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Sexual Health Disparities and Gentrification: The Role of Public Health

Written by: Kieran Todd

As an economist with a greater interest in public health interventions, I know that concern for efficiency can only get us so far. My training in economics alone did not prepare me to foster relationships that lead to successful community-based participatory action research. No sole discipline can be tasked with engaging the inequities in cities as a result of gentrification. Often, economists are sought for their expertise in guiding policy interventions that affect populations. But, economists are not equipped to establish policy and interventions that attend to HIV in cities, or maintain safe work environments for trans sex workers. Candidly, my experience as a trans person of color informs my desire to strengthen marginalized communities from alongside them, and motivates my work in a field prepared to engage sexual minorities in cities the right way. Public health needs to be part of an inter-disciplinary conversation as we are well- equipped to address the sexual health disparities that arise with the displacement of sexual minorities. The concern for increased economic development without public health can, and has, exacerbated the HIV epidemic, and further marginalizes trans sex workers.

How can urban economic development manifest itself in US cities, while simultaneously avoiding harm to the people who have lived there long before investors staked claim to their neighborhoods?

When I have worked in spaces dedicated to diagnosing and treating the ramifications of gentrification, economists often view their role as one of efficiency and efficiency can argue for the displacement of low-income people of color, and the movement of people living with HIV (PLHIV) into lesser-quality housing, penalized for economic growth. Only a handful of US economists are thinking about equity, and when they are, it often is because the economics argues it is efficient to be equitable. But what about when it is not efficient? Are policy interventions only to be informed by hierarchical models where someone has to lose? This is why public health needs to intervene. A primary tenet of public health is the reduction of disparities in communities. Public health scholars are more capable of addressing sexual health issues like the social and economic barriers to outdoor trans sex workers, arguing that a just society should be prioritized ahead of an efficient one.

Impact on Transgender Sex Workers

Consideration of economic and sexual health in cities is especially important for transgender sex workers. Sex workers in cities experiencing gentrification battle with new businesses who condemn them and threaten long-established sex work environments. Outdoor trans sex workers in Vancouver, Canada reported that long held relationships with local business owners allowed them to continue working in ways economically accessible to them. As the streets where they work become increasingly gentrified, workers are being met with increased police presence and hostility, forcing them to work in more violent parts of the city. The Vancouver study also noted that “…physically altering buildings was another way that businesses attempted to disrupt sex work activity” (Lyons, T, et al, 2017). New gates and security systems barred workers from accessing a space to apply make-up or take shelter from the elements. This a prime example of what it means to be structurally vulnerable. Whether it be physical, social, or political structure, gentrification tears down the structural integrity of spaces historically used for the survival of trans sex workers, particularly transfeminine sex workers of color. Sex work is seldom considered in economic discussions of job security for low-income residents of cities, or that jobs remain available for potentially displaced residents. Sex work has been a means of survival for some trans people long before new coffee shops and high rises consumed city streets.

Economics can certainly provide great behavioral models, and even predict economic downturns. However, economists are limited in their assessment of the disparities that have evolved in the wake of a modern age of urban renewal, especially in terms of sexual health disparities. As gentrification is a contributor to sexual health inequities, gentrification is a public health issue.

Kieran Todd is a Research Associate with the iSTAMP project here at CSHD.


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