TransActions: learning from trans sex workers to provide good care

The Issue

It is well documented that sex work is ‘associated with a range of adverse health outcomes’ (NIHR, 2023, n.p.). The complex and intersecting health inequalities experienced by sex workers are exacerbated by criminalisation (Platt et al, 2018). Poor health outcomes often disproportionately impact the most marginalised sex workers, including those who are trans, racialised, migrants, sex workers who use drugs and those living in poverty (Mac and Smith, 2018).

The aim of the TransActions project is to improve accessibility and quality of care for trans people who sell sex. TransActions centres sex workers and people with lived experience as experts and has co-production and collaboration at its centre. Working alongside community members, activists, expert practitioners (within and outside the NHS) and others, we explore experiences of health services, and co-design resources to improve care. 

The Project

TransActions has so far produced three resources which centre the experiences and expertise of trans sex workers.

2025: A TransActions practitioner toolkit: providing good care to trans sex workers

The TransActions practitioner toolkit is specifically for healthcare professionals who want to provide good care to trans people who sell sex. The toolkit embeds an intersectional approach in recognising and seeking to respond to the health and wellbeing needs of trans sex workers. It acknowledges the experiential expertise and diverse intersectional identities and lived realities of sex working people, who may also be part of racialised communities, be disabled people, have insecure citizenship status, be people who use drugs, be homeless or have other identities and experiences which are inextricably linked to healthcare for sex workers. The toolkit comprises three booklets with clear action points on how to stop harm, support and sustain trans sex working communities, an informational poster and posters for clinics and other healthcare spaces.

Access the toolkit

2023: Health and wellness services: learning from trans sex workers to provide good care

In 2023 the TransActions project focused on how trans people who sell sex experience different healthcare settings and services. We interviewed 15 people with current or historic involvement in sex work about their experiences of finding, accessing and using health and wellbeing services in the UK. Our community booklet documents the findings from these interviews, focusing on:

1. the positive and negative experiences people have had when accessing services;
2. what an ‘ideal service’ might look like;
3. how the dual identity of being trans and a sex worker can lead to gaps in service provision;
4. how people seek out services, the importance of service location and issues around continuity of care.

This co-produced project centres the experiences and words of trans sex workers, making stark the lived experiences of this group. We call for more inclusive practices within the NHS and beyond. 

We have presented this work to the:

• Josephine Butler Society
• National Police Chief’s Council Sex Work Working Group
• National Sex Work Practitioner Forum
• UK Health Security Agency
• British Association of Gender Identity Specialists
• Northern Region Gender Dysphoria Service
• Welsh Gender Service

2017: TransActions: a project with trans people who sell sex

The first cycle of TransActions work explored the multiple issues and exclusions faced by trans people who sell sex face in their everyday lives. Documenting conversations we had with 14 trans people who do sex work and practitioners providing services to this population, we considered intersecting and pressing issues including: health and wellness, migration, routes into and the transition out of sex work, criminal and social justice and crucially, the intersectional discrimination faced by people who are both trans and sex workers. We call this transwhorephobia. Our co-produced community booklet considers these themes, and calls for a more intersectional understanding of the discrimination faced by trans sex workers. 

We presented this work at the Trans Health Matters annual conference and to the Northern Region Gender Dysphoria Service.

The People

Launched in 2016, TransActions is an action research project that seeks to work collaboratively with practitioners and people with lived experience at all stages of project development, design and delivery. As such, our project teams have changed over the years. The project is led by Dr Mary Laing (University of York). Please reach out to Mary to find out more about the project or to get involved.

2025 toolkit authors:

• Dr Mary Laing (University of York)
• Dr Angelika Strohmayer (Northumbria University)
• Del-Beach Campbell (Delversity)
• Alexx Dixon (Wandsworth Community Drug and Alcohol Service)
• Robin Rose (Spectra)
• Dr Sophie Quinny (Welsh Gender Service)
• Dr Kate Nambiar (Welsh Gender Service)
• Professor Karl Atkin (University of York)
• Pablo Molina (University of York)

2023 booklet authors:

• Dr Mary Laing (University of York)
• Dr Angelika Strohmayer (Northumbria University)
• Del-Beach Campbell (Delversity) and Carly

2023 booklet collaborators:

• Robin Rose (Spectra)

2017 booklet authors:

• Dr Mary Laing (Northumbria University)
• Dr Angelika Strohmayer (Northumbria University)
• Del-Beach Campbell (National Ugly Mugs) and Harley.

2017 booklet collaborators:

• Dr Matt Jones (Northumbria University)
• Tom Nappey (Newcastle University)