Sex Worker Health and Social Justice: A Critical Ethnography of Sex Worker Mobilization to Address Health Inequalities

Purpose The purpose of this critical ethnographic study is to examine sex workers' engagement with the health policy issues they identify as harmful to their health.;Background The "problem" of sex work and health is situated at the nexus of multiple competing perspectives and moral paradigms that define health priorities for sex workers in research and policy. Sex workers' own perspectives are rarely central to analysis of this problem, leading to research and policy solutions that contribute to silencing sex workers' priorities.;Methods I collected ethnographic data from four sources: In-depth qualitative interviews with 35 sex worker activists and advocates in a metropolitan area of the North American West Coast; 60 hours of participatory and observational fieldwork of sex worker activist and advocacy events; 14 informal field interviews; and public discourse analysis on sex work in the state and local area. I analyzed data following a grounded theory approach.;Findings Sex workers were active participants in defining health issues and setting policy agendas to address the inequalities that impacted them. These efforts were transformative in challenging the dominant social constructions of sex work, and in clarifying the social structures that shape sex workers' health and human rights. Sex workers challenged homogenous portrayals of sex work as a violent sexual risk behavior, and claimed structural drivers of health inequalities as policy priorities. Violence experienced by sex workers at the interpersonal level was perpetuated and justified by structural and symbolic violence, devaluing sex workers' lives. Sex workers' potential to contribute to social change was largely dismissed in society, as dominant understandings of sex work portrayed them as social deviants or victims.;Conclusions Sex worker activism is focused on addressing broad social injustices that drive health inequalities and their associated risks within sex work. Through collective action and grassroots organizing, sex workers are shifting the paradigm of the "problem" of sex work, situating it in multiple systems of oppression. Creating formal mechanisms to include sex workers' perspectives and experiences in the development of policies that have direct health implications for them is necessary for the improvement of sex worker health.