Sex Workers Can Teach You a Thing Or Two About Sexual Health

The only person I know who uses a dental dam is a sex worker based in London. She's also the only person I know who gets a sexual health check-up every single month and never, ever, ever has unprotected sex. I don't know anyone else who is quite as on it with their sexual health.

This might fly in the face of many popular opinions about "full service" sex workers (SWs), but the truth is those opinions have no real basis in fact. There have only been a smattering of studies into the sexual health of sex workers, and none have been conclusive enough to make any kind of definitive statement.

One study, published in 2014, notes: "Female sex workers (FSWs) are assumed to be at an increased risk of STIs, but there is limited comparative data with other population groups available." Analysts compared the rates of STIs between FSWs and other female patients at GUM clinics in England. After adjusting for demographic factors, they concluded that FSWs were almost twice as likely to have chlamydia and three times more likely to have gonorrhoea. But they weren't any more likely to have HIV or syphilis. "As FSWs made more visits on average than other female attendees, this increased prevalence may have been linked to the higher number of opportunities to be diagnosed," the researchers argued. So, maybe sex workers are just more aware of their STI status.

This research, from 2015, found that "men who pay for sex and their paid partners have been recognised as particularly vulnerable to STIs". Another, published the same year, argued that sex workers in the UK were one of the hardest groups to reach with sexual health interventions. After looking at the experiences of 22 sex workers in 2016, researchers in Hackney found that "SWs reported poor experiences of using mainstream sexual health services". But it had a small sample which holds a geographical bias.

I arranged to speak to some SWs so they could explain how they manage their sexual health.

Auntie Wussy Pillow, a 31-year-old SW based in north London, arrived for the interview on a unicycle, at midnight, following a consensual kidnapping. "Most SWs that I know are pretty fucking on it when it comes to sexual health," she explained after changing out of her "kidnapping uniform", cradling a cup of tea and lighting a joint. "We use condoms religiously; I think more than other groups in society. Most of us know a lot more about sexual health too."

"Just basic shit, like when you're playing with someone it's got to be one hand for your genitals and one hand for their genitals. I use gloves if I'm going in someone's bum hole, I use [dental] dams if I'm going to lick someone's bum hole. I go to the clinic every month."

Wussy Pillow believes that some of the general population could learn a thing or two from SWs. "I'm more knowledgeable about sexual health since becoming a sex worker," she said. "I'm always telling my [non-SW] mates off for not being safe enough. Most people don't even use gloves – that's basic. We talk a lot about our health in this industry, we educate each other. We're on it. If you ever have a sexual health question, ask a sex worker."

Kim*, a 25-year-old escort based in west London, takes a similar approach to Wussy Pillow. "I have to take a lot of care over this," she explained. "I rely on my health for money, so I have a check-up at a sexual health clinic every four weeks and I don’t have unprotected sex." Sometimes she carries out additional checks, too: "Especially if it's a new client, I want to see a recent STI report if I'm worried, and I check them to make sure they haven't got any visible sores."

Has this strategy worked? "Well, I've never had an STI in four years of doing this,” she told me. "That could be partly good luck, but also maybe just the kind of clients that I'm choosing. It's hard to generalise, but I guess not offering unprotected vaginal or anal sex cuts some of the big STI worries out pretty quickly."

For the people I spoke to, going to a clinic every month was the industry norm. "I get tested every four weeks for everything, despite the fact I don't offer unprotected services," said Charlotte, a 37-year-old London-based sex worker. "By getting tested every four weeks we minimise infections. SWs can also use it as an opportunity to access mental and sexual health workshops."

Dr Rosie Campbell, at the University of Leicester, was part of a team that recently conducted a research project, "Beyond the Gaze", looking into how the internet has affected the sex industry in the UK. After hearing from 640 sex workers and 1,500 clients, they found that the internet plays a part in protecting the sexual health of SWs, too. "Our research found that online SW forums and private online peer support groups were vital for networking between sex workers, sharing information about sexual health matters and alerting each other to potential customers they have health concerns about," she told me in an email.

The UN, Amnesty International and the World Health Organisation have now all indicated that they would like to see decriminalisation of all aspects of consensual sex work (as seen in New Zealand) in the UK. But, in reality, we're going in the opposite direction: If a recent debate in the House of Commons is anything to go by, the UK could be about to follow the US' lead by banning websites – such as Adult Work and Vivastreet – that enable sex workers to advertise their services. A move which campaigners are in little doubt will increase all risks that sex workers face.

*Name changed at the request of the subject.

@oldspeak1