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.
CMAJ Open. 2021 May 14;9(2):E482-E490. doi: 10.9778/cmajo.20200049. Print 2021 Apr-Jun.
Young adult sex workers may benefit from sexual and reproductive health care services; however, little research has examined their access experiences. This study aimed to assess barriers to and facilitators of access to sexual and reproductive health care among young adult sex workers, and identify practices suggested by participants to improve services.
This was a community-based mixed-methods study of adults aged 18-29 years who were currently or had previously been engaged in sex work, conducted in Toronto in 2017-2018. The study was guided by a Youth Advisory Committee of 4 youth with lived experience of sex work. Participants completed an online survey, or participated in a focus group or a one-on-one interview; all 3 modalities included parallel questions about barriers to and facilitators of access to sexual and reproductive health care. We summarized quantitative data using descriptive statistics and identified qualitative themes using thematic analysis, followed by triangulation of the 2 strands.
There were 54 survey respondents (response rate 48%) and 17 participants in the qualitative phase (14 in focus groups and 3 in interviews), for a total sample size of 71. Survey respondents reported suboptimal access to sexual and reproductive health care, with 8 (15%) reporting no regular source of care, and only 6 (11%) reporting that they disclose their sex work experience to providers. Actual or expected stigma regarding sex work on the part of providers was the dominant barrier to care, whereas nonjudgmental providers, particularly those who themselves have sex work experience, was a key facilitator. Participants suggested 7 practices to improve access to sexual and reproductive health care.
Young adult sex workers face many barriers to accessing sexual and reproductive health care. Including people with sex work experience in the development of solutions will maximize the capacity to address the needs of this underserved population.
年轻成年性工作者可能受益于性健康和生殖健康护理服务；然而，很少有研究调查他们获得这些服务的经历。本研究旨在评估年轻成年性工作者获得性健康和生殖健康护理服务的障碍和促进因素，并确定参与者提出的改善服务的建议。
这是一项在多伦多进行的以社区为基础的混合方法研究，对象为 18-29 岁的成年人，他们目前或以前从事过性工作。研究由一个由 4 名有性工作经历的年轻人组成的青年顾问委员会指导。参与者完成了在线调查，或参加了焦点小组或一对一访谈；所有 3 种方式都包括关于获得性健康和生殖健康护理服务的障碍和促进因素的平行问题。我们使用描述性统计数据总结定量数据，并使用主题分析确定定性主题，然后对这 2 个方面进行三角分析。
有 54 名调查参与者（回复率为 48%）和 17 名定性参与者（14 名参加焦点小组，3 名参加访谈），总样本量为 71 名。调查参与者报告称性健康和生殖健康护理服务的获得情况不理想，8 名（15%）报告没有固定的护理来源，只有 6 名（11%）报告他们向提供者披露性工作经历。提供者对性工作的实际或预期的污名化是护理的主要障碍，而不评判的提供者，特别是那些自己有性工作经验的提供者，是一个关键的促进因素。参与者提出了 7 种改善性健康和生殖健康护理服务获取的建议。
年轻成年性工作者在获得性健康和生殖健康护理服务方面面临许多障碍。让有性工作经验的人参与解决方案的制定将最大限度地提高满足这一服务不足人群需求的能力。
