Sex worker peer research practice
Trans and Male Sex worker (TaMS) project
This first case study describes work undertaken by Respect Inc, the lead peer-based sex worker organisation in Queensland, Australia, as part of the 2018 Trans and Male Sex worker (TaMS) project. This community participatory project involved a collaboration between Respect Inc and The University of Queensland, investigating the sexual health experiences and needs of trans and male sex workers in Queensland. Findings from it highlight the importance of peers driving research and critical points of leadership and participation across all aspects of research.
This qualitative study included semi-structured interviews - undertaken by two peer researchers - with 35 transgender and male sex workers from across Queensland to explore identified topics including work experiences, stigma, healthcare experiences and desired changes to improve sex workers’ well-being. Data were analysed by one of the peer researchers in collaboration with The University of Queensland researchers to identify trends and themes. In the project, to overcome power imbalances between university and sex worker stakeholders, the research partners developed a collaboration embedded in mutual respect and acknowledgment of the rights and responsibilities of all, outlined in a memorandum of understanding.
Universities typically hold grant or research money. In the TaMS study, the grant signatories were Respect Inc and The University of Queensland. Significantly, Respect Inc drove project spending and other major decisions. A TaMS steering committee, involving peers and academics and led by the lead peer investigator, directed and monitored all research activity, from study design and data collection to analysis, reporting and presentation. Peers also led the authorship of the TaMS Report (Jones et al. 2018) and this case study. Peers represented the project in the public sphere - including at the International AIDS Conference in Amsterdam (2018) and the Australasian H1V&AIDS Conference in Sydney (2018) - reinforcing the importance of sex workers leading project outcomes.
Research underpinned by a community participatory approach enables peers to develop research skills. Peer researchers received training from the academic partners in interviewing, data collection, qualitative analysis and reporting. These are core skills that may create longer-term career opportunities for peers. In the TaMS project, peer researchers drove recruitment and completed all interviews, gaining access to participants that a mainstream project never could, such as in unlicensed brothels.
To date, much funding for sex work research has been associated with the promotion of sexual health, with an emphasis on HIV and sexually transmissible infections (STI). This can result in a blinkered, singular focus on the pathologi-sation of sex work. Trans people (primarily trans women but also trans men and others) are often combined with cis men as research participant groups. This conflation of intersecting yet discrete communities is a recognised problem in the HIV and STI sectors. In the TaMS project, the funder’s priorities meant that cis male and trans workers were again merged into one project, demonstrating that
Sex worker-led change 237 collaborative research faces the same problematic trends as any other and is not immune to their potential pitfalls.
TaMS results identified that most participants described stigma and discrimi-nation as barriers to accessing health services, however, these experiences differed between transgender and male sex workers. In particular, cis male workers spoke of the impact of homophobia but not as a specific barrier to access. Trans workers experienced transphobia and described how this combined with a lack of appropriate transgender affirming healthcare was a key barrier to accessing sexual health services. These differences highlight the problem with merging two very separate populations in a research project, even when all are sex workers.
The challenges of merging discrete populations, which is often driven by funders’ priorities rather than community needs, raises the question of how to be critical in defining the topics pursued. Understanding HIV and STI issues must include exploration of general well-being and human rights. What peers wanted from the TaMS project was advocacy for décriminalisation, as a step towards improving sex worker health and well-being. How, then, could the TaMS project advance décriminalisation of sex work?
The research analysis identified themes relating to human rights, privacy, police abuse, stigma and marginalisation resulting from the law. This provided evidence of systemic obstacles of relevance to sex worker communities. As such, although décriminalisation was not specifically addressed in the research interview questions, it was an overarching theme and was presented in the final report as a determinant of sex worker health.
In the case of the TaMS project, the main output was a report to State government, with the sex worker peer researchers as lead authors. The report was presented to the State Health Minister, but the government has not provided funding to implement the project’s key recommendations. Respect Inc has prioritised work identified by the TaMS outcomes, in particular sustainable, ongoing peer education led by trans and male sex workers. However, once the research was complete, and without follow-up funding, there was no ethical way to reorient service provision and institute identified recommendations, short of cancelling other activities. Problems often arise in short-term or brief activities targeting marginalised communities. TaMS identified that a longer-term commitment is required for project work to be fair, equitable and genuine. Nonetheless, the report has provided guidance for short-term work.
Engagement between the peer and academic researchers did not end with the TaMS report. The University of Queensland team and Respect Inc forged a relationship during TaMS that continues today. Activities by the university researchers include media involvement and lobbying for sex work décriminalisation, support within the health sector to raise the profile of sex worker issues, speaking at joint events, and discussion of trends and issues. The University of Queensland and Respect Inc workers are in the same sector and can harness academic and health practitioner credibility in support of décriminalisation, ensuring that sex worker demands receive attention in ways that sex workers alone cannot achieve. Messages from sex workers may be taken more seriously comingfrom academics, raising the issue of how to achieve that balance without academics taking over. The TaMS relationship has built trust between these groups.