Sex work and non-sexual health: A Call For Shifts in Research To Address the Diverse Health Concerns of Sex Workers


Introduction

            Though much research related to female sex workers’ (FSWs) health has focused on sexual health, STI spread, violence, and physical abuse, little research has been done with respect to mental health, emotional well-being, and general health-related concerns of sex workers, despite some evidence that FSWs themselves may prioritise these concerns (World Health Organisation [WHO], 2013; Sanders, 2004). This study aims to address these concerns through asking: How do female street based sex workers (FSWs) in an urban area perceive general health( ie: non- sexual health)?  Asking this may provide first steps in elaborating and better defining the health-care perceptions of FSWs.

Literature Review

Due to the intense scrutiny by the general public as well as research communities, research into the health concerns of FSWs have been largely focused on sexual health, despite evidence that FSWs themselves may not prioritise this aspect of health (Sanders, 2004). While street-based FSWs may be at risk for STIs due to the prevalence of environmental factors like intravenous drug use, assault, and needle sharing, which are endemic to the urban locales where FSWs work (Rekart, 2005; Shannon, Bright, Gibson, & Tyndall, 2007; Astemborski et al., 1994; Kral et al., 2001; Spittal, et al., 2003), there no direct correlation between sex work itself and STIs (Spittal, et al., 2003). Nevertheless, the WHO lists sex work as a category subsumed under the wider concern of HIV/AIDs, with latest publications all related to prevention and management of STIs in sex workers (2013). These research perspectives and similar stigmatising narratives of sex work have often led to implicit conclusions that sex workers are vectors for sexually transmitted infections (STIs) such as HIV (Abel, Fitzgerald, Healy, & Taylor, 2010; Church, Henderson, Barnard, & Hart, 2001; Astemborski et al., 1994; Kral et al., 2001).

Lack of control over sexual transactions due to violence can also impact street-based FSWs’ health since they are unable to thoroughly screen for abusive clients due to the short time frame in which street-based negotiations take place (Sanders, 2004). Streets also provide fewer opportunities for third party interventions to halt abusive encounters (Sanders, 2004). The norms of street-based sex work indicate low prevalence of condom use (Sanders, 2004; Barnard, 1993), possibly because requesting condom usage by FSWs increased their likelihood of receiving violence by 46% (Panchandeswaran et al., 2012) .

Though 73% of street-based sex workers reported being physically assaulted and 68% reported being raped while at work (Farley & Kelly, 2000), work by Sanders has shown that sex workers may prioritise emotional, psychological, and mental health concerns over concerns related to violence and sexual health (2004). While the latter problems are isolated to the workplace, mental health concerns permeate all aspects of FSWs’ lives (Sanders, 2004; Day & Ward, 2007). Street-based FSWs’ often report having post-traumatic stress disorder, anxiety, and depression due to the constant pressures of “information management” (ie: maintaining a “double life” without “being discovered”), managing their emotions regarding clients, and dealing with stigma related to their profession (Koken, 2012; Sanders, 2004). Stigma can be theorized as a complex social process of labeling someone due to specific behaviours marked as undesirable by dominant social values (Link & Phelan, 2001; Link & Phelan, 2006). This process eventually leads to the reduction of “a whole and usual person to a tainted, discounted one” (Goffman, 1963, p. 3).

Deacon (2006) further elaborates that in health-related contexts, stigmatizing discourses often support dominant social narratives of blaming contraction of illnesses on groups like sex-workers whose behaviours are marked as deviant. When stigma is thus enacted through hostile encounters with medical professionals which may focus on their sexual health and practices, FSWs’ may be reluctant in seeking out healthcare (Scorgie, 2013; Scambler & Hopkins, 1986). Due to cultural norms regarding sex work, FSWs may feel stigmatized without specific enacted incidents of stigma; this “felt stigma” may deter FSWs from seeking healthcare or disclosing health concerns to medical personnel since FSWs are wary of potential negative responses by medical professionals (Phillips & Benoit, 2005; Scambler & Hopkins, 1986; Scorgie, 2013).

Compounded with the lack of employee benefits, stigma may play a particularly crucial role in FSWs’ reluctance to seek health-care for chronic body pain (Shumka & Benoit, 2008), muscle and joint pain such as arthritis (Messing, 2002; Shumka & Benoit, 2008), and gastrointestinal concerns (Shumka & Benoit, 2008), though these concerns are often highlighted in interviews.

Since so little work has been with respect to how FSWs perceive health, it is unclear if stigma is the main deterrent to seeking healthcare, or if FSWs’ conceptualization of health simply does not prioritise those concerns as necessitating professional medical management, even while that same conceptualization of health potentially allows them to prioritise these concerns through complex coping strategies (Sanders, 2004; Koken, 2012). Furthermore, the intense scrutiny of researchers into FSWs’ sexual health might overshadow FSWs’ perceptions of general, non-sexual health.

Purpose

Though some insightful research has revealed FSWs’ mental health, the perceptions of street-based FSWs with respect to their general, non-sexual health remains unclear. Recent literature has often conceptualised health along the lines of possessing adequate biological and acquired capacities in coping with the demands of everyday life (Bircher, 2005; Law & Widdows, 2008). There is thus a clear precedent to further explore the general, non-sexual health concerns of FSWs, through the question: How do female street based sex workers (FSWs) in an urban area perceive general health( ie: non- sexual health)? Asking this may provide first steps in elaborating and better defining the health-care perceptions of FSWs.

The broad goals of this study are to understand and describe street-based FSWs’ perspectives of general health in an urban locale. Specifically, the objectives of this study involve understanding, a) their assumptions, ideas, perceptions, and concerns about general health, b) FSWs’ prioritization of general health concerns and how they value health and c) the social, professional, and personal impact of these health-perspectives in their lives. This study will provide a starting point in addressing broader aims of 1) widening the scope of academic research related to sex workers’ health, and 2) health policy changes to better address the quotidian health-care needs of sex workers.

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