Canadian Sex Workers Weigh the Costs and Benefits of Disclosing Their Occupational Status to Health Providers.

Prostitution stigma has been shown to negatively affect the work, personal lives, and health of sex workers. Research also shows that sex workers have much higher unmet health care needs than the general population. Less is known about how stigma obstructs their health-seeking behaviors. For our thematic analysis, we explored Canadian sex workers' accounts (N = 218) of accessing health care services for work-related health concerns. Results show that participants had mixed feelings about revealing their work status in health care encounters. Those who decided not to disclose were fearful of negative treatment or expressed confidentiality concerns or lack of relevancy. Those who divulged their occupational status to a health provider mainly described benefits, including nonjudgment, relationship building, and comprehensive care, while a minority experienced costs that included judgment, stigma, and inappropriate health care. Overall, health professionals in Canada appear to be doing a good job relating to sex workers who come forward for care. There is still a need for some providers to learn how to better converse with, diagnose, and care for people in sex work jobs that take into account the heavy costs associated with prostitution stigma.

Sex work and three dimensions of self-esteem: self-worth, authenticity and self-efficacy.

Sex work is assumed to have a negative effect on self-esteem, nearly exclusively expressed as low self-worth, due to its social unacceptability and despite the diversity of persons, positions and roles within the sex industry. In this study, we asked a heterogeneous sample of 218 Canadian sex workers delivering services in various venues about how their work affected their sense of self. Using thematic analysis based on a three-dimensional conception of self-esteem - self-worth (viewing oneself in a favourable light), authenticity (being one's true self) and self-efficacy (competency) - we shed light on the relationship between involvement in sex work and self-esteem. Findings demonstrate that the relationship between sex work and self-esteem is complex: the majority of participants discussed multiple dimensions of self-esteem and often spoke of how sex work had both positive and negative effects on their sense of self. Social background factors, work location and life events and experiences also had an effect on self-esteem. Future research should take a more complex approach to understanding these issues by considering elements beyond self-worth, such as authenticity and self-efficacy, and examining how sex workers' backgrounds and individual motivations intersect with these three dimensions.

Prostitution Stigma and Its Effect on the Working Conditions, Personal Lives, and Health of Sex Workers.

Researchers have shown that stigma is a fundamental determinant of behavior, well-being, and health for many marginalized groups, but sex workers are notably absent from their analyses. This article aims to fill the empirical research gap on sex workers by reviewing the mounting evidence of stigmatization attached to sex workers' occupation, often referred to as "prostitution" or "whore" stigma. We give special attention to its negative effect on the working conditions, personal lives, and health of sex workers. The article first draws attention to the problem of terminology related to the subject area and makes the case for consideration of prostitution stigmatization as a fundamental cause of social inequality. We then examined the sources of prostitution stigma at macro, meso, and micro levels. The third section focuses on tactics sex workers employ to manage, reframe, or resist occupational stigma. We conclude with a call for more comparative studies of stigma related to sex work to contribute to the general stigma literature, as well as social policy and law reform.

Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program.

BACKGROUND: Social marginalization and criminalization create health and safety risks for sex workers and reduce their access to health promotion and prevention services compared to the general population. Community empowerment-based interventions that prioritize the engagement of sex workers show promising results. Peer-to-peer interventions, wherein sex workers act as educators of their colleagues, managers, clients and romantic partners, foster community mobilization and critical consciousness among sex workers and equip them to exercise agency in their work and personal lives. METHODS: A pilot peer health education program was developed and implemented, with and for sex workers in one urban centre in Canada. To explore how the training program contributed to community empowerment and transformative learning among participants, the authors conducted qualitative interviews, asked participants to keep personal journals and to fill out feedback forms after each session. Thematic analysis was conducted on these three data sources, with emerging themes identified, organized and presented in the findings. RESULTS: Five themes emerged from the analysis. Our findings show that the pilot program led to reduced internalized stigma and increased self-esteem in participants. Participants' critical consciousness increased concerning issues of diversity in cultural background, sexual orientation, work experiences and gender identity. Participants gained knowledge about how sex work stigma is enacted and perpetuated. They also became increasingly comfortable challenging negative judgments from others, including frontline service providers. Participants were encouraged to actively shape the training program, which fostered positive relationships and solidarity among them, as well as with colleagues in their social network and with the local sex worker organization housing the program. Resources were also mobilized within the sex worker community through skills building and knowledge acquisition. CONCLUSION: The peer education program proved successful in enhancing sex workers' community empowerment in one urban setting by increasing their knowledge about health issues, sharing information about and building confidence in accessing services, and expanding capacity to disseminate this knowledge to others. This 'proof of concept' built the foundation for a long-term initiative in this setting and has promise for other jurisdictions wishing to adapt similar programs.