For Sex Workers, Stigma Is a Barrier to Healthcare

Sex work (ie, offering sexual services for payment) is neither a crime nor immoral, but a job like any other, according to groups that advocate for sex workers’ rights. These groups seek to combat the stigma associated with sex work: A stigma that affects the health of these workers.

The claim that sex work is a job like any other “is the starting point for a nondiscriminatory approach toward sex workers,” said Hermine Gbedo, secretary of the Committee for the Civil Rights of Prostitutes, an Italian organization. “Think about those who are victims of assault or violence and show up in the emergency room. A nondiscriminatory approach is fundamental to good care for these individuals. Associations that work for the rights of sex workers can act as a bridge.”

Isolation and discrimination have even more serious consequences when sex workers are undocumented immigrants. “Migrant sex workers and undocumented transgender individuals with limited knowledge of Italian and the healthcare system do not access healthcare services partly because they do not know their rights and fear being reported due to their irregular status. These are all factors that isolate sex workers and expose them to the risk for violence and aggression,” said Gbedo. “Another useful initiative to overcome barriers is to have a trained linguistic or cultural mediator available in general practitioners’ offices.”

Umbria’s Experience

Sex workers labor in heterogeneous conditions. Some work in an apartment, while others work on the street in a more dangerous, exhausting, and unhygienic environment. Some have more financial resources, while others live in precarious conditions. Some have Italian citizenship, while others lack documents. Risks and health status depend on many factors.

“In Perugia, most of those engaged in prostitution at the moment come from sub-Saharan Africa, mainly from Nigeria,” said Marina Toschi, MD, a gynecologist who collaborates with the Cabiria Street Unit. Active throughout Umbria, this organization provides sex workers with information, social mediation, and harm reduction for sexually transmitted diseases. “They are mostly women recruited in their countries with the prospect of working in Italy, then directed to the streets. They are deprived of documents to keep them vulnerable. They do not have residency and therefore are often not registered with the National Health Service and do not have a general practitioner. The Cabiria Mobile Unit goes to the street to listen to their needs, distribute condoms, contact them, and offer them medical assistance in public family planning clinics.”

Sexually transmitted diseases are obviously one of the main risks for those working in this sector. “Many clients refuse to use condoms or secretly remove them during intercourse,” said Toschi. “In parallel is the problem of unwanted pregnancies, which these women usually interrupt clandestinely using a misoprostol-based drug procured by those who control their activity. The drug is often taken in inappropriate doses and ways. And if something goes wrong, they are afraid to turn to the emergency room because the law imposes a fine of €5000-€10,000 for women who have clandestine abortions.”

Comprehensive Approach Needed

Language barriers and social isolation prevent many sex workers from accessing healthcare and having a general practitioner. For this reason, the workers turn to gynecologists provided by groups such as Cabiria for help with health problems that are not directly sexual. “Among the most common conditions for which they seek help are urinary tract infections, constipation, and digestive system disorders due to unhygienic conditions in the environments where they sleep and work; unbalanced nutrition; and lack of sanitary facilities,” said Toschi. “Respiratory infections, including tuberculosis, are also frequent. Many also use cortisone-based skin-whitening creams obtained from African shops. Especially if used for a long time, these creams can damage the skin and seriously alter the endocrine system, thus promoting hypertension, diabetes, and infertility.”

The care of sex workers cannot be limited to strictly medical concerns. To improve the health of these patients effectively, clinicians must consider the social and cultural factors that these patients face. “These people must be informed of their rights and empowered to exercise them,” said Toschi. “For example, women from Nigeria, Ivory Coast, and Mali often bear female genital mutilation that they suffered when they were very young. In addition to treating the physical consequences of these mutilations, clinicians must inform these patients that they can receive a residence permit based on the Istanbul Treaty as victims of violence, which must be confirmed by a medically trained professional. These patients must be assisted or referred to someone who can help them apply for a residence permit because obtaining it has positive consequences on every aspect of their life, including health. It is necessary for healthcare workers to collaborate with lawyers and nonprofit organizations dealing with migration and supporting the rights of sex workers, also to facilitate processes and understanding through the use of linguistic and cultural mediators.”

This story was translated from Univadis Italy, which is part of the Medscape professional network, using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.