'Viral' Tweets
Mapping Sex Workers' Digital Discourse and Activism for Mpox Vaccine Access
From May 17 2022, when the first case of Mpox in the U.S. was discovered in the state of Massachusetts, clusters of the virus appeared mainly in large cities and exploded soon after June 2022 Pride events. 1 There have been close to 30,000 cases in the U.S. since then. 2 Public health departments considered men who have sex with men (MSM) to be the most at-risk for contracting Mpox and the priority population for vaccination with the JYNNEOS smallpox vaccine. However, MSM sexual networks are more expansive and nuanced than that, and might also include heterosexual-identified, queer, and transgender women, some of whom perform sex work. A new global study published in The Lancet found that among a sample of 136 cisgender, transgender and nonbinary people assigned female at birth who tested positive for the virus, 89% of people reported having sex with men at some point in the last month. 3
In regard to the Mpox vaccine, women-identified sex workers are one group that have not been prioritized for vaccine access in 40 of 56 jurisdictions across the U.S. 4 Sex workers can now get vaccinated for Mpox in central locations in many large cities, and may possibly be able to get access through some health departments in more rural areas, but it has been a battle for particularly Black and brown women-identified sex workers who are already marginalized in health settings to get their shots. Notably, more white-presenting sex workers seemed to have spoken out on social media about lack of Mpox vaccine access and identified themselves. This could be due to increased policing of Black and brown and transgender sex workers.
This project maps some of the Twitter threads of conversation, education, and activism that occurred among sex workers along with the locations in which vaccines became available across the U.S. throughout the 2022 Mpox outbreak; it also demonstrates sex worker-centered public health solutions to better vaccine and care access.
New York City
Over 30% of the Mpox cases in the U.S. were reported in New York City at the peak of cases in July 2022. 5 Yet by the end of July, vaccine rollout was still slow and inaccessible to many Black, Latinx, and transgender people and sex workers. Activists gathered at Foley Square to demand better vaccine availability for these populations.
Cecilia Gentili, a prominent HIV, trans rights, and sex workers' rights activist, spoke at the ACT UP NY-sponsored rally to demand an emergency fund specifically for people who do sex work for survival and test positive for Mpox in addition to the demand for expanded JYNNEOS vaccine access.
Philadelphia
Sex workers in Philly spoke out in the media about their inability to get vaccinated against Mpox. In an interview with The Philadelphia Inquirer, a sex worker who goes by Madeline Layne detailed their anxiety about contracting the virus and about the inadequacy of COVID-19 precautions such as masking to prevent a virus spread by skin-to-skin contact. They chose to pause their work until they could get vaccinated in August, one month before New York City sex workers could get vaccinated.
Raani Begum, a sex worker and organizer with the sex work advocacy organization Philadelphia Red Umbrella Alliance, vocalized the urgency for sex worker vaccination and a dissatisfaction with the disclosure and questioning process at one of the Philadelphia health department's health centers offering the Mpox vaccine.
Pittsburgh
In Pittsburgh, sex workers were equally vocal about their demands to get vaccinated, on social media and in the press. A sex worker who goes by Leigh Woods, after disclosing themself as such and getting turned away from a vaccination site, did an interview with VICE to document their experience.
A sex worker named Jessie Sage was also quoted in the VICE article, and subsequently published their own article in the Pittsburgh City Paper about the trials of getting the MPox vaccine in Pittsburgh. Right after the publication of the article, Sage was able to get a vaccine appointment.
Sage then publicized a safe location for sex workers and the LGBTQ+ community to get the vaccine in Pittsburgh: Allies for Health and Wellbeing. In addition to Mpox vaccination, the clinic also offers HIV testing and PrEP.
Washington, D.C.
D.C. was one of the first cities to offer sex workers, transgender women, and employees of establishment where sex occurs access to the Mpox vaccine, as of June 27, 2022 . 6 Bicoastal sex worker Savannah Sly shared this news with their community. However, vaccine appointments were difficult to come by until another 3,000 appointments became available on July 14, 2022, according to DC Health updates.
Columbus
The organization Central Ohio Sex Workers Outreach notified sex workers that they could get vaccinated without self-disclosure or insurance, and with free transportation to Central Outreach Wellness Center, an LGBTQ+-friendly community health center offering STI testing and PrEP. They also offered a support person, which could be helpful for trans sex workers who are innately more susceptible to violence.
A Columbus-based sex worker who goes by Goddess Alexandra Snow commented that this was one of the most positive experiences they have had as a sex worker in a state-sponsored medical setting. With state policing of sex work and medical bias against sex workers being so prevalent, this experience seems noteworthy.
New Orleans
New Orleans-based queer bar The Phoenix hosted a "shot for shot" event, that offered MSM and sex workers their first Mpox vaccine along with a shot at the bar. Bringing the vaccine directly to the community at a place where they are already socializing is one way to incentivize getting vaccinated and taking care of general health with STI testing, PrEP consultations, and COVID vaccines.
Las Vegas
SW Mutual Aid Vegas, organized by sex workers, allows sex workers in the Las Vegas community, the only city in the U.S. where sex work has been legalized, to anonymously apply for $100 aid grants as needed. They connected sex workers to vaccine appointments with the Southern Nevada Health Department and also supply sexual health needs including condoms and emergency contraception.
San Jose ---> San Francisco
One sex worker who goes by the name Camille D. on Twitter documented their 55-mile journey renting a UHaul from San Jose to San Francisco to access the vaccine at SF General Learning Center due to a lack of availability in San Jose. In an early August article , CNN documented MSM waiting for hours, even overnight, for vaccines in major cities. 7 Since sex workers were considered even less of a priority group for vaccination, some had no choice but to travel for a shot.
Another sex worker who goes by Bianca Lawless informed peers of their successful vaccine appointment at the same San Francisco location.
Los Angeles
PASS, an organization that supplies sex workers and people who work in the pornography industry with STI testing, linked up with the L.A. LGBT Center and was instrumental in supplying hundreds of people in the Hollywood area with their Mpox vaccinations. Because PASS was already an organization working with this population, they had the trust of and access to communicate with the sex worker community in the city.
Seattle
University of Washington Medicine's Sexual Health Clinic at Harborview offered Seattle sex workers confidential vaccination along with STI testing. Sex Worker Lorelai Rivers shared their positive experience with that location. Seattle Central College also offered a series of vaccine clinics that included sex workers and did not require disclosure of identity with insurance or immigration status, another important factor for sex workers seeking vaccination.
New York City/Brooklyn
New York City sex workers finally got the vaccine access in September 2022. A sex worker with the username @botticellibimbo who has over 13,000 followers publicized the key information that there was not a disclosure process involved for them to get the vaccine.
Sex Workers Outreach Project (SWOP) Brooklyn encouraged sex workers to get vaccinated as soon as eligible and also organized a mutual aid fund to benefit in-person sex workers who have to take time off from work to quarantine for Mpox.
The common threads across cities that have made Mpox vaccines eligible for sex workers were no requirement for disclosure of sex workers' identities or to present health insurance for vaccination. This issue of disclosure can also be redressed by making vaccines available at LGBTQ+-safe health centers in both large cities and rural areas and bringing the vaccine to places where queer people and sex workers might congregate organically or be engaging in close contact or sex acts, including bars, strip clubs, and sex clubs. Sex workers on social media were integral to so much of the advocacy and publicity around vaccine availability. Peer-to-peer education among sex workers is one of the key factors for harm reduction in a 2017 review published in the journal AIDS and Behavior. 8 The review concluded that training sex workers as peer educators resulted in more consistent sexual health behavior including condom use, and fewer instances of STIs. Along with that, sex workers are often the ones organizing advocacy coalitions and mutual aid funds within their community to offer both emotional support and financial support if people need to pause their work due to illness. A 2022 article published in The Lancet on Mpox harm reduction for sex workers calls for many of the same initiatives: culturally sensitive medical environments that do not require disclosure of identity from sex workers, mobile health clinics serving sex workers out in the community and at establishments where sex takes place, and paid sick leave for sex workers. 9
As a result of increased vaccination that includes all members of the LGBTQ+ community and more sex workers, Mpox cases have dropped across the board in the U.S. New York City's case numbers have fallen from almost 100 recorded cases per day on average at the peak of the outbreak in July 2022 to just about 0 cases per day as of December 2022. 10 The CDC estimates that people who are not vaccinated against Mpox are 10 times more likely to contract the virus. 11 Getting Mpox vaccine access is just one piece of the equation of improving sexual health for people who do sex work, and sex workers have been the ones who are most successful in rallying their community and prioritizing their health.