What Sex Workers Have to Say About HIV After FOSTA/SESTA

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This past March, the House and Senate passed two trafficking bills: the Fight Online Sex Trafficking Act (FOSTA; the House bill) and the Stop Enabling Sex Traffickers Act (SESTA; the Senate bill). Both bills specify that third-party content providers (such as websites with community posts like Craigslist and the now defunct Backpage) can be held liable for enabling trafficking. These bills have had reverberating effects on communities of sex workers, making it increasingly more difficult for them to use online platforms to conduct business and pushing them into the streets.

When we asked numerous sex workers what effects FOSTA/SESTA have had on their ability to maintain agency over their sexual health, the feedback was quite shocking (though not altogether surprising). How do sex workers navigate potentially dangerous conversations around sexual health after the passage of these bills? Additionally, for sex workers currently living with HIV, there is stigma on top of stigma. How do sex workers living with HIV navigate disclosure in a world that is increasingly more hostile to their profession?

In interviewing numerous sex workers about HIV prevention -- both sex workers currently living with HIV and those who are not -- we heard that some of the most striking consequences of FOSTA/SESTA are how these bills have further exacerbated economic and racial disparities in working conditions. Sex workers spoke of being forced from the relative safety of internet work onto the streets -- vastly increasing their vulnerability to arrest, police harassment, and violence. In addition, the passage of FOSTA/SESTA seems to be having the greatest impact on street-based sex workers, especially those of color and trans workers.

Related: Building Solidarity to Overcome Invisibility: Sex Workers and HIV-Focused Activism

"As a worker with a lot of relative privilege -- I'm white, work as cis, am on the thinner side, and college educated -- I have always felt comfortable enough to enforce covered [blow jobs] and [vaginal sex], and that hasn't changed," said one person who chose to remain anonymous.

Similarly, Mia, who reports making between $5,000-10,000 per month from sex work, said, "My health hasn't changed[;] … I don't feel pressured to do any extras." Another high-end provider reported that she "doesn't feel like it [FOSTA/SESTA] has had any impact" on her. There is a common thread of white, more economically privileged workers reporting that their physical health has not been impacted by FOSTA/SESTA. However, workers we interviewed with less racial and economic privilege had a different experience.

Phoenix, an escort with experience working on the street, discussed how clients are more demanding for sex without condoms and to engage in services not typically offered: "I have had requests for services I don't provide, and they want those services without condoms," Phoenix said. "One client called me and flat-out said, 'I know you don't have a lot of choices.'"

Thus, one way in which providers report being affected by FOSTA/SESTA that seems constant across economic and racial differences is the pressure not to be "picky" and to take on requests to which one might normally be inclined to say no.

Community-based programs and social services that provide access to resources seem to be diminishing, as well, after FOSTA/SESTA, for lower-income sex workers who rely on them.

"There had been small indie programs in the past where sex workers could rely on a small community of people to help distribute condoms, pay for Plan B, take people without transportation to check-ups, etc.," said Phoenix. "Since FOSTA/SESTA, it seems like folks are scared to keep engaging in that work. They don't want to be held accountable for breaking the law. I also am in the process of finding a new OB/GYN because my last one (who knew my history in sex work) won't schedule me anymore."

Another common thread after FOSTA/SESTA is the toll this has taken on some sex worker's mental health. Phoenix said: "I remain terrified at the idea of meeting back up with old clients that I know are abusive. I worry about my friends who are taking more and more risks with their work. I worry that our online safe spaces are shutting down. Physically I am okay … until I must see someone I cut off. Mentally, I am a wreck." Knowing the toll stress can take on the body for anyone, it appears to be only a matter of time before this ongoing stress will lead to additional health concerns for some.

Despite all of this, the bigger issue may be the risks people might be willing to take to survive, particularly those who already did not have a lot of choice for screening clients other than online tools and websites. When faced with the need for survival and having any sort of income, it seems reasonable that someone engaging in sex work will do what is necessary to keep the money coming in.

As noted by workers like Phoenix, potential clients now feel emboldened to ask for services outside what is offered -- and without the use of barrier protection, such as condoms. When a potential client demands condomless sex, and possibly rough sex, the risk of exposure to HIV is compounded because HIV needs a point of entry into the body, and rough sex can lead to tearing or micro-abrasions in mucosal tissues that line the vagina and rectum and, thus, exposure to semen or other fluids that can transmit HIV. FOSTA/SESTA has taken away many of the sites often used to solicit and screen clients to weed out those who want services that pose more risk to the provider.

Some people had found some safety in advertising on Backpage or Craigslist for clients, as the volume of requests could easily mean having a selection and choice of which clients to see and which services to provide. With those sites now shut down, some workers are being forced to face a new choice of losing income and the ability to survive or having to engage in more street-based sex work. Unlike using internet-based websites to screen and negotiate the terms of work, working on the streets means no record of contact or communication exists should something go wrong. Screening clients on the streets often means making a visual assessment and a split-second decision of whether to take on a client. And, under those circumstances, it can be a life or death decision.

Not all situations are quite so extreme, but the potential of an impact on one's life is ever present when working on the street. Does a worker feel as safe asking about HIV status in person? Does condom negotiation feel safe when done face-to-face? Does declining to take on more risk mean opening up the potential for violence, sexual assault, or having a gun pointed at one's head? When legislation like FOSTA/SESTA is in place, it can mean sex workers are encouraged to ignore negotiating and just do what the client asks to avoid the risk of physical harm.

And what about when a worker is living with HIV? Having the option to disclose one's HIV status and/or negotiate around using protection through online, phone, or text conversation can make all the difference. Workers can ask the questions they most want answered without the fear of immediate safety concerns and then have a choice of whom they take on as a client and whom they can say no to.

So, how do we as a society take a different approach? Maybe it's time to start lifting people up, providing them with more choice, rather than less, and listening to what people have to say. What if we were to provide sex workers with the tools they needed to advertise, safely screen clients, and make the choices best suited for them? What would that world look like?

Like many communities of people, sex workers are the people best suited to define what they need and determine how it should be provided. Society should look in the mirror and let that sink in. This lens is rarely applied when decisions are being made. A few options might be to create websites that are specifically sanctioned for sex workers to promote their business and screen clients, place some accountability on the clients rather than the workers, and open access to tools to protect oneself.

In the world of HIV, we have done some remarkable things over the years, but the results have not been made equally accessible to all. Take pre-exposure prophylaxis (PrEP), for example. There have been large-scale campaigns in cities and on gay hook-up sites to message and reach gay and bisexual men to inform about this great tool for preventing HIV. Why not expand these campaigns and access to PrEP to the sex working community? It would provide another tool in the tool-box of HIV prevention for sex workers.

Easy access to insertive (female) condoms is also very much needed for sex workers on the receiving end of sex. When taking the choice of wearing a condom out of the penetrative and often male clients' hands and empowering the receptive sex worker to decide when and where to use barrier protection, we are giving people choice rather than taking it away.

Maybe it's time to open up the prevention tool-box to all people, not just those whom decision makers have decided are deserving of such access. Those same decision makers -- who often find themselves on the evening news for having utilized the services of sex workers -- would likewise benefit, as would all of their other partners. Of course, that topic never finds its way into the discussion on who is impacted by HIV and the legislation being put in to place to "help" or "save" people. It's fucking maddening!

Sex work has been going on for countless years and it will continue to go on as long as people are having sex. There is tremendous resilience among people, particularly those that continue to be marginalized, and that resilience means people will find a way to survive and in many cases thrive. Why not be humane and empower people to have choice, protect themselves in the ways they see fit, and allow each one of us the opportunity to benefit? FOSTA/SESTA may have arisen from the best intentions in the world, but the reality is that it will likely do more harm than good.

When we don't create a fair and just society that allows all of us to thrive, including sex workers, then we have failed.

Jake Ketchum is a person living with HIV and an HIV advocate working in public health. He has a strong passion for community and social justice. In his downtime, he can be found spending time with his family and reading car magazines.

Laura LeMoon is a sex worker, trafficking survivor, and writer based in Seattle. She has written for the Huffington Post and is the co-founder of Safe Night Access Project Seattle, a nonprofit aimed at providing outreach to street-based sex workers. She can be found eating Mexican food in bed with her dog, Little Bear.