Vectors of Disease: Sex Workers as Bodies to Be Managed

A few years after my entrance into the sex industry in the early 2000s I learned the line “sex workers know how to take care of their health better than everyone else—the idea that sex workers spread disease is a media-based myth.” I said it with a smile, my hands palm up, neither overbearing nor angry, and always willing to engage in dialogue for as long as needed for my audience to come around.

Myself and others clung to this, our motto of legitimacy. We were emissaries of safer sex info—and we learned our examples and statistics to prove our case. We trot out stories of clients at Australian brothels standing nude in front of us as we combed through pubic hair looking for unsightly bumps, squeezed the tip of their dick ceremoniously waiting for any kind of unsightly eruption of discharge—yellow, grey, or green. We had twice monthly health checks, and a lower rate of sexually transmitted infections than the general public. I told clients they had herpes, calmly and kindly, and instructed them how we could continue to have sex safely. I saw clients with HIV and we discussed their status as well as mine. The sex we had was safe, but then sometimes it was not.

For me the burden of being a responsible sex educator as well as a passionate and greedy hooker became tiresome. The emotional labor of giving someone the illusion of complete intimacy intertwined with moments of peppy sexual health boundary setting proved to be something I didn’t have the energy for some days and a deep feeling of guilt settled inside me.

In 2008, I moved to the United States and became involved in public health professionally. It was then that I realized how amplified the risk I’d perceived from bareback blowjobs and condoms slipping off. I went to the hospital after a client removed a condom during sex and came on my stomach. Full of fear, I went to the hospital late on a Saturday night waiting five hours to get post-exposure prophylaxis as soon as possible. The doctor showed me a Centers for Disease Control chart that showed the likelihood of HIV transmission from an encounter with a client who was HIV positive. It was somewhere around 8 in 10,000. I left without medication feeling confused and betrayed. For so long I had been operating under the idea that any moment of unprotected sex would create disease, because that is what sex workers are taught to believe in Australia. It is part of our duty to aspire to the status of responsible, well-behaved whores.

As I started studying to cut through the misinformation of my overly rigorous sexual education, I found myself turning around and using the same good hooker narrative I was trying to unlearn. I became the harm reduction coordinator at St. James Infirmary, the United States’s only peer-based clinic for current and former sex workers. Part of this job was taking the lead in our annual bartering with the Department of Public Health, where we battled to continue having sexually transmitted infections (STI) testing available for our community. I would repeat the story again that our HIV infection rate was low because sex workers make sure to be safe—after all, an STI can destroy our ability to do our job! Then I supplanted this narrative by calling up fears about what one sex worker with an STI could do to a client population that was far less likely to access testing.

Despite the truth of these arguments, I was minimizing the diversity of experience of sex workers and trading the right of people to obtain health care regardless of their behavior or their impact on “civil society” to a simple, easy to digest narrative. This narrative requires that there is only one kind of sex worker: a person who has the opportunity to prioritize their sexual health while working, but I knew that there are many who did not. By this time, however, I had learned that public health...