Leigh's activism spans decades, as a COYOTE member, founding member of ACT UP and SWOP, and co-founder of Bay Area Sex Worker Advocacy Project.

She has performed internationally as Scarlot Harlot, including several years touring with the Sex Worker Art Show Tour. In 1999 she founded the San Francisco Sex Worker Film and Arts Festival. Leigh was lead organizer of the San Francisco Board of Supervisor's Task Force on Prostitution.

She has worked closely with Desiree Alliance supporting an intersectional / economic / racial / gender justice emphasis within the sex worker rights movement. She has worked with Joseph Kramer, creating sexual health / education videos including work on 'healthy porn watching.'

Leigh served as a consultant for AIM For Human Rights' "Trafficking Policy Impact Tool" (Netherlands). She currently sits on the Sex Workers / Trafficking Policy Impact Committee on The San Francisco Mayor's Task Force on Prostitution.

Leigh received a generous grant from the Creative Work Fund for the Sex Worker Media Library in collaboration with the Center for Sex and Culture. For several years she has been focusing on this library and the collection of work, Collateral Damage: Sex Workers and the Anti-Trafficking Campaigns.