University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
Int J Drug Policy. 2023 Dec;122:104237. doi: 10.1016/j.drugpo.2023.104237. Epub 2023 Oct 20.
Stigma towards people who use drugs and those who engage in sex work is well-documented, leading to consequences such as reduced access to health services and support, especially in rural milieus. Stigma reduction has been recognized as a priority in the opioid overdose crisis, but little attention has been paid to within-group attitudes and beliefs. This study aimed to explore how people who use drugs in rural counties across the United States appraise sex work by themselves or other community members.
Qualitative interview data came from the Rural Opioid Initiative (ROI), a project coordinated by research teams across 65 rural counties in 10 states. Interviews were individual and conducted from 2018 to 2020. All participants reported past 30-day opioid use and/or any injection drug use. A working group coded the data, then used an iterative inductive-deductive approach to organize data into themes of stigma among people who use drugs, focusing on stigma towards sex work.
Across sites, 355 interviews were conducted. Mean participant age was 36, 55 % of participants were male, and 93 % were white. Participants expressed negative attitudes towards sex work as a function of its criminal-legal repercussions or framed sex work as morally transgressive. Many appraisals were gendered, with the behavior conveyed as being "easier" for women who were often described as "whores," with more neutral terms used to describe men. Some viewed sex work as an implicit "exchange" for drugs. Several participants noted a lack of agency as a feature leading to involvement in sex work, with partner power dynamics influencing an individual's behavior. Finally, a few participants acknowledged the circumstances under which they would newly engage in sex work.
We identified several patterns by which people who use drugs evaluate community members who sell sex. These included gendered and morally-charged forms of stigma, which may represent barriers to community acceptance and support among this subgroup.
针对吸毒者和性工作者的污名化现象已有大量记录，这导致他们获得医疗服务和支持的机会减少，这种情况在农村环境中尤为明显。减少污名化已被公认为阿片类药物过量危机的重点，但对群体内的态度和信念关注甚少。本研究旨在探讨美国农村县的吸毒者如何评价自己或其他社区成员的性工作。
定性访谈数据来自农村阿片类药物倡议（ROI），这是一个由跨越 10 个州的 65 个农村县的研究团队协调的项目。访谈是个人进行的，时间为 2018 年至 2020 年。所有参与者均报告过去 30 天有使用阿片类药物和/或任何注射药物。一个工作组对数据进行了编码，然后使用迭代式归纳演绎方法将数据组织为吸毒者群体中的污名主题，重点关注对性工作的污名。
在各个地点共进行了 355 次访谈。参与者的平均年龄为 36 岁，55%为男性，93%为白人。参与者对性工作持负面态度，认为其具有刑事法律后果，或认为性工作在道德上是越轨的。许多评价带有性别色彩，认为女性从事这种行为更容易，通常将女性描述为“妓女”，而对男性则使用更中性的术语。一些人认为性工作是一种隐含的“交换”，用毒品来换取性服务。一些参与者注意到缺乏自主权是导致从事性工作的一个特征，因为伴侣之间的权力动态会影响个人的行为。最后，有少数参与者承认在某些情况下会新从事性工作。
我们确定了吸毒者评价从事性交易的社区成员的几种模式。这些模式包括性别化和道德上有争议的污名化形式，这可能成为该群体获得社区接纳和支持的障碍。
