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We’re Not Crazy For Doing This: Sex Workers With Mental Illness

“Patients Waiting To See A Doctor, With Figures Representing Their Fears” by Rosemary Carson (via wikimedia)

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.

Xin’Ai: Chinese Sex Workers Helping Each Other

lanlan1
Lanlan conducting legal training conducted at Xin’Ai’s office. Photos courtesy of the author.

Willa Dong reached out to us as a translator/liason for Chinese sex worker activist Lanlan, who founded the Xin’Ai Home. We’re very happy to have Lanlan’s account of working to create and grow an NGO from the ground up. For more information on detainment of sex workers in China, as well as general background, read this report by Asia Catalyst, an organization that has worked with Lanlan in the past and to whose blog Dong has contributed to.

“Let us face disease, discrimination, the police, love, and family together because we are sisters. Let us welcome the rain, and embrace the sunshine!” –Excerpt from Xin’Ai’s blog

In May 2008, four sex workers established the Xin’Ai Home, a not-for-profit, nongovernmental organization, in the Dongli District of Tianjin, China. The organization was founded with the aims of promoting self-confidence and self-love, as well as fostering solidarity and mutual aid, to uphold the rights of female sex workers, eliminate violence against women, and increase awareness of women’s health. This organization primarily serves low-income female sex workers, including providing HIV/STD prevention workshops, health care referrals,  training in vocational skills, violence prevention, and women’s legal issues. As of now, over 90% of female sex workers in Dongli District have received services from Xin’Ai, and around 3000 people in total have been reached. All of Xin’Ai’s staff members are women, and currently there are three full-time staff, two part-time staff and ten volunteers.

PrEP: What It Is and How Sex Workers Can Use It

Truvada, the only HIV medication approved to be used in PrEP so far. (Photo by Jeffrey Beall, via Wikipedia Commons.)
Truvada, the only HIV medication approved to be used in PrEP so far. (Photo by Jeffrey Beall, via Wikipedia Commons.)

Lindsay Roth cowrote this post with sex worker ally and colleague Cassie Warren. Roth and Warren work together at PxROAR (Research, Outreach, Advocacy, and Representation), a program for community activists which offers training and support around biomedical HIV prevention research and advocacy. Readers can contact them with questions about PrEP at lindsay@swopusa.org and cassandra.r.warren@gmail.com.

So you’re telling me you can take a pill to prevent HIV?

Yup. We believe that if done right, PrEP has the potential to be one of the best tools brought to market for receptive partner protection and power since the pill in the 1960’s. PrEP doesn’t double as a contraceptive, but it does reduce your risk of HIV by 90% when taken correctly. It’s still a sweet tool to have in your make-up bag, hard femme box, tool kit, whatever you call it. We are still in the middle of an epidemic, with trans and cis women, men who have sex with men, and injection drug users still being hit hard and unjustly. We deserve to have access to all the options that protect us against HIV.

In what follows, we’d like to lay out the basics of PrEP (no really, what is it? does it cost the first month’s rent?), add context to some of the controversies, and offer our take on what this means for sex workers. We do not anticipate that we’ll be able to answer all the questions people have in this one post, and we hope that you will comment or reach out to us directly if you’d like to know more.

What the heck is it?

PrEP stands for Pre-Exposure Prophylaxis. The main part to note here is “pre,” implying treatment before exposure. In this context, we are talking about exposure to HIV (Human Immunodeficiency Virus). So, PrEP is a medication an HIV-negative person would take to prevent them from becoming positive. Currently, Truvada is the only form of PrEP approved by the Food and Drug Administration.

Truvada is an NRTI (nucleoside analog reverse transcriptase inhibitor) which is just a fancy name for an HIV medication. It has been used to treat HIV since 2004. We used to know HIV as the virus that caused AIDS, and knew AIDS as a death sentence. However, because of advancements in the treatment of HIV, positive folks can live long, healthy lives. Folks can even be positive, on treatment, and unable to transmit the virus to anyone else. Recently the medical establishment stopped giving AIDS diagnoses: Because of new treatment options people can be at various stages in their HIV diagnosis, and we now classify HIV as stage 0, 1, 2 or 3 HIV.

Many readers may be familiar with PrEP’s sibling, PEP, or post-exposure prophylaxis, the use of antiretroviral drugs—ARVs (again, a fancy name for HIV medications)—to mitigate the risk of HIV transmission after a potential exposure. Any doctor can write a prescription for PEP, most Medicaid programs pay for it, and Gilead, the large research based pharmaceutical company which makes Truvada, has a patient assistance program to cover the the costs for the uninsured or underinsured, regardless of immigration status.

To summarize, PrEP vs. PEP:

  • Truvada as PrEP is taken before an exposure to HIV, specifically one pill a day, every day.
  • PEP is taken after an exposure to HIV, specifically within 72 hours, and consists of 30 days of full-regimen HIV treatment medication.
  • Both prevent you from acquiring HIV.

How does PrEP work?

The rationale behind PrEP is based on the way most doctors are treating HIV-positive individuals with ARVs. Truvada is a combination of two medications, tenofovir and emtricitabine. If HIV is presenting itself in one’s body, this medication blocks the replication of HIV in the body. Doctors currently prescribe one pill a day, as the medication must be present in the body to do its work. However, there are trials underway to test the efficacy of other ways of taking PrEP. So far, the results of the iPrEX OLE (open label extension) say that if you take it 2-4 times a week you are protected 85% of the time against HIV, and if you take it 5-7 times a week, you are protected 99% of the time against HIV (not other STIs or pregnancy). If you take it less than 2 times a week you have zero protection. 1

Can I take it right before I meet a date?

No. PrEP acts like a full metal jacket around your T-cells, so if HIV is introduced to your body it can’t get into the cells it wants to infect and replicate itself.2 It takes about seven days to make this metaphorical metal jacket around the cells in the rectum (drugs taken orally are absorbed quicker in the digestive track), and about 20 days to make a metal jacket around the cells in the vagina (our apologies if you call your junk something else) and in the bloodstream. So, for full protection, you’d need to be taking it every day for a week before you’re protected during anal sex, and every day for three weeks before you are protected during vaginal sex or during any activity in which you would share blood (e.g., sharing needles for tattoos, hormones, drugs, piercings, etc.).

Ask Ms. Harm Reduction: She’s Pregnant and on Dope

Ms. HR wants the best for you and your bun in the oven. (image via Flickr user trialsanderrors)
Ms. HR wants the best for you and your bun in the oven. Though you probably won’t want to nurse your tot if you’re on methadone after it’s born. (“Nurse the Baby” poster by Erik Hans Krause, via Wikipedia Commons)

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 info@titsandsass.com.

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.

Sincerely,  

Girl On Opiates is a Great, Amazing Homey

Ask Ms. Harm Reduction: Getting High With Clients

If your session looks like this, Ms. Harm Reduction urges you to read this month's column. (Image by Flickr user Doki hawk)
If your session looks like this, Ms. Harm Reduction urges you to read this month’s column. (Image by Flickr user Doki hawk)

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