Rethinking the relationship between sex work, mental health and stigma: a qualitative study of sex workers in Australia

AIMS

Sex workers may experience stigma both related to their occupation as well as to mental health issues that they face. There is limited research on the lived experience of sex workers managing mental health and stigma. This study examined the experiences of sex workers in Australia in relation to stigma surrounding sex work, and sex workers' mental health, including self-management and experiences of accessing mental health services.

METHOD

Six focus groups and two interviews were conducted with 31 sex workers. Data collection was co-moderated by a sex worker and a university-based researcher. Analysis was informed by an approach which positioned sex workers as agential and capable, and which drew attention to structural aspects of stigma.

RESULTS

Sex workers identified that the stigma surrounding their profession had a significant impact on their mental health. The need to manage risks through selective disclosure of sex work was a pervasive experience. Management of mental health and the stigma associated with sex work was described as a responsibility primarily of the individual through self-care activities and occasional access to mental health services. Participants reported poor treatment from mental health practitioners who saw sex workers as victims lacking agency, imposed beliefs that sex work was the pathological root cause of mental health issues, or approached the issue with fascination or voyeurism. Other presenting issues (especially mental health) were lost or obscured in therapeutic encounters resulting in suboptimal care.

CONCLUSION

The threat of stigma is pervasive and has mental health implications for sex workers. Our findings point to the need for increased training and capacity development for mental health practitioners, funding for peer support services to ameliorate internalised stigma, and action from governments to introduce enabling legal environments, stigma reduction programs and structural protections from sex work stigma.

"Wear Some Thick Socks If You Walk in My Shoes": Agency, Resilience, and Well-Being in Communities of North American Sex Workers

Using a participatory action research (PAR) paradigm, this study investigated how 35 individuals involved in the sex work industry exemplified aspects of agency and intentional well-being under harsh work environments. Using PAR and qualitative research, sex workers were asked to identify research questions and help to design a study investigating the relationship between well-being and sex worker agency. Participants in the study each completed one semi-structured individual interview to share their experiences in the sex work industry. Data from these interviews were analyzed using constructivist phenomenology; standards of trustworthiness were accounted for using multiple tools. Four themes emerged from the data that described how the participants understood their own resilience and areas of needed attention with respect to their mental health: (1) validating sex work and eliminating whorephobic oppression; (2) safety and mobility within practice environments; (3) sexual boundary setting; and (4) social support for sex workers. Implications of the findings on theory, research, practice, and advocacy are discussed.

Competing Discourses about Youth Sexual Exploitation in Canadian News Media

Media holds the power to create, maintain, or break down stigmatizing attitudes, which affect policies, funding, and services. To understand how Canadian news media depicts the commercial sexual exploitation of children and youth, we examined 835 Canadian newspaper articles from 1989-2008 using a mixed methods critical discourse analysis approach, comparing representations to existing research about sexually exploited youth. Despite research evidence that equal rates of boys and girls experience exploitation, Canadian news media depicted exploited youth predominantly as heterosexual girls, and described them alternately as victims or workers in a trade, often both in the same story. News media mentioned exploiters far less often than victims, and portrayed them almost exclusively as male, most often called 'customers' or 'consumers,' and occasionally 'predators'; in contrast, research has documented the majority of sexually exploited boys report female exploiters. Few news stories over the past two decades portrayed the diversity of victims, perpetrators, and venues of exploitation reported in research. The focus on victims but not exploiters helps perpetuate stereotypes of sexual exploitation as business or a 'victimless crime,' maintains the status quo, and blurs responsibility for protecting youth under the UN Convention on the Rights of the Child. Health care providers and researchers can be advocates for accuracy in media coverage about sexual exploitation; news reporters and editors should focus on exploiters more than victims, draw on existing research evidence to avoid perpetuating stereotypes, and use accurate terms, such as commercial sexual exploitation, rather than terms related to business or trade.