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Sex Workers Struggle to Get Vaccinated Against Monkeypox

“We cannot forget sex workers, because for so many of us, sex is not just pleasure, it’s also work.”

Despite being at a high risk for contracting monkeypox—a virus that can be spread through sexual or other close physical contact, and was just declared a global health emergency by the World Health Organization—sex workers say they’re struggling to get access to the vaccines that would help keep them safe.

Repeating some of the same mistakes of the disastrously confusing and frustrating vaccine rollout for COVID-19, the launch of monkeypox vaccines in the U.S. so far has been a mess. We’re already facing a shortage of supply; the far-right is using the crisis to fuel hate against queer people; anti-vaxxers are vowing not to protect themselves; and sex workers are being forced to try to stay safe without help from the government bodies that are meant to protect public health.

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“Nothing about the way this country handles pandemics makes sense”

Leigh Woods, a sex worker based in Pittsburgh, told me that on Monday, she called the Allegheny County clinic that she regularly visits for routine STI testing to ask for a vaccine appointment. She’d read that the health department was administering vaccines on a “case-by-case basis,” and had seen other sex workers tweeting about getting the vaccine in cities like D.C. and Boston. But when she called the clinic, the provider who answered the phone was flippant and dismissive, she said. “As a sex worker, I am more than familiar with the negative stigma surrounding sex work in our society and the common biases held against us,” she said. “At this point, I was angry.” 

It was only after repeatedly explaining her situation and asking about traveling to other cities—where some clinics have been more inclusive of sex workers getting vaccinated—that she was able to get through. “In less than a minute, she returned to let me know that the providers approved my eligibility to receive the monkeypox vaccine, and she transferred me back to the front desk to be scheduled for my first dose,” Woods said. 

In New York City, Zil Goldstein, nurse practitioner and Associate Medical Director for Transgender and Gender Nonbinary (TGNB) Health at Callen-Lorde, told me that she’s sending her patients to the city’s department of health locations for vaccines with mixed success. “I had someone who was turned away yesterday. I've had people who have gotten the vaccine already,” she said. “Nothing about the way this country handles pandemics makes sense.”

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Goldstein said that persistence seems to be the main determining factor between getting the vaccine and not getting it. Patients are spending hours arguing with doctors at the health department who refuse to give them the vaccine, she said.

“That's not something that everyone can do, and just doesn't address the risks,” said Goldstein. “Sex workers are of incredibly high risk for monkeypox, and don't know the sexual history of their partners. So they could very easily be having sex with someone who also has sex with men. And there's a lot of potential for crossover there.” 

“In my case, I had to fight for my eligibility to receive the monkeypox vaccine,” Woods said. “I worry about my colleagues who may be too fearful to advocate for themselves in the face of adversity. The reality is this: if members of my community want to be vaccinated, we must seek it out. There will be no public acknowledgement or eligibility determination for sex workers. This is just an extension of our reality.” 

The CDC has a list of recommendations for who should get vaccinated, including anyone recently exposed, people with “multiple sexual partners in the past 2 weeks in an area with known monkeypox,” and people whose jobs may expose them to orthopoxviruses—meaning, laboratory staff and public health workers. I asked the CDC whether sex workers should qualify, and a spokesperson sent me that list, which doesn’t explicitly mention sex work.

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“If the government doesn't start helping us protect ourselves, it isn't only failing us, it's failing you, too. And it won’t be our fault”

Making the entire process more confusing, each state—and sometimes, individual counties within a single state—have different criteria for who is and isn’t eligible for a vaccine. In Washington, D.C. and San Francisco, for example, sex workers of any sexual orientation or gender are specifically named as among those eligible for a vaccine. 

Los Angeles County’s Department of Public Health will allow a vaccine for anyone who has had multiple sex partners in the last two weeks or engaged in “survival and/or transactional sex,” but limits recipients to gay or bi men and trans individuals only. Santa Clara and Contra Costa counties’ are similar, allowing for transactional sex but only if you’re male or trans. 

In Miami, Florida, where cases are spiking, the criteria is extremely limited: only lab workers and men who have sex with men who are also immunocompromised or have a history of STDs can get the vaccine. In Southern Nevada and Las Vegas, where monkeypox has been detected in the wastewater, eligibility is limited to people who may have been exposed and “gay, bisexual, or other men who have sex with men, and/or transgender, gender non-conforming, or gender non-binary who had multiple or anonymous sex partners in the last 14 days,” but even people who fit that criteria are reportedly being turned away.

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Some states make you fill out a form before learning if you qualify. The city of Richmond, Virgina’s form is long and full of questions about your sexual history, gender and orientation, including “Have you engaged in anonymous sex or sex with partners you don't know in the last three months?” 

Jessie Sage, a sex worker and writer based in Pittsburgh, documented her recent experience trying to navigate the bureaucracy of getting a vaccine. She called an infectious disease doctor, two local clinics, and the Allegheny County Health Department, all of which told her she didn’t meet the criteria or vaccines weren’t available. The health department initially told her she qualified, then called back to say she didn’t. It was only after making all of these calls, and writing an article for the Pittsburgh City Paper, that she was finally able to get a vaccine appointment. 

“We are parents, partners, friends, and colleagues who want to safely do our jobs and prevent the further spread of this disease,” Sage wrote. “If the government doesn't start helping us protect ourselves, it isn't only failing us, it's failing you, too. And it won’t be our fault.”

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Woods, too, was only able to get an appointment through persistence. At her first vaccine appointment, she was met with a very different tone than when she tried scheduling it on the phone days earlier. “The provider was friendly, patient, and informative,” she said. “The disappointment I held onto for the last few days had dissipated. I am incredibly grateful for the clinic and their willingness to acknowledge that sex workers are a high-risk group.”  

Without help from the government, sex workers are again forced to find their own ways to stay safe. Cecilia Gentili, co-founder of Callen Lorde’s COIN Clinic for sex workers, posted a list of demands from herself, ACT UP and PrEP4All for more inclusive public health access that includes better management, inclusiveness, and transparency for vaccine access. “We cannot forget sex workers,” she said at an ACT UP rally in New York. “Because for so many of us, sex is not just pleasure, it’s also work.” 

Last week, Performer Availability Screening Services, a testing and health program run by the adult industry’s trade association Free Speech Coalition, announced new guidelines for porn producers who are trying to navigate work and shoots around the threat of monkeypox, including reducing physical contact when possible and disinfecting surfaces diligently. They worked with the LA LGBT Center to open a vaccine clinic specifically for sex workers, and are continuing that work more broadly. All of this is not-distant history repeating itself: In March 2020, much of the adult industry shut down production due to COVID-19 risks, and the industry has always been a leader in taking public health seriously long before the rest of the population.

While a vaccine won’t guarantee you won’t contract monkeypox, it can lessen the risk. Sex workers who aren’t able to get vaccinated take on expounded risk because their livelihood is contingent on their health: Quarantining for two weeks because they have monkeypox means two weeks of missed income. 

Woods said that while she waits for her second dose in four weeks, she’s decided to stop taking new clients and limit bookings. “I will most certainly suffer a financial loss; however, it is nowhere near as detrimental as if I were to contract the virus,” she said. “My physical, mental, and sexual health are my top priorities. I have determined that practicing amplified discernment is more than necessary to ensure my safety.”

“We've already missed the boat on keeping this from becoming an epidemic disease in New York City,” Goldstein said. “It's entrenched and here to stay at this point, because the CDC has been so slow on prevention, and it's making treatment so difficult to access.”