Experiences of stigma and discrimination can dissuade sex workers from seeking mental health services, according to new research published in the journal Sexual and Relationship Therapy. The study uncovered a “concerning level” of stigma facing sex workers who seek support from professional psychologists and psychiatrists.

“Sex workers face routine stigma and discrimination in all areas of society,” said study authors Josephine Rayson and Beatrice Alba of Monash University.

Rayson in particular witnessed “countless examples of sex workers facing negative treatment, stigma and discrimination, including by mental health professionals and in mental health settings” when she managed the Western Australian Sex Worker Organisation (Magenta).

“We don’t believe the general public are aware of just how extensive this kind of negative treatment is. Often the general public may assume that professionals like doctors, police, and mental health professionals (which may be accessed during a time of vulnerability) are always helpful and don’t cause harm. In reality, they can be a source of trauma for marginalised communities,” Rayson and Alba explained.

For the study, the researchers surveyed 189 current or former sex workers (ages 18 to 60 years) regarding their experiences of stigma and discrimination from a range of professionals. The participants were from 22 different countries, but the majority were born in Australia and the United States.

Approximately 64% of the participants said they had “sometimes,” “often,” or “always” experienced negative treatment, stigma, or discrimination in general because of their status as a sex worker.

Similarly, approximately 57% of participants who had sought mental health support said they had “sometimes,” “often,” or “always” experienced negative treatment, stigma, or discrimination from mental health professionals.

The researchers also found that experiences of stigma and discrimination were associated with a lower likelihood of seeking professional help. Approximately 79% of the sex workers said they would be very unlikely or less likely to seek mental health support in the future because of past experiences of stigma and discrimination.

“It is important to emphasise that this study is not suggesting that sex work causes mental health difficulties, or that sex workers necessarily have mental health difficulties. Rather, that everyone in our society deserves access to quality mental health support, but sex workers often don’t get this,” Rayson and Alba told PsyPost.

“Furthermore, the purpose of our study was to show that the stigma and prejudice that sex workers can experience from mental health professionals can itself be a source of psychological distress, and make them less likely to seek help.”

But not everyone who engages in sex work experiences stigma — and not everyone who experiences stigma faces negative mental health outcomes.

“There is a lot of research linking stigma and discrimination to poorer mental health. However, this is certainly not an inevitable outcome for sex workers. Not all sex workers report experiences of stigma or discrimination (Benoit, McCarthy & Jansson, 2015; Hargreaves et al., 2016), and not all of those who do will necessarily experience mental health difficulties as a result (Sanders et al., 2017),” the researchers explained.

“In a Vietnamese study conducted by Ngo et al. (2007), researchers found that those who framed sex work as a profession like any other became indifferent to criticism, experienced little stigma, and demonstrated higher self-esteem.”

Previous research has found evidence that sex workers who face repressive policing (such as arrest, prison, displacement from a workplace, extortion or violence by officers) are more likely to experience poorer sexual and mental health outcomes.

Sex workers in many countries face a range of regulatory and legal issues including criminalisation, registration, licensing, and mandatory testing in some jurisdictions. These issues create a complex system of barriers for sex workers accessing services, and enable discrimination against sex workers that majority groups don’t experience.

“Decriminalisation, and the recognition of sex work as an occupation like any other, is vital to improve sex worker health and safety,” Rayson and Alba said.

But many studies on sex workers are beset with methodological issues, according to the researchers.

“Much previous research into sex work has been incredibly biased. Samples have often been drawn from sections of the community who may experience increased marginalisation, such as street-based or incarcerated sex workers,” they explained.

“Sex work research has often been conducted and published with little regard to context or acknowledgement of limitations, by researchers attempting to find psychological pathology amongst those who choose a profession that they themselves would not.”

“To prevent exploitation and misrepresentation of sex workers by researchers, future research should be peer-led. This is occurring increasingly and has been recognised as best practice.”

“It would be useful to compare these issues across different countries. This would take into account variances in legal systems, social perceptions of sex work, as well as cost and access to healthcare,” Rayson and Alba told PsyPost.