A new counselling service launched by a Vancouver sex-worker resource organization reveals an issue often neglected in healthcare: the stigma that sex workers can potentially face within the healthcare system.

The frontline PACE (Providing Alternatives Counselling and Education) Society, founded by sex workers and allies in 1994, offers low-barrier programs, services, and support led by, with, and for sex workers.

PACE executive director Laura Dilley told the Georgia Straight that PACE's support services have offered one-to-one assistance for a wide range of issues. In addition to emotional support, issues that can be addressed include healthcare, housing, the criminal justice system, occupational health and safety, family reunification, goal setting, transitioning out of sex work, nutritional services, bad-date reports, harm-reduction and safe-sex supplies, and more.

PACE support services coordinator Kenzie Gerrand explained that in the past, PACE has focused more on outdoor sex workers in the Downtown Eastside due to the urgency of numerous issues, such as the overdose crisis, housing crisis, aging populations, and the criminalization and stigmatization of sex work.

After community consultations, however, Dilley said that they found that some indoor sex workers have been reluctant to use PACE's services because they didn't want to take any services away from sex workers who were impoverished.

Accordingly, a new sex-work-friendly counselling service, announced on January 5, is designed to ensure that indoor sex workers have access to a non-judgemental counsellor, which may not be available or accessible elsewhere. A sliding-scale payment system is based on clients' ability to pay, as opposed to a non-negotiable, fixed rate.

"All revenue made from counselling goes directly back into supporting the PACE counselling program," Dilley added. 

Dilley said that demand increased for counselling services informed about trans and non-binary needs after the 2016 launch of their free gender self-determination project, which helps individuals legally change their names and gender markers on government identification documents.

PACE counsellor Lindsay Chronister pointed out that sex workers can face many barriers in accessing healthcare, including counselling. She explained that while counsellors and healthcare providers are supposed to be supportive and caring, they "are not always trained in, aware of, or aligned with rights-based frameworks", or may not have basic understanding of issues such as consent, safety, harm reduction, being sex-positive or kink-positive, and more.   

"This can manifest in therapy in super judgmental and stigmatizing ways like conflating sex work with trafficking; using offensive and old-school language about sex work; making harmful assumptions about workers’ needs, wants, and history; or insisting folks transition out of sex work into square work," Chronister said. "For me, this is a core piece of what this service intends to address: for people to feel affirmed and supported in their occupational choices during therapy, to come in with the basic understanding that they will not have to feel judged or shamed, and that no assumptions will be made that their work has anything to do their mental-health needs.” 

For more information about PACE's programs and services, visit the PACE website.