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Benoit C, Smith M, Jansson M, Healey P, Magnuson D. "The Prostitution Problem": Claims, Evidence, and Policy Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1905-1923. [PMID: 30498916 DOI: 10.1007/s10508-018-1276-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 05/12/2023]
Abstract
Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.
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Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada.
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Priscilla Healey
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
| | - Doug Magnuson
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
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Benoit C, Smith M, Jansson M, Magnus S, Maurice R, Flagg J, Reist D. Canadian Sex Workers Weigh the Costs and Benefits of Disclosing Their Occupational Status to Health Providers. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2018; 16:329-341. [PMID: 31423291 PMCID: PMC6669194 DOI: 10.1007/s13178-018-0339-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prostitution stigma has been shown to negatively affect the work, personal lives, and health of sex workers. Research also shows that sex workers have much higher unmet health care needs than the general population. Less is known about how stigma obstructs their health-seeking behaviors. For our thematic analysis, we explored Canadian sex workers' accounts (N = 218) of accessing health care services for work-related health concerns. Results show that participants had mixed feelings about revealing their work status in health care encounters. Those who decided not to disclose were fearful of negative treatment or expressed confidentiality concerns or lack of relevancy. Those who divulged their occupational status to a health provider mainly described benefits, including nonjudgment, relationship building, and comprehensive care, while a minority experienced costs that included judgment, stigma, and inappropriate health care. Overall, health professionals in Canada appear to be doing a good job relating to sex workers who come forward for care. There is still a need for some providers to learn how to better converse with, diagnose, and care for people in sex work jobs that take into account the heavy costs associated with prostitution stigma.
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Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research and Department of Sociology, University of Victoria, 2300 McKenzie Ave., Victoria, BC V8N 5M8 Canada
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research and Department of Sociology, University of Victoria, 2300 McKenzie Ave., Victoria, BC V8N 5M8 Canada
| | - Samantha Magnus
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| | - Renay Maurice
- Department of Sociology, University of Victoria, Victoria, BC Canada
| | - Jackson Flagg
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| | - Dan Reist
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
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Ma PHX, Chan ZCY, Loke AY. The Socio-Ecological Model Approach to Understanding Barriers and Facilitators to the Accessing of Health Services by Sex Workers: A Systematic Review. AIDS Behav 2017. [PMID: 28631228 DOI: 10.1007/s10461-017-1818-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Inequities in accessing health care persist among sex workers. The purpose of the review is to understand the health-seeking behaviours of sex workers and their access to health care services with socio-ecological model. Of 3852 citations screened, 30 met the inclusion criteria for this review. The access that sex workers have to health services is a complex issue. A wide range of barriers and facilitators at multiple levels could influence sex workers' utilization of health care services, such as health or service information, stigma, social support, quality of health care, available, accessible and affordable services, healthcare policy. Health services or future intervention studies should take into account the facilitators and barriers identified in this review to improve the health services utilization and health of sex workers, as part of the effort to protect the right of humans to health.
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“Well, It Should Be Changed for One, Because It’s Our Bodies”: Sex Workers’ Views on Canada’s Punitive Approach towards Sex Work. SOCIAL SCIENCES 2017. [DOI: 10.3390/socsci6020052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Kille J, Bungay V, Oliffe J, Atchison C. A Content Analysis of Health and Safety Communications Among Internet-Based Sex Work Advertisements: Important Information for Public Health. J Med Internet Res 2017; 19:e111. [PMID: 28408364 PMCID: PMC5408134 DOI: 10.2196/jmir.6746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/14/2017] [Accepted: 03/04/2017] [Indexed: 11/13/2022] Open
Abstract
Background The capacity to advertise via the Internet continues to contribute to the shifting dynamics in adult commercial sex work. eHealth interventions have shown promise to promote Internet-based sex workers’ health and safety internationally, yet minimal attention has been paid in Canada to developing such interventions. Understanding the information communicated in Internet-based sex work advertisements is a critical step in knowledge development to inform such interventions. Objective The purpose of this content analysis was to increase our understanding of the health and safety information within the Internet advertisements among women, men, and transgender sex workers and to describe how this information may be utilized to inform eHealth service development for this population. Methods A total of 75 Internet-based sex worker advertisements (45 women, 24 men, and 6 transgender persons) were purposefully selected from 226 advertisements collected as part of a larger study in Western Canada. Content analysis was employed to guide data extraction about demographic characteristics, sexual services provided, service restrictions, health practices and concerns, safety and security, and business practices. Frequencies for each variable were calculated and further classified by gender. Thematic analysis was then undertaken to situate the communications within the social and commercialized contexts of the sex industry. Results Four communications themes were identified: (1) demographic characteristics; (2) sexual services; (3) health; and (4) safety and security. White was the most common ethnicity (46/75, 61%) of advertisements. It was found that 20-29 years of age accounted for 32 of the 51 advertisements that provided age. Escort, the only legal business title, was the most common role title used (48/75, 64%). In total, 85% (64/75) of advertisements detailed lists of sexual services provided and 41% (31/75) of advertisements noted never offering uncovered services (ie, no condom). Gender and the type of Web-based platform mattered for information communicated. It was found that 35 of the 45 women’s advertisements were situated in personal websites and hosted details about nonsexual aspects of an appointment. Men and transworkers used Internet classified advertisement platforms with predetermined categories. Communications about sexually transmitted infections (STIs) occurred in only 16% (12/75) of advertisements with men accounting for 7. Women’s advertisements accounted for 26 of the 37 advertisements noting safety restrictions. Zero men or transpersons restricted alcohol or drug use. In total, 75% (56/75) of advertisements offered out-call services and the average minimal hourly rate ranged from Can $140/h to Can $200/h. Conclusions The study findings contribute to understandings about the diverse platforms used in commercial sex advertisements, and how sex workers frame information for potential clients. This information affords health care providers and policy makers insights to how they might assist with promoting the health of Internet-based sex workers and their clients.
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Affiliation(s)
- Julie Kille
- Providence Health Care, Vancouver, BC, Canada
| | - Vicky Bungay
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - John Oliffe
- University of British Columbia, Vancouver, BC, Canada
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O’Donnell P, Tierney E, O’Carroll A, Nurse D, MacFarlane A. Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. Int J Equity Health 2016; 15:197. [PMID: 27912783 PMCID: PMC5135741 DOI: 10.1186/s12939-016-0487-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. METHODS This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. RESULTS Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. CONCLUSIONS Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.
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Affiliation(s)
- Patrick O’Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Edel Tierney
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Austin O’Carroll
- North Dublin City General Practice Training Scheme, Catherine McAuley Centre, Nelson Street, Dublin 7, Ireland
| | - Diane Nurse
- National Social Inclusion Office, Primary Care Division, Health Service Executive, Mill Lane, Palmerstown, Dublin 20, Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Moore E, Han J, Serio-Chapman C, Mobley C, Watson C, Terplan M. Contraception and clean needles: feasibility of combining mobile reproductive health and needle exchange services for female exotic dancers. Am J Public Health 2012; 102:1833-6. [PMID: 22897527 DOI: 10.2105/ajph.2012.300842] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Young women engaged in exotic dancing have a higher need for reproductive health services than women not in this profession, and many also use drugs or exchange sex for money or drugs. Few report receiving reproductive health services. We describe a public health, academic, and community partnership that provided reproductive health services on needle exchange mobile vans in the "red light district" in downtown Baltimore, Maryland. Women made 220 visits to the vans in the first 21 months of the program's operation, and 65% of these visits involved provision of contraception. Programmatic costs were feasible. Joint provision of needle exchange and reproductive health services targeting exotic dancers has the potential to reduce unintended pregnancies and link pregnant, substance-abusing women to reproductive care, and such programs should be implemented more widely.
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Affiliation(s)
- Eva Moore
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Bungay V, Kolar K, Thindal S, Remple VP, Johnston CL, Ogilvie G. Community-based HIV and STI prevention in women working in indoor sex markets. Health Promot Pract 2012; 14:247-55. [PMID: 22885289 DOI: 10.1177/1524839912447189] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community research into women's experiences in the indoor commercial sex industry illustrated an urgent need for sexually transmitted infection (STI) and HIV education, prevention, testing, and treatment and culturally appropriate services to support the sexual and reproductive health of commercial sex workers (CSWs). This work also revealed that a high number of immigrant--primarily Asian--women are involved in the indoor sex industry. In response, the authors developed a community-academic research partnership to design and implement a blended outreach research program to provide STI and HIV prevention interventions for indoor CSWs and their clients. This Community Health Worker Model HIV Prevention and Health Promotion Program incorporated health education, primary care referrals, STI testing using self-swab techniques, and a point-of-care HIV screening test. Here the authors report on program implementation, design, and the experiences of participants and team members and provide research and vaccination recommendations for future work in this area. This work work affirms that community-based service providers can be a key entry point for indoor CSWs to access health care and sexual health promotion and education and may be a solution to missed opportunities to provide culturally and contextually appropriate education and services to this population.
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Affiliation(s)
- Vicky Bungay
- University of British Columbia, Vancouver, British Columbia, Canada.
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Bungay V, Halpin M, Halpin PF, Johnston C, Patrick DM. Violence in the massage parlor industry: experiences of Canadian-born and immigrant women. Health Care Women Int 2012; 33:262-84. [PMID: 22325026 DOI: 10.1080/07399332.2011.603868] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We examined and contrasted 129 Canadian-born and immigrant women's experiences of violence and associated structural and interpersonal factors within indoor commercial sex venues. The majority experienced at least one form of structural, interpersonal, or both types of violence, with the attempted removal of a condom during sexual services being cited most frequently. Canadian-born women reported more frequent violent assaults in the survey data. The women's qualitative narratives illustrated that perceptions of violence differed significantly among Canadian versus non-Canadian born women. Findings concerning racialization and gendered relations of power have important implications for prevention and interventions to support victims of abuse.
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Affiliation(s)
- Vicky Bungay
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
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Khan MS, Unemo M, Zaman S, Lundborg CS. Health-seeking behaviour of women selling sex in Lahore, Pakistan. Int J STD AIDS 2011; 22:376-80. [DOI: 10.1258/ijsa.2011.010375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to describe the knowledge and health-seeking behaviour related to sexually transmitted infections (STIs) and abortion among women selling sex in Lahore, Pakistan. This was a cross-sectional, community-based, quantitative study. A total of 730 women selling sex were recruited by respondent-driven sampling. A pretested structured questionnaire was administered through face-to-face interviews. The median age of the participants was 30 years. Thirteen percent of the participants said it was common for them to have an abnormal vaginal discharge. Seventy-five percent of the participants recognized STIs as either leucorrhoea or AIDS. Sixty-five percent of the participants complained of having suffered from STI(s) in the six months preceding the survey, of whom 28% sought treatment. Women selling sex who reported consistent condom use were 1.5 times (95% confidence interval [CI]: 1.1–2.2) more likely to seek treatment than women who did not report consistent condom use. The level of knowledge about STIs remains low among women selling sex in Lahore, Pakistan, and health-seeking behaviour for the management of STIs and abortions is influenced by ability to pay and ease of access in the private sector.
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Affiliation(s)
- M S Khan
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm
| | - M Unemo
- National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden
| | - S Zaman
- Institute of Public Health, Lahore, Pakistan
| | - C Stålsby Lundborg
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm
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Schmidt AJ, Marcus U. Self-reported history of sexually transmissible infections (STIs) and STI-related utilization of the German health care system by men who have sex with men: data from a large convenience sample. BMC Infect Dis 2011; 11:132. [PMID: 21592342 PMCID: PMC3121611 DOI: 10.1186/1471-2334-11-132] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 05/18/2011] [Indexed: 01/30/2023] Open
Abstract
Background In Germany, testing and treatment of sexually transmissible infections (STIs) services are not provided by one medical discipline, but rather dispersed among many different providers. Common STIs like gonorrhoea or Chlamydia infection are not routinely reported. Although men who have sex with men (MSM) are particularly vulnerable to STIs, respective health care utilization among MSM is largely unknown. Methods A sexual behaviour survey among MSM was conducted in 2006. Questions on self-reported sexual behaviour, STI-related health care consultation and barriers to access, coverage of vaccination against hepatitis, screening for asymptomatic STIs, self-reported history of STIs, and partner notification were analysed. Analysis was stratified by HIV-serostatus (3,511 HIV-negative/unknown versus 874 positive). Results General Practitioners, particularly gay doctors, were preferred for STI-related health care. Low threshold testing in sex-associated venues was acceptable for most respondents. Shame and fear of homophobic reactions were the main barriers for STI-testing. More than half of the respondents reported vaccination against hepatitis A/B. HIV-positive MSM reported screening offers for STIs three to seven times more often than HIV-negative or untested MSM. Unlike testing for syphilis or hepatitis C, screening for asymptomatic pharyngeal and rectal infections was rarely offered. STIs in the previous twelve months were reported by 7.1% of HIV-negative/untested, and 34.7% of HIV-positive respondents. Conclusions Self-reported histories of STIs in MSM convenience samples differ significantly by HIV-serostatus. Higher rates of STIs among HIV-positive MSM may partly be explained by more testing. Communication between health care providers and their clients about sexuality, sexual practices, and sexual risks should be improved. A comprehensive STI screening policy for MSM is needed.
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Affiliation(s)
- Axel J Schmidt
- Robert Koch Institute, Department for Infectious Diseases Epidemiology, Berlin, Germany
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