ZeeSJSWHIV Interview

Z St. James, a sex worker and advocate, shares their journey into sex work and how they became involved in organizing and activism. They discuss the importance of decriminalization for all aspects of the sex industry, as well as the harmful effects of partial decriminalization policies. They emphasize that decriminalization would improve access to healthcare, safer practices, and reduce violence, including the risk of HIV. Z also highlights the discrimination and barriers they faced in accessing healthcare as a sex worker. They call for equitable care for sex workers, including anonymous testing for HIV, and advocate for policy changes such as full decriminalization, improved social safety nets, transgender rights, and ending the war on drugs. They stress the need for investments in housing and HIV-specific policies that prioritize privacy and confidentiality. Hi, I'm Z St. James. I go by they and them. I'm a collective member with Answer Detroit. I've been a sex worker for over 10 years and an advocate for about 8 years. I got into sex work as a young person. At first, it was to be able to afford living on my own and going to school. At this time, I felt very isolated. I didn't know anyone else who did what I did. Most of my sex work was arranged online, either through camming or setting up escort dates, so I didn't have a physical workplace where I would interact with other sex workers. Eventually, I would come across an online publication by and for sex workers called Tits and Sass. It was the first time that I learned what I was doing was called sex work. I also learned harm reduction strategies to keep myself safer and about the history of the sex worker rights movement. After connecting with workers online from around the country, learning how I could engage other workers in my area, I slowly started to get involved in organizing and activism. Right before the pandemic, I had reached the point where my disabilities made it so I couldn't work most jobs or finish school. It wasn't until I received pandemic unemployment assistance and had the time to organize mutual aid projects with my co-organizers at Answer Detroit that I started to imagine a different future for myself. Having a little more stability in my life allowed me to slow down enough to pursue gender transition. This was also during a time where remote work became more common. This leveled the playing field for me, and I was able to take on consulting positions that utilized my subject matter expertise around sex work, harm reduction, and sex worker rights movements, as well as lean into the world of grassroots non-profits to help build the infrastructure of Answer Detroit. Decriminalization means the full decriminalization of all aspects of the sex trades, so an end to the policing of what is referred to as prostitution, but also the policing of our clients and third parties. Third parties include managers and those who we may hire to help us, think booking assistants, drivers, etc. These laws also criminalize our partners, families, children, friends, and other systems of support. The people in our lives are implicated by association if we share housing, contribute to expenses, or if they accept money or gifts from us. Currently, sex workers are criminalized for working together or sharing a work space, making it even more difficult to keep each other safe, let alone begin to organize around our labor and human rights. Legislation that decriminalizes the selling of sex but criminalizes purchasing and other aspects of the sex industry, a.k.a. third parties, can put us in more danger. In fact, in places with these policies that are often referred to as Nordic Model, Swedish Model, End Demand, or Equality Model, we actually see higher rates of STIs, including HIV. According to UNAIDS, countries that criminalized key populations saw less progress toward HIV testing and treatment targets over the last five years, with significantly lower percentages of people living with HIV knowing their HIV status and achieving viral suppression than in countries that avoided criminalization. When we are criminalized for working together and when our clients are afraid of arrest, it restricts our ability to work safely. Clients are less willing to provide information to us to screen. We're unable to negotiate condom usage. Dates are rushed because everyone fears arrest. Full decriminalization of all aspects of sex work would make it safe for us to access health care, to implement safer sex practices, and reduce violence, which is a key risk factor for HIV. Social stigma is cemented by the criminalization of sex work. Criminal records are a barrier to employment. Even sex workers who do legalized forms of work, like porn work or webcamming, have their bank accounts frozen or closed because of their source of income. I first learned about harm reduction from other sex workers. I've often found myself in situations where I know more than the health care workers do. Unfortunately, my early attempts at self-advocacy with health care providers resulted in discrimination. For example, it took me far too long to get access to PrEP, which I learned about from a national sex worker warm line, because it was 2016 and I was assigned female at birth. One physician I sought PrEP from didn't even know there was a medication you could take that would prevent HIV. When I told him the reason I wanted it, he looked at my arms to check for track marks, profiling me as someone who injects drugs. When I finally did get set up with HIV prevention care, the frequent HIV testing showed up on my parents' insurance, putting a strain on our relationship. Now that I'm an advocate, I get invited to the table where policy decisions around HIV prevention and care are made. Being an advocate, I'm now invited to the table to talk policy around HIV prevention and care. I'm in rooms where they talk about people like me as numbers, as engaging in high-risk behavior. Knowing what I know now, there are still some issues that get in the way of equitable care for sex workers. The United States has a history of forced HIV testing upon arrest that is still practiced to this day. In a country where 30 states have policies that criminalize HIV, the potential of molecular HIV surveillance to criminalize our communities only serves to deter people from knowing their status. More often than not, when I speak up about these issues in state HIV care spaces, suddenly I'm no longer the expert. I'm an advocate without a college degree who doesn't know what they're talking about because data is inherently good, right? No. As Positive Women's Network says, people, not clusters. If you care about the health and safety of people in the sex trades, you'll make sure we have access to care that respects our privacy and the privacy of our partners, including anonymous testing for HIV. What policy and legislative changes need to occur in order to create equity and safety for sex workers? One, full decriminalization of all aspects of the sex trades. We already have the laws we need to prevent exploitation, but if we're afraid of arrest, how could we ever speak up about violence we experience? Two, the World Health Organization named five key populations to end the HIV epidemic. They are sex workers, men who have sex with men, transgender people, incarcerating people, people who inject drugs, and people living with HIV. We need policies that improve the lives of all key populations, which, besides decriminalizing sex work, includes health care for all and investment in broader social safety nets, ending the war on drugs, decriminalizing drug use, paraphernalia, implementing safe supply, transgender rights, freedom from violence, access to gender-affirming care, legal rights and protections in housing and employment, decarcerating people from prisons, and ending forced treatment, institutionalization, and family separation. Investments in housing first initiatives. After all, housing is primary prevention. Number three, HIV-specific policies that will have a positive impact on sex worker health include ending the criminalization of HIV, calling for a moratorium on molecular HIV surveillance, centering privacy and confidentiality in all aspects of care, and providing access to anonymous HIV testing.