Reducing stigma in healthcare and law enforcement: a novel approach to service provision for street level sex workers

Abstract

IntroductionProviding services for street level sex workers requires a multidisciplinary approach, addressing both health and safety concerns typical of their age and gender and those that arise specific to their line of work. Despite being a diverse population, studies have identified some specific health needs for sex workers including addictions treatment, mental health. Additionally, studies have shown a higher risk of physical and sexual assault for this population. The Persons at Risk program (PAR) in London, Ontario, Canada was started in 2005 to address the specific needs of street level sex workers by using a harm-reduction model for policing and healthcare provision. This qualitative study evaluated this model of care in terms of improving access to healthcare and essential police services for street level sex workers.MethodsA total of 14 semi-structured interviews were conducted with current and former female street level sex workers enrolled in the PAR program. In addition, 3 semi-structured interviews were conducted with health and law enforcement professionals. The research team then analyzed and coded the transcripts using qualitative description to identify key themes in the data.ResultsResults indicated that participants represent a vulnerable population with increased safety concerns and healthcare needs relating to addictions, mental health and infectious disease. Despite this, participants reported avoiding healthcare workers and police officers in the past because of fear of stigma or repercussions. All participants identified the harm reduction approach of the PAR program as being essential to their continued engagement with the program. Other important aspects included flexible hours, the location of the clinic, streamlined access to mental health and addictions treatment and the female gender of the police and healthcare worker.ConclusionsThe PAR program provides sex workers access to much needed primary healthcare that is flexible and without judgment. In addition, they are provided with a direct avenue to access law enforcement. We feel a similar model of care could be applicable to many cities across Canada.

Overlapping HIV and sex-work stigma among female sex workers recruited to 14 respondent-driven sampling surveys across Zimbabwe, 2013

“…However, we found differences for internalised as well as experienced stigma, with no evidence that disclosure of HIV status influenced either type of stigma. Our data support the hypothesis that Zimbabwe is undergoing a shift in relative levels of stigma associated with HIV-infection and sex-work (Bodkin, Delahunty-Pike, & O'Shea, 2015;Mtetwa, Busza, Chidiya, Mungofa, & Cowan, 2013;Scorgie et al, 2013). Our finding of high levels of reported stigma is consistent with other studies, for example the Zimbabwe stigma index found 65.5 % of people LWH reported stigma while the proportion was higher proportion among sex-workers (90.5%).…”

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

“…In December 2016, the World Health Organization (WHO) released guidelines related to HIV self-testing (HIVST) [ 2 , 3 ], recommending that HIVST be offered in addition to standard HIV testing services to help achieve realization of this target and as an entry point into HIV prevention services for those testing negative. In particular, the guidelines recognize the importance of the development of new approaches such as HIVST for members of key populations that frequently have lower uptake of HIV testing services due to multilevel factors such as healthcare provider stigma [ 4 , 5 ] and lack of legal protection [ 6 ].…”

Intersectional Stigma, Identity, and Culture: A Grounded Theory of Female Escort Perspectives from Brazil and Pakistan

“…Due to the discrimination and stigmatization of sex workers they remain under-represented, over-judged and live their lives with little or no support. Research carried out on support and stigma with sex workers has focused on health-related issues with regards to the prevalence, transmission and seeking of help for HIV and sexually transmitted diseases (eg: Day and Ward, 1997;Brown at al, 2003;Duffy, 2005;Scambler and Paoli, 2008) as one of the fundamental impacts of stigma is the restricted access to health services (Bodkin et al, 2015;Rael 2015;King et al, 2013;Scorgie et al, 2013;Lazarus et al, 2012). This is an issue of growing importance in a global pandemic era.…”