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The Sex Workers Fighting for Better Health Care

"Many sex workers are uninsured and pay out of pocket for healthcare, often relying on harm reduction projects, public health funding, or sliding scale clinics."
Photos courtesy of Hookers for Healthcare

American healthcare is in limbo. Senator Mitch McConnell's senate bill collapsed, but the Senate majority leader has vowed to repeal and replace the Affordable Care Act. Across the United States, sex workers and porn stars remain concerned about the future of their health care, because they've been battling insurance issues already for years—many of which will be familiar to basically every freelancer in the country.


"Getting your own insurance when you're self-employed is a bitch," says Joanna Angel, who is a porn star and founder of, and does not identify as a sex worker. "Some performers try and give up because it's a pain in the ass. My husband was one of them but I stepped in and did it for him."

"This one particular bill is dead, but we don't know what will be next," explains Alice Little, a prostitute in rural Nevada. "We aren't 100 percent sure what way they'll be taking things."

Throughout the summer, Little and other Bunny Ranch employees organized protests against Trumpcare. Her group Hookers for Healthcare rallied at the state capitol and held phone drives, bombarding the lines of Republican Senator Dean Heller. They worried about still pending potential Medicaid cuts that could end coverage for many prostitutes' children.

"One of the big issues is right now you can't live between two states to receive coverage in that location," Little points out. "A lot of the ladies, they travel for their jobs. They need to be able to get medical care where they need it. They still need to be able to go to the ER in an emergency."

As the marketing of sex work has gravitated more and more to websites and message boards, health care has become more vital to workers. "To receive a ten rating on the Erotica Review, a worker must offer some combination of less safe activities: bareback blowjobs, anal, deep french kissing, etc.," points out sex worker and writer Tara Burns. "Sex workers working under criminalization often don't feel safe sharing their profession and actual risks with their doctors, and this can mean they don't get the same level of education and testing they should."


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Burns ties the healthcare battle to other movements, like prison reform. "There is the criminalization of HIV that in many states makes prostitution a felony," Burns explains. "We have people doing 10-plus years in the US for the crime of being an HIV positive sex worker, and the health care and nutrition they receive is often really bad." She highlights organizations like HIPS, PERSIST, and the Saint James Infirmary, which help sex workers find insurance coverage.

Since sex work is only legal in rural Nevada, workers' unique health care obstacles often stem from prostitution bans. "Sex work should be decriminalized and sex workers should have the right to negotiate for our own labor and safe work conditions," Burns says. "We should be fully enfranchised in the same systems of health insurance, public health, and workplace protections as other workers."

Over the past decade, Burns has seen girls rely on various forms of healthcare, from Social Security Disability to coverage obtained through a part-time job at the Olive Garden. But she notes, "Many sex workers are uninsured and pay out of pocket for healthcare, often relying on harm reduction projects, public health funding, or sliding scale clinics." Few, if any, sex workers receive insurance through employers.

One time, Burns broke her hand, and went the DIY route for a solution. "I didn't want to pay $3,000 for treatment so I watched a bunch of YouTube videos and made a cast out of moose hide and then plaster," she recalls.

People in other fields have gone to similar measures. Experts worry about the rise of people crowdfunding funds for medical procedures. "[Sex workers' problems are] not any more difficult than any other self-employed person," Burns admits. Angel agrees, "I have lots of other friends outside the porn industry with freelance jobs who share the same issues."

"For the most part it's on us to get our health insurance," remarks Kayden Kross, a porn performer based in Los Angeles. "Any advocacy we'd be doing would really be for a better healthcare system as a whole in this country."

Correction: This story originally said Broadly spoke to sex workers. This post has been updated to reflect that Broadly spoke to both porn performers and sex workers.