I never felt safe discussing my work with any health care providers, fearing they would not understand and would judge me and change the way they treated me as a patient.

As a sex worker, I had a range of experiences trading sexual services. It began as a way to support myself in college, and I worked as few hours as possible, to leave time for schoolwork and my other job as an English tutor. But I stayed in the sex industry after school ended, looking for jobs in my area of study and sometimes volunteering for a magazine written by people in the sex trades. I knew other sex workers and felt great community with them, both working and socializing.

But working for others in the industry (rather than for myself) sometimes forced me to compromise my own comfort level or desires to appease their needs. Sometimes I was coerced by managers -- they would pressure me to see clients I didn't want to see or engage in activities I didn't agree to. It's not like you have a Human Resources department when you work at a dungeon or a brothel. Since I was working in an industry that is illegal and also stigmatized, I felt like I didn't have a choice in the matter. That's what I was told when I spoke up. When you don't have the rights that most workers have and you know what you're doing is illegal, it's hard to ask for what you need and just about impossible to file any sort of complaint.

After college, I got involved with a man who also worked in the industry and began working for his company. The relationship was very negative for both my emotional and physical safety. I considered calling the police many times but never did, out of fear of being shamed, not being believed, or even being arrested due to my work. I never saw the police as people who could help me. Many people I have spoken to through Persist have shared similar experiences. Some are also dealing with issues like racism, homophobia, and transphobia, especially when dealing with social services or law enforcement. Others are undocumented or have limited family support.

I was "outed" to my mother, and she told me she would never forgive me. That made me afraid to disclose to most anyone else. I also never felt safe discussing my work with any health care providers, fearing they would not understand and would judge me and change the way they treated me as a patient. Before I began working, I learned that people should be tested every 6 months to a year if they are sexually active, and so I started asking for regular testing from my OB/GYN. He asked me why "a girl like me" needed so much testing. I knew from then on not to go to people who would respond like that, and I became much more careful about what I told doctors about myself.

When I started working, I ended up disclosing less and less about myself, even the sex I was having in my personal life or the kinds of people I was having sex with. I had also heard horror stories from other workers of providers telling them what they did was wrong or disgusting, of health care providers making assumptions about them being messed up because of their work or treating them differently after they knew. And though I always made safe choices at work, I had harder times setting boundaries in my personal life, so I just refrained from being honest about either.

When I got my first full-time job that could support me without sex work, I left the industry, not just because I wasn't fulfilled by the work anymore, but also because I was tired of dealing with the stigma. Hiding what I was doing from those around me was exhausting. Working other jobs while managing a second identity was also draining. Even now that I've left sex work, disclosing my history to those who have not done sex work is still difficult.

Now, as a peer counselor for Persist Health Project, my understanding of myself has changed. I am able to provide care for others in the same way that my friends in the sex trade looked out for me when I was working. I provide information, try to listen without judgment or assumption, and advocate for them when they need someone to have their back.

From Stigma to Pride

Persist is a New York City community health partnership of health educators, social workers, nurse practitioners, and human rights advocates, all of whom have either experience in the sex trade or are allies. We connect people in the sex trade to affirming and non-judgmental health care providers. We believe that taking control of our health through education is an act of empowerment and a tool for positive change.

Working as a peer counselor has also allowed me to see the public debates about sex work and sex trafficking in a different way. So much of what we see in the media portrays all sex work as violence against women, so it can be so hard to understand how trafficking -- the use of force, fraud, or coercion for the purpose of exploitation -- actually affects sex workers. For example, the media tell us that no people, or at least very few, choose to do sex work -- that they only work in exploitive working conditions. I chose to do sex work, but that doesn't mean I didn't experience coercion. My work with Persist has shown me that the reality is more complex and that people's lives have many layers of truths.

As I guide people toward health care -- whatever that is, based on what they need or want for their lives -- I realize how much all our lives are a mixture of choice, circumstance, and coercion. Health is so much more than just seeing a doctor. It's how we treat each other and how we are able to move in the world. I have seen how health is adversely affected by shame and stigma, which can also lead to negative health outcomes for people of color, LGBT folks, and people with HIV. That's why it's so important to me to create a safe space for all sex work experiences -- positive, negative, or somewhere in between -- to be heard and validated. I am proud to work for an organization that focuses on the actual lives of those we serve and recognizes the diversity of experiences they can have when trading sexual services.