I believe where I left off was at the results of a sex workers needs assessment we had conducted in Guelph, Ontario.
This was an assessment we conducted to help identify some of the needs and barriers as well as opportunities for improved service delivery and new programming ideas that could help meet the HIV prevention needs of sex workers in our community. Its aim is also to identify opportunities for other service providers to create more supportive environments in which to provide sex workers with HIV prevention and sexual health resources.
The sharing of this assessment in October really helped to generate dialogue within our community, so much so that we are trying to start a sex worker's action group, in hopes of improving connections and collaborations between sex workers and service providers.
Numerous barriers were identified in the assessment, the first of which were addiction, housing insecurity and food insecurity. The following is taken directly from the report.
Addiction & Condom Use
The participants (both sex workers and service providers) in this survey reported that sex work among women in Guelph is commonly associated with substance use. Most often, sex work was reported as a means to an end (for example to fulfill the need to acquire drugs). However, some of the participants noted that the relationship between sex work and substance use was not always linear:
Mind you, too, the population I was working with who were engaged [in sex work], nine times out of ten they were high when they were engaging. And it’s that chicken or the egg, do they get high to do it or they do it to get high, it’s hard to say. They’re kind of interconnected. [P9, Service Provider]
One of the women I worked with here, that’s [sex work is] how she went through school. And then dropped out because it came to drugs. So she had a very clear idea, I’m going to do this so I can pay my tuition, but then she felt so ashamed of herself that in order to do it she started injecting Oxy and then that just took everything over. [P9, Service Provider]
There are girls out there right now who are using this as a means to fulfilling an addiction, or they’re a means to– I mean, I have a business degree, I went to school – I mean, it fulfilled me through many phases of my life, through addiction, it filled my needs through all of these things, so there’s many other women and many other faces of what it’s fulfilling. [P7, Person with lived experience]
For the participants, the role of substance use is relevant to the topic of HIV prevention and sexual health, because it can interfere with the sex worker’s ability to negotiate condom use.
I think bargaining to use condoms is a huge one. Especially when they are sick, like dope sick… Because they’re sick and they’re gonna screw for drugs no matter what. And then if the john doesn’t want to wear a condom, they’re also going to do it because they’re sick. So I think that’s a huge one. [P10, Service Provider]
I’m sure it’s probably a lot easier [for johns] to manipulate girls my age, especially when you’re addicted to something, “well, I’m not going to give you it [the drug] unless you do it”. Like, “oh fuck I don’t want to, but y’know I want that [drug]”. [P6, Person with lived experience]
Housing and/or Food Insecurity & Condom Use
The need to acquire housing or food was also frequently mentioned. Sex workers and service providers both described arrangements where a woman agrees to provide sex (and sometimes rough sex, frequent sex, or condomless sex) in exchange for housing or temporary shelter. The pressing need to access housing or food can act as incentives to consent to condomless sex. It was reported, from multiple participants, that condomless sex pays better, which is of considerable significance when the sex worker is in urgent need of food or housing:
I think there are financial benefits to not wearing condoms, you get paid more, and if you’re somebody who doesn’t have a place to live, well that is incentive not to.[P5, Service Provider]
Service providers cited challenges with accessing food in the community, including limited availability, as well as stigma and poor treatment when attempting to access certain services. Service providers also cited the urgent need for affordable housing in Guelph in Wellington County, referring to the long waiting times (the average wait time is 3-9 years for a social housing unit in Guelph & Wellington County, depending on the particular needs of the individual) (Grodzinski, E., Londerville, J., and Sutherns, R., 2013).
Ironically, two service providers reported that the experience of engaging in sex work could act as a barrier to housing, creating a catch-22. One service provider, below, describes just one example of how stigma can affect access to housing:
It’s just like, one more obstacle to think about in terms of like access to housing. I just remember one person I support that was dancing and she thought her landlord came in. And she was like, “now I’m going to be outed and now I’m going to get evicted.” [P5, Service Provider]
Stay tuned for Part IV where we will talk about other identified barriers to condom use.