Sadly, we live in a culture where needle exchange programs for intravenous drug users are more socially accepted than health programs for sex workers. Given the illegality of sex work in America, sex workers, even those who are insured, are sometimes met with disdain from the medical community. This often leads to a muted dialogue about prudent health history between current and former sex workers and the physicians they visit.
Changes Needed in Physician Education
A 2010 survey conducted by the University of California, San Francisco, detailed the fact that 53 percent of medical students believed they lacked sufficient training to comfortably address patients’ sexual queries. This is a reflection of general patients, so the outlook for today’s newly minted doctors being able to properly discuss health issues with sex industry workers is bleak. Visiting a clinic with an established history of treating sex workers is ideal because they not only present a more welcoming environment, they are also more adept at discussing relevant issues.
Fortunately, there are organizations willing to support sex workers and put anyone who asks into contact with a clinic with a proven history of open communication, understanding and compassion. The first step is to contact the nearest Sex Workers Outreach Program chapter to request a referral. Even if they are not local, a chapter may be able to make a reference in another area. Or they can make phone calls to vet clinics to determine their history of treating sex workers.
Transgender sex workers seeking medical care have a unique need in finding medical centers with staff respectful of untraditional gender identification. Educating physicians on how to best treat transgender patients should not be a patient’s responsibility, but sometimes giving an open-minded doctor the chance to become acquainted with the transgender community is beneficial. Questioning a physician prior to a first visit about the level of comfort in seeing transgender patients is acceptable.
Why Detail Sex Work to a Physician?
When contemplating how upfront to be with a new doctor, sex workers are tempted to be less than honest to escape judgement. A trusted relationship with one’s physician is based on total honesty. The primary reason for this is the added sexually transmitted infection, or STI, risks faced by those with multiple sexual partners, especially when condoms are not used. Everyone should be forthright about their sexual history when speaking to a physician, especially those who are at an increased risk for STIs such as:
-Human papillomavirus (HPV)
-Pelvic inflammatory disease (PID)
STIs that go untreated increase risk for contracting another STI. Lesions and irritation caused by several STIs compromise the skin’s natural protective barrier. The Centers for Disease Control reports that people are 2-5 times more likely to contract HIV if they have a syphilis lesion and 2-4 times more likely to contract HIV if they have unprotected sex during an active herpes outbreak. If you are experiencing symptoms, do not delay seeking medical diagnosis.
Access to Medical Records
Insurance companies are not privy to your medical records. However, they do review the types of tests being performed. Many sex workers opt for confidential STI tests from free or sliding scale clinics in an effort to not submit regular STI testing costs to their insurance company.
A common theme among parents working in the sex industry is the fear that a medical professional will submit a report to Child Protective Services upon learning about patient involvement in the sex industry. While you should be upfront about the number of pregnancies and live births you have had, there is no need to detail specifics about the number of children in your custody. Courts rarely subpoena a doctor to release your medical records, but they do have the right to do so.
Sex workers often fear adverse reactions from someone in their personal lives when seeking medical care. Anyone managing the sex industry career of another cannot access medical records even if they are paying for office visits. If you are afraid to go to a clinic for care because you are being strong-armed into not doing so, you may smooth the way by saying you intend to tell medical professionals you are in an open relationship and have multiple sexual partners.
If you remain adamant that you do not feel comfortable or safe with detailing your occupation to a clinic, you can actually claim to be in an open relationship that exposes you to multiple partners. This informs the physician that you are at higher risk for STIs and will yield the comprehensive medical care you deserve. While complete honesty is always the best policy, the most important factor is getting the care you need.
The Bottom Line
Regular STI testing is a must for anyone in the sex industry. Even more important is seeking care when symptoms present. While we do not discount the fact some medical professionals raise an eyebrow to a sex worker’s chosen profession, it happens much less often than imagined by those hesitant to secure the care they need. Medical workers should not be thought of in the same realm as law enforcement. Doctors have taken an oath to treat those in need and are advocates for their patients’ optimal health. Do not let fear of judgement separate you from your right to qualified care.
Sources: Sex Workers Outreach Project USA