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 email@example.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.
Amanda Brooks is the acclaimed author ofThe Internet Escort’s Handbookseries, the first one of which she published in 2006. They served as an important resource for escorts advertising online back when there were few other how-to sources on the topic. She was also one of the earliest escort bloggers starting in 2005, writing entries brimming with eloquence and common sense atAfter Hours.
The two fell off the map recently.
When they returned, we were shocked to read Brooks’ blog post about what they’d endured: a campaign of terror by one of Brooks’ clients, affluent lawyer Percy LaWayne Isgitt. Isgitt—Brenneman and Brooks call him “Pig”—caused both Brenneman and Brooks severe brain injuries when his arrogance and negligence piloting a plane the three of them were in led to a catastrophic “hard landing.” Despite the fact that Brooks was clearly incapacitated and near death, Brenneman had to browbeat Pig into taking her to the hospital the next day. Once Brooks was checked in, Pig fraudulently signed in as her relative and attempted to control her treatment. Despite her still severely injured state, Brooks continued to see Pig as a client for two sessions after her hospitalization, in desperate need of money to pay for medical bills. When she finally tried to break ties with him, he hired people to make threatening phone calls to both women. In response, Brooks went into hiding, so Pig sent men to stalk, rape, and beat Brenneman on a number of occasions, trying to discover Brooks’ location. Neither the police, nor the many medical facilities that misdiagnosed them along the way, nor the personal injury lawyer they hired were any help to the two women against a deranged, abusive man with wealth and social capital.
The injuries Brenneman suffered from the plane crash combined with the injuries she sustained from the attacks led to the fatal exacerbation of her previous medical conditions. Her doctors have told her she has very little time left to live.
This story illustrates the insidious way institutions empower abusers to commit violence against sex workers. The only people they can often rely on in these situations are other sex workers. You can read the original account here and donate to their Giftrocket account using this email address: firstname.lastname@example.org. Donations will be shared equally between them to cover their respective medical costs.
Amanda, you write in your blog post, in reference to Jill’s past abuse:
To those who doubt, her stories are true. They’re things only men would think up and most of the time, it’s the mundane details that stand out the most to both of us. I’ve read stories from so-called trafficking victims who describe ridiculous “Satanic” rituals or elaborate set-ups. The truth is, the men who were Bruce’s [Jill’s captor’s] clients weren’t very bright, in my opinion, and they had a lot of the same stupid fantasies and beliefs that most vanilla clients do—only much darker and violent.
This factor plays into your story of how Pig hurt you both, too. There’s a voyeuristic undertone to the way people listen to stories of abuse. People expect the “elaborate set-ups,” and yet abuse is usually no different than other misbehavior in kind, if not in degree—abusers do it because they want to feel big, or because they care about themselves a lot more than they care about anyone else. How do you think the fact that often stories of abuse are mundane and banal makes it harder for victims to get help?
Jill Brenneman: People don’t want to believe the mundane stories, they want to believe the exotic stories. Like a wife who gets hit. Unless she’s put in the hospital, no one cares. Or she returns home because she has children. But the trafficking victim imported from Estonia gets all the attention.
Amanda Brooks: Because they’re too believable or not dramatic enough. [Pig] raped me twice, yet it’s not something most people acknowledge as rape. It even took me a while to realize that it was rape, despite how I felt about it. People like to parse situations down to the point where the only way it’s “real” is if it’s outlandish.
Jill, you were held captive by a sadist for three years in your teens, and forced to endure unimaginable abuse. As an adult you returned to sex work voluntarily to make a living, and then you went through this ordeal with Amanda at Pig’s hands. What unusual problems have you faced as a sex working abuse survivor? What can we do as a movement to make things better for the abuse survivors among us?
Jill: The ordeal that Amanda went through made me livid and still does.
Working as an abuse survivor led me to more abuse. I learned from [my captor and abuser] Bruce in the 80’s. Bruce was a cliche master sadist. There was never a sense of love or affection between him and I. I was an object. I did what I was was told. I was taught how to relate to clients. I overapplied this training as an adult. I willingly went back to work as a professional submissive. This was a place that I did not belong. Despite there being a 19 year gap between [my captivity and going back to] sex work, I did not belong in sex work —especially as a professional submissive. I needed the money to pay for very expensive subcutaneous blood thinners because of a clotting disorder. I needed to pay the rent, the car payment, food, care for the dog, etc. I took the work that came. I started off with two old pictures of myself, no website, no reviews, and took some pro-sub clients to make money when it was tight. I did not belong in sex work. I was still far too impacted from previous abuse to be doing it but I had no choice, I needed the money.
The most important thing the movement needs to do is work on decriminalization so that we have options.
Amanda: The movement truly doesn’t have the power to deal with this, unfortunately. Until the laws are changed, we never will.
Dear Ms. Harm Reduction,
I am transitioning into full service work, and need help getting clients to use condoms. One sugar daddy in particular has had a vasectomy, and a recent clean test, so he prefers no condoms for any activity. But I still feel uncomfortable with this. How can I negotiate to protect myself? On a related note, do you know where low income/uninsured women can get the HPV vaccine for free? I am over 26 years old, in California, if that matters. I really want to be as safe as possible while still earning money in this industry.
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 email@example.com and firstname.lastname@example.org.
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.).
Dear Ms. Harm Reduction, About six months ago I had my first ever genital herpes outbreak. I am a cis female and a full service provider. I don’t do bareback, but I do still continue to work. I am on herbal suppressive therapy (lysine, other immune boosters and stress management) and haven’t had an outbreak since the first one. I know it’s controversial, but I love my job and I don’t want to do any other type of work. I just want to know how to be as safe as possible. Also how big of a risk is this? Am I totally fucked up for working? For the record I would never work during an outbreak, but outside of that, is it ok? I was also wondering if internal condoms (female condoms) offer more protection because they cover external surface area?