Alternative Models Of Care And Sex Work: Sex Workers’ Activism Disputing Public Policy In Brazil

“social movements’ resistance but also their public policy alternatives often emerge in contestation to how the state target specific populations or to the lack of formal state action addressing these populations’ demands as social problems worthy of political action

Carolina Rezende Moraes and Mariana Prandini Assis
University of Brasília and Federal University of Goiás



Carolina Rezende Moraes is a PhD student at the Political Science Institute of the University of Brasília and is a supporter of the Tulipas do Cerrado collective. Carolina is interested in the relationships between sex workers and other social actors, including the state and feminists, and their discursive disputes.

Mariana Prandini Assis, PhD, is Assistant Professor of Political Science at the Federal University of Goiás, and a founding member of Margarida Alves Collective for People’s Legal Aid, a group of feminist antiracist lawyers who harness the law to advance movements for social and reproductive justice. Her areas of research include feminist political and legal theory, human rights, social movements, public policy, and informality in economies, institutions, and practices.



This paper examines the mutual aid network developed by the Tulipas do Cerrado collective during COVID-19 pandemic in the Federal District, Brazil. This initiative is contextualised within the long history of sex workers’ activism in the country where, in the absence of state public policies, sex workers have found ways to survive in normal and in exceptional times, deploying strategies of dialogue, confrontation, and direct action both in parallel to and against the state. The Tulipas do Cerrado collective, during a multidimensional global crisis, ensured people’s survival by developing a network of care and support for marginalised groups. As such, they not only responded to an immediate and pressing social need, but, and perhaps more importantly, envisioned and practiced an alternative policy model for care and sex work. Their experience is a vivid example of novel approaches to public policy that interrogate the centrality of top-down technocratic solutions for social problems, by turning the gaze to alternative models produced within and by civil society.



Public policy; mutual aid; sex workers’ activism; civil society.



Public policy studies have usually focused on the state, its institutions and agents as the primary site of policy making. It is meaningful that some of the most well-known definitions of public policy often engage the government in one way or another – “whatever governments choose to do or not to do” (Thomas R. Dye, 2013, cited by Birkland 2020), “the actions of government and the intentions that determine those actions” (Clarke E. Cochran et al., 2010, cited by Birkland 2020), “the sum of government activities, whether acting directly or through agents, as it has an influence on the life of citizens” (B. Guy Peters, 2010, cited by Birkland 2020), “what governments do and neglect to do” (Klein and Marmor, 2006, 892). As such, public policies are primarily understood as instruments through which “officers of the state attempt to rule” (Goodin, Rein and Moran, 2006, 3), even when non-state actors are acknowledged as intervening in some of the phases of policy making, such as agenda setting, implementation or evaluation. As Howlett, Ramesh and Perl (2020, 1-2) explain, “Although the activities of non-governmental actors can often influence governments’ policy decisions, […] the efforts and initiatives of such actors do not in themselves constitute public policy”.

A young but growing literature has disrupted this state-centric approach, acknowledging that civil society actors can also produce public policy, outside or even against state institutions and frameworks. Within this literature, policymaking is characterised as engaging complex processes that are at once ideational, experimental, and relational. Rather than a top-down technocratic solution for a social problem, public policy is understood as the amalgamation of practical lived experiences across time and place that puts in action ideas emerging from interactions among a plethora of social actors, in both formal and informal political domains (Tatagiba, Abers, and Silva 2018). In this new approach, social movements are seen as developing alternative models of public policy, which consist of ideational structures that translate their political project into public policy proposals, while they trigger a set of confrontational interactions (Tatagiba, Abers, and Silva 2018; Perissinotto and Swako 2017). Most importantly, some movements not only develop alternative models against the dominant ones, but also act upon those models through practical experiences and direct action that make their political ideas a reality. Thus, even on small-scale, these experiences can be understood as a type of public policy from below (Cornwall 2004).

In this paper, we examine the initiatives of a Brazilian grassroots collective of sex workers in response to the COVID-19 pandemic through that theoretical lens. We claim that not only social movements’ resistance but also their public policy alternatives often emerge in contestation to how the state target specific populations or to the lack of formal state action addressing these populations’ demands as social problems worthy of political action.

We acknowledge that initiatives such as the one discussed in this paper, which centers people’s immediate needs, care and survival in the midst of a multidimensional crisis, may be interpreted as charity or de-responsibilisation of the state in the current regime of globalising financialised capitalism (Parson 2014; Spade 2020). Because most of the care work that these initiatives undertake falls on women (cis and trans) and gender diverse people, it may also be examined as another unintended consequence of the alliance between liberal feminist values and neoliberal ideology (Fraser 2009).

We contend, however, that this approach, which frames mutual aid initiatives as manifestations of neoliberal rationality, is insufficient to capture all the complex dimensions of the many such experiences organised by historically marginalised groups. Particularly, this critique is likely to diminish their deeply political foundation as they challenge deep-seated patterns of non-recognition and social exclusion while providing people basic means of survival right here, right now. We evoke the lessons of feminist scholar-activist Silvia Federici on the importance of social movements to go beyond a politics of ideas or imagination only and engage in direct action as their main strategy – to “reproduce the struggle” while working on the “transformation of people’s everyday lives” (Gonçalves and Assis 2022, 22). This means, in Federici’s words, “overcoming isolation, creating collective forms, affective ties, trust etc., that is to say, building a reproductive infrastructure for our struggle and a new ensemble of relations” (Gonçalves and Assis 2022, 22). Drawing on these ideas, feminist anthropologist Miriam Ticktin has described initiatives such as the one examined in this paper as “feminist formations” built upon “capacious structures and infrastructures of political care” (2021). These formations open our imagination to possible new futures while making these a reality for people now. These, we claim, should also and legitimately be understood as public policy – they are deeply political in the transformation they produce in people’s lives and worldviews while also solving social problems.

In what follows, we discuss how the sex workers’ movement in Brazil, for decades now, has engaged in generating novel ideas and experiments about care, self-care, health, and sex work, in interaction with and against the state. As we revisited the historical role of this social group in Brazilian politics through documentary research, we interviewed the general coordinator of a sex workers’ collective – the Harm Reduction and Sex Workers Network of the Federal District and Surroundings (or Tulipas do Cerrado collective) -, Juma Santos, and wrote a paper with her about their activities during the COVID-19 pandemic (Moraes, Santos, and Assis 2020). In addition, we engaged with the collective as participant observers, attending their meetings and activities, and providing them legal support, what allowed us to learn about the recent mutual aid network developed by them. We argue that these experiments emerging from the Brazilian sex workers’ movement in general, and from Tulipas specifically, should be understood as alternative models of public policy, grounded upon values of horizontality, solidarity, respect, mutuality and dignity for historically disenfranchised groups, often in the absence of but also in confrontation with the state.


Brazilian sex workers’ collective action dates to the 1980s, when they formed civil associations and political organisations focused on confronting violence, accessing financial survival means and decent work, and preventing sexually transmitted infections (STIs). Meanwhile, transgender people’s organisations were also emerging, many of them shaped by the ideas and experiences of sex workers. Since then, several sex workers’ collectives have arisen across the country, organised mainly in three national networks – Central Única de Trabalhadoras e Trabalhadores do Sexo (Sex Workers Central Union), Rede Brasileira de Prostitutas (Brazilian Network of Prostitutes) and Articulação Nacional de Profissionais do Sexo (National Articulation of Sex Workers) – and in collaboration with the international sex workers’ movement.

From the 1990s onward, sex workers have actively taken part in the formulation and implementation of public health policies, particularly on STIs prevention, while facing the stigma of being an “HIV risk group” (Murray 2015). Juma Santos told us that she became politicised – which would later lead to the founding of the Tulipas collective – through the public policy of harm reduction, a policy formally regulated by Brazilian Health Ministry since 2005.

But Juma and the collective adopted harm reduction as a practice and a philosophy that is independent of the state’s mandate, especially considering their commitment is not only to sex workers, but also homeless people and drug users, among other marginalised and stigmatised groups. These groups constitute a public that has complex relationships with the state – state actors can simply not acknowledge their existence or be relatively amicable or actively attack them. Our fieldwork has shown that the interactions between sex workers and street levels bureaucrats are more than often structured around very personalised standards dictated by the bureaucrat herself rather than by official policy documents and guidelines. 

Besides stigmatisation, Brazilian law on sex work is vague and imprecise (while being a sex worker is not criminalised, all activities that provide the infrastructure for this occupation are, and their labor relations are not regulated), so that a central demand coming from sex workers is work regulation through the enactment of a more protective legislation. In this scenario, state and non-state actors can legitimise and naturalise the precariousness experienced by sex workers, as if their lives had already been lost, similarly to what happens to other populations (Butler 2016).

During the COVID-19 pandemic, sex workers found themselves once again excluded from public policy intended to respond to the multiple crises that, particularly in Brazil, were experienced on a deeper scale – socioeconomic, sanitary, ecological, and of social reproduction. Given the Brazilian federal government’s denialist posture throughout the public calamity, several social segments were affected in even more severe ways. Sex workers faced specific difficulties to access emergency social relief, to maintain their source of income, and to follow public health guidelines (Santos et al. 2020). In addition, they saw the deterioration of the spaces for political participation that they had built since the 1990s in dialogue with the state. As Juma Santos put it, sex workers have become so invisible that, this time around, they have not even been seen as a group with greater potential to become infected and transmit COVID-19. After all, although being framed as a risk group during the HIV epidemic was stigmatising and violent, in her view, it at least had pushed the state to do something about and with this group.

The COVID-19 pandemic shed light on and intensified social inequalities around the world and, particularly in Brazil, these were escalated by the denialist, anti-gender and anti-human rights administration of President Jair Bolsonaro. The federal government approach to the crisis was a continuation of its declared anti-gender and anti-poor politics adopted from the start of his administration. In the rare occasions when the federal government or its allies included sex workers in their public practices or discourses, these were grounded on damaging stigmatising assumptions and were mainly contradictory, like the evictions suffered by CasaNem, a shelter home, in the midst of the pandemic – with the temporary arrest of its leader Indianarae Siqueira, an activist sex worker, – parallel to negotiations between the collective and the local government (Santos et al. 2020) or the religious groups’ attempts to provide training and professionalisation opportunities for the Tulipas, as long as they were based on salvationist discourses – which would assume that every sex worker wants to stop doing this work. Lourdes Barreto, a sex worker who is also an activist since the 1980s, explained to Carolina during an interview in 2021, what the pandemic represented for them: 

We sex workers are a very vulnerable population [during the COVID-19 pandemic], because of sex work itself, because of the hugs [and physical contact], because of the places where we are, places lacking dignified working conditions, we are at great risk. And that’s it. We are in this fight for rights and citizenship. It is a permanent fight, a fight that takes place every moment, every day. (Moraes 2021, 164).

As Lourdes stresses, sex workers come from a long history of not only looking for ways to survive in normal and in exceptional times – as during the HIV epidemic and more recently, the COVID-19 pandemic, but also to develop and deploy strategies for dialogue, confrontation, and action in parallel to and against the state. Throughout these past decades of activism, sex workers’ organisations across the country have developed and learned strategies of mutual aid and shared responsibility for individual and collective care and survival.

Tulipas’ sex workers are not different. They do not seek out state institutions very often, opting instead to “solve” their problems themselves and with the support of close allies, donors, and professional volunteers (such as lawyers, nurses, psychologists). These problems include lack of income and basic needs, such as food, shelter and medication, protection from threats and aggression, awareness about STIs and drug abuse. But when they do turn to the state, they find state actors, even those who claim to be progressive or feminist, fearing to support them and being contaminated by sex work stigma. Knowing this, as the pandemic hit the country in March 2020 and the number of clients started to reduce, Tulipas began collecting money and food donations to guarantee support for themselves and those around them, including homeless people and people who use drugs. Afraid of the infection, the isolation, and the loneliness, they also started taking measures to ensure their mental and physical health, caring for themselves and one another.

Knowing that sex work is mostly performed by cis women and transgender people, concerns about the specificities of these groups also became a priority for Tulipas do Cerrado.

Since many sex workers, especially transgender sex workers, do not have their families as their care network, and others had to spend more time with their intolerant families during the isolation period, LGBT+ specialised social assistance in the Federal District was overwhelmed with the demand. In addition, with school closures, those who are mothers had their children staying with them throughout the day, making it more difficult to work at home. 

Seeing this context, Tulipas quickly organised donation campaigns, distributing food, hygiene items and masks. They also held public events on self-care, citizenship and rights. Yet, without adopting the common stance of rescuing sex workers, they promoted training for other occupations, such as caregiving for the elderly, so those who wanted to shift professions would have a choice to do so. And acknowledging that many would continue making their income through sex work throughout the pandemic, Tulipas prepared informational material with guidelines for prevention and harm reduction.

In Belo Horizonte, collectives Clã das Lobas and Rebu, and the association APROSMIG, held online workshops in which we also participated offering a space to debate the state, human and labor rights, and sex work. Similar actions of empowerment, political awareness, and mutual aid were developed in several cities in the country, supporting the basic notion that sex workers’ politics is focused on care and life maintenance (Santos et al. 2020). This movement has been carried out in countries on all continents, with associations of sex workers and LGBTQIA+ people focusing their efforts on ensuring conditions for survival – including those related to physical and mental health – at both normal and exceptional times, and providing support through local and transnational networks (AMMAR 2020; Red Umbrella Fund 2020).


With actions and networks like the ones we described above, sex workers not only fill public policy voids, but also, and perhaps more importantly, develop alternative ways of framing and dealing with health, care, work, and sexuality. Rather than treating these as separate domains of life, they adopt harm reduction measures, value interpersonal and collective relationships, confront stigma and fear and challenge the individualistic neoliberal logic that produces a crisis of social reproduction (Fraser 2016).

While we witness the dismantling of social protection along with the flexibilisation of labor relations for sectors that used to be protected by constitutional frameworks and other regulations, sex workers have never subjects of protective laws and public policies throughout the 20th century, even before the current neoliberal turn (Cruz 2013). Thus, if with other social groups there is a legitimate apprehension that directly supplying services can reinforce individual over-responsibilisation and authorise discourses exempting the state from these obligations, this is not the case with sex workers. On the contrary, through their discourses and practices, sex workers have long fought the marginalisation of women (cis and trans) and their families, allowing for an important shift in the logic of overvaluation of the individual to the detriment of collective practices. Their practices are based on shared responsibility, mutuality and reciprocity for survival and are combined with demands for the state to recognise their work and their rights. Thus they ultimately also challenging the frame that devalues their lives as losable and frames them untrustworthy, irresponsible, and discredited, while ensuring they survive today.

This is probably why Juma Santos always makes a point in saying that what they do at Tulipas do Cerrado collective is not charity. Through their everyday practices in the absence of the state, sex workers build for and around them “alternative infrastructures of care, guided by principles other than profit” (Moraes, Santos, and Assis 2020, 652). As such, they fight for a new and more just world for themselves and their communities as they build this very world through their everyday activities and collective direct action. By deploying an approach to sexuality, care and health that moves away from moralistic, monogamous, and cis-heteropatriarchal frames, sex workers also dispute practices, discourses and frameworks that disrupts hegemonic understanding about the very way of living in society. For all of this, we must acknowledge in them policy makers who are elaborating, experimenting and disputing alternative policy models that serve their needs and those of their communities.


Observing Tulipas‘ work and realising that it is a continuation of decades-long Brazilian sex workers’ actions, we find support for the approach that displaces the state from the center of public policy production, viewing other actors who produce alternative policy models even when they feel distrustful of the state and the spaces it creates. Moreover, Tulipas teach us that mutual aid can take place through actions that, while fulfilling people’s immediate needs, engage in the deep political practice of denouncing state absence and negligence in addressing sex workers’ demands for health, work, and care in a way that does not reproduce sex work stigma. Finally, by developing an alternative model of care for oneself and for others, grounded upon shared responsibility, mutuality and radical respect, Tulipas also offer an approach that simultaneously defy the privatisation and invidualisation of care, suggesting alternatives pathways for the feminist literature that is anguished by the crisis of social reproduction.

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