Incorporating a Veteran’s lived and living expertise of sex work and substance use into clinician education

BACKGROUND: Sex workers, particularly those who use drugs, experience intersecting stigma and structural barriers that can worsen mental health and sexual health outcomes and limit access to affirming care. Although lived and living expertise is increasingly recognized as valuable in clinician education, perspectives from sex workers who use drugs remain underrepresented in mental health clinician training. METHODS: In April 2025, a virtual, 1-h educational discussion was delivered to interdisciplinary Veterans Affairs mental health staff and trainees. The session was led by a bisexual, cisgender male sex worker who was a United States Army Veteran in recovery and moderated by a social worker with lived expertise. Topics included defining sex work, the role of substances in sex work, harm reduction strategies, and person-centered care. Anonymous pre-/post-surveys included items adapted from a previously published survey instrument and used 5-point Likert scale responses to assess attendee characteristics and changes in knowledge and attitudes related to sex workers. RESULTS: Thirty-six clinicians attended; 24 completed both surveys. Most were physicians (37.5%) or psychologists (20.8%). Half (50.0%) had previously cared for a sex worker, yet only 29.2% reported prior formal education on sex work. Post-session surveys showed increased self-rated knowledge about sex work (2.2 ± 1.1 to 3.2 ± 0.8), improved recognition of sex workers' rights to access mental health care (4.7 ± 1.0 to 5.0 ± 0.2), and greater awareness of healthcare barriers encountered by sex workers (4.0 ± 1.0 to 4.3 ± 0.8). Willingness to provide care was high at baseline and remained high post-session (5.0 ± 0.2 to 5.0 ± 0.2). CONCLUSIONS: A brief, Veteran-led discussion incorporating lived and living expertise was associated with meaningful short-term increases in clinician knowledge about sex work. Findings support integrating sex work-informed, trauma-informed content into routine clinician education and partnering with lived and living experience educators to improve relevance and reduce stigma.