive approaches. “This is quite encouraging because it really speaks to the fact that the new generation of doctors wants to learn to do things the right way,” Ho comments.

In creating this seminar, Ho did not want to leave the voices of sex workers out. Indeed, I have been coming to the seminar for the last several years as a sex-working “standardized patient” — someone who stands in as a patient for medical training.

“I have learned that sex workers have stories to share and that oftentimes those voices are not heard by health care providers for any number of reasons,” Ho says. “I feel like it is on us as healthcare providers to create environments where sex workers can feel safe and empowered to share those stories because it leads to greater discussions of what can be done to prevent illness and promote health wellness.” In other words, listening to sex workers makes his students (and his colleagues) better doctors.

Sex workers want to be heard, and doctors in training are ready to listen. “This is a lesson that the School of Medicine at the University of Pittsburgh is working on teaching their incoming first-years with their inaugural Community Alliance Program (CAP) where students are paired with community partners in Pittsburgh to learn more about various marginalized lived experiences,” Martina explains.

It is indeed encouraging to see Pittsburgh-based doctors and public health professionals taking the lives and experiences of sex workers seriously, and asking themselves what they can do to better serve a marginalized, stigmatized, and criminalized community. We can only hope that the work that they are doing can change outcomes for future generations of sex workers. After all, as the world’s oldest profession, we aren’t going anywhere and deserve respect and care, just like everyone else.

*If you are a sex worker looking for various kinds of professional resources in Pittsburgh, SWOP Pittsburgh has put together a resource guide that includes medical professionals. You can find it here. And, if you are a doctor and you would like to see my (much less formal) survey of what sex workers want from doctors, you can check out this tweet thread.