BackgroundSocial marginalization and criminalization create health and safety risks for sex workers and reduce their access to health promotion and prevention services compared to the general population. Community empowerment-based interventions that prioritize the engagement of sex workers show promising results. Peer-to-peer interventions, wherein sex workers act as educators of their colleagues, managers, clients and romantic partners, foster community mobilization and critical consciousness among sex workers and equip them to exercise agency in their work and personal lives.MethodsA pilot peer health education program was developed and implemented, with and for sex workers in one urban centre in Canada. To explore how the training program contributed to community empowerment and transformative learning among participants, the authors conducted qualitative interviews, asked participants to keep personal journals and to fill out feedback forms after each session. Thematic analysis was conducted on these three data sources, with emerging themes identified, organized and presented in the findings.ResultsFive themes emerged from the analysis. Our findings show that the pilot program led to reduced internalized stigma and increased self-esteem in participants. Participants’ critical consciousness increased concerning issues of diversity in cultural background, sexual orientation, work experiences and gender identity. Participants gained knowledge about how sex work stigma is enacted and perpetuated. They also became increasingly comfortable challenging negative judgments from others, including frontline service providers. Participants were encouraged to actively shape the training program, which fostered positive relationships and solidarity among them, as well as with colleagues in their social network and with the local sex worker organization housing the program. Resources were also mobilized within the sex worker community through skills building and knowledge acquisition.ConclusionThe peer education program proved successful in enhancing sex workers’ community empowerment in one urban setting by increasing their knowledge about health issues, sharing information about and building confidence in accessing services, and expanding capacity to disseminate this knowledge to others. This ‘proof of concept’ built the foundation for a long-term initiative in this setting and has promise for other jurisdictions wishing to adapt similar programs.Electronic supplementary materialThe online version of this article (10.1186/s12939-017-0655-2) contains supplementary material, which is available to authorized users.

This article examines the narratives of men who purchase sex from street-level providers in a mid-sized city in Western Canada. We explore what men's stories tell us about how masculinity is constructed in relation to street sex work. These men narrated their purchase of sex as attempts to exercise or lay claim to male power, privilege, and authority; at the same time, research reveals how tenuous this arrangement is for men. Study participants drew on conventional heterosexual masculine scripts to rationalize their actions and behaviors. Their stories reveal that their purchase of street-level sex is motivated by a sense of failure to successfully align with classed and gendered norms of hegemonic masculinity in which the purchase of sex was an attempt to "feel like a man again." In this article, we move beyond the notion that static "types" of men purchase sex, highlighting instead that sex work customers are complex social actors with multifaceted reasons for purchasing sex but that are nonetheless inseparable from socially valorized forms of masculine comportment. We conclude that hegemonic masculinity is not only injurious to some men, but also to the sex workers on whom it is enacted.

In the last few decades there has been a resurgence of interest in the social causes of health inequities among and between individuals and populations. This ‘social determinants’ perspective focuses on the myriad demographic and societal factors that shape health and well-being. Heeding calls for the mainstreaming of two very specific health determinants - sex and gender - we incorporate both into our analysis of the health gap experienced by girls and women in Canada. However, we take an intersectional approach in that we argue that a comprehensive picture of health inequities must, in addition to considering sex and gender, include a context sensitive analysis of all the major dimensions of social stratification. In the case of the current worldwide economic downturn, and the uniquely diverse Canadian population spread over a vast territory, this means thinking carefully about how socioeconomic status, race, ethnicity, immigrant status, employment status and geography uniquely shape the health of all Canadians, but especially girls and women. We argue that while a social determinants of health perspective is important in its own right, it needs to be understood against the backdrop of broader structural processes that shape Canadian health policy and practice. By doing so we can observe how the social safety net of all Canadians has been eroding, especially for those occupying vulnerable social locations.

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In Canada, as elsewhere in the world, caesarean sections are the most common surgical procedure performed in hospitals annually. Recent national statistics indicate 28% of infants in Canada are born by c-section while in the United States that number rises to 33%. This is despite World Health Organization recommendations that at a population level only 10–15% of births warrant this form of medical intervention. This trend has become cause for concern in recent decades due to the short and long-term health risks to pregnant women and infants, as well as the financial burden it places on public health care systems. Others warn this trend may result in a collective loss of cultural knowledge of a normal physiological process and, in the process, establish a new “normal” childbirth. Despite a range of interventions to curb c-section rates—enhanced prenatal care and innovation in pregnancy monitoring, change in hospital level policies, procedures and protocols, as well as public education campaigns—they remain stubbornly resistant to stabilization, let alone, reduction in high-income countries. We explore—through a review of the academic and grey literature—the role of cultural and social narratives around risk, and the responsibilization of the pregnant woman and the medical practitioner in creating this kind of resistance to intervention today.