Rebuilding bridges: Removing the stigma from sex worker health

Pictured: Lena Van Hale, Operations Manager at Vixen, Victoria's peer-only sex worker organisation.

The Sex Work Decriminalisation Act 2022 introduces occupational health and safety protections, anti-discrimination provisions, and removes a slew of decades-long specific and coercive regulations of sex workers. It recognises sex work as legitimate, regulated like all other industries in the state through standard business laws. 

This decriminalisation has been an essential step in ensuring better health and human rights outcomes for sex workers.

Before the Act came into force, sex workers were legally mandated to have sexual health screenings every 3 months. The consequences of these were often dire, resulting in the criminalisation of workers living with sexually transmitted infections (STIs) or blood-borne viruses (BBVs), including HIV.

Sex workers were effectively forced to “come out” to health care providers every time they attended for a mandatory screening. “Outing” has tangible risks. It can result in direct harm involving friends, family, or housing. It can also be raised in family court, or used to exclude sex workers from other services.

In addition, health care staff themselves were not always supportive, with UNSW’s Centre for Social Research in Health revealing in 2022 that 46 per cent self-reported negative behaviours toward sex worker patients.

These medical visits were the main form of engagement with health services for most sex workers. Perversely, the experience often fostered a distrust of the health system and contributed to poor health outcomes. The combination of potential discrimination and the harms which can result from a person sharing their sex worker status amounted to a powerful disincentive to engaging with health services.

There was a bitter irony at the base of this. The old regulations perpetuated the antiquated view of sex workers as vectors of disease. This ran counter to many research findings, including studies conducted in Melbourne and Sydney, showing that in reality they have higher rates of prophylaxis use, lower rates of STIs, and higher sexual health literacy than the general population.

The regulations also burdened Victoria’s stretched sexual health and general practice services.

Decriminalisation of sex work halted that harm so that healing could begin, but this is a complex process.

It requires solutions to support sex workers and health care providers to engage safely and within the law.

To assist with this the Department of Health commissioned VHHITAL to co-design with Vixen, Victoria’s peer-only sex worker organisation, a suite of education sessions aimed at the primary health care workforce to explain the legal changes and provide recommendations for changes to practice.

The result was the Sex Worker Health Program, a suite of education sessions that consider individual changes to practice and systemic changes to health systems to be two sides of the same coin.

“The program leverages VHHITAL’s expertise and network in the field of sexual health, including historically stigmatised infections like HIV or hepatitis, as well as Vixen’s experience training on sex work stigma and discrimination,” explains Naomi Cooper, NWMPHN’s VHHITAL lead.”

“Sex workers deserve the same access to supportive health care as any other person,” said Lena Van Hale, Vixen’s Operations Manager.

Now that we’ve removed the harmful legislative frameworks that exposed sex workers to criminalisation and discrimination, we still have work to do on changing the stigmatising attitudes about sex workers in society, which have been entrenched over generations.

“Co-designed projects such as this one, working alongside sex workers and centring our expertise, are a vital step in breaking down stigma, and achieving health equality.”

The Department of Health has renewed the funding for this program for 2023-24.

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