I’ve struggled with severe insomnia for years. A few weeks ago I received a recommendation for a local hypnotherapist who specializes in sleep disorder issues, so I rang her up for an hour-long phone intake. “Liz” had a very distinctive voice — deep, raspy, commanding — and, as we exchanged information, I couldn’t shake the feeling that I’d heard it before. My stomach grew restless with anticipatory dread. When she directed me to her website to reference some materials, my reluctance was palpable. Sure enough, a professional photo of her smiling face stretched across the homepage. I let out a groan as soon as I recognized her.
Liz owned the domination house in which I saw private clients in San Francisco. We’d shared each other’s company dozens of times, whether to exchange money or to work doubles sessions together. My most recent memory of Liz is of her face, skin flushed and smile wide, as we suspended a man from the ceiling while taking matching leather whips to his balls. I’d had no idea that she managed a hypnotherapy practice on the side, advertising her services under a different name.
Liz was amused when I interrupted her to share my discovery.
“Andre! I thought you sounded familiar, too,” she chuckled. “Sorry about the insomnia, but you know I can’t help you now, right?”
“I know,” I acknowledged mechanically. I terminated the call before Liz could respond, collapsed on my bed, and took a long, defeated drag off a fat joint.
Sex workers and LGBT individuals already face unparallelled challenges when it comes to receiving comprehensive, non-discriminatory, financially accessible healthcare in the United States. We’re disproportionately uninsured and routinely expected to endure being condescended to, misgendered, victimized, criminalized, and shamed by those we’re going to for help. To make matters worse, we’re frequently forced to educate our own providers on how to best serve and treat us, taking on undue emotional labor when we’re at our most vulnerable. That’s why it’s so important that our providers prioritize inclusivity, accessibility and familiarity with our unique care. Finding one of those magical providers — and building trust with them — can sometimes feel like a pipe dream.
When queer sex workers like me seek healthcare, we can’t afford to take chances by calling our insurance companies for recommendations or perusing Yelp reviews. We instead research non-profit organizations and clinics with sliding-scale payment options only to be put on lengthy waitlists with no guarantees, or rely on personal referrals from peers to ensure that we’ll be entering informed, respectful safe spaces. You’d think this process would significantly narrow the chances of a professional incompatibility, but apparently that’s only the case if you’re a queer sex worker who never leaves the house and has a subtle social media presence. If you’re “unpopular.” If you’re invisible.
My interaction with Liz was the latest in a long string of providers denying me services because of my connections and “stature” within the very marginalized communities that limited me. Over the course of two agonizing years I had MFT interns recognize me from my pornographic work mid-session, psychiatrists cancel upcoming appointments after discovering we had mutual Facebook friends and relationship coaches bolt when realizing they’d taken workshops from me at sexuality conferences. I was even recently denied access to a sex worker support group because the group facilitator and I had shot a porn scene together almost four years ago.
With each letdown came the same message: “I can’t. It would be an ethics violation.” It became a running joke between my partners and I, that I was both too stigmatized and too famous to get my needs met. For a while, one of my partners took on the role of secretary, calling around and vetting providers on my behalf. He’d sacrifice entire afternoons collecting fresh leads when my feelings of being “othered” paralyzed my search.
Considering that sex workers and LGBT folks are dramatically impacted by suicide — oftentimes motivated by feelings of extreme isolation — my situation seemed darkly ironic.
In the end, I’m sorry to say that I burned out. I lost drive; I lost hope. These days I mostly rely on Planned Parenthood for physical health needs, personal growth programs to fill my mental health services void and physician friends across the country to write me emergency prescriptions if time is of the essence. I’ve maintained my fitness routine, started a new vitamin and supplement regiment and upped my self-care ante. A friend recommended 7 Cups of Tea, a complementary online app that has trained listeners available 24/7, and I use it occasionally in times of extreme stress and anxiety.
I wouldn’t even have half of these minimal resources available to me if I weren’t so well-networked, and if I didn’t live in the state of California. Under an impending Trump presidency, California is one of the few places in the country that stands a chance of continuing to accept and protect people like me. I’m also a white, middle-class cisgender woman with functional depression. Even as a marginalized person, my privilege is directly responsible for the small survival gains on which I’ve come to depend.
I’m no stranger to professional codes of ethics. I can empathize with providers having to make challenging judgment calls around exhibiting healthy boundaries and not treating people they “know.” But where do we draw the line? Are there ever acceptable ways of knowing a potential patient outside of one’s practice? I strongly believe that part of being an ethical provider is making sure treatment isn’t withheld when it is needed, particularly when that treatment involves services for underprivileged communities. Due to how tightknit these communities can be — and how much overlap can exist between them — there’s a good chance that you’ll “know” any provider to which you’re referred. If the current knee-jerk reaction in these circumstances prevails — one where providers are so fearful of incurring an ethics violation that they don’t even bother to strategize alternative or creative care for the community member right in front of them — then we’re doomed. This litany of complex and amorphous barriers to care impacts far too many queer sex workers, and ensures that they don’t receive the healthcare services they desire and deserve. I, for one, would like to live a long, happy, healthy life. I just wish I didn’t have to fight tooth and nail to do so.