System-involvement resulting from anti-trafficking interventions and the criminalization of sex work and migration results in negative health impacts on sex workers, migrants, and people with trafficking experiences. Due to their stigmatized status, sex workers and people with trafficking experiences often struggle to access affordable, unbiased, and supportive health care. This paper will use thematic analysis of qualitative data from in-depth interviews and ethnographic fieldwork with 50 migrant sex workers and trafficked persons, as well as 20 key informants from legal and social services, in New York and Los Angeles. It will highlight the work of trans-specific and sex worker–led initiatives that are internally addressing gaps in health care and the negative health consequences that result from sexual humanitarian anti-trafficking interventions that include policing, arrest, court-involvement, court-mandated social services, incarceration, and immigration detention. Our analysis focuses on the impact of criminalization on sex workers and their experiences with sexual humanitarian efforts intended to protect and control them. We argue that these grassroots community-based efforts are a survival-oriented reaction to the harms of criminalization and a response to vulnerabilities left unattended by mainstream sexual humanitarian approaches to protection and service provision that frame sex work itself as the problem. Peer-to-peer interventions such as these create solidarity and resiliency within marginalized communities, which act as protective buffers against institutionalized systemic violence and the resulting negative health outcomes. Our results suggest that broader public health support and funding for community-led health initiatives are needed to reduce barriers to health care resulting from stigma, criminalization, and ineffective anti-trafficking and humanitarian efforts. We conclude that the decriminalization of sex work and the reform of institutional practices in the US are urgently needed to reduce the overall negative health outcomes of system-involvement.

Globally, sex workers have highlighted the harms that accompany anti-prostitution efforts advanced via anti-trafficking policy, and there is a growing body of social science research that has emerged documenting how anti-trafficking efforts contribute to carceral and sexual humanitarian interventions. Yet mounting evidence on the harms of anti-trafficking policies has done little to quell the passage of more laws, including policies aimed at stopping sexual exploitation facilitated by technology. The 2018 passage of the Allow States and Victims to Fight Online Sex Trafficking Act (FOSTA) in the U.S. House of Representatives, and the corresponding Senate bill, the Stop Enabling Sex Traffickers Act (SESTA), is a case study in how efforts to curb sexual exploitation online actually heighten vulnerabilities for the people they purport to protect. Drawing on 34 months of ethnographic fieldwork and interviews with sex workers and trafficked persons (n = 58) and key informants (n = 20) in New York and Los Angeles, we analyze FOSTA/SESTA and its harmful effects as a launchpad to more broadly explore how technology, criminalization, shifting governance arrangements, and conservative moralities cohere to exacerbate sex workers’ vulnerability.