Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Collections
  • Authors & Reviewers
    • Overview for Authors
    • Preparing manuscripts
    • Submission Checklist
    • Publication Fees
    • Forms
    • Editorial Policies
    • Editorial Process
    • Patient-Oriented Research
    • Submit a manuscript
    • Manuscript Progress
    • Submitting a letter
    • Information for Reviewers
    • Open access
  • Alerts
    • Email alerts
    • RSS
  • About
    • General information
    • Staff
    • Editorial board
    • Contact
  • CMAJ JOURNALS
    • CMAJ
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ Open
  • CMAJ JOURNALS
    • CMAJ
    • CJS
    • JAMC
    • JPN
CMAJ Open

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Collections
  • Authors & Reviewers
    • Overview for Authors
    • Preparing manuscripts
    • Submission Checklist
    • Publication Fees
    • Forms
    • Editorial Policies
    • Editorial Process
    • Patient-Oriented Research
    • Submit a manuscript
    • Manuscript Progress
    • Submitting a letter
    • Information for Reviewers
    • Open access
  • Alerts
    • Email alerts
    • RSS
  • About
    • General information
    • Staff
    • Editorial board
    • Contact
  • Subscribe to our alerts
  • RSS feeds
  • Follow CMAJ Open on Twitter
Research
Open Access

Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study

Lori E. Ross, Andrea Sterling, Cheryl Dobinson, Carmen H. Logie and Sandra D’Souza
May 14, 2021 9 (2) E482-E490; DOI: https://doi.org/10.9778/cmajo.20200049
Lori E. Ross
Dalla Lana School of Public Health (Ross, D’Souza), Centre for Criminology and Sociolegal Studies (Sterling) and Factor-Inwentash Faculty of Social Work (Logie), University of Toronto; Planned Parenthood Toronto (Dobinson); Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrea Sterling
Dalla Lana School of Public Health (Ross, D’Souza), Centre for Criminology and Sociolegal Studies (Sterling) and Factor-Inwentash Faculty of Social Work (Logie), University of Toronto; Planned Parenthood Toronto (Dobinson); Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Cheryl Dobinson
Dalla Lana School of Public Health (Ross, D’Souza), Centre for Criminology and Sociolegal Studies (Sterling) and Factor-Inwentash Faculty of Social Work (Logie), University of Toronto; Planned Parenthood Toronto (Dobinson); Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Carmen H. Logie
Dalla Lana School of Public Health (Ross, D’Souza), Centre for Criminology and Sociolegal Studies (Sterling) and Factor-Inwentash Faculty of Social Work (Logie), University of Toronto; Planned Parenthood Toronto (Dobinson); Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sandra D’Souza
Dalla Lana School of Public Health (Ross, D’Souza), Centre for Criminology and Sociolegal Studies (Sterling) and Factor-Inwentash Faculty of Social Work (Logie), University of Toronto; Planned Parenthood Toronto (Dobinson); Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Article Figures & Tables

Tables

    • View popup
    Table 1:

    Demographic characteristics of study participants

    CharacteristicNo. (%) of participants*
    Quantitative strand
    n = 54
    Qualitative strand
    n = 17†
    Overall sample
    n = 71
    Mean age (range), yr25.6** (18–29)25.7 (19–29)20.9 (18–29)
    Mean age at first sex work involvement (range), yr19.8†† (9–28)20.4†† (15–27)19.9 (9–28)
    Currently involved in sex work
     Yes33 (61)14 (82)47 (66)
     No21 (39)2 (12)23 (32)
     No response0 (0)1 (6)1 (1)
    Racial/ethnic identity‡
     White32 (59)15 (88)47 (66)
     Indigenous5 (9)1 (6)6 (8)
     Black4 (7)0 (0)4 (6)
     Other§9 (17)1 (6)10 (14)
     No response10 (18)0 (0)10 (14)
    Gender identity‡
     Woman/female32 (59)15 (88)47 (66)
     Nonbinary identity11 (20)0 (0)11 (15)
     Genderfluid/genderqueer3 (6)1 (6)4 (6)
     Trans3 (6)0 (0)3 (4)
     Two-spirit2 (4)0 (0)2 (3)
     Male1 (2)1 (6)2 (3)
     Femme1 (2)0 (0)1 (1)
     No response9 (17)0 (0)9 (13)
    Sexual identity‡
     Queer17 (31)7 (41)24 (34)
     Bisexual15 (28)5 (29)20 (28)
     Straight/heterosexual9 (17)4 (24)13 (18)
     Pansexual9 (17)1 (6)10 (14)
     Questioning3 (6)0 (0)3 (4)
     Two-spirit2 (4)1 (6)3 (4)
     Other¶11 (20)0 (0)11 (15)
     No response9 (17)0 (0)9 (13)
    Sex work experience‡
     Agency escort25 (46)7 (41)32 (45)
     Fetish14 (26)4 (24)18 (25)
     Independent escort35 (65)8 (47)43 (61)
     Massage parlour attendant10 (18)1 (6)11 (15)
     Outdoor worker2 (4)1 (6)3 (4)
     Pornography actor12 (22)4 (24)16 (22)
     Stripper/exotic dancer6 (11)4 (24)10 (14)
     Sugar baby17 (31)12 (71)29 (41)
     Survival sex11 (20)5 (29)16 (22)
     Webcam host22 (41)5 (29)27 (38)
     Other1 (2)1 (6)2 (3)
    • ↵* Except where noted otherwise.

    • ↵† Includes 3 participants who completed individual interviews and 14 participants who completed focus groups.

    • ↵‡ Participants could check more than 1 option.

    • ↵§ Includes Arab, East Asian, South Asian, mixed race and Latin American.

    • ↵¶ Includes demisexual, gay, lesbian, woman who has sex with women and other sexual identity (no details provided).

    • ↵** Twelve participants did not provide data on this variable, although all answered the eligibility question indicating they were aged 18–29 years.

    • ↵†† One participant did not provide data on this variable.

    • View popup
    Table 2:

    Barriers to and facilitators of accessing sexual and reproductive health care most frequently reported by survey participants

    Barrier/facilitatorNo. of participants% of participants (95% CI)
    Barriers (n = 53)
    I think health care providers judge sex workers3362 (48.8–74.1)
    I am concerned about my anonymity/confidentiality3362 (48.8–74.1)
    I think health care providers are uninformed about sex workers3260 (46.9–72.4)
    I feel emotional distress, depression or anxiety2955 (41.4–67.4)
    The cost of things I need for my sexual health, like birth control, condoms or other prescriptions2853 (39.7–65.6)
    I am worried about my friends or family finding out2751 (37.9–63.9)
    Facilitators (n = 52)
    Staff and volunteers who have sex work experience4179 (65.8–87.9)
    Nonjudgmental staff and volunteers3873 (59.7–83.3)
    Antioppressive space3873 (59.7–83.3)
    Knowing that I will not be reported to the police, social worker or child protection services for my involvement in sex work3262 (47.9–73.6)
    Staff and volunteers who are similar to me (e.g., in age, gender identity, sexual identity, race)2548 (35.1–61.3)
    Convenient location2038 (26.5–52.1)
    • Note: CI = confidence interval.

    • View popup
    Table 3:

    Illustrative quotes from qualitative data analysis regarding barriers to and facilitators of accessing sexual and reproductive health care

    Theme; subthemeIllustrative quote
    Barriers
    Provider stigmaInterviewer: What was it like [when you disclosed your sex work experience]?
    Participant: Incredibly aggravating, frustrating, offensive. I felt like it was someone’s mother scolding me. I felt incredibly judged … I didn’t seem to matter. So when I had questions, they [health care provider] were very vague and unresponsive. Almost like I wasn’t even there. (Focus group 4)
    Cost of interventionsI did get my first round of HPV shots last week. It was disgustingly expensive. I had to pay about $215. … I called several health outlets, and all of them [said] unless you’re a student in high school or you have some sort of coverage as a postsecondary student [you have to pay out of pocket]. (Focus group 3)
    Clinic forms and proceduresI try to get tested every 3 months. And there have been times and different facilities, particularly the [sexual health clinic], where they seem to be a little critical of coming so frequently, and they ask why. Which feels like a bit of a judgment, when I’m having as much as I’m having. But I’ve stopped going there as a result. (Interview 3)
    Intersecting stigmasI never actually told any doctor that I’ve spoken to that I’m a sex worker for many, many reasons. Including the fact that I live with PTSD, and the minute you tell somebody that you’re somebody who suffers from PTSD, and that you’re a sex worker, you can no longer make decisions for yourself as an adult in the medical community. (Focus group 3)
    Facilitators
    Respectful, nonjudgmental service providersInterviewer: Could you explain what made [the service encounter] a positive experience, if you can recall how the person responded, or what made you feel comfortable telling them [about your sex work experience] in the first place?
    Participant: Just right off the bat … the tone was very calm and welcoming, so I knew that there was never any hostility in terms of the environment and initial responses. It just felt very casual. … I would just say, “Oh, I’m a sex worker, this is how many partners I’ve had” … while we’re doing testing … just so they could learn my history. But it was just a lot of … “Oh, I see,’” nodding, asking if I was being safe … the precautionary questions that they have to [ask] everyone. But … I think the tone was the biggest factor, and facial expressions. (Interview 1)
    Access to free, anonymous servicesI know [name of service, where], for homeless youth, there’s free doctors. You don’t have to show ID. … That’s where I was most comfortable going to get tested, rather than going to my family doctor. So things like those — walk in, where you know the doctor’s there from 1 to 4, and … they don’t really know who you are. I think that you’re more inclined to be honest [about sex work experience] because they don’t know who you are, but you’re getting the treatment that you need, if you need treatment. And you don’t feel as judged, I guess. (Focus group 1)
    Personal characteristicsOnce they [health care provider] speak to me for a couple of minutes, any sort of stigma that they probably typically have and would hold onto in other situations subsides. So I am fully aware of that privilege. I think that’s exactly what it is. And I’ve even had friends that have come over here, from Russia and the Ukraine, that fall into [sex work] because they’re just trying to get things in order for themselves and can’t qualify for other jobs. They themselves, who are highly educated, much more than I am, they deal with attitude when they see a doctor, and it can be the same person who I saw maybe 2 days before and had a wonderful experience with. … I think that I’m lucky in a way … I can be very assertive and I’m never shunned. But if I were not who I am … I’d have a very different outcome. I don’t doubt that for a second. (Focus group 3)
    • Note: HPV = human papillomavirus, ID = identification, PTSD = post-traumatic stress disorder.

    • View popup
    Table 4:

    Participant-recommended practices to improve service delivery

    Recommended practiceIllustrative quote
    Adopt a nonjudgmental approach to working with sex workersSo it’s just really about education and … not judging a book by its cover, and I think that’ll make the girls feel a lot more open. … If they know … there’s so many different reasons I could be doing it [sex work], and they’re not going to judge me, they’re just going to help me. (Focus group 1)
    Become familiar with the social realities of sex workWhat I would like to see from a medical institutional framework or standpoint would be an understanding of the social context of sex work. So I would like to see an institution come out and say, “We understand that sex workers want decriminalization, that sex workers deserve rights, and labour rights, and human rights, that are lacking at this time.” I would like to see an explicit kind of support of that from an institution that I go to. (Interview 3)
    Make your work place accessible for sex workers[A local sexual health clinic] is great but is hard to get to if I’m not downtown.
    [Local public health] clinics don’t have the greatest times and are often full. (Survey respondent)
    Provide appropriate servicesA sexual health clinic insisted I must be having unprotected sex when I stated I was not, and tried to convince me to leave the industry because I seemed tired and stressed (I’m a student, of course I seem tired and stressed). (Survey respondent)
    Publicly voice your position on sex workI want to know from the get-go … that they [the doctor] were sex positive and they were sex work positive. … I don’t need someone that doesn’t get it or that’s really conservative in their mindset. (Interview 2)
    Recruit staff and volunteers with sex work experienceSurvey question: What are your sources of strength and resilience?
    Respondent: Being around others working in this industry.
    Understand the diversity of sex work experiencesKnowing that people in this industry are literally from all walks of life. Some girls are doing it for survival. Some girls are doing it to get through school. Some girls are doing it because they’re into sex. … I have one girl that I used to work with and her dad worked in the parliament buildings. … She didn’t need to be working, she just loved to work. That was her thing. And she went to [university], and it was just her extra money … that’s what she liked to do, and there was nothing wrong with that. So just knowing that … we’re not all … damaged, and because I think a lot of people think, “Oh my gosh, if I tell the doctor this, they’re going to think I have daddy issues, or I’ve been — something’s happened to me, traumatic, that this is why I’m here.” It’s not always like that. … You could just be going through school, and it’s [income from sex work] helpful. (Focus group 1)
PreviousNext
Back to top

In this issue

CMAJ Open: 9 (2)
Vol. 9, Issue 2
1 Apr 2021
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ Open.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study
(Your Name) has sent you a message from CMAJ Open
(Your Name) thought you would like to see the CMAJ Open web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study
Lori E. Ross, Andrea Sterling, Cheryl Dobinson, Carmen H. Logie, Sandra D’Souza
Apr 2021, 9 (2) E482-E490; DOI: 10.9778/cmajo.20200049

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study
Lori E. Ross, Andrea Sterling, Cheryl Dobinson, Carmen H. Logie, Sandra D’Souza
Apr 2021, 9 (2) E482-E490; DOI: 10.9778/cmajo.20200049
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Collections

  • Clinical
    • Sexual Medicine
      • Lesbian, bisexual, gay, transgendered health
      • Reproductive medicine
      • Other sexual medicine
    • Family Medicine, General Practice, Primary Care
      • Other family medicine
    • Vulnerable populations

Content

  • Current issue
  • Past issues
  • Collections
  • Alerts
  • RSS

Authors & Reviewers

  • Overview for Authors
  • Preparing manuscripts
  • Manuscript Submission Checklist
  • Publication Fees
  • Forms
  • Editorial Policies
  • Editorial Process
  • Patient-Oriented Research
  • Submit a manuscript
  • Manuscript Progress
  • Submitting a letter
  • Information for Reviewers

About

  • General Information
  • Staff
  • Editorial Board
  • Contact Us
  • Advertising
  • Media
  • Reprints
  • Copyright and Permissions
  • Accessibility
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 2291-0026

All editorial matter in CMAJ OPEN represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected].

View CMA's Accessibility policy.

 

Powered by HighWire