Peer Support using a Mobile Access Van Promotes Safety and Harm Reduction Strategies among Sex Trade Workers in Vancouver’s Downtown Eastside

Abstract

Women in the sex trade whose economic and social base are urban streets face multiple dangers of predation, isolation, and illness. A Mobile Access Project (MAP) to provide emergency medical help, peer counseling, condoms and clean needles, resource information and referral, and a place of respite and safety was initiated for sex trade workers in Vancouver, British Columbia, Canada. We conducted surveys with 100 women sex workers who accessed MAP services and reviewed MAP logbooks to document use of services. We assessed the impact of MAP through review of data from a concurrent cohort study of injection drug users and a survey of 97 women at a drop-in center in the Downtown Eastside. Over 90% of MAP clients reported that the van made them feel safer on the street. Sixteen percent of surveyed MAP clients recalled a specific incident in which the van's presence protected them from a physical assault and 10% recalled an incident when its presence had prevented a sexual assault. Distribution of needles and condoms has increased steadily since the implementation of MAP. Eighty percent of women surveyed at a drop-in center in the Downtown Eastside had received services from MAP. The peer-led Mobile Access Project has emerged as a viable harm reduction strategy for serving the immediate health and trauma-related needs of women engaged in street-level sex work.

The role of nurse practitioners in outreach services and facilitating access for marginalized adult women in British Columbia

“…Salmon et al (2009) reported that 79.2% of the women in their study group had recently experienced violence, and two of the women were killed in violent circumstances during the course of the study-thereby illustrating the profound cruelty to which this population is exposed. In the downtown eastside of Vancouver, over 60 sex trade workers have gone missing since 1980 (Janssen et al, 2009). Salmon et al (2009) also emphasize that women experience violence-not only from their peers, drug dealers, interpersonal relationships, and clients in the sex trade-but also from the health care system, and from the health care providers.…”

“…Although the focus of this paper is on marginalized adult women in general, it is important to note that in this literature review there is an over representation of marginalized Aboriginal women (Butters & Erickson, 2003 ;Deering et al, 2011a;Janssen et al , 2009;Kurtz et al, 2008;Lazarus et al, 2012;Marshall, Charles, Hare, Ponzetti, & Stokl, 2005;Salmon et al , 2009). For example, Marshall et al (2005) found that, of the women using Sheway, the downtown eastside street-front service, 80.7% were Aboriginal.…”

“…Eight studies using data relating to British Columbia have been reviewed (Deering et al, 2011a;Janssen et al, 2009;Jozaghi & Andresen, 2013;Kurtz et al, 2008;Lazarus et al, 2012;Marshall et al, 2005;Salmon et al, 2009;Wardman, Clement, & Quantz, 2005). Four studies from Ontario were identified and included (Butters & Erickson, 2003;Daiski, 2005;Goodman, 2006;Woolhouse, Brown, & Lent, 2004).…”

“…Outreach centers provide women with access to a variety of information, for example, when a bad batch of drugs hits the market (Janssen et al, 2009). These centres are also known to provide bad date postings, which circulate information to women-and through women-in the sex trade regarding clients who are known to be abusive and to be avoided (Deering et al, 20lla;Janssen et al, 2009 (Jozaghi & Andresen, 2013 , p. 6). This finding is significant, inasmuch as it indicates that women feel that their sense of safety has increased on the basis of these outreach initiatives.…”

“…Research shows that, when outreach centres work on the basis of flexible health delivery models, women are not required to show identification in the course of seeking health care (Daiski, 2005;Deering et al, 2011a;Islam & Conigrave, 2007;Islam et al, 2012;Janssen et al, 2009). There is also the necessity for services to be free where the populations served do not have medical coverage (Islam & Conigrave, 2007;Islam et al, 2012).…”