Disclosure as an Unsafe Practice: A Qualitative Exploration of How Stigma and Discrimination Shape Healthcare Engagement and Receipt of Quality Care for Sex Workers in Victoria, Australia

Based on a qualitative health needs assessment with 31 diverse sex workers and 17 key stakeholders (including two mental health practitioners) in Victoria, Australia, this article adds to the emerging literature on stigma, sex work, and mental health. It does so by focusing on one element that plays a key role in determining sex workers’ experience of mental health support: whether they would disclose their sex work to a practitioner, why so, and what happens as a result. Our study finds that experiences and fears of being stigmatised by health practitioners when disclosing may prevent some sex workers from seeking professional mental health support in the first place and lead others to silence it or obfuscate; thus, potentially complicating access to safe and affirming mental healthcare. The value and role of disclosure is analysed in context by acknowledging the agency and ability of sex workers to understand, or take action in response to, their own mental health needs. Peer-to-peer support and solidarity are identified as key to sex workers’ mental well-being. Criminal restrictions on sex work are found to negatively impact sex workers’ access to mental healthcare. The findings from this study support ongoing efforts aimed at the full decriminalisation of sex work in order to improve sex workers’ access to high-quality mental health support, should they seek it, as well as the implementation of sensitivity training for mainstream mental health providers and the creation of reliable and accessible referral lists of sex worker-friendly mental healthcare providers.