Gaps in health research related to sex work: an analysis of Canadian health research funding

The Ethics of Financial Incentivization for Health Research Participation Among Sex Workers in a Canadian Context

“…To develop a comprehensive, purposeful sampling approach that would enable us to capture rich and illuminative data about research incentives (Patton, 2015), we first developed a Canadian-specific profile of the sex work-related health research. As detailed in our earlier paper, (Bungay et al, 2021), we analyzed the publicly available, federal health research granting agency database held by the Canadian Institutes of Health Research (Canadian Institutes of Health Research, 2018) to identify the people, geographical places and focus of research over a 15-year period. Funding allocation represents the complex social processes inherent in the logic and strategy of building an evidence-base for health improvement (Kavanagh et al, 2020).…”

“…Moreover, the research that has occurred has focused on whether financial incentives are ethical from the perspective of formalized research ethics (clearance) (e.g., Largent et al, 2012; Molyneux et al, 2012; Ripley et al, 2010), versus the perspective of researchers and participants about the doing of research and what it means to give and receive financial incentives. Recently, numerous scholars (Benoit et al, 2019; Bungay et al, 2021; Hunt, 2013) and advocates for sex workers’ rights to self-determination (NSWP, 2013; Pivot Legal Society, 2017) have identified the need for critical ethical inquiry into the socio-structural context of health research. This call to action has specifically requested attention to relations of power and privilege in the research setting as influential for potential harm as well as practices that foster sex workers’ health, human rights, and self-determination.…”

“…Although sex work occurs in all countries and across varied locations and economic contexts, health research involving sex workers regularly occurs within environments of severe poverty such the street-level, survival-based marketplaces (Collins et al, 2017; Krüsi et al, 2016; Orchard et al, 2019) or in low-income countries with high HIV prevalence and limited economic opportunities (Bungay et al, 2021; Kamalo et al, 2017; Nyangulu et al, 2019). Sex work most often transpires in a quasi or highly criminalized context accompanied by stigma, discrimination, and the consequential increased vulnerability for significant health and social inequities (Bungay et al, 2021; Bungay & Guta, 2018; Reed et al, 2014).…”

“…Although sex work occurs in all countries and across varied locations and economic contexts, health research involving sex workers regularly occurs within environments of severe poverty such the street-level, survival-based marketplaces (Collins et al, 2017; Krüsi et al, 2016; Orchard et al, 2019) or in low-income countries with high HIV prevalence and limited economic opportunities (Bungay et al, 2021; Kamalo et al, 2017; Nyangulu et al, 2019). Sex work most often transpires in a quasi or highly criminalized context accompanied by stigma, discrimination, and the consequential increased vulnerability for significant health and social inequities (Bungay et al, 2021; Bungay & Guta, 2018; Reed et al, 2014). People experiencing severe economic disadvantage, stigma, discrimination, and/or criminalization are often regarded as “socially vulnerable” within institutional research ethics guidelines with cautionary guiding statements concerning incentive use among those considered socially vulnerable state that incentives “should not be so large or attractive as to encourage reckless disregard of risks” (Government of Canada, 2018).…”

“…Research about risk and participant welfare has also considered the nature of study designs. Sex workers are often asked to participate in physically and emotionally invasive research, such as providing blood and tissue samples, medication trials, and responding to questions regarding intimate sexual practices, trauma histories, and violence (Anderson et al, 2016; Bungay et al, 2021; Reed et al, 2017). Such studies carry potential harms, such as medication side effects (Brown et al, 2015) and re-traumatization (Reed et al, 2017; Urada & Simmons, 2014).…”