Providing healthcare and support to the sex worker community has been part of the work of APF, IPPF's Portuguese member, for over 20 years. The organisation’s northern regional delegation, APF Norte, has been operating Espaço Pessoa – a service providing care to sex workers and people who use drugs - in Porto since 1997. We spoke to Alexandra Ramos and Jorge Martins from APF Norte about Espaço Pessoa’s work.
Espaço Pessoa has both a community centre and a street team working on the ground with people who do sex work. In addition to specialised psychology, nursing and social services, the centre’s users have access to changing rooms, clothing, and laundry facilities. Meanwhile, the street team provide sex workers with contraceptive care, information, and advice on STIs, as well as essential screening tests for syphilis, HIV and Hepatitis C, and vaccinations. By listening actively to the concerns and difficulties of the communities they support, they are able to build trust, to talk to people about their social rights, provide crucial psychosocial support and make referrals to more formal support services when necessary.
Over the last decade, Espaço Pessoa’s team has observed a massive shift from people working on the street to indoor sex work. This is particularly true for trans sex workers, who face multiple layers of stigma and high levels of violence. Alexandra Ramos said, ‘Although when they are inside, sex workers are more protected from the everyday verbal abuse they face on the street, in many ways their vulnerability has increased; there is little to no protection from violent clients when working alone in an apartment.’
Legal framework falls far short of protecting sex workers
Sex work is not criminalised within the Penal Code in Portugal. However, the law states that third parties are not permitted to profit from, promote, encourage or facilitate prostitution, which was originally intended to prohibit brothels and pimping. In some cases, this can be problematic for sex workers wishing to work together or in collective settings. Public and political discourse is very much focused on defining women who do sex work as victims, or conflating sex work with trafficking, despite these being two distinct issues. This perpetuates the notion that sex work can never be a choice; the reality is it is still not recognised as work.
The Constitutional Court issued a statement in May 2023 in favour of sex workers’ rights, stating that criminalising all third parties without distinguishing between exploitative and non-exploitative ones is unconstitutional. Although this is a welcome move, APF believes that the national legal framework still has a long way to go to support sex workers, and underlines that there is still a lot of social and political division. Language plays a big part, and APF explains that the term sex work, preferred by the people who do the work, affirms the agency of sex workers and helps to destigmatise both the work and those who do it.
Sex workers experience many, often intersecting, systemic inequalities and oppressions, and the criminalisation of aspects of their work exposes them to high levels of violence and rights violations. APF explains that in Portugal, undocumented sex workers are at particular risk because of their lack of access to social rights, together with the current legal context and the social stigma that they face. These factors mean that they rarely report incidents to police for fear of repercussions. Many of those now engaging in sex work are non-nationals, predominantly from Brazil, which means most fall through the cracks. Jorge Martins underlined the difficulty in providing care for those excluded by the system: ‘Undocumented people face the greatest difficulties in accessing social and healthcare services. Unfortunately, referral becomes very difficult, which places them in increasingly marginalised, hidden and helpless spaces.’
At least, according to APF, migrant sex workers are rarely targeted by law enforcement and a service providing some healthcare for sex workers is provided within Portugal’s national healthcare system, although access becomes much more complicated in cases where coordination and referral to other services is required.
Adapting to the changing needs of sex working people
Sex workers are some of the most marginalised and socially stigmatised groups in Portugal. The transient nature of their work means some lead extremely solitary lives.
Alexandra said: “People are socially isolated, and many of them move from city to city, and room to room, without creating any links outside of the local bus station or airport. Opportunities to establish social support networks are increasingly few, particularly outside of the sex work circuit. Homelessness has also become an increasingly big problem with rent hikes making access to housing a massive barrier.”
In response to changing needs, APF Norte has considerably increased the number of shifts of its street team, and initial contact is typically made through consulting sex workers’ adverts online. Through their continuous presence, they have established a good level of trust with the sex worker community. Crucial to that is the presence in their team of a peer educator who has firsthand experience of sex work and is therefore able to play the role of trusted mediator with some members of the community, working in close collaboration with the technical team. APF’s approach has enabled it to support people with interventions that go beyond the delivery of contraceptives.
Empowerment and education are key to eradicating stigma
Espaço Pessoa tends to reach sex workers who have no other support system, so their outreach places a great deal of emphasis on empowerment. Sex workers navigate legally precarious territory, which means many have internalised stigma. Ingrained perceptions make some more likely to accept being subjected to sexual and physical violence, and/or non-consensual sexual practices. The Espaço Pessoa team works to build awareness of these issues amongst sex workers by educating them on their human rights, teaching them to recognise harmful behaviour, as well as deconstructing the myths and underlying prejudices surrounding sex work, always with a commitment to supporting the needs and autonomy of each person they reach.
Read more about IPPF’s global policy position on sex work, which strongly supports decriminalisation of all aspects of sex work, together with social policies that address structural inequalities, as the only way to protect the health, safety and lives of those who do sex work.