Inside Argentina’s Fight for Sex Worker Health Equity

In a small community clinic in Buenos Aires, a health worker greets a patient she’s known for years—a transgender woman who depends on sex work to survive. She’s there not just for care, but for safety, respect, and a reminder that her health matters. But behind this simple act of care lies a complex web of politics, ideology, and power: Who decides which services exist? Who supports or blocks policies that protect sex workers’ health and livelihoods?

A new study published in Frontiers in Public Health offers answers—and a roadmap for change.

Understanding the Landscape: Who Holds the Power?

Researchers from Fundación Huésped and partners used a stakeholder mapping approach to uncover who influences sexual and reproductive health (SRH) policy for cisgender and transgender female sex workers in Buenos Aires.

Between February and September 2023, they identified 147 key actors, ranging from government officials and health providers to civil society, media, and abolitionist groups. Each was analyzed for three traits:

• Knowledge of sex workers’ health realities
• Interest or agreement with implementing SRH policies
• Influence or power to shape outcomes

This process revealed six positions on the policy landscape—from promoters to blockers—painting a vivid picture of the political and social forces that shape access to health care and protection.

Key Insight: Only four groups had detailed knowledge of sex workers’ health and policies, highlighting how misinformation and distance from lived experience shape policymaking

The Findings: Allies, Blockers, and Everyone in Between

Among all actors:

• 16% were promoters, often within national and local government health agencies.
• 68% were supporters, including civil society organizations and sex workers’ unions like AMMAR and ATTTA.
• 10% were blockers, mostly security forces and abolitionist organizations opposed to recognizing sex work as legitimate labor.
• The remaining were neutral or observers

This mapping exposed a crucial dynamic: those most supportive of reform often had the least power, while those most resistant—such as police or conservative groups—had outsized influence.

Still, the researchers found reason for optimism: most institutional actors were willing to support a rights-based SRH policy for sex workers, especially within the Ministry of Health and local public defenders’ offices.

Why This Matters for Public Health

For public health professionals, this study is a reminder that policy change is a social process, not a technical one. Programs that aim to protect sex workers’ health can succeed only when they navigate power structures, build trust, and address ideological resistance head-on.

Stakeholder mapping isn’t just about identifying “who’s who”—it’s about understanding who listens to whom, whose voices are missing, and where collaboration is possible.

“Ethical policymaking in marginalized contexts must not only ‘include’ but actively center the voices and lived experiences of affected communities,” the authors write.

What This Means in Practice

For those designing or implementing SRH and equity-focused interventions, the findings translate into clear action steps:

For local health departments:

• Conduct your own stakeholder mapping before launching interventions.
• Partner early with community-based groups to ensure participation and legitimacy.

For NGOs and advocacy groups:

• Identify “high-risk blockers” (e.g., security forces) and develop rights-based engagement strategies—such as training, accountability, and dialogue—rather than confrontation.
• Support low-power supporters with communication tools and coalition networks to amplify their voices.

For policymakers:

• Institutionalize the participation of affected communities in the policy design process.
• Regularly update stakeholder maps to reflect shifts in political leadership or public sentiment.

Visual tools, such as influence-interest matrices or network maps, can help illustrate where alliances can be strengthened and where tensions persist.

Looking Ahead: From Mapping to Mobilizing

The study’s authors note that their analysis was conducted before Argentina’s 2023 change in national leadership—an event that could alter the policy climate. But that’s precisely why stakeholder mapping must be iterative: as political winds shift, so must engagement strategies.

Globally, this method offers a replicable template for other marginalized groups—from migrant workers to LGBTQ+ communities—whose health rights depend on navigating layered systems of power and prejudice.

Barriers and Next Steps

Challenges remain. The mapping was limited to Buenos Aires and relied on third-party assessments of influence and interest. Future work should include direct input from each actor and network analysis to reveal relationships and informal alliances.

Yet despite those limitations, the message is clear: understanding power is essential to achieving health equity.

Discussion Questions

• How might your organization use stakeholder mapping to anticipate resistance to new equity-focused health policies?
• What local partnerships could help shift power toward those most affected by inequitable systems?
• How do we ensure marginalized communities aren’t just “consulted” but co-lead health policy processes?