The health and safety of sex workers: It's not an issue most of us tend to think about every day, but it's yet another example of how marginalized populations are often left out of essential public policy discussions on subjects like health care, housing, education, and workforce development.

That's why we thought it would be a good idea to jump on the phone with some leaders in the field of health and safety for sex workers to find out what philanthropy is doing, and what philanthropy could do, about this segment of our community. We talked with Scott Campbell, executive director of the Elton John Aids Foundation (EJAF), and Crystal DeBoise, co-director of the Sex Workers Project at the Urban Justice Center, to learn more about what is going on for sex workers, and what philanthropy can do to bring this issue in from the margins.

Part of the problem is that, due to the social stigma of sex work, people are generally more comfortable avoiding the issue. In philanthropy, both Campbell and Deboise stressed that this is a big part of the problem. Campbell noted how the issue of sex-worker rights is still taboo among some of the leading foundations. But if these foundations recognized how sex work is connected to other issues that funders are working on—like over-incarceration, homelessness, and poverty—the work they do could be more effective.

That's where the Elton John Aids Foundation, and programs like the Sex Workers Project, are stepping in to provide a better model that includes the care and protection of sex workers in public policy discussions.

"Philanthropy needs to go where government can't or won't go in terms of reaching this population," said Campbell.

Campbell talked about how, at EJAF, the goal is to support people who are HIV positive and to make sure that people who are at risk for HIV have access to the education and health care they need. "We want to make sure every HIV person knows their status and can get and stay on treatment," he said.

Campbell emphasized that philanthropy could play a bigger role in reducing HIV/AIDS by investing in programs that take a nonjudgmental approach to sex work, and that provide harm reduction counseling services. "We want to create programs that emphasize options for people in the center of this epidemic," he said. "At all times, we want to respect their human rights."

DeBoise added that philanthropy needs to help remove the barriers to access to health care and other services for sex workers. She also agreed emphatically with Campbell's call for funders to provide the resources for nonjudgemental harm reduction services. "These are respectful approaches, and sex workers live in an environment that's criminalized and stigmatized, so taking those extra steps to meet people where they're at and honor their experiences is key."

Both emphasized access to legal services and its critical role in helping sex workers. Funders who are trying to tackle homelessness, poverty, or workforce development, should look toward investing in legal services for this population to help.

"We are the only legal services organization for sex workers in the U.S.," said DeBoise. "This is a major unmet need."

The kinds of legal services that sex workers need range from help with workplace discrimination issues, such as being fired from jobs when employers find out about sex work, to being rejected from housing because the landlord discovers a sex work history. She also talked about how many undocumented people are engaged in sex work because it is one of the only ways to earn income, and are in need of help with the immigration process to obtain a work visa.

I asked DeBoise and Campbell if they foresee the possibility of funders coming together to really hammer on the problem of discrimination against sex workers. "It's happening with collective advocacy," Campbell noted. "The Red Umbrella Fund is a group that has come together on this globally," he said, as advocates supporting an agenda for human rights for sex workers. (We've reported before on the Red Umbrella Project, a separate group which focuses in New York and has received support from the New York's Women Foundation, among other funders.)

Related - Dept. of Edgy Grantmaking: $60K to a Group Supporting Sex Workers

But neither Campbell nor DeBoise predicted that big funders would be coming together to impact the health and safety of sex workers anytime soon. "I think there's a lot more education that needs to happen," said Campbell. He and DeBoise recently participated in a panel discussion at Funding Forward for the very reason of bringing this issue to a larger funding arena—in this case, funders for LGBTQ issues.

"One of the things we were trying to do in that conversation is make it clear the variety of intersecting issues that bring people to sex work and why other funders should be interested. So homelessness, poverty, over-incarceration," said Campbell, are all issues that often intersect with sex work.

DeBoise talked about legal progress that is being made. The Sex Workers Project wrote a bill in New York State in 2010 to vacate convictions of anyone who was trafficked. Since 2010, the project has had 244 convictions successfully vacated. "That is an immediate relief to all of those former sex workers who are now seeking work, and just the psychological relief to get that off your record."

The project advocates decriminalization because, said DeBoise, the evidence is overwhelming that it's what is needed to meet the needs of sex workers for health care and legal help. "We cannot underestimate the negative impact of criminalization on a population that is selling sex mostly to get by financially," said DeBoise.

The safety of sex workers, DeBoise said, would also be greatly improved by decriminalization. Because of criminalization, sex workers are at greater danger for physical and sexual violence, because perpetrators know they are unlikely to come forward to police. With decriminalization, more sex workers could report the violence they experience, making the community safer for everyone.

DeBoise noted that in New York, some police protocols are finally beginning to move toward an approach that reduces arrests for small crimes and is realizing the benefits of doing this. She said that if we could redirect some of the money spent on "broken windows policing" into services for sex workers like access to health care and access to social services, there would be a wealth of resources available to serve this population.

As the pendulum swings against Draconian law-and-order policies, with a variety of reform efforts now underway, including the legalization of pot in several states, finding more constructive ways to deal with sex work is another obvious area for change.

Still, while decriminalization is an important advocacy priority that LJAF funds, Campbell said that the foundation's first focus is services to improve the health and safety of sex workers. "Our focus is saving lives."

One area that funders and nonprofits could further emphasize, said DeBoise, is helping LGBTQ youth who are involved in "survival sex" because they've been kicked out of their homes, often for being gay. "This is a huge unmet need." With only 200 beds available in New York City, said DeBoise, and about 4000 homeless youth on any given night, this young, vulnerable, and marginalized population has major unmet needs.

I asked about the growing awareness of LGBTQ issues in the U.S., and whether children coming up now might be more willing to address the concerns of sex workers in the future. Both DeBoise and Campbell were hopeful that this might be the case, but didn't see this transition as imminent. "I don't think it's really on the table yet," said Deboise. "There are not enough resources for this population at all, and it's also a population that's criminalized higher than others."

Both Campbell and DeBoise also raised the issue of including the transgender population in policy discussion. "I know nationwide a lot of trans youth do not get into shelters," DeBoise said.

"There are huge challenges that transgender people face," said Campbell, noting that even within the LGBTQ community, there is difficulty with inclusion of transgender people. "So the more we can talk about this, and the more people can realize the linkages, the better."

Campbell and DeBoise talked about the need for philanthropy to support programs that provide wraparound services—access to medical care, legal help, and access to education and employment. DeBoise also advocated for supporting a "peer workers" model for sex workers, where sex workers can help each other with access to needed services.

"We need more research on this population," DeBoise said, stressing that funders who make such research a priority will be doing a critical job. For example, it's not even known how many sex workers there are in the United States.

DeBoise's advice to nonprofits that work with the sex worker population: "Get involved in policy making." Whether needle exchange or counseling, said DeBoise, direct service providers on the ground need to take that information and use it to create policy that's helpful.

"They also need to understand the linkages with issues they are already working on, so if they're an organization for homeless youth, they understand that there's a connection there," added Campbell.

Campbell hopes more organizations will come forward seeking grants from EJAF as awareness about the needs of this community increases. He hopes as the issue gets more attention, the foundation will receive more requests for funding. How's that for an invitation?

Related: