As a Sex Worker With a Chronic Illness, FOSTA Means Losing My Medical Care
Illustration by Elnora Turner.


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As a Sex Worker With a Chronic Illness, FOSTA Means Losing My Medical Care

In a nation lacking universal healthcare, recent legislation effectively cut a thread by which many disabled people climbed out of poverty.

This essay originally appeared in the Privacy & Perception Issue of Vice Magazine, created in collaboration with Broadly. You can read more stories from the issue here.

Sex work comes in many forms. My job falls under the category commonly referred to as “escort service.”

Like many sex workers I know, I first started advertising on Craigslist and Backpage due to urgent financial need, exacerbated by the fact that I had a long-misdiagnosed genetic condition that made other employment options impossible to maintain.


Strange as it might sound, sex work has been an excellent option for me and many of my friends who have “invisible illnesses” like fibromyalgia, chronic pain, and endocrine disorders, which, while undetectable to any observer or client, make it difficult or impossible to keep a full-time, decently paying job for a long time. At sex worker community gatherings, I’ve heard many stories of joining this industry for reasons related to health issues; anecdotally speaking, there appears to be an unusually high proportion of sex workers with chronic, invisible disabilities. That’s because certain sick folks must navigate a gray area: What do you do if you’re too sick to hold down a full-time job, yet not “sick enough” for disability benefits, and a typical part-time job isn’t enough to survive on—especially with medical bills? The answer sometimes is: You reconsider how you feel about lingerie and older men.

As with many small business owners, all of my advertising has historically been online. I started out posting on the classified ad sites, living hand-to-mouth, and after receiving high ratings from clients on the Erotic Review (basically Yelp for sex workers), prospective clients were able to read that I was a legitimate person worth seeing, not a fake ad, and that my online photos were representative of how I actually look.

That online screening goes both ways. When clients reach out, I typically request that they provide a list of escorts they’ve previously seen. (Every escort has their own policy for when a client is completely new and has no references, such as requesting proof of the client’s employment, or a copy of their ID.) I then contact these references by email, verifying with my colleague—often a fellow sex worker with whom I’ve communicated in the past or know socially in some respect—that their experience with the client was safe and smooth. It’s not that far removed from a potential employer calling the listed references on a job application, except with the goal of ensuring that the applicant isn’t a murderer or a cop. This crucial safety step is only made possible by the extra barrier and time that advertising over the internet provides—when someone approaches you on the street, you only have a few seconds to decide if you’re going to take them as a client.


With online ad services, the longer I did sex work, the safer I became: With good reviews, I was able to raise my rates incrementally, which allowed me to be more selective about which clients I saw after conducting safety screenings. I grew happier with my work, too, and I came to think of certain regular, trusted clients of mine as friends. Eventually, I was able to afford medical treatment that I certainly wouldn’t have been able to receive otherwise.

On April 11, however, all of that stability was lost when President Trump signed the FOSTA bill. The Allow States and Victims to Fight Online Sex Trafficking Act purports to reduce sex trafficking by holding websites legally accountable for any user-generated content “with the intent to promote or facilitate the prostitution of another person.” That might sound dandy on the surface, but here’s the issue: The bill conflates consensual, independent sex work with “sex trafficking,” which is a bit like conflating all labor with slavery. Worse yet, it doesn’t even accomplish its stated goal; as many victims of actual sex trafficking and their advocates were quick to point out, banning discussion of trafficking from the internet simply drives it deeper underground, decreasing the likelihood of it being detected in the first place.

The bill’s signing had been posted on the White House’s public schedule that morning, having passed in the House and Senate in the weeks prior. For some reason, I chose to torture myself by holding out hope that something would prevent its passage. In anticipation of its signing, some of my friends obsessively refreshed news websites for any sign of an update, but I just lay in bed with a knot in my stomach until texts from friends started rolling in: “There it is”; “Fuck, fuck, fuck”; and one that just read, “People are going to die”—not a threat, but rather an expression of terrified worry about the fate of the poorest sex workers who might now return to the streets.


Our online infrastructure had already begun to fall apart by that point. Soon after Congress passed FOSTA but before Trump signed it into law, federal authorities seized Backpage and similar sites and shut them down. In order to avoid the same fate, Craigslist had already removed its personal ad categories entirely. The Erotic Review shut down US reviews, and eventually blocked access from the country. As many sex workers observed, it felt like showing up for work one day, only to discover that the building was gone. And Trump’s signature ensured it would never be rebuilt.

Other online escort directories like Slixa and Eros remain standing, hosted on offshore servers. But increased security costs money—and, importantly, those directories often cost hundreds of dollars per month to advertise with. Now, I am privileged enough to have reached a point where I can afford to do so occasionally, but the earning gap among sex workers has suddenly widened into a massive canyon. There are those who can afford to pay large sums for ads, and then there are poorer workers who have suddenly lost all venues for free online advertising, and who are now driven to work on the streets or to return to pimps—options that can be life-threatening.

In the weeks that followed the bill being signed, a pattern appeared. Even from the pricey directories that remained, I received zero emails from new clients. Even if someone new somehow found me, they seemingly weren’t willing to take a risk without reading reviews. I realized with horror that I could relate, being a predictable millennial unwilling to buy a slice of pizza without checking Yelp about the joint first. I grew anxious, unsure whether this was temporary while the dust settled, or the new normal. Simultaneously, I began receiving emails from old clients whom I hadn’t seen in ages, saying that they had read about FOSTA and just wanted to “see if I was OK.” This would have seemed thoughtful, if they weren’t largely clients whom I had blacklisted due to bad behavior, exploiting the fact that they assumed I would now be desperate enough to see them again.

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The long-term effect remains unclear for me, though the outlook is certainly bleak for countless others. In a nation lacking universal healthcare, FOSTA effectively cut a thread by which many disabled people climbed out of desperate poverty. And in a nation in which the working poor continue to fight for a living wage, it’s undermined a rare opportunity for wealth redistribution in which clients (who are mostly older white men with financial ability) compensate sex workers (who are mostly younger women and femmes, often trans and of color) in a significant way, rather than with the crumbs of minimum wage.

Personally, I’ve been lucky; my health has improved with the help of my escorting income, and while I still love my job, I could now pursue a full-time career in a different field if I so choose. In fact, I just started studying medicine. But if FOSTA had passed earlier, I would have never had a fighting chance. Now many disabled people never will.