‘Change creates change’ – older female sex workers’ experiences through the early COVID-19 pandemic

Abstract

COVID-19 and associated policy responses created unique social, economic and health risks for sex workers. Through semi-structured interviews we explored pre- and early COVID-19 experiences and work practices of ten cisgender female sex workers 50 years of age and older in Queensland, Australia, analysing the findings using a risk environment framework. Throughout early 2020, participants navigated a complex risk environment, managing economic needs, health and safety, occupational stigma and policing. Australia’s policy responses altered the risks and opportunities available to participants. Half the participants continued sex work and half stopped sex work with some accessing economic support and withdrawing superannuation savings. Those who continued sex work drew on life and work experience to reassess changing health, stigma, and policing risks, and adapted their work strategies by increasing client screening and modifying services. Participants relied on information from peer networks and organisations to guide work practices but remained wary of contact tracing, police and the media. Decriminalisation of sex work and the strengthening of sex worker organisation and government partnerships are important in embedding equity in responses to ongoing and new public health threats.

Keywords:

• Sex work
• COVID-19
• risk environment
• ageing
• women

Introduction

COVID-19 has been a global disrupter, generating uncertainty, new health risks and political, economic, and social changes (Biddle et al. 2020; Matilla-Santander et al. 2021). The impacts of COVID-19 have not been uniform, often reinforcing pre-existing inequities among marginalised populations, including people in precarious employment (Gravlee 2020; Matilla-Santander et al. 2021). Precarious employment is characterised by job insecurity, limited rights and protections, and increased exposure to health risks (Matilla-Santander et al. 2021). Older workers, women and sex workers are populations that have historically experienced work-related insecurity, discrimination and inequity (Australian Human Rights Commission 2009, 2016; Decker et al. 2015). Consequently, older female sex workers may be exposed to multiple forms of insecurity and risk but little is known about their occupational experiences. There is a paucity of research on the experiences of older female sex workers generally, including occupational experiences during the COVID-19 pandemic.

Sex work in COVID-19

Early in the pandemic, sex workers and health and human rights academics called for the grounding of COVID-19 responses in human rights to ensure that sex workers had access to economic and social protection (Adebisi et al. 2020; Avafia et al. 2020; Global Network of Sex Work Projects and UNAIDS 2020; Jozaghi and Bird 2020; Platt et al. 2020). Despite these calls, sex workers have been largely excluded from economic support programmes, and increased policing and stigma have heightened workplace health risks (Callander et al. 2020; Dziuban, Możdrzeń, and Ratecka 2021; Mantell et al. 2021; Global Network of Sex Work Projects and UNAIDS 2020; Platt et al. 2020). In criminalised sex work settings, policy responses have been punitive rather than protective (Adebisi et al. 2020; Dziuban, Możdrzeń, and Ratecka 2021; Nyabeze et al. 2022). Within regulated sex work settings, the closure of licenced sex work establishments and exclusion from economic and social safety nets have heightened financial precarity (Azam, Adriaenssens, and Hendrickx 2021; Tan et al. 2021).

Sex workers’ barriers to accessing economic support during COVID-19 included lack of work documentation and eligibility issues, occupational stigma and privacy concerns and processing delays (Prostitution Information Center and SekswerkExpertise 2020; Tan et al. 2021). With inadequate economic support, many sex workers continued sex working during the early phases of the pandemic, often in more dangerous settings, with reduced client demand affecting earnings and sometimes contributing to riskier behaviours (Azam, Adriaenssens, and Hendrickx 2021; Hassan et al. 2023; Mantell et al. 2021; Singer et al. 2020). Local sex worker organisations have been instrumental in supporting sex workers with emergency funding, food, shelter and childcare, information and education, masks, gloves and sanitiser, access to vaccinations, conflict negotiation, networking and advocacy (N.F. Bromfield, Panichelli, and Capous-Desyllas 2021; Dziuban, Możdrzeń, and Ratecka 2021; Lam 2020; Santos et al. 2020).

Australian sex work context

A strong sex worker rights movement supported Australia’s effective response to the HIV epidemic and created a strong infrastructure for skill sharing, advocacy and communication between sex workers (Bates and Berg 2014; Jeffreys 2017; McMahon 2014). Despite notable public health successes, low rates of HIV and sexually transmitted infections sex work remains criminalised, or criminally regulated in the majority of Australian states and territories. The State of Queensland operates under a regulated framework which licences small (five-room) brothels and permits sex work by individuals working alone but polices business structures and work practices, prohibiting partnerships, cooperatives, working from massage parlours or escort agencies (Sullivan 2008). Since few licenced brothels operate, the majority of sex work is conducted by sole traders working alone, or through services provided illegally (Berg and Bates 2008; Prostitution Licensing Authority 2020). Sex workers of different ages and backgrounds work in varied policy settings across Australia (Callander et al. 2016; Respect Inc 2017; Selvey et al. 2017; Woodward et al. 2004).

Australia’s early COVID-19 response

Australia experienced two waves of COVID-19 infection in 2020, with a cumulative total of 28,000 cases and 900 deaths in the first year (Stobart and Duckett 2022), placing it at the lowest quartile of global deaths per capita at that time (N. Bromfield and McConnell 2021). State and federal governments responded with rapid policy changes: restricting movement across borders, implementing quarantines and restricting business operations and personal movements (Holley, Coatsworth, and Lipman 2021). Alongside the closures and restrictions, in March 2020 the government implemented multiple economic support programmes, providing temporary economic support for businesses and individuals impacted by COVID-19 shutdowns (Friel et al. 2021). Policy measures for economic support included a Coronavirus Supplement for welfare payments, the COVID-19 emergency disaster payment and Job Keeper wage subsidy as well as measures to access personal capital, allowing people who met loss of income tests to access superannuation savings. In April 2020, Queensland public health orders directed the closure of licenced brothels, strip clubs and massage parlours and prohibited in-person sole operator sex work services (Queensland Health 2020a, 2020b). Queensland’s business reopening was staged from May 2020, but the reopening of the sex work sector was delayed until July 2020, when COVID-safe compliant sex work businesses were permitted to resume following advocacy by sex worker organisations (Queensland Health 2020c; Scarlet Alliance 2020).

Sex work risk environment

Sex workers manage occupational health and safety within a continuum of risk in their workplaces, complicated by structural conditions such as prohibition, regulation and policing of the occupation (Platt et al. 2018; Sanders and Campbell 2007). Criminal regulation of sex work contributes to precarious work environments, where policing, stigma and discrimination persist, and sex workers have to balance complex and competing health and social risks (Anderson et al. 2013; Begum et al. 2013; Foley 2017). Decriminalisation of sex work contributes to an enabling environment for harm reduction, but few jurisdictions across the globe have decriminalised sex work (Abel et al. 2010; Rhodes et al. 2011).

Social and structural conditions can produce or mitigate occupational health and wellbeing risks (Rhodes 2002). Rhodes developed a conceptual understanding of ‘risk environment’, which he describes as ‘the space – whether social or physical – in which a variety of factors interact to increase the chances of harm occurring’ (Rhodes 2009, 193). Within this framework, risk factors are identified and analysed across four domains: physical, social, economic and policy. Identifying risk factors at different levels (from personal micro-level to social or national macro-level) can inform interventions to create an enabling environment for harm reduction, grounded in human rights principles (Rhodes 2009; Rhodes et al. 2011).

The risk environment framework was formulated in the context of drug use and harm minimisation (Rhodes 2002) but has been applied to sex work settings (Rhodes et al. 2011). It has been used to explore spatial characteristics within the built environment on the HIV risks for street-based sex workers in Vancouver (Deering et al. 2014), social and structural factors contributing to gender-based violence against female sex workers in Tanzania (Leddy et al. 2018), and the impacts of decriminalisation policy on sex workers’ movement between different work sectors in New Zealand (Abel and Fitzgerald 2012). Its principles have been applied to understand the interplay of policing and stigma risks in the Australian sex work context (Stardust et al. 2021). In this paper, we apply the risk environment framework to show how older female sex workers working within a legalised but criminally regulated setting negotiated changing policies and risks before and during the early government COVID-19 pandemic responses of 2020. We argue that the pandemic altered existing risk environments, and that participants actively mitigated risk by drawing on trusted information sources and their experience as older workers.

Methods

This study was a part of broader qualitative and retrospective research exploring older women’s experiences of sex work across the life course. It used principles of participatory sex worker research (Jones et al. 2018; Lobo et al. 2021) including recognising sex work as work, the leadership and active involvement of sex workers and sex worker organisations throughout, and addressing priorities identified by sex workers. The research was developed in consultation with Queensland’s sex worker organisation, Respect Inc, and was guided by an advisory panel of four women with extensive sex work, peer education and research experience.

Participant recruitment for the broader study commenced in June 2019 through referrals by Respect Inc, text messages sent to online/newspaper advertisements and flyers sent to licensed brothels. When COVID-19 was characterised by the World Health Organization (WHO) as a pandemic in March 2020 (WHO (World Health Organization) 2020), 12 cisgender female sex workers 50 years of age or older in Queensland had been interviewed, so they were each invited to a follow-up interview to discuss the impacts of COVID-19 on their work. The ten who consented were 50-64 years of age with two to 30 years of sex work experience. Half had university education, all were Australian citizens or permanent residents, including one who migrated to Australia as an adult. Seven worked in cities and three in small towns in Queensland.

RB, a sex worker peer, conducted the initial interviews face to face, at mutually agreed locations, with follow-up interviews by phone, Zoom or in person. At the initial interview participants completed a demographic questionnaire and the discussion explored career pathways, sex work practices, strengths and challenges, wellbeing, ageing and retirement. Follow-up interviews explored changes in work practices through the Queensland COVID-19 lockdown in early 2020. Interviews were between 45 min to two hours and were audio recorded and transcribed using pseudonyms to protect confidentiality. Participants were remunerated with $100 per interview. Ethics approval was granted by the University of Queensland Human Research Ethics Committee (Reference: 20190000007).

Interview transcripts were downloaded into NVivo 12 and analysed using a thematic analysis and multi-stage review process (Braun and Clarke 2006). As part of the broader research, RB constructed participant life grids from questionnaires and transcripts (Nico 2016) and inductively coded the transcripts, grouping codes together to identify themes pertaining to the impacts of COVID-19 on work. The themes were reviewed against transcripts and life grids and discussed with the sex worker advisory panel and co-authors. The discussions provided clarity and supported use of the risk environment framework to present the findings. This part of the research focuses on changes in work practices between initial interviews conducted between June and November 2019 and COVID-19 interviews conducted in July – August 2020.

Findings

Participants negotiated their sex work practices, balancing four broad occupational factors: 1) financial needs and goals, 2) protecting health and safety, 3) avoiding policing, and 4) managing sex work stigma. During the early phases of the COVID-19 pandemic, participants negotiated an intensified risk environment including increased layers of health, policing and stigma risks. During the mandated lockdowns of 2020, participants assessed their financial circumstances, access to COVID-19 economic support and whether they could afford to stop work. Those who continued sex work during lockdowns, or resumed afterwards, mitigated health, policing and stigma risks by accessing local information about COVID-19 through sex worker organisations, media and government updates and community observation, assessing risks in the context of their own lives and adapting their work practices.

Pre-COVID-19—business as usual, balancing benefits and risks in sex work

In the 2019 interviews, participants described diverse household, economic, family circumstances and work histories. Where disclosed, weekly sex work earnings varied from under $200 to over $3,500, with half solely relying on sex work income and others combining sex work with income from other employment, properties, businesses or welfare. As older workers, some participants struggled to get other jobs, but having multiple income sources stabilised fluctuating sex work earnings and buffered occupational stigma. Anong¹ explained how having another job helped conceal her sex work and mitigate stigma risk.

I don’t let anyone know … All they know is that I’m a barber. Work in the barber’s shop. Do hairdressing. (Anong)

Most worked as sole traders to comply with Queensland’s sex work laws, which increased work related costs and exposed them to safety risks of working alone:

… say if [Mary] and I were working together, for instance, it would be half the cost. You know? And we could sit here and look after each other. (Princess)

Participants used a range of strategies to stay safe, avoid the police and mitigate stigma, including screening new clients, insisting on condom use and only working during the day. Mary described how using these strategies also helped her establish regular clientele, which further mitigated potential risk.

I run my business and I’m sure I get my returning clients on the fact that I’m friendly, I conduct a clean, you know, safe, environment, and I’m good at what I do, so they come back. I don’t need to go and be unsafe to get returning clientele. (Mary)

Economics of stopping work during COVID-19 lockdown

The 2020 interviews showed that participants evaluated new occupational risks, which layered upon existing occupational risks. These included COVID-19-related risks to health and safety, changed economic opportunities and increased policing and occupational stigma. Concerned about the health risks of COVID-19, several participants stopped sex work prior to mandated lockdowns; however, the capacity to stop work was driven by financial considerations – both immediate and for the future:

Sometimes I think, am I being greedy? And then I think, I need some more money behind me. I’m going to be sixty in a year and a half. … I see my partner’s mother is in aged care. But she had money. So she’s fine. My mother will be fine. But I see a lot of people at the hospital. They’ve got no money. They’re not fine. (Barbara)

Half of the participants stopped sex work during the COVID-19 mandated lockdown, four of whom accessed COVID-19 supplemented unemployment benefits and withdrew $10,000–$20,000 from superannuation savings. They discussed having to disclose their occupation to get benefits but experienced lockdown as a positive time for career reflection. They variously reorganised finances, paid debts, considered career changes or retirement, and took a paid break from an occupation that provides no paid vacation, long-service or sick leave. Long-term lower-earning sex workers particularly valued the interruption, with Heather describing it as ‘the best thing that’s happened to me in years’ and Kathy further explaining:

Woo hoo! After ten and a half years in the industry, I’ve got a three-month long service leave on half pay. (Kathy)

With financial support these participants all discontinued sex work during the lockdown. Kathy explained how stopping work protected her from health, policing and stigma risks:

Why would I need to put myself at risk and put my Centrelink benefit at risk, and why do I need to draw the attention to myself, and why do I need to potentially attract the police attention to my lovely quiet street and expose myself to all my neighbours? (Kathy)

Not all participants who interrupted sex work during lockdowns accessed economic support programmes. The only migrant participant worked at an illegal massage parlour that shut through the lockdown, but she was unwilling to disclose her work to apply for benefits and subsisted with minimal hairdressing income.

Half the cohort continued sex work through the mandated COVID-19 lockdown, citing financial need for doing so. For some, the COVID-19 and government benefit programmes were inadequate to meet their financial obligations: ‘I’d rather work than I have debts and I worry’ (Helen). However, for others having no superannuation savings, concerns about being ineligible, having to repay benefits or the need to disclose their occupation deterred access to any of the economic support programmes offered.

Assessing risks of continued sex work

Participants weighed heightened risks of COVID-19, policing and public exposure when deciding when and where to work. They used information from sex worker organisations, the government, media and community observations.

Helen monitored COVID-19 cases in an urban area but did not think the number of cases was high enough to necessitate stopping work, even though she acknowledged some risk:

I’ve just got to cop it sweet if someone comes in, and I get it. You know? (Helen)

As a long-term touring worker doing sex work across Queensland, Dawn moved from an urban to a regional area, perceiving it to be safer for work during lockdowns:

I preferred regional work because there were less cases going regional than there were going city. And going city might have been a little bit less safe in social distancing. People not caring … and then there’s space. So, but if I go regional, it’s open space. (Dawn)

She also monitored public behaviour and social distancing in different locations to guide her work decisions. Participants also compared sex work risks to permitted work and activities. Barbara continued to see a few regular clients at home, judging the risk as equal or lower than her other work and commute.

[W]ell, the conditions I’m working at [cleaning job] would be probably worse than—or just as dangerous as sex working. Catching [public transport]. You know? I don’t know who’s sat there before me. I don’t know if the person whose head’s right near me at the back has got it. (Barbara)

Participants relied on peers and sex worker organisations for practical updates on benefits, stop-work mandates, arrests, advertising changes, and health and safety training.

I have to ring Respect this week and get on to all the points of what I have to do to go back into work … I mean, I can’t afford a $3,000 fine and I certainly don’t want people to be unsafe. (Denise)

Mitigating risks—screening clients, adapting services, avoiding exposure

Participants who continued sex work during or after lockdown enhanced their client screening practices and adapted their services to mitigate transmission risks, but still faced increased policing and public exposure risks. Some participants only saw regular clients. Despite not seeing new clients, Mary reported being busier than pre-COVID-19. Dawn questioned new clients about their relationships and movements, favouring those who were locked down and reprimanding and refusing to see higher-risk clients:

He goes, ‘I messaged a lot of escorts’. And I go, ‘Are you a truckie?’ And he goes, ‘Yeah’. And I said, ‘Do you cross borders?’ And he said, ‘Yeah’. And I go, ‘Well, I don’t think you should be seeing escorts from state to state’. (Dawn)

Some altered their working hours to avoid weekend and late-night bookings with ‘riskier’ clients:

I had always said I don’t do clients under 25 … I upped that to 30 … And in the last week I’ve upped it to 35. Because, you know, I can’t put my older clients at risk. My regulars. (Kathy)

Enhanced screening strategies were not always effective, and Helen inadvertently accepted a booking with an undercover police officer and received a $1,300 fine for breaching COVID-19 regulations. It did not stop her working but increased her costs.

Participants also adapted the services they provided to minimise COVID-19 transmission risks. Some stopped kissing, avoided face-to-face positions, restricted the number and length of bookings, increased intervals between clients, increased showering, cleaning, and handwashing, or offered services outdoors or with a mask. Some provided online content, video messaging services or phone sex, attracting clients from a broader geographical region. Dawn negotiated socially distanced in-person bookings including toy shows, role playing, watching porn together or chatting. She managed multiple tours, camping across the state, and avoiding police. The demand for intimacy and connection throughout lockdown was so high she increased her rates, was more selective in who she saw and had repeat bookings. Dawn enjoyed learning from and teaching clients about staying safe, ‘It’s made it more fun. Change creates change’.

Participants used their experience and authority associated with being older to set boundaries with clients especially when refusing to provide services they considered too risky.

I went over to his house … and then when I told him I wasn’t kissing, he said, ‘Oh, oh, no, I can’t come—I can’t come unless I’m kissing’. And I said, ‘Mate, like its fucking COVID’ … Anyway, he’d already given me the money, so I kept $50 as cancellation fee, and just left. (Judy)

Concerns about being ‘outed’ were heightened during COVID-19 lockdown, and participants did not trust police, media, or government to protect their privacy. They feared vilification if they were in a COVID-19 cluster.

I mean, can you imagine if the media got hold of a sex worker who got COVID and passed it on to 200 people? I mean, can you imagine the naming and shaming that you would get? (Kathy)

All participants who worked after lockdown completed training and implemented Sex Industry COVID-safe Plans, requiring them to keep client identification records, but were reluctant to disclose information, mistrusting the confidentiality of contact tracing programmes.

The only thing he said to me was, ‘If either of us get COVID, please—I won’t put you on the contact trace, like the contact screen. Please don’t put me on it either’. Which I wouldn’t have anyway. (Heather)

Discussion

Older female sex workers in Queensland actively managed workplace risk environments, assessing and balancing competing risks associated with economic security, health and safety, social stigma, and policing as they navigated uncertainty and changing circumstances in the early phase of COVID-19. Policy changes that closed borders, prohibited non-essential work, augmented welfare and liberalised access to personal superannuation savings reshaped the risk environment for all workers. As older women (Australian Human Rights Commission 2009), as workers in a precarious work sector (Tweedie and Chan 2022), and as sex workers subject to a criminal regulatory framework with widespread stigma and discrimination (Broady et al. 2020; Sullivan 2010), participants were already navigating a complex risk environment prior to COVID-19. Prior to and through the onset of the pandemic, participants actively assessed and balanced competing concerns about economic security, health and safety, social stigma and policing to make decisions about their work practices.

The Australian Federal Government’s macro-level policy interventions to mitigate the spread of COVID-19 in 2020 resulted in very little community transmission in Queensland (Queensland Government Statistician’s Office 2022; Stobart and Duckett 2022). Participants proactively mitigated physical risks of COVID-19 by stopping work, or when working, by assessing geographical and context-specific risks and adapting work practices to minimise possible transmission. Capacity to stop or adapt work practices relied on financial security and access to updated and local COVID-19 information and industry-specific updates from sex worker organisations.

Most participants did not access any COVID-19 economic support programmes due to concerns about stigma, illegal work, needing a higher income, or having no superannuation to draw upon. COVID-19 economic policy responses can further marginalise people in illegal or undeclared work sectors (Williams and Kayaoglu 2020). Decriminalisation of sex work can help mitigate risk and stigma, but using an intersectional lens, we recognise that some sex workers experience more marginalisation and precarity than others (Armstrong and Abel 2020). As Collins et al. (2019, 1) state, ‘the intersectional risk environment highlights how outcomes are products of processes and relations that are embodied, reflected, and challenged while situated within social, historical, and geographic contexts’. To better understand sex worker occupational health and safety, and orient future programmes and interventions, we must recognise the diversity of people who engage in the sex industry across intersections of identities including age, ethnicity, class, gender, sexuality and migration status (Armstrong and Abel 2020; Callander et al. 2020). With limited work years to supplement superannuation and savings, for some participants the risks of continuing work were outweighed by financial concerns. Women over 55 are the fastest growing group of homeless people in Australia (Faulkner and Lester 2020) and this study illustrated how policy changes during COVID-19 overlaid not just the sex work risk environment, but also pre-existing housing, welfare and ageing policy risk environments in Australia, with their cumulative and gendered effects over the life course (Australian Human Rights Commission 2009, 2013).

A small number of participants accessed the Federal Government’s COVID-19 economic support programmes, claiming supplemented welfare and withdrawing superannuation savings that provided an opportunity to pause work and plan work transitions, which can be challenging for sex workers (Sandy, Meenagh, and Nes-Ladicola 2019). The rapid roll-out of economic support illustrates adaptive policy associated with COVID-19, and although short lived, that more equitable policy change can be implemented quickly (Grebely, Cerdá, and Rhodes 2020). However, as a temporary policy response the Federal Government’s economic support programmes in Australia failed to reduce many of the inequities experienced by people in precarious employment, instead entrenching policy conditions that contribute to the widening of inequities (Friel et al. 2021). Participants who withdrew money from superannuation savings may face long-term financial challenges as they approach retirement (Hodgson 2020). Accessing superannuation has impacted those on lower incomes the most, particularly older women (Friel et al. 2021) who face economic inequities with substantially lower superannuation savings than men (Weiss, Parkinson, and Duncan 2015), and barriers to participation in the workforce (Australian Human Rights Commission 2016, 2009). For older women continuing sex work since COVID-19, ongoing systemic barriers associated with Queensland’s regulatory framework continue to exacerbate economic challenges (Jeffreys, O’Brien, and Fawkes 2019; Sullivan 2010).

Policing is an ongoing issue for sex workers in Queensland (Stardust et al. 2021) that was heightened during COVID-19. Sex work differed from other occupations during COVID-19 because Queensland already had a police task force solely dedicated to monitoring sex work businesses (Jeffreys, O’Brien, and Fawkes 2019), which were the first to attract COVID-19 fines (Lynch 2020). Even after lockdowns ended, media reports portrayed sex worker arrests in 2020 as a ‘Coronavirus Crackdown’, revealing sex workers’ names, nationality, visa status and services offered (Irby 2020b, 2020a) and reinforcing stereotypes of sex work as a public health threat. The targeted policing of sex work and media sensationalism of raids, especially of migrant sex workers, reinforces occupational stigma and racist stereotypes and undermines public health programmes (Mai et al. 2021). Australian sex workers face high levels of stigma and discrimination (Treloar et al. 2021) and have a low level of trust in public health programmes that require sharing personal health information (Newman et al. 2020). Findings from this study show that this mistrust extended to COVID-19 contact tracing programmes. Over-policing of public health is counterproductive and harmful, creating barriers to participation in public health programmes (Joint United Nations Programme on HIV/AIDS 2020).

Sex workers and sex worker-led organisations are safer sex advocates influencing community norms on safer sex (Bates and Berg 2014; Sanders 2006), and this study highlights how they expanded this role to provide COVID-19 safety education (N.F. Bromfield, Panichelli, and Capous-Desyllas 2021; Dziuban, Możdrzeń, and Ratecka 2021; Santos et al. 2020). Established trust between sex workers, peer-run sex worker organisations and allies was key to information sharing and a coordinated and collaborative response (N.F. Bromfield, Panichelli, and Capous-Desyllas 2021; Dziuban, Możdrzeń, and Ratecka 2021; Santos et al. 2020). Peer sex worker organisations in Australia played an important role in harm mitigation through information sharing, online training, fundraising and distribution of emergency relief (Scarlet Alliance 2020; Callander et al. 2020). However, this was constrained by the regulatory and policy environment, under resourcing and inadequate and delayed government consultation on policy responses (Scarlet Alliance 2020). Funding and including sex worker organisations in policy and programme development would support the creation of an enabling environment for harm reduction, benefiting sex workers and the wider community.

As we recover from the COVID-19 pandemic, public health researchers have called for a focus on building a fairer society, a social vaccine that tackles the root causes of inequities, comprising policies that keep people well and mitigate structural drivers of inequities (Friel et al. 2021; Marmot et al. 2020). We join researchers who call for the full decriminalisation of sex work in Queensland as a key policy response for equitable occupational health and safety of sex workers (Callander et al. 2020; Platt et al. 2018).

Limitations

Involving Respect Inc in recruitment may have resulted in a cohort connected with sex worker organisations. The monolingual, white researcher likely decreased diversity of participants. Migrant workers constitute a substantial percentage of the sex work workforce (Donovan et al. 2012; Selvey et al. 2017) and understanding their experiences remains important in light of COVID-19-related racism (Ben and Paradies 2020), exclusion from COVID-19 economic support programmes (Friel et al. 2021) and heightened policing concerns (Selvey et al. 2018).

Conclusion

Throughout early COVID-19, sex workers in Queensland and elsewhere in Australia continued a legacy of leadership in addressing public health challenges, drawing on peer networks to proactively adapt work practices to manage health and safety. COVID-19 economic interventions were not always accessible or adequate, requiring some to continue sex work. Sex workers’ ability to mitigate COVID-19 risks were hindered by Queensland’s regulatory framework for sex work, targeted policing and media-perpetuated stigma, which undermined economic support and contact tracing programmes. Public cooperation remains a critical part of Australia’s COVID-19 response. It is important that the systemic issues that affect participation are urgently addressed. Decriminalisation remains an important step towards strengthening partnerships between governments and sex worker organisations. Meaningful and timely involvement of sex worker organisations is needed in research, policy and programme development, to inform best practice public health responses to infectious diseases.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

RB is partially supported by an Australian Government scholarship with a Training Program Stipend and Tuition Fee Offset through The University of Queensland.

Notes

1 All participant names are pseudonyms.