Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US
1.1. Sexual Humanitarianism and Anti-Trafficking
1.2. Impact of Peer-to-Peer Interventions
3.1. Current Social and Legal Landscape of Sex Work, Migration and Trafficking in the US
“Recently we saw a spate of arrests of migrant trans sex workers from Queens—and we’re not entirely sure why. But then we saw lots more migrant trans sex workers going through Queens Court … Overall, there are more cisgender women going through the courts. But in terms of black trans vs. migrant trans being represented in courts, it depends on location typically, and has to do with policing. In Queens HTIC, we see a lot of migrant trans women. In Brooklyn HTIC, it’s more black trans women. We think it has to do with policing in those neighborhoods in one part, but also has to do with where different trans communities are hanging out … There is definitely discriminatory policing happening against trans people–for much of the same reasons related to the idea that trans sex workers do this work voluntarily and are not vulnerable to the same exploitation cis women are.”(Interviewed 20 December 2018)
3.2. Negative Health Impacts of Criminalization
“[During the arrest] The cops were assholes to me. They were slamming me against cars. They said I was ‘too stupid’ to advertise myself online … Now you know why people tell trauma stories of arrest. They treat you like a criminal–not a victim … When I got arrested, I was in jail for 23 h. I refused to go to the bathroom because they were so disgusting. And I got a UTI [urinary tract infection] after 23 h, but I didn’t know–I had no symptoms. So I got sick. 103 fever and my back was on fire. The woman working with me took me to the hospital because the UTI was spreading to lungs and kidneys … Medication didn’t help. I was in the hospital for five days. The case worker sent through the arrest records to the other case worker—because I was in foster care. And she was like ‘Oh well. This is what you’re doing [sex work] and this is why you’re here.’”
“I explained that some people are not trafficked—but they [anti-trafficking organization] didn’t hear me. I never felt like a trafficking victim. Sex work was the best option for me at the time. I feel like I was a victim of the courts … [Anti-trafficking organization] didn’t give me room to talk about the reasons I did it [sex work]. $5 a day and a yoga class is not going to fix that!”
“When the police arrested me, there was a lot of violence and discrimination in the station… They used my real name rather than my female name … At the station, I was in the same cell with another trans woman and a man … I was stressed, had headaches, I was not sleeping well from stress from my arrest, my court case, and from not working. It was very traumatic—all of it. It really affected me. It affected me mentally and psychologically. I have a psychologist to help with all this … I’m always stressed about police–even though I have papers. It’s very stressful living here … I worked a little again after that [arrest], because I had to. But I was scared. I only worked with clients who still had my number.”
“I had to go to a men’s jail. It was horrible. I was isolated with someone who committed attempted murder who stabbed someone in the neck with a saw. That mentally fucked me up. Their reasoning was keeping me out of general population. I had no violence from inmates in jail. I actually had a lot of sympathy. But I had several bad situations with the CO [correctional officer] and the nurse … I was [also] starving in jail … I couldn’t eat. I didn’t have an appetite. I didn’t have a sense of day or night. Other than looking out the little whole in the window. I witnessed two suicides. Two guys almost killed each other in a cell. I spoke to the guy who killed hisself [sic] the day before. It was really traumatic… After that I felt targeted by the cops all the time … Got out, I was on probation. I had to pay a healthy fine. From where? What was I supposed to do getting that money? … Which left me to do survival sex work again.”
“I’ve been arrested and assaulted many times by police. After arrests, guards inside Rikers raped and molested me. They let inmates rape me. People doing more than a year they let rape people. If they have to do more time in prison, they tried to get on us. [The] officer got me raped. ‘You want to get raped faggot?’ He got inmates to do it. I threw all my HIV paperwork to them to show them I was positive. That fucked me up. Still have PTSD from that … I’m fearful to go back on the street [to work] because of police harassment. They say, ‘Suck on my dick or I’m gonna arrest you.’ Happened to me plenty of times. Some police laugh at trans people when they arrest you.”
“We were tired and on the run, and ICE got us immediately. We were processed and then put in [immigration] detention. We were still wet from the river and they put us in a freezing cold holding area. I told them that I wasn’t a woman, so they put me in my own cold room. The food and treatment were terrible in detention. The guards would laugh when I said I was cold … I was deported. I came back in 15 days and went through it all over again … An ICE officer asked if I was trans, and they said that they could offer me asylum. So they transferred me to prison instead of detention. I hadn’t showered or changed my clothes in three days. I was finally able to shower in prison. It was the best day when I was transferred from detention to prison. In the detention center in McAllen (Santa Isabel), in the “Freezer” or “Refrigerator” as we would call it, woman would take off their clothes to wrap up their children. It was excruciating. When I got to prison, I was very severely dehydrated. I had mosquito bites all over my body, and I was finally able to get the care that I needed. They put me in my own cell in a clinic now with women. There, I was able to contact my mother. I was able to start fighting for hormones in prison.”
“In prison, I was getting hormones and Wellbutrin, but in detention, they confiscated my hormones and said the medications were too expensive so they wouldn’t give them. Instead, they gave me medication for anxiety even though I had depression. They doubled my dosage, but it didn’t do anything. They would give me sleeping pills just to make me pass out. There was no stable healthcare provided in detention. The doctor didn’t always come. The correctional officer who was advocating for us couldn’t get anything.”
“I was constantly cuffed and placed in an area with mentally ill people. I had my own cell in a wing of the building that was all men, so people constantly harassed me, even asking to have me put into their cells so that they could rape me. They would cuff me in the shower “for my protection” and I would be all alone and unable to move. They treated us like dogs, and they didn’t give us any drink, so we would have to drink from the toilet. Food was only provided under the door for eight days … The most traumatizing thing was that when they transported us on a plane, they would put us in handcuffs, so even drinking water was very difficult. Now, I am so traumatized that I can’t go on planes. I was terrified that I would be stuck if anything happened on the plane.”
“Once the guard wouldn’t let me go to the bathroom, I was taking a shit, and I took too long, so she took me out and cuffed me and put me in the yard in the rain, and I told them they can’t do this.”
“[One person I knew] started to get blisters. They wouldn’t let her see a doctor. It took a long time [for her to get medical attention and she experienced] … dizziness, vomiting. They didn’t take care of her. They didn’t believe she was sick. They said ‘No habla Español.’”
3.3. Struggles in Accessing Health Care
“When I was a sex worker, [a mainstream national sexual health organization] would not give me a full panel of STIs. I didn’t feel it was safe to be out [as a sex worker there] because I didn’t want to talk to a social worker. I asked for testing. But they refused me. I asked to be tested, and so they should just test me! … it’s doing harm when they didn’t test me.”
“Back then, they didn’t know [what people really needed]. They [cops] caught me with drugs, but there were no rehabs. Acupuncture just made me sleepy. Talking to a psychiatrist didn’t help. I was like, ‘You’re not taking me off the streets. You’re not doing anything to really help me. So why the fuck am I talking to you? I’m only here to talk to you for a few hours.’ So no, they didn’t really help me. And the community service didn’t help me. The army helped me. It gave me stability and structure. But when you got out, they didn’t provide anything. I was homeless when I got out. No housing. Nothing. No mental health provider. No money. No help in any way.”
“I have hep C from injecting and sharing needles … I also need to see a psychiatrist for my mental health stuff. But I’m trying to find a sex worker–friendly therapist. I used to go to PERSIST Health Project through RedUP. But it’s sort of defunct now [the project has officially ended; more on this below]. So it’s hard finding sex worker friendly services, in general. I’ve had a lot of stigma from general health providers. They always talk down to me and treat me badly because I’m a sex worker and a drug user.”
“I lived in Texas for a little while, and my doctor was very stigmatizing. She told me, ‘You have gender identity disorder. You need counseling. You’re mental. You’re lying to yourself.’”
“I used to be very sick from an infection from a super-bacteria. I was really sick for six months. I’m getting better now but getting health care in the US is very hard and medical bills are my biggest issue right now. I was able to get treatment in New Jersey, which is different from NY in terms of insurance. I’m also undocumented. It feels like this is my big problem. While I’m waiting for my T-Visa, I’m very scared. My sibling is in California, but I feel like I can’t even take a plane there because I’m afraid of what would happen. I have a lot of fear. I’m worried about any moment I could get deported, get arrested, get in trouble. I am in constant fear of that.”
3.4. “Standing in the Gap:” Community-Based Health Interventions and Support
“We had a situation where we thought somebody had been incarcerated, forced and entrapped, so Lysistrata rallied around that to obtain funds for the person … it really just came out of necessity because of criminalization… It was a couple of people in the sex industry who started it… People who had a little bit more money were putting money into the fund and people who need the money would receive it … We don’t have grants or anything like that … It’s about harm reduction … we literally meet people where they’re at … Sometimes it’s going to hospitals when people have been hospitalized. And sitting with them and making sure they have food and that nurses aren’t treating them shitty and they’re using their pronouns … So it’s understanding that … these real-life scenarios exist and that they impact the ability for somebody to be well and whole [and] that we play the part of … eliminating or alleviating what pressures could force people to do this type of work.”
“When do we begin to heal ourselves? We don’t have time for that because we’re constantly living in crisis … [this] crisis is not just … [from] the state of the government, it’s housing and gentrification and displacement and disruption and police violence and police presence … All of these things that impact the environment’s health, impact people [too] … I hope we [Lysistrata] don’t exist anymore [in the future] … Because if we don’t exist anymore that means that people do not need our services … It’s unfortunate that it takes community to help community to get our life together, [and] that it’s not the people who are making shitty-ass laws about us. It’s not people who are impacting our ability to work or live full lives [who help us]. It’s not those people who are responsible for the trauma that is helping [us] … [Instead] it has to be people who are living in traumatic situations helping other people who live in traumatic situations to come out of it.”
“SWOP Behind Bars continues to try to provide services and support for sex workers who are in prison and as they are released. We do this through newsletters, pen pals and Amazon wish lists. It’s not been easy to get sex work-positive information into prisons. Every time we get a new member, we send them a welcome letter telling them who we are and what we do and over the past few months even that welcome letter is being refused from many prisons. We are constantly having to adjust our ‘content’ so we can still reach people who are in prison … This month we are trying a new concept … and that is to send them material about being financially literate … or to better understand money and credit … We are hoping that this document will clear the mail rooms without any complications … at least it gets in there with our name and address and community support line number.
We also try to assist our members who are released by sending them a smartphone and a gift card for clothes … We try to help folks get connected to their identification documents and then refer them to local food banks, job centers and thrift stores to make their money go further and to help them fill gaps in services. In fact, I think I can honestly say that standing in the gap is what SWOP Behind Bars has always done. We are excited to see many more of these community-based food banks and job centers are becoming much more ‘sex work literate’ and many of them have started to provide a few health and mental health care services that make sense. We try to make alliances with these kinds of community-based organizations and help them learn about sex workers who have been in prison or jail … Right now we have literally NO FUNDING to do these things independently …”(from email correspondence on 22 May 2019)
“Being at RedUP and PERSIST Health Project was the first time I was given the language to explain what I was experiencing. And that I’m the expert on my own experience. I can actually make my own decisions. I was a sex worker not a trafficked victim. It all made more sense to me. [During the court case] I couldn’t tell my lawyers what was happening because I didn’t have the language. [At RedUP] I was then able to discover advocacy for human rights was really needed. People can dictate what they need. I had agency in my life. I would be able to make the decisions I made. I made a choice. And stuck to it. Being connected to RedUP and PERSIST gave me the tools and language to learn that. They gave me the tools to be able to advocate for myself and others.”
“Sex workers are very resourceful—we have a lot resources that are not readily available [in mainstream settings]. Sex workers are good at self-care … We don’t want to deal with state sanctioned violence at hospitals. We have ways to get around not having insurance, or if we need medication. Sex workers are the best place to go! We’re a self-contained community!
If it [sex work] was legal, it would be better, and we could be a lot more useful. When decriminalized, we can also protect ourselves from fraudulent activities … If you go to Community Healthcare Network, you can be out. That’s only place I’ve ever told I was a sex worker. The ER [emergency room in hospitals] has to report if they think someone is trafficked. So we can’t tell them there. We [RedUP] do best practice training for service providers. We also know sex worker-friendly therapists and doctors. We either create our own resources, or vet people out for sex workers.”
“I love this community! … I share everything with them. It pains me when they suffer … It’s like we are a family … My experiences have been great… They are really focused on health, housing, and about learning about the laws, and providing workshops about my rights.”
“I definitely have a strong support network among sex workers. We have built a network for ourselves. The network in NY is completely different from anything I ever experienced. Dallas was really segmented and sparse, which is how it is in other cities. But NY is special because there is opportunities to go to events and meet people and meet doms, whether you’re queer or trans … The [sex worker] community has been built up, and with social media, the way we are able to reach communities online across the country–especially for those who can’t meet other sex workers–is really amazing. So I’ve met with people from other parts of the country or the world. So it’s nice to have that support system that’s grounding me.”
“I experienced what [it] was like empowering trans sex workers to carve out our rightful place in a highly hostile society.”
“We need safe places. We need more sex worker friendly spaces. We need funding for those. We need where they can find you jobs, school, sex working friendly spaces.
Sex workers should not be arrested, but instead referred to counseling, job training, work release, or service to the community … We need sex work programs and harm reduction just for sex workers, like more drop-in centers for all women and girls who do sex work. Regular SEP [syringe exchange programs] are not welcoming enough …
We need better LGBT liaisons … We need protection laws. Do they [cops] think they can rape lesbian, bi, and trans women? Cops can’t get away with that! Something must be done. All law enforcement needs laws to protect people both inside and outside the system, and when we’re protesting so we can get people out of jail.
All programs need training and education on developmental disabilities, and chronic and severe mental illness that can lead to suicide. Train law enforcement in transgender [issues]. They have to understand these diagnoses and be educated and trained. If they can open more and more courthouses, jails and prisons, why can’t they do more training and programs for when people get out?! … We need advocates who support us, especially those of us who were harassed, targeted, or teased, or trafficked people. It’s not their fault if they get raped! …
I think sex work should be allowed–either legalized or decriminalized. Sometimes when you do sex work, you do what you can to survive and eat and feed your kids or get your sex change. Transmen, transwomen, we do it for different reasons… Treat us like… the humans we are! We need more transgender support groups and harm reduction programs, more more more trans support groups!”
4.1. Theoretical Contributions
4.2. Methodological Contributions
4.3. Policy Recommendations
4.4. Directions for Future Research
Conflicts of Interest
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In another study in Canada, sex workers experienced stigma from their HIV status and sex work and faced structural racial, gender, and sexual inequalities that created formidable health barriers and limited their coping strategies (Logie et al. 2011).
Trump’s weaponization of fear (Altman 2017) is linked to various legislative developments and immigration enforcement practices. These shifts include but are not limited to the passage of SESTA/FOSTA, the repeal of the DREAM Act for childhood arrivals, the separation of families at borders, and heightened surveillance by Immigration and Customs Enforcement (ICE) in courts and schools.
CHN has been providing community health and HIV+ service provision to mostly undocumented Latina transgender sex workers for over 30 years.
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Hoefinger, H.; Musto, J.; Macioti, P.G.; Fehrenbacher, A.E.; Mai, N.; Bennachie, C.; Giametta, C. Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US. Soc. Sci. 2020, 9, 1. https://doi.org/10.3390/socsci9010001
Hoefinger H, Musto J, Macioti PG, Fehrenbacher AE, Mai N, Bennachie C, Giametta C. Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US. Social Sciences. 2020; 9(1):1. https://doi.org/10.3390/socsci9010001Chicago/Turabian Style
Hoefinger, Heidi, Jennifer Musto, P. G. Macioti, Anne E. Fehrenbacher, Nicola Mai, Calum Bennachie, and Calogero Giametta. 2020. "Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US" Social Sciences 9, no. 1: 1. https://doi.org/10.3390/socsci9010001