I know, we’re not supposed to talk about that. We’re not supposed to talk about bareback fucking without following it up with that ubiquitous “but use a condom!” statement. However, many communities face significant barriers to condom use and have very legitimate reasons for foregoing them—and these are the communities whose voices have largely been excluded from broader conversations defining “safe sex.”
That’s a big problem. As harm reductionists and sex educators, we can’t talk openly about what people are really doing behind closed doors. We aren’t supposed to legitimize sex without a condom as an option, or rather, we aren’t supposed to acknowledge that it may be the only option for many marginalized people. And that’s exactly the kind of dishonesty that allows HIV stigma to proliferate.
As an HIV counselor and longtime public health activist, as well as an ex-sex worker and IV drug user, I want this attitude to change. We need to re-open the conversation around what safe sex means in America and internationally, because while condoms can be an excellent means of STI protection, they are by no means a realistic option for every person in every situation. And sex workers in particular need to be involved in this conversation, since it is the most marginalized groups among us—drug-using sex workers, sex working trans women, street workers, sex workers of color, and people who fit into many or all of the above categories—who most often find ourselves in situations in which providing bareback services is our only option if we want to make a living.
Most people have some form of a lurid narrative about drugs, exploitation, childhood abuse, and mental illness come to mind when they imagine the life of a sex worker. However, sex workers’ relationships to their identity are far more complex and difficult to characterize than that trite narrative allows for. When it comes to sex workers who do live with the stereotypical trope of also having a mental illness, it becomes even more essential to uncover what these sex workers themselves have to say about their lived experiences of that mental illness and sex work.
People diagnosed with mental illness frequently have their decisions invalidated and undermined by the dominant culture. Many individuals who do not have much experience with mental illness will attribute any socially unacceptable behaviors to “mental illness.” In much the same way, people who have never been in the sex industry tend to sideline the decisions of sex workers by inferring that trauma or abuse must have predestined them to a life in the sex industry. When people who are neither mentally ill nor in the sex industry say these things, they are robbing us of our ability to exert agency.
Amber, a full-service worker from Washington DC, states, “I very strongly believe that the way that society treats sex workers, mentally ill people and other marginalized communities (that often intersect)…[is] based on kyriarchal/patriarchal, colonialist, and capitalist systems of control. In order to treat marginalized people better, I think we all have a lot of work to do regarding the unlearning of certain stigmas and stereotypes.”
The presence of stigma is one the key aspects of institutional violence keeping communities and individuals subjugated. It proliferates because it benefits those in power in this way. Stigma creates legal and moral justifications for the criminalization of sex work in America. It also creates an environment in which mentally ill people can be stripped of their rights through court-ordered institutionalization, coerced medication, and the assignation of relatives as proxies to control them legally and financially. The disqualification of the decision-making abilities of communities on the margins is a weapon of the oppressor.
Tara Johnson, a stripper from Portland, Oregon, elaborates on the ways in which decision making can be invalidated based on association with the sex industry, especially if one also has a diagnosis of mental illness: “Just because I’m (sometimes) crazy, doesn’t mean I’m wrong. My sex work was not me acting out, or indulging in yet another form of self-harm. It was nothing that entitles people to belittle my full humanity. It’s nothing that automatically means that mentally ill sex workers, especially ones who may have other issues too (drug use, etc.) should automatically be deprived of the rights that privileged, able-bodied civilians are entitled to.”
Sex work is not a dysfunctional behavior stemming from our disease. Rather, it is often the best choice we can make to adapt to our mental illness. In truth, many people with mental illness find sex work helpful in a variety of ways as an occupational choice. It gives us a less rigorous schedule which allows for more emotional instability. Sex work can also affirm us as something we can excel at when mental illness has hindered our success in more traditional pursuits.
Dear Ms. Harm Reduction, I’ve been escorting and doing pro domme work for a year and a half. Sometimes I do a gram of coke with regulars, or even do drugs with new clients on occasion. I’d like to be smart about this, but I feel like I can’t ask the the sex workers I know for advice because none of them would ever take that risk in the first place. Do you have any tips on how to stay safe while partying with clients? Wilder Than (my) Friends
Gabrielle is the Care Coordinator for Persist Health Project. Persist Health Project is a peer-led, community-based health and community organizing project for sex workers based in Brooklyn, New York. As Persist’s Care Coordinator, Gabrielle vets service providers, provides community members with supportive referrals, and helps lead Persist’s Best Practices Trainings.
While many of us dream of the ideal client who will deposit money annually into our retirement fund or enroll us in their kick-ass work health insurance plan, he probably won’t come along for all of us. Here are some things you can do to get quality health care service in the meantime without breaking the bank:
1. First things first, you could be eligible for government subsidized health insurance through Medicaid! Check with an Affordable Care Act (ACA/Obamacare) navigator to see if you are. You can also call a Medicaid Hotline (1-800-541-2831) to check your eligibility. If you make under $1,300 a month (for a single person, that number goes up with family size) in reported income, are pregnant, or have recently had a child, you may be eligible for Medicaid. If you have recently been diagnosed with HIV you are also eligible for AmidaCare through Medicaid.
While open enrollment for the ACA has ended, if you are eligible for Medicaid or government assistance with your health care plan you are still able to enroll without a fee. Reach out to Callen-Lorde Community Health Center if you think you might be eligible and get enrolled today!
All the queries Ms. Harm Reduction answers are actual questions from readers. If you have a quandary related to drugs, sex, work, or any of the other pitfalls and pleasures of life that you need Ms. Harm Reduction’s solution for, please write in at firstname.lastname@example.org.
Dear Ms. Harm Reduction, I’m a recovering addict/alcoholic stripper (20 months clean) and I just found out my best friend at work is a pregnant heroin addict. I’m one of the only people who knows she is pregnant, and I’ve been trying to talk her into getting some prenatal care as well as food stamps and WIC because she never seems to have enough to eat. Last week I learned that she doesn’t want to go to the doctor about her pregnancy because she’s a heroin addict. The resident dope dealer/stripper [at work] (also a pretty close friend) confided in me that she is also worried about her. I always thought she was falling asleep at work because she works too much but now I realize she was nodding off, and now I also understand why she never has enough money despite doing well at dancing and why she’s so underweight. Lately, she’s been looking extra pale, dark circles under her eyes, and crying a lot. I’m worried. I know she’s hiding her addiction from me because she knows I’m in recovery and because I’m somewhat of a mentor to her and she doesn’t want to disappoint me. I also understand firsthand the painful shame that often accompanies drug addiction.
I don’t want to embarrass her or make her feel defensive, but I also want to let her know that I do love her regardless and most importantly I would like to give her some information about harm reduction. Is there a way I can go about this that won’t feel invasive? I know a former sex worker who works at a harm reduction center that will give her clean needles. I’ve also been hearing a lot about a bad batch of heroin that’s been going around my city. We’ve had a huge spike in overdoses and I want to make sure she knows it’s out there.
And finally, what the hell is a pregnant drug addict supposed to do? Will she be arrested when her baby tests positive for heroin? Drug addict or not, she needs prenatal care. I can understand the difficult position she is in.
I’m not naive enough to think I can talk her out of her addiction, but I also don’t want her to feel like she needs to hide it from me. I want her to know I’m not judging her and that I’m here to help her if she decides she needs it.