Bodkin Kate, Delahunty-Pike Alannah, O'Shea Tim
Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Int J Equity Health. 2015 Apr 9;14:35. doi: 10.1186/s12939-015-0156-0.
Providing services for street level sex workers requires a multidisciplinary approach, addressing both health and safety concerns typical of their age and gender and those that arise specific to their line of work. Despite being a diverse population, studies have identified some specific health needs for sex workers including addictions treatment, mental health. Additionally, studies have shown a higher risk of physical and sexual assault for this population. The Persons at Risk program (PAR) in London, Ontario, Canada was started in 2005 to address the specific needs of street level sex workers by using a harm-reduction model for policing and healthcare provision. This qualitative study evaluated this model of care in terms of improving access to healthcare and essential police services for street level sex workers.
A total of 14 semi-structured interviews were conducted with current and former female street level sex workers enrolled in the PAR program. In addition, 3 semi-structured interviews were conducted with health and law enforcement professionals. The research team then analyzed and coded the transcripts using qualitative description to identify key themes in the data.
Results indicated that participants represent a vulnerable population with increased safety concerns and healthcare needs relating to addictions, mental health and infectious disease. Despite this, participants reported avoiding healthcare workers and police officers in the past because of fear of stigma or repercussions. All participants identified the harm reduction approach of the PAR program as being essential to their continued engagement with the program. Other important aspects included flexible hours, the location of the clinic, streamlined access to mental health and addictions treatment and the female gender of the police and healthcare worker.
The PAR program provides sex workers access to much needed primary healthcare that is flexible and without judgment. In addition, they are provided with a direct avenue to access law enforcement. We feel a similar model of care could be applicable to many cities across Canada.
为街头性工作者提供服务需要采取多学科方法，既要解决她们因其年龄和性别所面临的典型健康与安全问题，也要解决因她们的工作性质而产生的特定问题。尽管这是一个多样化的群体，但研究已确定性工作者的一些特定健康需求，包括成瘾治疗、心理健康。此外，研究表明这一群体遭受身体和性侵犯的风险更高。加拿大安大略省伦敦市的高危人群项目（PAR）始于2005年，通过采用减少伤害模式来提供治安和医疗保健服务，以满足街头性工作者的特定需求。这项定性研究评估了这种护理模式在改善街头性工作者获得医疗保健和基本治安服务方面的效果。
对参与PAR项目的现任和前任女性街头性工作者总共进行了14次半结构化访谈。此外，还对健康和执法专业人员进行了3次半结构化访谈。然后，研究团队使用定性描述对访谈记录进行分析和编码，以确定数据中的关键主题。
结果表明，参与者是一个弱势群体，在成瘾、心理健康和传染病方面的安全担忧和医疗保健需求增加。尽管如此，参与者报告称过去由于害怕污名化或受到影响而避开医护人员和警察。所有参与者都认为PAR项目的减少伤害方法对她们继续参与该项目至关重要。其他重要方面包括灵活的工作时间、诊所的位置、简化的心理健康和成瘾治疗途径以及警察和医护人员为女性。
PAR项目为性工作者提供了获得急需的灵活且无歧视的初级医疗保健的机会。此外，还为她们提供了一条直接接触执法部门的途径。我们认为类似的护理模式可能适用于加拿大的许多城市。
