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The Healthcare Hustle

ahealthustlefeministryanDanielle 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, Danielle 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!

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.).

The Affordable Care Act and Sex Workers

via Flickr user 401 (K) 2012
via Flickr user 401 (K) 2012

Next Monday is the deadline to sign up for health care under the Affordable Care Act (ACA), if you don’t already have insurance you want to stick with. Here in New York City, we at Persist Health Project, a peer-led group that connects sex workers with non-judgmental and affordable health care, have been linking our friends and community members up with ACA “navigators” (grant-funded folks who walk you through the application) from Callen-Lorde Community Health Center, our local LGBTQ service provider, to help them through the process. We’ve also partnered nationally with the Sex Workers Outreach Project Chicago (SWOP) and HOOK Online to offer anonymous, online chats about the ACA to answer questions, get folks signed up and help them get into care that works for them (the final chat before the deadline is this Thursday, March 27th at 10 pm EST).

In the process of chatting with sex workers about the ACA, people have talked about various roadblocks they’ve had, especially around having to report income, which is one of the essential steps in insurance enrollment. As one community member told us, “The first thing they did was ask about my income. I just quit right there. I still don’t have insurance.” Getting insured and finding health care can be a frustrating process for anyone, but it’s particularly trying when you don’t feeling comfortable sharing how you make money, or may not even be certain how much you make in order to report it. Most people in the US have had some kind of trouble signing up on the Healthcare.gov site by themselves, and it’s also a time-consuming process (they estimate it takes about 45 minutes to an hour and half to fill out everything, and that’s with an ACA navigator assisting you).

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

Whore’s Bath—More Than Washing Your Pussy For The Next Client

The author indulging in the sort of whore's bath many of us take between clients. (Photo by Justin Bruce Malcolm)
The author indulging in the sort of whore’s bath many of us take between clients. (Photo by Justin Bruce Malcolm)

[The next Whore’s Bath/Solace Spa Suite event will be held at the Desiree Alliance conference on Weds, July 17th, between 11 AM and 6:30 PM. At the time of posting, we believe you can still register  for the Desiree Alliance conference, though you will no longer receive a room discount.—ed.]

Whore’s Bath is a day long retreat into spa and wellness treatments, by sex workers and for sex workers, created for the 7th San Francisco Sex Worker Festival in 2011 by sex worker community organizer Erica Fabulous. Her vision was “to provide a space for current and former sex workers to come together to focus on self care and get some much needed healing and nourishment, something we are generally giving to others while leaving ourselves without.” The bathing is both symbolic and literal. The idea behind the cleansing rituals in the Whores’ Bath offerings are cleansing the body and mind of stress, baggage, pain, confusion, tension, negative energy, drama, isolation, and much more. Water is not necessarily required. At this kind of Whores’ Bath, you can let the love and skill sharing from other providers be the source that replenishes you.

This year, the Whores’ Bath event created for the 8th San Francisco Sex Worker Film and Arts Festival was held at a cute two and a half star (#PricelineHookers) hotel in the Marina district. Three rooms were rented and there was a large turf grass area with hammocks tied to palm trees where everyone ate delicious food catered by Ckiara Rose. When you arrived on the grass, you were directed to plates and tables of food and drink and could sign up for tarot readings, a tantra workshop, full body massages, reiki, a meditation workshop, foot massages, and express facials. When the sun went down, we all migrated into the bigger suite and continued to bond and commune; laughing, griping, unwinding, eating, drinking and creating new friends and new memories. The late, wonderful Robyn Few, founder of the national Sex Workers Outreach Project and a major contributor to Desiree Alliance conferences, firmly believed in the power of these kinds of good times. It was in hotel room kickbacks like this that she planted seeds in people to grow her revolutionary garden of sex worker organizers. “Hanging with whores is supposed to fucking feel good,”I can imagine her saying, while passing me a gigantic joint.