Table 3:

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

Theme; subthemeIllustrative quote
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)
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.