Agency of Sex Workers in Policy and Organizing
An important piece of creating public health policies that reflect the needs of sex workers themselves is including sex workers voices in the creation of these policies, and allowing for organizing to be centered around the needs of sex workers themselves.
In the text and material about sex workers in France in the 1800s, there is very little consideration of the perspective and voice of the sex workers themselves. As a result of access to resources, and the way that lack of technology prohibited organizing and communication, it is difficult to document any agency on the part of sex workers in policy and organizing and to see how this affects public health outcomes. Most material about sex work at the time is written from the perspective of doctors or other public officials, showing a lack of documented agency in terms of healthcare resources for sex workers at the time.
Sex workers having agency over public health policy has a significant impact on the public health outcomes because it allows the policy to actually reflect the needs of sex workers themselves. The reasons sex workers choose not to access certain resources has to do with the resources not doing enough to be accessible. For example, many healthcare providers are extremely judgemental of sex work, making it difficult to access these resources. There have been several organizations created specifically to meet these needs. COYOTE, CAL PEP, and SJI, all organizations primarily by and for sex workers that offer services including but not limited to STI testing and information. These groups are examples of the way activist groups can create organizations that are official non profits under the state can still allow the organization to pursue oppositional goals while allowing the government to better address the needs of marginalized groups. From an institutional perspective, activist led sex worker healthcare organizations can work when partnered with the government. Despite the fact that partnering with the state presents logistical and philosophical difficulties, the institutionalization can allow sex workers to better access well funded resources that are tailored to their needs. In this case, these groups are able to fully meet the needs of sex workers by offering comprehensive services that take the whole lives of the sex worker into account.
What is different:
The organizations created based on the agency of sex workers are well documented and present today more so than in France in the 1800s. In addition, there is little evidence of sex workers having a significant role in official public health policy. Although there was certainly information sharing that went on among the sex workers in private, there was no official organization like there is today.
What has stayed the same:
Despite the groups and organization that have arisen to advocate specifically for the needs of sex workers, still most healthcare is not geared towards the needs of sex workers. In addition, many sex workers cannot access these services due to their geographic location or knowledge of these types of services. There were are still are a lot of institutional barriers to sex workers having agency over policy and healthcare, like the stigma associated with sex work that makes it difficult to out oneself as a sex worker. In addition, many sex workers also have to deal with intersecting barriers like poverty, addiction, or homelessness. These factors make it even more difficult to organize effectively and advocate for policy. 
 Majic, Samantha. American Governance : Politics, Policy, and Public Law : Sex Work Politics : From Protest to Service Provision. Philadelphia, PA, USA: University of Pennsylvania Press, 2013. ProQuest ebrary. Web. 2 March 2016.
 Grant, Melissa Gira (2014-03-11). Playing the Whore: The Work of Sex Work (Jacobin) (p. 29). Verso Books. Kindle Edition.