ABSTRACT
Therapists and case workers need to address their countertransference and their colleagues' countertransference toward sex work. Many people oppose sex work (or, as it is otherwise termed, "prostitution") for religious, political, and philosophical reasons. When any client who is a sex worker senses a health care provider's judgment about how she earns her money, she wi l l not reveal her profession. This drives the H I V epidemic further underground in this population. The patient is in danger of being reinfected, and she may transmit the virus to her customers. The following example illustrates how a clinic can easily lose a transgendered client who is a sex worker. Georgina was a fifty-five-year-old M T F pre-op transsexual sex worker. She attended our outpatient clinic for two months and suddenly dropped out. I later ran into her on the street. She explained what had caused her to stop attending the clinic:
I didn't feel safe telling my doctor anything, especially how I make a living, night after night behind Grand Central Station, giving blow jobs in alleys and carrying a knife in my purse for protection. He never asked me how I caught pneumonia. So I never told him about giving blow jobs outside in the middle of winter at three in the morning. He never told me to wear a condom on my penis. I think he wanted to believe that I didn't have one. He didn't even examine me fully naked. He seemed afraid of me. M y body freaked him out, even if he never saw it. He requested that I keep my clothes on. I got the message. I missed one appointment because the police picked me up during a raid. But I couldn't tell him or the receptionist that I missed because I was in jail. I was afraid they'd ask me why. I'm sure he's relieved that I never came back. It's easier just to forget it. I sniff my coke: that got me through Christmas.
