Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study

Abstract

ngagement in sex work (the exchange of sexual services for money, services or goods) is associated with a higher chance of contact with sexually transmitted and blood-borne infections including HIV, both in Canada and globally. 1,2 Although participation in sex with multiple partners, exposure to sexual violence, intravenous drug use, an unstable living environment and a criminalized working environment are contributors to this elevated risk for some sex workers, stigma in health care settings also contributes to inadequate access to health care services. 1 Sex workers have reported a variety of reasons for not seeking health care, and stigma associated with sex work appears to be a primary barrier. 3,4 Young adults (aged 18-29 yr) who engage in sex work appear to be particularly at risk for HIV and other infections and associated risk factors. 5 These risks, particularly among youth, are a major concern given the well-established longterm health impacts of untreated sexually transmitted infections. [6][7][8] However, we could identify no Canadian research that has specifically examined the experiences of young adult sex workers in Canada in accessing sexual and reproductive health care services.In a recent local needs assessment of the experiences of youth in Toronto, Ontario, with sexual health care services, respondents who reported experience with sex work were more likely than other youth to cite unmet sexual health needs and to lack access to sexual health information and services. 9 To address this local need and the gap in Canadian research more broadly, we conducted a study to address the following research questions: 1

Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization – A scoping review

“…If they do not disclose -they are barred from receiving care that could be tailored to their needs. Existing literature on sex workers' encounters with healthcare providers demonstrates that women mostly choose nondisclosure (Dourado et al, 2019;Lowe et al, 2019;Ross et al, 2021).…”

“…For example, sex workers in Tanzania (Faini et al., 2020) missed monthly contraceptive supplies provided by family planning clinics because these were only open during the day when they rested after working at night. Another common issue was a high or unaffordable service fee (Bick et al., 2017; Corneli et al., 2016; Oza et al., 2015; Rocha‐Jiménez et al., 2018; Ross et al., 2021; Wahed et al., 2017). A study conducted in Kenya suggested that the inaccessibility of RHC services intensified following COVID‐19‐related government priorities (Gichuna et al., 2020).…”

“…Stigmatization seemed to have occurred mainly within client–provider interactions: eight of the studies reported incidents whereby sex workers experienced negative and differential treatment from staff members (Bick et al., 2017; Corneli et al., 2016; Ochako et al., 2018; Parmley et al., 2019; Rocha‐Jiménez et al., 2018; Ross et al., 2021; Wahed et al., 2017; Zenouzi et al., 2021). For example, a woman with high‐risk sexual behaviour from Iran said:

I don't like to go to health centers.

…”

“…Sex workers in Canada reported condescending attitudes, including refusal to take women's self‐reported needs seriously, efforts to convince women to leave sex work and intersecting forms of stigma (ageism, sexism and ableism) (Ross et al., 2021):

I never actually told any doctor that I've spoken to that I'm a sex worker for many, many reasons. Including the fact that I live with PTSD, and the minute you tell somebody that you're somebody who suffers from PTSD, and that you're a sex worker, you can no longer make decisions for yourself as an adult in the medical community.

…”

The needs and preferences of Eastern Canadian sex workers in mitigating occupational health and safety risks through the use of Information and Communication Technologies: A qualitative study

“…Participants in this study mentioned the impact of sex work stigma on their OHS risks, consistent with the risks identified in Benoit et al’s 2018 study on prostitution stigma. Notably, participants described how judgement on the part of healthcare workers could result in avoidance of health care services [ 40 ], as has been documented in previous studies [ 4 , 52 , 53 ]. To address this concern, the participants in this study recommended a directory of professionals that do not stigmatize sex workers, including healthcare providers, therapists, and STI testing clinics, be made available as part of a novel ICT OHS tool.…”