“How different it would be if for a moment health care providers could feel what we feel when we go to a hospital and are challenged…”
And so, the women sex workers of RedTraSex (Network of Women Sex Workers from Latin America and the Caribbean) developed Ponte en Nuestros Zapatos (re-edited 2015). Now, reaching out to a wider community, is the brand new English version Walk in our Shoes: Good Practices Guide for Health Care Staff (2016, translated by Alejandra Sardá-Chandiramani). Yes, it is so brand new that it is not up on their website as yet, though we have permission to use it here.
As the RedTraSex women say, “In this society that with its double moral standards condemns us but also demands our services, health teams are our friends. Indispensable allies. This is why we wrote this Guide based on our experiences and in our own words. We wanted to talk to you in the first person, as a sex worker to a health care provider.”
Here are two excepts from Chapter 2: Illnesses related to conditions at work.
OUR REALITY
In every job, the conditions at work can have a direct impact on workers’ health. They can cause illnesses, accidents, a reduction in their life expectancy and, sometimes, even their death. Health teams need to know the conditions under which women sex workers conduct their trade so they can identify the ailments we may suffer from and know how to treat them. As one of us says, “Our health problem do not start or end in our genitals”.
When referring to women sex workers’ health issues, the only ones mentioned are typically HIV/AIDS and Sexually Transmitted Infections (STIs). But we experience many other situations that need to be taken into account.
First and foremost, most women sex workers don’t tell anybody the kind of work they do for fear of being rejected and discriminated against by society at large and, most particularly, by their most loved ones. As a result, they also don’t describe their work and life conditions to medical practitioners even when those could be the direct causes of many illnesses.
For example:
“In the streets you get the rain, the heat, there is traffic all the time…”
“When we get our period, I use the sponge to go to work and that has brought me several infections already. I would like to rest on those days, but I can’t lose the money.”
“The bars are full of smoke.”
“We spend a lot of time standing, with high heels, in the cold. That has consequences: varicose veins, arthrosis.”
“Some of us go far away to work, the issue of uprooting is also important.”
“The music is so loud that I have lost my hearing, I have a buzzing sensation in my left ear.”
All these situations and many others are hardly known about. Stigma and double moral standards make society view women sex workers only as those body parts associated with sex work. Historically, health policies have been focused on “protecting” the rest of the population from Sexually Transmitted Infections instead of caring for the health of women engaged in sex work.
In this Guide, health practitioners will find a different proposal: to take care of women sex workers from a comprehensive perspective, seeing us as what we are: persons with rights who, like everybody else, feel vulnerable when our health is compromised, and need to be assisted with warmth, quality, respect and confidentiality.
Seeing women sex workers as entitled to comprehensive health care without stigma or discrimination is a recent perspective. In Latin America, there is still very little known about health care needs related to the working conditions for sex work.
This is why organized women sex workers invite health care teams to work together with us in the different countries. These Guidelines, drafted together with health professionals who have already been sensitized, are a first step towards working together towards a common goal: being able to speak freely with all healthcare professionals about our work, with the certainty of being treated on an equal basis with everybody else, being provided with quality healthcare by committed and respectful professionals, and protected by confidentiality. We know that if you are reading these lines, it is because in you and in the team you work with – doctors, nurses, administrative staff and social workers – we have allies to start moving towards that point where which our rights are respected and the lives of all of us are improved.
SITUATIONS AFFECTING OUR HEALTH
On the next page you will find a chart with the work conditions affecting women sex workers’ health.
We suggest that each healthcare team, based on its own experience and together with women sex workers’ organizations in its country, improves and expands this initial description. In this way, we will be able to jointly improve quality of care with a comprehensive health approach to healthcare.
| WORK CONDITION | HEALTH PROBLEM |
| WORKPLACE | |
| HOTELS AND SAUNAS:
– Lack of water to clean yourself and have a shower – Using the same sheets with different clients – Fleas – No toilet paper – Cloth and not disposable towels |
– Skin swelling
– Scabies – Lice in the pubic area – Fungus |
| CABARETS AND BARS:
– Humidity – Closed environments with a lot of smoke – Exposure to weather changes by going in and out of the premises with clients |
– Respiratory diseases |
| IN THE STREETS:
– Exposure to street violence |
– Beatings
– Knife or firearm injuries |
| ALL WORKPLACES:
– Working standing up – Walking on high heels for a prolonged time |
– Varicose veins, swollen veins
– Fainting, headaches, fatigue – Foot mycoses, bunions, scoliosis, metatarsal problems – Lower back pain |
| BOSSES (Supervisors, pimps, policemen) | |
| – Police violence | – Beatings and torture
– Having to pay bribes – Having sex with policemen to avoid being taken to jail – Psychological crisis due to fear – Being locked up in jail |
| – Working extra to pay those who demand money for letting us work
– Over-working to feed one’s kids, pay for the room, other needs, etc. |
– Fatigue, physical tiredness and over demands on the body
– Emotional damage due to pressure from policemen and pimps, linked to the violence and abuse they inflict on us so we pay them |
| – Pimps do not allow women to leave to see the doctor when they experience genital pain and discomfort | – Self-medication with capsules sold in pharmacies that are sometimes not right for what we have. |
| – Being pushed to drink with clients
– Being pushed to use drugs and sell them to clients |
– Risk becoming dependent on particular substances
– Risk of being prosecuted for drug-related crimes |
| – Alcohol and other drugs are used by bosses and pimps to control women sex workers | – Vulnerability and docility: it is easier to take away our money if we are drugged, and we have fewer reflexes to resist when faced with abuse, sexual exploitation or extortion. |
| – Social stigma and discrimination
– Double-life of women sex workers |
– Guilt and low self-esteem
– Anxiety and anguish – Emotional dependence on the partner – Suicidal attempts – Violence towards one’s children – Being rebuked by one’s grown-up children |
| GENITAL HYGIENE | |
| – Use toilet paper all the time | – White discharge with lumps |
| – Frequent vaginal cleansing | – Eliminates vaginal flora
– Yellowish and foamy discharges – Dry vulva: less lubrication which makes it more likely for the condom to break |
| – Compulsory use of sponges when menstruating
– The sponge stays inside |
– Bad smell
– Vulvo-vaginal infections that can become very serious – Sexually Transmitted Infections |
| SEXUAL PRACTICES | |
| – Oral sex without condoms | – Sexually Transmitted Infections |
| – Using condoms too often
– Lack of access to water-based lubricants |
– Genital fissures
– Infections caused by dryness |
| – Clients pay more for sex without condoms, bosses put pressure on us to work without condoms | – Sexually Transmitted Infections including HIV
– Unwanted pregnancies |
| – Accidents with condoms: they remain inside the vagina, break or slip, or the semen leaks out | – Infections caused by condoms remaining inside
– Unwanted pregnancies – Sexually Transmitted Infections |
| WORKING DURING PREGNANCY | |
| – Having sex often | – First quarter: Vulvo-vaginal infections and greater risk of abortion due to rough intercourse
– Second quarter: Infections with discharges – Third quarter: Premature birth risk |
| – Not using condoms | – Getting a Sexually Transmitted Infection (HIV, syphilis, chlamydia) with a high risk of passing it to the baby during the first stage of the infection
– Some of these infections can cause skin diseases, malformations, disability and even fetal death |
| NUTRITION | |
| – Unbalanced eating, lots of street food | – Acute diarrhea
– Obesity |
| – Drinking lots of coffee and carbonated drinks to control one’s weight and save money |
– Malnutrition (very thin women with large bellies) – Gastritis: stomach burns and acidity – Ulcers that burn, hurt and bleed |
Every chapter ends with recommendations for health care providers. Walk in our Shoes will soon be on the RedTraSex website.
