Sex work has had a central role in my professional life since I was 19. I still remember the conversation that started it all, leaning against the door to the ladies toilets behind the library in my university. I had been tasked with writing an essay on sexual health education and the impact on STI rates. Feeling uninspired as I had already worked in schools doing sex education and looking for something new, I was speaking to a friend in the year above. She had recently had some lectures about the forgotten groups in sexual health and wondered if that could help me find my way. One of these groups were sex workers and a quick literature search showed me that there was enough data for me to write an interesting essay – but also, really not enough support or infrastructure for this group of individuals.
My initial essay looked at sexual health interventions for the sex working community in the UK. This introduced me to the world of criminalisation and how this impacted upon the health of sex workers. It was through thorough balanced research that I reached the conclusion that decriminalisation allowed empowerment of those who choose to sex work whilst supporting those coerced or vulnerable. However, this concept is often squashed with the misconception that it increases sex working numbers.
Having submitted my essay and trying to figure out how to be an advocate, it was another perfect accident that occurred: A local homeless charity was doing a guest lecture at my university, where they spoke at length about their work with sex workers. At the end of the lecture, I tentatively approached the team, explained my research and my desire to be part of the change. They welcomed me with open arms, explaining they needed new outreach workers... and that was that! I spent the next five years of medical school doing one night a week as an outreach worker in Brixton, South London. We gave out condoms, clothes and food. We offered health, social and legal advice. It transpired that many outreach workers had been sex workers themselves and now came with a variety of skills to support the health of this often neglected community in the UK.
I continued to work on the academic perspective, too. I wrote a dissertation comparing legal frameworks surrounding sex work and the health outcomes around the world. I developed teaching aids for medical students and healthcare professionals to promote open-minded and holistic care. During my public health rotation, I investigated the decriminalised zone in the city of Leeds in Northern England and how they were showing improved health outcomes for sex workers compared to the rest of the country. I became fully immersed, creating my own subspecialty of occupational health!
With my catalogue of evidence and genuine desire to both learn and help in whatever way I could, I approached The New Zealand Prostitutes Collective (NZPC). Founded by a group of sex workers, including Dame Catherine Healy, in 1987 in response to the lack of access to health care and workers rights, NZPC has supported sex workers and campaigned tirelessly since. They were at the forefront of the Prostitution Reform Act in 2003, decriminalising nearly all aspects of sex work in New Zealand. Three days after qualifying as a doctor, I was on a plane to Wellington. I spent two months living and working with the Collective. I met incredible people, worked with sex workers from all walks of life and from all around the world. I provided healthcare and updated guidelines but equally, they taught me much more. It was during this time I first learnt about menstrual sponges, which ones were safe (and which ones were not!) and a lot about removing them. I began to challenge unconscious biases that I didn't even know I had whilst writing reports at an international human rights level... When I had to return to the UK to start my internship, my heart broke! It was worse than any break-up I have had before or since.
Click here for Elesha's article "Soft tampons vs. menstrual sponges - everything you need to know."
Upon return to the UK, I worked with the London School of Hygiene and Tropical Medicine. I was a community researcher doing outreach work with the sex work community of East London. I interviewed sex workers in a variety of settings about their experiences with health care professionals and the police. Some of my most memorable interviews include spending time in a Bulgarian brothel and hosting multiple interviews in a 24hr McDonalds at 3 am. The evidence is still being collated but as you can imagine, the criminalised nature, as well as the current relationship with police in the UK, means that people are often having incredibly poor experiences.
Covid massively moved the face of sex work in Britain as large portions moved online, making platforms such as OnlyFans so successful. I spent summer 2021 going back to my routes as an outreach support worker in Athens, Greece. The street-based sex workers of Athens were largely a resilient, self-sufficient group who were wary of healthcare professionals, largely as spending too much time with us on the street could disrupt their income!
Sex workers are a diverse, vibrant community but it is the criminality in which they sit internationally that often leaves them vulnerable. I urge you to do your own reading, explore the issues around sex work with an open mind. I personally think it is an important issue that you should make your own decision about.
Any questions – please reach out. My door is always open.
Dr Elesha x