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Sex Workers Deserve Mental Health Care, Too

Sex work is a difficult job. Many in the field have few (if any) workplace rights, and there’s a high risk of abuse and violence.

Anywhere from 45 to 75 percent of sex workers around the world experience workplace violence in their lifetime, according to a 2014 review. Plus, intense stigma around the profession can both negatively affect mental health and dissuade people from seeking treatment. 

Yet sex workers ― a term that describes a plethora of jobs related to sex and eroticism, from adult film stars and strippers to people who work at brothels or on the street ― rarely feature in discussions about mental health. There are few studies on the topic, and the research that does exist is limited in scope, often omitting male and transgender sex workers, for example. In fact, trans people and people of color make up an outsize segment of the sex worker community, yet they’re often left out of the conversation entirely. 

Sex workers are regular people, says Dr. Victoria Hartmann, and they deserve access to mental health care just like anyone else. Hartmann, 48, a clinical sexologist, certified mental health counselor and executive director of the Erotic Heritage Museum in Las Vegas, has spent over 10 years working with sex workers. An advocate for the rights of sex workers ― a community that includes her own husband ― Hartmann fears that recent legislation will intensify the stigma they face.

In April, President Donald Trump signed the FOSTA-SESTA bill package aimed at curbing online sex trafficking. Critics of the legislation say it conflates voluntary sex workers with victims of trafficking ― and puts at risk the privacy and physical safety of sex workers, many of whom use online forums to advertise their services and screen clients. Opponents of FOSTA-SESTA also warn that it could make sex workers even more vulnerable to violence by driving their work deeper underground.

HuffPost sat down with Hartmann to talk about her work with this marginalized group and how to be an ally to the sex worker community.

It’s important to make a distinction between voluntary sex work and sex trafficking. Can you describe the difference?

When a person willingly takes part in the sale of sex, it is consensual and doesn’t affect their human rights ― this is called sex work. When a person takes part in the sale of sex through threat, abduction or other means of coercion ― this is called sex trafficking.

You live in Nevada, where brothels are legal in some parts of the state. No other state in America does this. Do you think that legal difference might have an impact on sex workers’ mental health?

I think legal sex work contributes to better mental health for sex workers. When there is suppression, any time we have to hide our mental health challenges, or any time we have to hide a part of ourselves, we find ways of coping that might be detrimental to us.

One of the things that helps the sex worker community in Nevada is that you can work at a brothel and you can choose to say, “I am a legal sex worker.” Not all sex workers would say this — because some still want to be incognito. But some of the sex workers will. And they can go home to their families, and they don’t have to hide that part of themselves.

Before you were the director of the Erotic Heritage Museum, you provided mental health counseling to sex workers. Why did you choose to work with this particular group of people?

They’re just really underserved. When I was working for a rape crisis center in Oregon, there was a lot of resistance to providing services to them. In Oregon, you don’t have any option of going to a brothel where you have legal sex work and the protections that come with that. I knew a lot of people there that were in the sex work industry that were struggling ― whether it be in adult films or street work. And when I tried to organize group therapy for these workers, one of the administrators stated, “Their work is inherently violent, so they’re kind of inviting the violence that that work entails.” I was completely taken aback by that.

So when I went into private practice, I wanted to do exactly the opposite. I don’t believe that being a sex worker means you have to deal with violence. My focus is to advocate for safe and consensual environments for people to engage in sexual behavior of their choosing.

It sounds like your profession can be hostile to sex workers. Can you explain that?

Well, that’s a really good question. Now, I’m a sexologist ― not a psychologist, not a sociologist. And in sexology, our approach to any kind of sexual issue or sexual profession is one of “management.” We stay away from saying “There’s something wrong with you,” or “You’re sinning.” Instead we ask, “How do we manage this effectively?” So, I’d say my profession is very welcoming of sex workers. But when you get into other realms, it seems there’s this mentality: “OK, your sex work is the cause of a lot of problems, and we’ll go from there.” They tend to look at the sex problem first, and then reach out and make that the target of repair or definition, and with sexology we don’t do that.

But it seems like the tide is definitely turning. You’re seeing a lot more mental health professionals who are embracing those who work as sex workers. But that shift has been happening more or less over the last five to 10 years.

What do you think is behind that shift?

The internet and social media have been a big contributing factor toward the destigmatization of sex work in the modern era.

Part of it is adult material has become much more widespread in its use. It’s much more public. And social media has been incredibly instrumental in the destigmatization of sex work, because you have people who are online promoting their business. Especially the female sex workers and female-identifying sex workers who are going online and saying, “Yes, I do this work. I’m a businessperson, I’m promoting it.” 

And now I think, especially with the passage of FOSTA-SESTA and how it’s affected more than the street-worker community, people are starting to recognize how sex workers are marginalized.

What do you think are some of the most effective ways to combat the stigmas around sex work and mental health?

Mental health challenges are not unique to a few. And if we each as an individual can say “Yes, I struggle with this,” we might be able to give someone else permission ― just in the act of being honest ― to be honest as well, and to go and get the help that they need.

One of the big things I experienced when I was working in private practice was that people just wanted be accepted for who they are, where they are, at the time that they are. And that included not always being OK, and not always having a smile on your face.  

How have you used your position as the executive director of the Erotic Heritage Museum ― which presents erotica as a way teach different aspects of sexuality through an academic lens ― to support this community?

I provide the space here at the museum for sex workers to meet and discuss issues they’re dealing with. Sometimes guest speakers come in, or a sex worker-organized event is arranged here. Generally I donate the space, I don’t make them pay for it. They’re already under a barrage of persecution by our government right now. I provide a space for sex workers to feel, well, human like the rest of us ― where they’re accepted and not judged for the work that they do.

Anything else you want people to know?

Sex workers are just like anyone else. They might do this work during the day and then go home and watch science shows at night with their kids while they’re doing homework. And for us to recognize the humanity in all of us and not put each other in a box and shut that box and close the door ― that’s what the basis of my work is.

This interview took place over the phone and by email. It has been edited and condensed for clarity. 

Need help? Visit RAINN’s National Sexual Assault Online Hotline or the National Sexual Violence Resource Center’s websiteCall 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

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