544 - Tackling Sexual Health Stigma and Building Better Healthcare for Marginalised Communities

Accessing sexual health care in Australia can still feel like navigating a minefield, especially for those in marginalised communities. This article unpacks the real-world barriers faced by sex workers and marginalised communities, from stigma and mistrust to policies that fail to reflect lived realities. Through powerful voices and fresh ideas, it calls for a bold reimagining of healthcare, one built on respect, co-design, and dignity for all. 

In this episode of Talking HealthTech, Peter Birch speaks with James Sneddon from Hyphen Health, along with advocates and creators Harper Valentine and Nova Hawthorne, about the sexual health stigma and the systems that need to be fixed to make healthcare genuinely accessible for marginalised and underserved communities. The discussion explores the realities faced by sex workers in Australia, the challenges to accessing dignified healthcare, and how co-design and patient-centred approaches can improve health outcomes for these communities.

Sexual Health Stigma and Healthcare Accessibility: Why the System Must Evolve

Sexual health sits at an uneasy intersection of medicine, culture, economics, and identity. While rates of sexually transmitted infections climb and the digital health industry booms, many Australians, especially those in marginalised communities, find sexual health care either inaccessible or unsafe. This episode of Talking HealthTech explores why healthcare systems often fail people at the edges, and how redesigning services with lived experience at the centre is essential for dignity, trust, and better public outcomes.

Understanding the Roots of Sexual Health Stigma

Sexual health stigma goes far beyond simple discomfort. It stems from entrenched biases around gender, sexuality, occupation, and morality. For sex workers and other marginalised groups, these prejudices remain constant obstacles to accessing proper care. Nova Hawthorne, a sex worker and social worker, explains:

"For some sex workers, talking to someone with authority or a decision-making power can be quite scary. It can be a daunting experience." 

Many who seek healthcare face questions that are invasive, ill-informed, or plainly stigmatising. Even well-meaning clinicians can accidentally undermine trust with poor assumptions or a lack of understanding of a patient's real circumstances.

Although sexual health services are available, the real challenge is finding providers who offer a genuinely safe space for open and honest conversations, free from judgment or a lack of understanding. As Nova highlights:

 "I've been treated like our work doesn't matter, like it's not important. If I've had a health concern, it's not been taken seriously or it’s been brushed off."

Inside the Diverse Realities of Sex Work

An effective approach to sexual health must recognise the significant diversity within the sex work industry. The term "sex work" covers a wide spectrum of activities, including brothel work, escorting, street-based labour, stripping, digital content creation, fetish services, pornography, and live camming. Individuals in the industry may operate as employees, independent contractors, or entirely self-employed. While some engage in direct, in-person interactions with clients, others work exclusively through online platforms. This complexity often presents challenges for policymakers and healthcare practitioners seeking to address the needs of this population.

Without a nuanced understanding of this landscape, healthcare services risk missing the mark completely. Harper Valentine, an advocate and lifelong sex worker, stresses:

"There’s in-person where you’re touching, in-person where you’re not touching, online, prerecorded and then online live—that covers the majority of things we do." 

For policymakers or service designers, painting sex workers with a broad brush ignores the different risks, needs, and barriers that come with each niche. A high-volume brothel worker with easy physical access to clinics may need something entirely different from a cam performer who never leaves their home.

Understanding these differences is crucial for creating healthcare services that are both effective and respectful. When the unique realities of sex work are overlooked, systems risk alienating those they are meant to support, leading to poorer health outcomes and diminished trust. A truly inclusive approach requires listening to the voices within the industry and tailoring care to meet the diverse needs of all workers.

When Healthcare Fails to Deliver

Australia's sexual health guidelines, whether intentionally or not, often fail to support those most at risk. While clinic pathways, waiting times, and 'high-risk' screening schedules may work for the general public, more often than not, they fail to align with the unique needs and realities of sex workers. James Sneddon, founder of Hyphen Health, argues:

"For our sex workers, STIs are on the rise and people aren’t testing enough. Positive infection in the community is downtime, no income—it can really hurt, especially if you’re a survivalist or just anyone earning an income." 

Guidelines developed within the sex work industry for screening and downtime are often stricter and more practical than official medical protocols. This gap between formal recommendations and the realities of lived experience leads many to delay seeking care until a serious issue arises. 

"Most infections in the community are actually undiagnosed, which causes real problems," James explains. 

Due to stigma, complex systems, and a lack of understanding from clinicians, many sex workers choose not to disclose their occupation, leaving healthcare providers unaware of their true risks and needs. 

Healthcare That Listens: The Case for Co-Design

Healthcare design is often top-down. Developers, policymakers and clinicians decide what services should do, and patients are expected to fit neatly within them. But for marginalised groups, the system too often feels unsafe or exclusionary, sometimes dangerously so. Co-design, genuinely working with communities to shape health services, emerges as a necessity, not a buzzword. As James notes: 

"Co-design is just essential. It’s continuous. It’s a continual inclusivity feedback loop."

The process isn’t about tacking on a token voice for 'diversity'; it’s about building from the ground up with the day-to-day, lived realities of those who know best. As Harper adds:

"All we’re looking for is to just be treated like people, to be treated like it’s not something weird or strange." 

Impactful co-design requires more than consultation; it demands long-term collaboration and a willingness to act on feedback. When communities are trusted as equal partners, health services become not only more inclusive but also more effective. 

Gaining Trust Through Honest Conversations

Designing patient-focused sexual health services takes more than just online surveys or focus groups. It involves actively engaging with people who have lived experience, listening to their honest and critical feedback, and implementing meaningful changes based on what they share.

Nova describes an informal but vital 'whisper network' that workers use to share information about health services: 

"If you had a really good experience, we share that with our social networks… Maybe we put that on close friends on social media, say ‘Hey guys, I found this awesome sexual health service.’" 

The flipside is a "don’t go" list, quietly circulated to avoid repeat trauma. These informal lists fill the gap left by unreliable formal systems. But as Nova reflects, 

"It does say a lot that we have to build these unofficial lists ourselves." 

True systemic change requires the formal health system to earn, not assume, trust. There is a call for healthcare providers to create spaces where trust is built through consistent respect and openness. It is not enough to simply collect feedback; patients need to see that their voices lead to tangible improvements. Only by valuing these experiences can the system transform into one that truly serves everyone.

The Role of Digital Health in Overcoming Barriers

The development of digital health has made sexual health services more accessible, especially for individuals who feel deterred by stigma or the inconvenience of traditional clinics. With virtual consultations, at-home tests, and secure online results, patients can now seek care in a way that feels private and convenient.

Platforms like Hyphen Health now run multiple virtual clinics dedicated to sexual health, allowing users to "activate healthcare on their own terms," says James. This model side-steps many traditional barriers: awkward conversations at reception, waiting room anxiety, the risk of being recognised by neighbours or colleagues, and clinician ignorance. As the health system faces chronic GP shortages and public clinic queues, digital health has a practical edge. 

"We could triage and do 80% of those patients. They don’t have to go and overwhelm the system," James observes, reflecting on the burden traditional clinics face.

Digital health represents more than just convenience; it signals a shift toward healthcare that adapts to people’s real lives. As technology continues to evolve, these platforms have the potential to normalise sexual health conversations, reduce stigma, and bring quality care to those who have long been overlooked. 

Improving Clinician Awareness and Communication

No digital system can compensate for a clinician’s face-to-face response. Workers report that the old saying, 'Don’t worry, doctors have seen it all,' often fails to ring true when they disclose sex work. Visits can switch instantly from medical to social, and patients find themselves teaching awkward, unprepared GPs about their own industry. Harper highlights the double irony: 

"The only time that has ever not been true. It has been awkward. Suddenly it becomes like a social interaction rather than a professional medical interaction and it’s awkward for everyone."

Clinicians don’t need to be experts on every niche of sex work. But they do need to display respect, self-awareness, and a willingness to listen. As Harper urges:

"You don’t need to know every single thing… We’re used to it. Just say, ‘Sorry, I was a little bit shocked because I don’t usually have someone say that, but let me help—let’s work together.’"

Industry-Led Advocacy and Education

Communities that have grown tired of waiting for respect or safe spaces are creating their own pathways forward. Peer-driven advocacy, trusted support networks, and specialised resources to navigate health, legal, and financial systems are emerging across Australia.

Sex worker advocates like Nova and Harper partner with digital health companies not just to test services, but to help design features, content, and culture from the ground up. They run events, explain new service features to their peers, and provide authentic feedback, both good and bad, to service providers. 

"I think the most powerful thing we get is that everyday conversation… Just being able to speak to people and give that information back to our community in casual, everyday, genuine human ways is the most powerful thing we do.", Harper shares.

Designing Care That Honors Every Patient

Digital innovation, co-design, cultural safety training, and peer-led education are all vital components of improving sexual health care. Yet, at its heart, true progress lies in ensuring that every individual is treated with dignity, no matter their occupation, gender, or background. Sex workers want a healthcare system that respects their needs and time, and where they can be open about their lives without fear or judgment. As Harper notes:

"It’s about being able to access services with dignity. That it’s something that we can just do as part of our health and is something that we need to do for our work." 

If services can embed this principle, they’ll earn not only higher engagement and follow-up but also genuine progress in public health. When dignity and respect are placed at the centre of care, the ripple effect extends beyond individual patients. It fosters stronger trust, encourages more people to seek help early, and creates a culture where sexual health is treated as a normal part of life. With the right approach, the future of healthcare can be one where no one feels invisible or unheard.

The Real Test: Making Dignity the Norm in Sexual Health Care

The challenges facing sexual health care in Australia are not unique, but are urgent and entirely solvable. When health systems are designed and managed with the real needs of those most at risk in mind, the benefits are felt by everyone. As Harper explains:

“Anything that we can get that leads us down that direction is massively helpful. We just want to be treated like people, like anyone else.”

Breaking stigma, improving care pathways, and creating solutions in collaboration with communities rather than imposing them from above are the next vital steps. The ultimate goal must be universal access, safety, and human dignity, not as a privilege, but as the foundation of Australian healthcare.

Related Companies

Hyphen Health

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Lived Experience

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