Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program

Abstract

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.

Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US

“…1 In an attempt to overcome stigma-related hurdles to care, a variety of research and NGO initiatives have emerged to position sex workers and affected community members as peer health advocates, particularly in the context of HIV interventions. A large body of research exists highlighting the benefits of sex worker-led sexual health programs and the positive outcomes of peer-to-peer outreach in STI and HIV prevention programs (Benoit et al 2017). In Songachi, Kolkata's largest red-light district 1 In another study in Canada, sex workers experienced stigma from their HIV status and sex work and faced structural racial, gender, and sexual inequalities that created formidable health barriers and limited their coping strategies (Logie et al 2011).…”

Women Trading Sex in a U.S.-Mexico Border City: A Qualitative Study of the Barriers and Facilitators to Finding Community and Voice

“…The constant state of powerlessness and isolation reported by many reflected their request for peer-to-peer groups to boost their self-esteem and help them feel validated and treated like "human beings". Peer-led education programs involving women in the sex trade have been found to reduce internalized stigma and help empower them to confront judgements from others [34]. These women in Tijuana largely did not benefit from human rights movements that only benefited the members of the organizations.…”

“…Participants experienced stigmatizing behaviors from social service and medical professionals, which could further prohibit them from accessing health and social services. However, peer support groups have been found to increase clinic visits and help empower women to stand up to health care professionals who exhibit stigmatizing behaviors [21,22,34].…”

Cancer risk in socially marginalised women: An exploratory study

“…Women asked questions of each other during the discussions (and gave advice) which might lend support to the case that mutual solidarity from peers can provide a social opportunity that is helpful in health improvement. It is recognised that support from peers who share similar life experiences can be a powerful tool for improving and maintaining health (Bagnall et al, 2015; Benoit et al, 2017; Naylor et al, 2013) and empowering people to manage their own health (NHS England, 2014). Indeed connectedness, trust and reciprocity as demonstrated in peer support can be seen as the social glue that ‘binds us together’ and has the potential to enhance medical services (Rippon and Hopkins, 2015).…”