People say that sex work is the oldest profession in the world, but few know it is also one of the most dangerous. Sex work, also known as prostitution, is the provision of sexual services in exchange for money, drugs, or other favors. Other forms of sex work, such as survival sex, exchange sex to pay rent or to buy food or other living supplies.
Sex workers face many dangers on the job, including exposure to disease, violence, discrimination, stigma, and exploitation. Harm reduction principles can help safe-guard sex workers lives, teach empowerment and survival skills, and prevent the spread of diseases such as HIV and hepatitis, acquired through unprotected sex and unsterilized drug equipment, which is often present in sex work.
April, a Durham sex worker and client of the North Carolina Harm Reduction Coalition, used to run her own cleaning business. Due to a tumultuous childhood of poverty and a difficult family life, she turned to drugs to ease the pain, and lost her business on account of the addiction. With no financial resources to support herself, she turned to sex work to make ends meet. For April and others like her, drugs and sex work form a cyclical relationship; turning tricks pays for drugs that are often used to escape painful and abusive living conditions, and drugs may ease the unpleasantness of turning tricks, creating a cycle very difficult to break.
April adopts several harm reduction strategies to protect herself when she works. For example, to help prevent the spread of infectious diseases such as HIV and hepatitis, April washes her hands and body often and always uses a condom when with a client, including for oral and anal sex. Harm reduction programs also encourage sex workers to use the reality, or female, condom, because it can be inserted in the vagina or anus up to eight hours before an encounter. This gives a sex worker more control over her own sexual health, instead of relying on her John to use a condom. Additionally, some workers use “cheeking,” hiding a condom in one’s cheek and putting in on discreetly during a blow job, as a harm reduction strategy.
“You have to watch your back in this business because clients will mistreat you,” April says. “I’ve been raped, stabbed, and beaten, but I’ve learned ways to stay safer.”
Harm reduction programs that provide condoms, lubricants, dental dams, antibiotics and other supplies to sex workers help lower the incidence of HIV and hepatitis in the community. Compare the cost of these supplies, which may only be a few cents per item, to the larger expense of treating disease: over the course of a lifetime, HIV costs about $700,000 to manage, while hepatitis C costs between $100,000 and $430,000 to treat.
But many harm reduction programs go further than providing safe sex supplies to workers; they also teach protection and empowerment strategies, such as how to escape from a violent client, the use of a “buddy system” where sex workers team up to stay safe, and rule-setting so that workers like April can maintain control of each encounter and avoid potential harm. “I used to go wherever the client wanted and that’s when all the bad stuff happened,” says April. “Now I bring clients back to my own place where there are people around to protect me if something went wrong. Also, I try to stick to regular clients whom I can trust, and I don’t get high with them because they can get crazy.”
In addition to offering empowerment strategies and safe sex supplies to sex workers, harm reduction programs work to curb discrimination and stigma against this profession by treating workers will dignity and respect.
“I’m grateful to [the NCHRC] because they understand my situation and don’t judge me,” says April. “They’ve helped me through hard times, probably even saved me from HIV. I used to run my own cleaning business. I hope that I can stay safe and healthy long enough to leave sex work and start my own business again.”