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Articles tagged with: HIV

Mar25

Sex in the City - Part Six

Wednesday, 25 March 2015 Written by // Olivia Kijewski Categories // Women, Research, Sexual Health, Health, Population Specific , Sex and Sexuality , Olivia Kijewski

Olivia Kijewski in the final part of her review of the challenges that sex workers face in small city Ontario (Guelph) with a look at solutions and new program ideas

Sex in the City - Part Six

The past five entries have primarily been about barriers to accessing local services for sex workers in Guelph. In some ways, that can feel really daunting and depressing. But luckily, our respondents were also full of great ideas about how to improve programs and services, as well as new program ideas. The following is taken directly from the report.

Access to condoms & other safer sex or harm reduction supplies

Not surprisingly, improved access to safer sex and harm reduction supplies was reported as a need. Most participants noted that they wished there was greater accessibility to services downtown (including HIV and harm reduction services and HIV testing locations). The participants below explain that services provided in less centralized locations are difficult for sex workers to access:

So just to say that girl that’s maybe at a really low point in her life servicing for her addiction, how is she supposed to get out there [to the sexual health clinic]? Is she going to go out there? That far? That’s not an area that’s serviceable to that. And especially that’s where you are getting the condoms and all of those things, how is that servicing that client base? Yeah, it needs to be where that need is.[ person with lived experience]

The location [is a barrier], definitely. So that would require a bus. And that would require three dollars to take a bus, plus to get home, plus to figure out how to use the bus. So, barrier. [service provider]

Of equal importance to having services available downtown was the need to make services/resources accessible 24/7. In particular, the need for harm reduction supplies and condoms around the clock was of importance:

I have relapsed in the past.  And I know what that looks like for me. And I need to know that I can have clean needles. I need to know that I can relapse safely. And if that means going out on the street, and working...I need to know I can do that safely too. And I need to know that that guy out there is going to be treated safely by me because I have the access in the community and it doesn’t matter what time of day it is.  That’s the thing. We need something 24/7 because...Addiction and street work and HIV just does not have a time frame. [Person with lived experience] 

Two service providers and one person with lived experience also argued that harm reduction supplies and condoms also need to be provided in ways that are not always attached to a human being – through condom dispensers, for instance. 

However, not everyone agreed that access to condoms was a pressing issue for sex workers.  Some felt that, while accessibility could always be improved, the community provided sufficient access to condoms, and that other barriers (such as stigma) were more pressing issues.  

Others noted barriers to sexual health resources (which were less dominant in the transcripts) were services that are only offered based on appointment, lack of doctors and psychiatrists, barriers to accessing health cards, and barriers around accessing the HPV vaccine.

Honest conversations between sex workers and service providers

The participants also conveyed the need for quality discussions between sex workers and service providers. As was mentioned earlier, because of stigma and a lack of understanding/awareness of sex work, honest and open conversations about this topic do not often happen. An initial judgmental response can shut down conversations from moving forward. Several sex workers reported a need to have honest and open conversations and safe spaces to speak where they are not judged:

I don’t think there’s enough out there because there’s, you know, there’s not really anywhere you can go and feel comfortable to talk to someone. Or when you do find someone you think is going to not judge you…next thing you know, you’re getting the looks like “oh my god, you know”, like judgmental things and I don’t think that’s right at all.…The women, need to have places like that so they can start learning more about how to feel comfortable about discussing things and you know, stuff like that. And quite frankly, there’s not really anything out there. [Person with lived experience]

However, how to best foster these kinds of honest conversations (apart from removing stigma) was somewhat disputed. The participants had various ideas about how conversations about sex work could best be facilitated.

The service providers reported that most disclosures of sex work, as well as disclosures of sexual assaults, took place only after a trusted relationship had developed. Women with lived experience were unlikely to disclose this personal information until she had reason to believe she will not be judged. However, the question of how a service provider could open up these conversations was somewhat disputed.

One service provider suggested that it might be helpful to simply ask if the client has engaged in sex work, and that, if done respectfully, it can give the client the freedom and permission to speak about her experiences. Another service provider found that by displaying posters or using social media to display a supportive, non-judgmental orientation towards sex work opened the door for disclosures and open conversations. One person with lived experience also cited the latter example as being beneficial.

Overall, when it came to improving service delivery, the participants most strongly cited the need for the reduction of stigma. However, there were indeed opportunities to improve access to condoms and HIV prevention resources by, for example, making services more accessible downtown and through anonymous means.

New programming ideas

Participants were given the opportunity to suggest how ARCH might overcome some of the barriers mentioned earlier and provide better sexual health services to sex workers. While the solutions provided were not always consistent, some very clear themes emerged.

Support groups & drop-ins

Most of the participants suggested that they would like to see support groups or drop-in centres that are specific to women who are currently, or have previously engaged in sex work. For two of the participants with lived experience who had exited sex work, support around how to engage in new romantic or sexual relationships was of interest.  Four sex workers and one service provider said that they would like to see a support group or drop-in group for sex workers, although it was often acknowledged that it may be difficult to attract participants, given the presence of stigma, shame, and lack of identification among sex workers with that particular label.

Education

Participants felt that social service providers, health care providers and police would benefit from education on topics specific to sex work, but also related issues such as Hepatitis C, HIV, Harm Reduction and PEP. The participants felt that sex workers could also use more information on condom use, HIV, STIs, sexual assault, and how to be physically safe while engaging in sex work. Two participants suggested that they would like to see information booklets that provided information that would be specifically directed to sex workers, for example on sexual assault or how to stay physically safe. One participant with lived experience referred to some of the resources provided in the literature review, (by POWER for instance) but said that local information (and in a smaller amount) would be more helpful.

It is also worth noting that the participants were specifically asked about whether or not they were familiar with PEP. Very few participants were aware of PEP, what it was or how to access it.  Providing more information about this medication may also be valuable.

Outreach in strip clubs

In many of the interviews, the participants discussed the importance of providing education and outreach through strip clubs, and to a lesser extent, massage parlours. Outreach could include, for example, providing education to sex workers (about HIV & STIs, HIV testing and available resources), providing education to management, and laying out resources (such as posters, business cards, condoms, or pamphlets.)

A few participants felt that this was a possibility, arguing that the management of said venues would want to make sure that their employees are using condoms and preventing the spread of HIV. However, most of the participants argued that there would be significant barriers to conducting any type of outreach in a strip club or other venue. For example, as was mentioned earlier, because of the criminalization of prostitution, proprietors of strip clubs wish to avoid giving the impression that sex work takes place at their venue:

The owners and the staff at that place are just so uneducated. …I think that they…I think they think that if they put condoms out, that they would get in shit with the police or something. …Because well if there’s condoms here then obviously there’s illegal prostitution happening.[Person with lived experience.]

I don’t think any of that [condoms, lube or other resources] was available there as far as I know. But I mean, I don’t know if they could provide condoms because obviously there’s signs everywhere saying that like, prostitution is illegal and obviously that goes on there but there’s signs that are saying that it can’t. So I think if condoms were provided then [the club] might be able to be held accountable for encouraging prostitution. [Person with lived experience.]

Peer outreach

The interview questions in this survey specifically asked participants about what they thought of the idea of peer outreach work (among sex workers). This idea was very well supported by the respondents, especially the participants with lived experience, who reported that peers are easier to relate to, they are more likely to trust a peer, they are more likely to feel supported and understood by a peer, and that peers could potentially provide support (through a support group) or could bring materials inside strip clubs to other sex workers in strip clubs/massage parlours.

As much as somebody who’s gone to school or university to help people, as much as they can have the information or the understanding of how your brain works or your emotions or whatever, somebody who’s lived through it is always going to have a more personal insight. Maybe not a better one, but a more personal insight, and the person living it currently is probably going to value their opinion and their information more. [Person with lived experience.] 

The idea was also supported by the service providers, even though two reported having tried (unsuccessfully) to utilize peers to help distribute supplies to other dancers in strip clubs. All of the service providers believed that peers would be important in the goal of providing outreach or support to sex workers, regardless of the difficulties.  One service provider, below, describes the effectiveness of using peers among hard-to-reach populations: 

I still think it’s a difficult population to reach. But I don’t think it’s impossible because the drug using community is also a difficult population to reach. All you need is one or two sex workers willing to work with you, to get you to reach that population, because peers is where it’s at. That’s the only way that you get people to trust you, right? So if we had a couple of dancers at [the local strip club] who were willing to help, and then a couple of girls that were street workers that were willing to help, then. [P10, Service provider.]

While complicated, it was very important to the respondents that women who work in strip clubs are provided with the resources that they need, and the overall message from the interviews was that, while problematic, finding some way to serve that population is important. However, providing greater education to service providers may also help to reduce stigma and increase awareness - other goals that were identified as important by the participants. Based on the discussion around support groups, drop-ins, and peer networks, the participants implied that addressing mental health needs and creating spaces just for women (in particular, sex workers) are important. 

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