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Powers RA, Burckley J, Centelles V. The Legality of Labor and Perceptions of Deservingness of Rights and Services for Sex Workers. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3609-3624. [PMID: 39138694 DOI: 10.1007/s10508-024-02951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 08/15/2024]
Abstract
Access to social services like healthcare, education, housing, and welfare are integral to creating an equitable society. While many populations inherently benefit from these services, sex workers are often denied these rights and services because of the nature of their work. The purpose of this study was to examine perceptions of deservingness of sex workers for a wide range of rights and services. This study distinguished those attitudes across legal and illegal forms of sex work, identified attitudinal and demographic correlates associated with those perceptions, and examined potential interactions between respondents' gender and age. Participants included a nationwide sample of adults from the USA (n = 549). Results indicated that participants perceived legal sex work as more deserving of rights and services compared to illegal sex work. Perceptions of deservingness were associated with attitudes toward abortion, LGBTQ+ rights, and perceptions of government legitimacy. Overall, older individuals were less willing to extend rights and services to sex workers and women were more likely to perceive sex workers as deserving of rights and services. There was an interaction between gender and age. For illegal sex work, gender differences in perceptions converged as participants aged, whereas for legal sex work, gender differences were exacerbated with age, with men reporting particularly restrictive perceptions of deservingness.
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Affiliation(s)
- Ráchael A Powers
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | | | - Vanessa Centelles
- Department of Sociology, Colorado State University, Fort Collins, CO, USA
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Winter ML, Olivia SG. Sex Work and Parenthood: The Experiences of Female Sex Workers Who Are also Parents or Caregivers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:852. [PMID: 39063429 PMCID: PMC11276712 DOI: 10.3390/ijerph21070852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024]
Abstract
Complex interactions exist between sex work and parenthood, impacting the lives of those in sex work who also provide care for others. This scoping review aims to review the experiences and challenges of female sex workers who are parents or caregivers, highlighting the socioeconomic, psychological, and legal dimensions of their dual roles. The rationale for this review stems from the recognition that sex workers who are also parents face unique and multifaceted challenges that significantly impact their wellbeing and that of their children. The five stages of a scoping review suggested by Arksey and O'Malley were followed in this study. A comprehensive literature search was conducted across electronic databases such as PubMed, PsycINFO, and Google Scholar. This study covered publications written in English from 2010 to 2023. Studies were selected based on their focus on sex workers who are parents or caregivers. Both qualitative and quantitative research articles were included. Thematic analysis was employed to synthesize findings across the selected studies. Studies published prior to 2013, studies that were not published in English, and studies that did not address the experiences of female sex workers who are parents or caregivers were excluded from this study. The review identified 14 studies meeting the inclusion criteria. Five key themes emerged from this study: (1) social stigma and healthcare discrimination; (2) legal challenges; (3) mental nexus; (4) risk behaviors and exposing children to a hazardous environment; and (5) social support. Sex workers who are also parents or caregivers navigate a multifaceted landscape of challenges and resilience. Policy reforms are needed to reduce stigma, provide financial support, and ensure legal protections for this key population.
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Affiliation(s)
- Mokhwelepa Leshata Winter
- School of Medicine, Faculty of Health Science, University of Limpopo, Private Bag X 1106, Sovenga, Polokwane 0727, South Africa;
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Perry C, Goldenberg S, Deering K, Patrick L, Braschel M, Shannon K, Bingham B. Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3450143. [PMID: 37961370 PMCID: PMC10635380 DOI: 10.21203/rs.3.rs-3450143/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objectives Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic. Methods Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020-August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months. Results Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33-16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33-11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43-15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06-6.94) had higher odds of experiencing recent difficulty accessing routine healthcare. Discussion Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.
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Josewski V, de Leeuw S, Greenwood M. Grounding Wellness: Coloniality, Placeism, Land, and a Critique of "Social" Determinants of Indigenous Mental Health in the Canadian Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4319. [PMID: 36901327 PMCID: PMC10002458 DOI: 10.3390/ijerph20054319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.
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Affiliation(s)
- Viviane Josewski
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | - Sarah de Leeuw
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | - Margo Greenwood
- School of Education, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
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Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
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Platt L, Bowen R, Grenfell P, Stuart R, Sarker MD, Hill K, Walker J, Javarez X, Henham C, Mtetwa S, Hargreaves J, Boily MC, Vickerman P, Hernandez P, Elmes J. The Effect of Systemic Racism and Homophobia on Police Enforcement and Sexual and Emotional Violence among Sex Workers in East London: Findings from a Cohort Study. J Urban Health 2022; 99:1127-1140. [PMID: 36222972 PMCID: PMC9727011 DOI: 10.1007/s11524-022-00673-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022]
Abstract
There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018-2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized sex workers (26.4%) reported more police encounters partly due to increased representation in street settings (51.4% vs 30.7% off-street, p = 0.002). After accounting for street setting, ethnically/racially minoritized sex workers had higher odds of recent arrest (adjusted odds ratio 2.8, 95% CI 1.3-5.8), past imprisonment (aOR 2.3, 95% CI 1.1-5.0), police extortion (aOR 3.3, 95% CI 1.4-7.8), and rape (aOR 3.6, 95% CI 1.1-11.5). LGB-identifying sex workers (55.4%) were more vulnerable to rape (aOR 2.4, 95% CI 1.1-5.2) and emotional violence. Sex workers identifying as ethnically/racially minoritized (aOR 2.1, 95% CI 1.0-4.5), LGB (aOR 2.0, 95% CI 1.0-4.0), or who use drugs (aOR 2.0, 95% CI 1.1-3.8) were more likely to have experienced emotional violence than white-identifying, heterosexual or those who did not use drugs. Experience of any recent police enforcement was associated with increased odds of rape (aOR 3.6, 95% CI 1.3-8.4) and emotional violence (aOR 4.9, 95% CI 1.8-13.0). Findings show how police enforcement disproportionately targets ethnically/racially minoritized sex workers and contributes to increased risk of rape and emotional violence, which is elevated among sexual and ethnically/racially minoritized workers.
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Affiliation(s)
- Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Stuart
- College of Business, Arts and Social Sciences, Brunel University, London, UK
| | - M D Sarker
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Hill
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Josephine Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Xavier Javarez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Carolyn Henham
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - James Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M-C Boily
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paz Hernandez
- Open Doors, Homerton University Foundation Trust, London, UK
| | - Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Pearson J, Shannon K, Krüsi A, Braschel M, McDermid J, Bingham B, Goldenberg SM. BARRIERS TO GOVERNMENTAL INCOME SUPPORTS FOR SEX WORKERS DURING COVID-19: RESULTS OF A COMMUNITY-BASED COHORT IN METRO VANCOUVER. SOCIAL SCIENCES (BASEL, SWITZERLAND) 2022; 11:383. [PMID: 37799135 PMCID: PMC10552798 DOI: 10.3390/socsci11090383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The COVID-19 pandemic has brought into stark focus the economic inequities faced by precarious, criminalized and racialized workers. Sex workers have been historically excluded from structural supports due to criminalization and occupational stigma. Given emerging concerns regarding sex workers' inequitable access to COVID-19 income supports in Canada and elsewhere, our objective was to identify prevalence and correlates of accessing emergency income supports among women sex workers in Vancouver, Canada. Data were drawn from a longstanding community-based open cohort (AESHA) of cis and trans women sex workers in Metro Vancouver from April 2020-April 2021 (n = 208). We used logistic regression to model correlates of access to COVID-19 income supports. Among 208 participants, 52.9% were Indigenous, 6.3% Women of Colour (Asian, Southeast Asian, or Black), and 40.9% white. Overall, 48.6% reported accessing income supports during the pandemic. In adjusted multivariable analysis, non-injection drug use was associated with higher odds of accessing COVID-19 income supports (aOR: 2.58, 95% CI: 1.31-5.07), whereas Indigenous women faced reduced odds (aOR 0.55, 95% CI 0.30-1.01). In comparison with other service workers, access to income supports among sex workers was low overall, particularly for Indigenous sex workers, demonstrating the compounding impacts of colonization and disproportionate criminalization of Indigenous sex workers. Results highlight the need for structural supports that are low-barrier and culturally-safe to support sex workers' health, safety and dignity.
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Affiliation(s)
- Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
| | - Brittany Bingham
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182-4162, USA
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Kenny KS, Krüsi A, Barrington C, Ranville F, Green SL, Bingham B, Abrahams R, Shannon K. Health consequences of child removal among Indigenous and non-Indigenous sex workers: Examining trajectories, mechanisms and resiliencies. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1903-1920. [PMID: 34468044 PMCID: PMC8765365 DOI: 10.1111/1467-9566.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
The child protection system can be a highly consequential institution for mothers who are sex workers, yet scant attention has been paid to the health consequences of its policies on this population. Drawing on 31 in-depth, semi-structured interviews with 19 Indigenous and 12 non-Indigenous sex workers in Vancouver, Canada, and using the stress process model and the concept of slow violence, this study proposes a typology of four trajectories through which child removal by this system shaped sex workers' health. Results suggest that child removal has health consequences beyond the conventionally thought of mechanism of mental distress and related health sequelae, to additionally alter women's social conditions, which also carried risks for health. Notably, while trajectories of Indigenous and non-Indigenous sex workers were similar, Indigenous participants, whose families are disproportionately impacted by long-standing colonial policies of child removal, were more severely jeopardized. Findings highlight how child removal can enact violence in the form of reverberating harms to sex workers' health, further reinforcing their marginalized statuses. This study calls for greater attention to how the child protection system (CPS) may influence the health of marginalized mothers, including how health inequities may be both causes and consequences of interventions by this system.
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Affiliation(s)
- Kathleen S. Kenny
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Flo Ranville
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Sherri L. Green
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Ronald Abrahams
- Fir Square Combined Care Unit, BC Women’s Hospital, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Ritland L, Thomas V, Jongbloed K, Zamar DS, Teegee MP, Christian WK, Richardson CG, Guhn M, Schechter MT, Spittal PM. The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities. PLoS One 2021; 16:e0252993. [PMID: 34111186 PMCID: PMC8191959 DOI: 10.1371/journal.pone.0252993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.
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Affiliation(s)
- Lisa Ritland
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Victoria Thomas
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Wuikinuxv Nation
| | - Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David S. Zamar
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Mary P. Teegee
- Takla Lake First Nation, Carrier Sekani Family Services, Prince George, BC, Canada
| | - Wenecwtsin-Kukpi Christian
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- Splatsin te Secwepemc
| | - Chris G. Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M. Spittal
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Hackett L, Biderman M, Doria N, Courville J, Bogner E, Spencer R, Miller D, McMillan J, Numer M. A rapid review of Indigenous boys' and men's sexual health in Canada. CULTURE, HEALTH & SEXUALITY 2021; 23:705-721. [PMID: 32223538 DOI: 10.1080/13691058.2020.1722856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
Indigenous boys and men in Canada face adverse social and structural circumstances that affect their ability to achieve and maintain sexual health. Research about Indigenous sexual health, however, is largely limited to matters relating to women and statistics on sexually transmitted infections. A rapid review of research was conducted to determine what is currently known about Indigenous boys' and men's sexual health in Canada. Given the prevalence of research documenting quantitative disparities, the current review included qualitative research only. Thirteen included studies explored a wide range of topics relating to sexual health and an overarching intersection between social conditions and individual health outcomes was observed. The results of this review reveal significant gaps in the literature relating to the holistic sexual health of Indigenous boys and men and highlight important domains of sexual health to consider in future research. Findings suggest that sexual health programmes that promote traditional Indigenous knowledge and intergenerational relationships may be effective for promoting sexual health among Indigenous boys and men.
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Affiliation(s)
- Lisa Hackett
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Maya Biderman
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Nicole Doria
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Julien Courville
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Emma Bogner
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Spencer
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | | | - Jane McMillan
- Department of Anthropology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Matthew Numer
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
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Lavoie JG, Philips-Beck W, Kinew KA, Kyoon-Achan G, Sinclair S, Katz A. The relationship between rates of hospitalization for ambulatory care sensitive conditions and local access to primary healthcare in Manitoba First Nations communities : Results from the Innovation in Community-based Primary Healthcare Supporting Transformation in the Health of First Nations in Manitoba (iPHIT) study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:219-230. [PMID: 33125638 PMCID: PMC7910355 DOI: 10.17269/s41997-020-00421-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 09/15/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The objective of this study was to assess the performance of models of primary healthcare (PHC) delivered in First Nation and adjacent communities in Manitoba, using hospitalization rates for ambulatory care sensitive conditions (ACSC) as the primary outcome. METHODS We used generalized estimating equation logistic regression on administrative claims data for 63 First Nations communities from Manitoba (1986-2016) comprising 140,111 people, housed at the Manitoba Centre for Health Policy. We controlled for age, sex, and socio-economic status to describe the relationship between hospitalization rates for ACSC and models of PHC in First Nation communities. RESULTS Hospitalization rates for acute, chronic, vaccine-preventable, and mental health-related ACSCs have decreased over time in First Nation communities, yet remain significantly higher in First Nations and remote non-First Nations communities as compared with other Manitobans. When comparing different models of care, hospitalization rates were historically higher in communities served by health centres/offices, whether or not supplemented by itinerant medical services. These rates have significantly declined over the past two decades. CONCLUSION Local access to a broader complement of PHC services is associated with lower rates of avoidable hospitalization in First Nation communities. The lack of these services in many First Nation communities demonstrates the failure of the current Canadian healthcare system to meet the need of First Nation peoples. Improving access to PHC in all 63 First Nation communities can be expected to result in a reduction in ACSC hospitalization rates and reduce healthcare cost.
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Affiliation(s)
- Josée G Lavoie
- Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
- Ongomiizwin Research, University of Manitoba, Winnipeg, Canada.
| | - Wanda Philips-Beck
- Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
- Ongomiizwin Research, University of Manitoba, Winnipeg, Canada
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Kathi Avery Kinew
- Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Grace Kyoon-Achan
- Ongomiizwin Research, University of Manitoba, Winnipeg, Canada
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Stephanie Sinclair
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
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Thumath M, Humphreys D, Barlow J, Duff P, Braschel M, Bingham B, Pierre S, Shannon K. Overdose among mothers: The association between child removal and unintentional drug overdose in a longitudinal cohort of marginalised women in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 91:102977. [PMID: 33129662 DOI: 10.1016/j.drugpo.2020.102977] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accidental overdose is a major public health concern in North America with research primarily focused on cisgender men. Little is known about the burden of overdose among marginalised women, particularly in the context of child custody loss. This study aims to examine the prevalence of overdose and the association with child removal in a cohort of marginalised women. METHODS This study draws on a merged dataset (2010-2018) of two community-based longitudinal cohorts of over 1000 marginalised women in Canada recruited using time-location sampling. After restricting to women who had ever had a live birth, bivariate and multivariable logistic regression using generalised estimating equations (GEE) were used to examine the association between child removal and overdose. Joint effects of child removal and Indigeneity were also investigated. RESULTS Of the 696 women who reported ever having a live birth, 39.7% (n = 276) reported child removal at baseline. Unintended, non-fatal overdose rates were high, with 35.1% (n = 244) of women reporting ever having an overdose. Using bivariate GEE analyses, having a child apprehended and being Indigenous were positively correlated with overdose. Using multivariable GEE, child removal increased the odds of overdose by 55% (AOR: 1.55; 95% CI 1.01-2.39) after adjusting for education and Indigenous ancestry. Using multivariable joint-effects analysis, Indigenous women who had experienced child removal had over twice the odds of an unintended overdose than non-Indigenous women who had not lost custody after adjusting for education, food insecurity, and sex work (AOR: 2.09; 95% CI 1.15-3.79). CONCLUSION This analysis suggests that, after controlling for known confounders, women who have a child removed experience higher odds of overdose, and these odds are highest among Indigenous women. The high prevalence of overdose in this cohort suggests the need for further strategies to prevent overdose among pregnant and parenting women.
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Affiliation(s)
- Meaghan Thumath
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER; University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC Canada V6T 2B5.
| | - David Humphreys
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Vancouver Coastal Health, Aboriginal Health, 2750 E. Hastings Street, Vancouver, BC
| | - Sophie Pierre
- ʔAq̓am, St. Mary's Indian Band, Ktunaxa Nation, 7470 Mission road, Cranbrook, B.C., V1C 7E5
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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13
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Kenny KS, Ranville F, Green SL, Duff P, Braschel M, Abrahams R, Shannon K. Family Separation and Maternal Self-rated Health: Evidence from a Prospective Cohort of Marginalized Mothers in a Canadian Setting. Matern Child Health J 2019; 23:1232-1239. [PMID: 31222596 PMCID: PMC7806192 DOI: 10.1007/s10995-019-02762-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Involuntary child removal via the child protection system disproportionately affects marginalized women, yet the impacts on maternal health are under-investigated. This study prospectively examined the association of child removal with self-rated health of mothers who are sex workers. Given high levels of intergenerational family separation in this population, particularly among Indigenous sex workers, we also estimated joint effects of child removal spanning two generations. METHODS Analyses drew on 2010-2015 data from AESHA (An Evaluation of Sex Workers' Health Access), a prospective cohort of sex workers (n = 950) in Vancouver, Canada. Using logistic regression with generalized estimating equations, we modeled the association of past child removal and current self-rated health in a sample of 466 sex workers who ever had a live birth. Joint effects of child removal and history of removal from own parents were also investigated. RESULTS Of 466 sex workers, 180 (38.6%) reported child removal at baseline and 147 (31.6%) had a history of removal from own parents. In main effects model, child removal was associated with increased odds of poorer self-rated health [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.04, 2.16]. Joint effects model showed higher odds of poorer self-rated health (OR 2.04, 95% CI 1.27, 3.27) among women with intergenerational family separation. CONCLUSION FOR PRACTICE Child removal was negatively associated with sex workers' health that was worsened when family separation spanned two generations. Findings underscore need to develop sex worker and Indigenous-led family support services, along with tailored interventions to address health needs of those separated from their children.
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Affiliation(s)
- Kathleen S Kenny
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, USA
| | - Flo Ranville
- Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Sherri L Green
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, USA
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Ronald Abrahams
- Fir Square Combined Care Unit, BC Women's, 2nd Floor, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.
- Department of Medicine, University of British Columbia, Vancouver, V6Z 2K5, Canada.
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Bingham B, Moniruzzaman A, Patterson M, Sareen J, Distasio J, O’Neil J, Somers JM. Gender differences among Indigenous Canadians experiencing homelessness and mental illness. BMC Psychol 2019; 7:57. [PMID: 31455404 PMCID: PMC6712855 DOI: 10.1186/s40359-019-0331-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/26/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Indigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence. METHODS This study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables. RESULTS In multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10-2.23) and sexual (AOR: 6.31, 95% CI = 2.78-14.31) violence. CONCLUSIONS Our analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account. TRIAL REGISTRATION This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374 ; ISRCTN57595077 ; ISRCTN66721740 .
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Affiliation(s)
- Brittany Bingham
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Michelle Patterson
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Jitinder Sareen
- Psychology and Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Jino Distasio
- Geography, University of Winnipeg, Winnipeg, MB Canada
| | - John O’Neil
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Julian M. Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
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15
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Argento E, Braschel M, Walsh Z, Socias ME, Shannon K. The moderating effect of psychedelics on the prospective relationship between prescription opioid use and suicide risk among marginalized women. J Psychopharmacol 2018; 32:1385-1391. [PMID: 30255717 PMCID: PMC6355147 DOI: 10.1177/0269881118798610] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Given high rates of depression and suicide among marginalized women, and increasing calls to integrate trauma-informed biomedical and community-led structural interventions, this study longitudinally examines the potential moderating effect of psychedelic use on the relationship between other illicit drug use and suicide risk. METHODS Data (2010-2017) were drawn from a community-based, prospective open cohort of marginalized women in Vancouver, Canada. Extended Cox regression analyses examined the moderating effect of psychedelic use on the association between other illicit drug use and incidence of suicidal ideation or attempt over follow-up. RESULTS Of 340 women without suicidal ideation or attempt at baseline, 16% ( n=53) reported a first suicidal episode during follow-up, with an incidence density of 4.63 per 100 person-years (95% confidence interval 3.53-6.07). In unadjusted analysis, psychedelic use moderated the relationship between prescription opioid use and suicide risk: among women who did not use psychedelics, prescription opioid use increased the hazard of suicide (hazard ratio 2.91; 95% confidence interval 1.40-6.03) whereas prescription opioid use was not associated with increased suicidal ideation or attempt among those who used psychedelics (hazard ratio 0.69; 95% confidence interval 0.27-1.73) (interaction term p-value: 0.016). The moderating effect of psychedelics remained significant when adjusted for confounders (interaction term p-value: 0.036). CONCLUSIONS Psychedelic use had a protective moderating effect on the relationship between prescription opioid use and suicide risk. In the context of a severe public health crisis around prescription opioids and lack of addiction services tailored to marginalized women, this study supports calls for innovative, evidence-based and trauma-informed interventions, including further research on the potential benefits of psychedelics.
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Affiliation(s)
- Elena Argento
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - M. Eugenia Socias
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,BC Centre on Substance Use, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Ma PHX, Chan ZCY, Loke AY. Conflicting identities between sex workers and motherhood: A systematic review. Women Health 2018; 59:534-557. [PMID: 30040603 DOI: 10.1080/03630242.2018.1500417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Being a mother is a traditional and central role for women. However, due to criminalization, social stigma and marginalized lifestyles, female sex workers (FSWs) may encounter disadvantages and social inequality. The aim of this review was to synthesize the results of studies focused on the challenges that FSWs face in negotiating their maternal identity with their stigmatized identity as sex workers. A total of 21 studies published from 2002 to 2016 were included in this review. Textual narrative and a thematic synthesis approach were adopted to synthesize key themes. Two common themes across countries were identified: conflicting identities between the jobs as sex workers and motherhood and responses to social expectations of ideal motherhood. Given the challenges that FSWs face with motherhood, comprehensive services, including health, family, social, and legal services, are needed to support FSWs as individuals and as mothers. A more holistic approach is recommended to address their physical, emotional, financial, and social problems faced by FSWs. Services should be offered in a friendly and non-judgmental manner. Further, to advance the health and safety of FSWs and their children, prostitution law may need to move toward decriminalization of sex work and educate the general public about respecting FSWs.
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Affiliation(s)
- Polly H X Ma
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
| | - Zenobia C Y Chan
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
| | - Alice Yuen Loke
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
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17
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Puri N, Shannon K, Nguyen P, Goldenberg SM. Burden and correlates of mental health diagnoses among sex workers in an urban setting. BMC WOMENS HEALTH 2017; 17:133. [PMID: 29258607 PMCID: PMC5735638 DOI: 10.1186/s12905-017-0491-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Abstract
Background Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. While much research has focused on HIV and sexually transmitted infections (STIs) among sex workers, there remains a gap in evidence regarding the broader health issues faced by this population, including mental health. Given limited evidence describing the mental health of women in sex work, our objective was to evaluate the burden and correlates of mental health diagnoses among this population in Vancouver, Canada. Methods An Evaluation of Sex Workers Health Access (AESHA) is a prospective, community-based cohort of on- and off-street women in sex work in Vancouver, Canada. Participants complete interviewer-administered questionnaires semi-annually. We analyzed the lifetime burden and correlates of self-reported mental health diagnoses using bivariate and multivariable logistic regression. Results Among 692 sex workers enrolled between January 2010 and February 2013, 338 (48.8%) reported ever being diagnosed with a mental health issue, with the most common diagnoses being depression (35.1%) and anxiety (19.9%). In multivariable analysis, women with mental health diagnoses were more likely to identify as a sexual/gender minority (LGBTQ) [AOR=2.56, 95% CI: 1.72—3.81], to use non-injection drugs [AOR=1.85, 95% CI: 1.12—3.08], to have experienced childhood physical/sexual trauma [AOR=2.90, 95% CI: 1.89—4.45], and work in informal indoor [AOR=1.94, 95% CI: 1.12 – 3.40] or street/public spaces [AOR=1.76, 95% CI: 1.03–2.99]. Conclusions This analysis highlights the disproportionate mental health burden experienced by women in sex work, particularly among those identifying as a sexual/gender minority, those who use drugs, and those who work in informal indoor venues and street/public spaces. Evidence-informed interventions tailored to sex workers that address intersections between trauma and mental health should be further explored, alongside policies to foster access to safer workspaces and health services.
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Affiliation(s)
- Nitasha Puri
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Paul Nguyen
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira M Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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18
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Experiences of chronic stress and mental health concerns among urban Indigenous women. Arch Womens Ment Health 2016; 19:809-23. [PMID: 26961003 DOI: 10.1007/s00737-016-0622-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/29/2016] [Indexed: 02/06/2023]
Abstract
We measured stress, depression and post-traumatic stress disorder (PTSD) levels of urban Indigenous women living with and without HIV in Ontario, Canada, and identified correlates of depression. We recruited 30 Indigenous women living with HIV and 60 without HIV aged 18 years or older who completed socio-demographic and health questionnaires and validated scales assessing stress, depression and PTSD. Descriptive statistics were conducted to summarize variables and linear regression to identify correlates of depression. 85.6 % of Indigenous women self-identified as First Nation. Co-morbidities other than HIV were self-reported by 82.2 % (n = 74) of the sample. High levels of perceived stress were reported by 57.8 % (n = 52) of the sample and 84.2 % (n = 75) had moderate to high levels of urban stress. High median levels of race-related (51/88, IQR 42-68.5) and parental-related stress (40.5/90, IQR 35-49) scores were reported. 82.2 % (n = 74) reported severe depressive symptoms and 83.2 % (n = 74) severe PTSD. High levels of perceived stress was correlated with high depressive symptoms (estimate 1.28 (95 % CI 0.97-1.58), p < 0.001). Indigenous women living with and without HIV reported elevated levels of stress and physical and mental health concerns. Interventions cutting across diverse health care settings are required for improving and preventing adverse health outcomes.
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Krüsi A, Kerr T, Taylor C, Rhodes T, Shannon K. 'They won't change it back in their heads that we're trash': the intersection of sex work-related stigma and evolving policing strategies. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:1137-50. [PMID: 27113456 PMCID: PMC5012919 DOI: 10.1111/1467-9566.12436] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In Vancouver, Canada, there has been a continuous shift in the policing of sex work away from arresting sex workers, which led to the implementation of a policing strategy that explicitly prioritised the safety of sex workers and continued to target sex workers' clients. We conducted semi-structured interviews with 26 cisgender and five transgender women street-based sex workers about their working conditions. Data were analysed thematically and by drawing on concepts of structural stigma and vulnerability. Our results indicated that despite police rhetoric of prioritising the safety of sex workers, participants were denied their citizenship rights for police protection by virtue of their 'risky' occupation and were thus responsiblised for sex work related violence. Our findings further suggest that sex workers' interactions with neighbourhood residents were predominantly shaped by a discourse of sex workers as a 'risky' presence in the urban landscape and police took swift action in removing sex workers in the case of complaints. This study highlights that intersecting regimes of stigmatisation and criminalisation continued to undermine sex workers citizenship rights to police protection and legal recourse and perpetuated labour conditions that render sex workers at increased risk for violence and poor health.
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Affiliation(s)
- Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
- Faculty of Medicine, University of British Columbia, CANADA
| | - Tthomas Kerr
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
- Faculty of Medicine, University of British Columbia, CANADA
| | - Christina Taylor
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
- Faculty of Medicine, University of British Columbia, CANADA
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Duff P, Shoveller J, Chettiar J, Feng C, Nicoletti R, Shannon K. Sex Work and Motherhood: Social and Structural Barriers to Health and Social Services for Pregnant and Parenting Street and Off-Street Sex Workers. Health Care Women Int 2015; 36:1039-55. [PMID: 25513844 PMCID: PMC4469630 DOI: 10.1080/07399332.2014.989437] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Our study documents the correlates of barriers to pregnancy and mothering among sex workers in Vancouver, Canada. We used baseline data from An Evaluation of Sex Workers' Health Access (AESHA), a prospective cohort of sex workers. Among the 399 sex workers who had ever been pregnant or had a child, 35% reported having ever experienced a barrier, with lower education, homelessness, and history of injecting drugs significantly correlated with pregnancy and mothering barriers. Our findings highlight a critical need for tailored and nonjudgmental services and supports, including improved programs to address intersecting aspects of poverty, health literacy, stigma, and substance use.
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Affiliation(s)
- Putu Duff
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
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21
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Kenny KS, Barrington C, Green SL. "I felt for a long time like everything beautiful in me had been taken out": Women's suffering, remembering, and survival following the loss of child custody. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1158-66. [PMID: 26194783 DOI: 10.1016/j.drugpo.2015.05.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Child Protective Services' (CPS) placements of children in out-of-home care disproportionately impact families marginalized by poverty, racism and criminalization. CPS' mandate to protect children from neglect and abuse is frequently criticized as failing to address the multiple social and structural domains shaping parents' lives, especially mothers. METHODS We conducted a thematic narrative analysis of in-depth interviews to explore the impact of child custody loss on 19 women who use drugs residing in Toronto, Canada. We also assessed the potential roles of intersectional forms of violence and inequities in power that can both give rise to child custody loss and mediate its consequences. RESULTS Trauma was identified as a key impact of separation, further exacerbated by women's cumulative trauma histories and ongoing mother-child apartness. Women described this trauma as unbearable and reported persistent symptoms of post-traumatic stress disorder and other mental health conditions. Practices of dissociation through increased use of drugs and alcohol were central in tending to the pain of separation, and were often synergistically reinforced by heightened structural vulnerability observed in increased exposure to housing instability, intimate partner violence, and initiation of injection drug use and sex work. Women's survival hinged largely on hopefulness of reuniting with children, a goal pivotal to their sense of future and day-to-day intentions toward ameliorated life circumstances. CONCLUSION Findings highlight needs for strategies addressing women's health and structural vulnerability following custody loss and also direct attention to altering institutional processes to support community-based alternatives to parent-child separation.
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Affiliation(s)
- Kathleen S Kenny
- Department of Maternal and Child Health, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA.
| | - Clare Barrington
- Department of Health Behavior, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC 27599-7400, USA
| | - Sherri L Green
- Department of Maternal and Child Health, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA
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Muldoon KA, Deering KN, Feng CX, Shoveller JA, Shannon K. Sexual relationship power and intimate partner violence among sex workers with non-commercial intimate partners in a Canadian setting. AIDS Care 2014; 27:512-9. [PMID: 25402720 DOI: 10.1080/09540121.2014.978732] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is little information on the private lives of women engaged in sex work, particularly how power dynamics within intimate relationships may affect intimate partner violence (IPV). Using baseline data of sex workers enrolled in a longitudinal cohort, "An Evaluation of Sex Workers' Health Access" (AESHA), the present study examined the association between sexual relationship power and IPV among sex workers in non-commercial partnerships in Vancouver, Canada. Pulweritz's Sexual Relationship Power Scale (SRPS) and The World Health Organization (WHO) Intimate Partner Violence against Women Scale (Version9.9) were used. Bivariable and multivariable logistic regression techniques were used to investigate the potential confounding effect of sexual relationship power on IPV among sex workers. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were reported. Of 510 sex workers, 257 (50.4%) reported having an non-commercial intimate partner and were included in this analysis. In the past 6 months, 84 (32.7%) sex workers reported IPV (physical, sexual or emotional). The median age was 32 years, 39.3% were of Aboriginal ancestry, and 27.6% were migrants. After controlling for known confounders (e.g., age, Aboriginal ancestry, migrant status, childhood trauma, non-injection drug use), low relationship power was independently associated with 4.19 increased odds (95% CI: 1.93-9.10) and medium relationship power was associated 1.95 increased odds (95% CI: 0.89-4.25) of IPV. This analysis highlights how reduced control over sexual-decision making is plays a critical role in IPV among sex workers, and calls for innovation and inclusive programming tailored to sex workers and their non-commercial intimate partnerships.
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Affiliation(s)
- Katherine A Muldoon
- a School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
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