Navigating Stigma in Romantic Relationships Where One or Both Partners Sell Sexual Services.

Romantic relationships are an important part of our social identities and well-being. In this paper, we report on qualitative findings with thirty Canadian couples, interviewed together, where it was known that one or both partners sell sexual services for a living. We asked a series of open-ended questions related to the background of the couple's relationship, their day-to-day interactions and work-related stressors. Participants talked about the ongoing negotiations they engage in as a couple, the benefits of being open to each other about working in the sex industry, and how they manage its emotional toll on their partnership. We conclude that there are various ways that sex workers are able to maintain intimacy in their romantic relationships after sex work has been disclosed. Widespread social stigma attached to sex work, complicated by criminalization in countries such as Canada, nevertheless threatens relationship quality in the long run.

Lower-risk substance use guidelines accessible by youth.

BACKGROUND: Lower-risk substance use guidelines (LRSUGs) are an evidence-based harm reduction strategy used to provide information to people who use drugs so they can reduce harms associated with substance use. OBJECTIVES: This study aimed to identify LRSUGs accessible to youth and to characterize the recommendations within these guidelines. The overall goal is to identify gaps in current LRSUGs and to inform researchers and policymakers of the kinds of health information youth can access. METHODS: We conducted a digital assessment using the Google search engine to identify LRSUGs that could be identified by youth when searching for official sources of information related to commonly used substances, including cannabis, caffeine, alcohol, hallucinogens, prescription opioids, nicotine, and/or prescription stimulants. LRSUGs were coded and data were extracted from them to identify gaps. RESULTS: One hundred thirty LRSUGs were identified; most focused on alcohol (n = 40, 31%), cannabis (n = 30, 23%), and caffeine (n = 21, 16%). LRSUGs provided recommendations about dosing (n = 108, 83%), frequency of use (n = 72, 55%), and when to use (n = 86, 66%). Most LRSUGs were published by health (n = 51, 39%) and third-sector organizations (n = 41, 32%), followed by provincial/state (n = 18, 14%), government (n = 14, 11%), municipal (n = 4, 3%), and academic (n = 2, 2%) sources. Only 16% (n = 21) of LRSUGs were youth-specific and one-quarter (n = 32, 25%) of LRSUGs provided gender-specific recommendations. Most guidelines featured information on short (n = 76, 58%) and long-term (n = 69, 53%) negative effectives and positive effects of substances (n = 56, 43%). Less than half (n = 50, 38%) of LRSUGs cited evidence in support of the information they provided. CONCLUSIONS: We identified several areas in the current LRSUGs for youth that need to be addressed. Among the gaps are a lack of LRSUGs developed specifically for youth, a lack of youth engagement in developing harm reduction strategies centered around them, and a lack of evidence-based LRSUGs. Youth-oriented, evidence-based LRSUGs are needed to better support youth who use substances and help them manage the negative effects of substance use.

Challenges and Benefits of Disclosure of Sex Work to Intimate Partners.

Sex workers' noncommercial intimate partnerships are marginalized on two counts - they are non-monogamous and at least one partner is in sex work, an occupation with much stigma. We asked a heterogeneous sample of Canadian sex workers (N = 218) about their decisions to reveal/not reveal their sex work to intimate partners, and the resulting challenges and benefits. A minority (58/183) of participants who had been or were currently involved in an intimate relationship kept their work secret from at least one partner or disclosed limited information, shielding them from stigma but resulting in a burden of secrecy. The majority of participants (151/183) who had been/were currently involved in an intimate relationship chose to disclose their sex work to at least one partner, which for most, had one or more negative consequences. A small group of participants related that disclosure resulted in acceptance, support, and understanding from their intimate partner. Some participants avoided the disclosure dilemma by forming intimate relationships from social connections where sex work status was already known. These relationships were generally supportive. We conclude that intimate relationships provide positive experiences for many people who sell sexual services and that these relationships could be stronger if societal stigma was reduced.

Access to Sexual Rights for People Living with Disabilities: Assumptions, Evidence, and Policy Outcomes.

Sexuality scholars have historically understudied the link between disability, sexual exclusion, and social justice, including equal rights for people living with disabilities (PLWD) to enjoy a sexual and intimate life in adulthood. There have been some recent efforts to rectify this situation, with studies emerging concerning strategies for promoting their sexual rights. Our Target Article explores one contentious service option-the possibility of "sexual assistance" for PLWD, which ranges in meaning across countries from sex surrogacy to physical contact with paid sexual assistants. We conducted a knowledge synthesis using a scoping review methodology to identify the breadth of the academic scholarship available and assess its alignment with current ethical and moral debates and recent policies and practices surrounding the sexual scripts of PLWD as they relate to sexual assistance. We categorized the relevant articles in our scoping review into two broad classes: those that support sex-negative perspectives (i.e., framing sexuality as risky, adversarial, etc.) and those that support sex-positive perspectives (i.e., framing sexuality as normative, consensual, etc.). Our results show that sex-negative cultural scripts call for limitations of the sexual rights of PLWD due to their inherent vulnerability as having disabled sexualities and/or due to their heightened risk of exploiting sexual partners, especially cis women who sell sexual services. The sex-positive cultural scripts understand PLWD as having the same rights to sexual citizenship as non-disabled individuals and that to achieve this, equitable access to sexual health services in decriminalized and regulated service environments is needed. We conclude with limitations of our investigation and recommendations for further research on this understudied topic, including the possible integration of positive disabled sexuality and abuse prevention.

The influence of sleep and movement on mental health and life satisfaction during the transition to parenthood.

OBJECTIVES: This study assessed whether sleep and physical activity impact mental health and life satisfaction across the transition to parenthood. This study assessed the impact of parenthood on mental health of new parents and parents expecting their second child, and whether change in mental health occurred dyadically across couples. DESIGN: Longitudinal 12-month study. PARTICIPANTS: One hundred and fifty-seven couples (N = 314) between the ages of 25 and 40, who were not expecting to have a child (n = 102), expecting their first child (n = 136), or expecting their second child (n = 76) were recruited. MEASUREMENTS: Participants completed measures at baseline, 6 months, and 12 months. Sleep was assessed with how often participants met sleep guidelines (7-9 hours). Physical activity was measured objectively via accelerometers. Mental health was measured using 6 items from the short form-12 Quality of Life Survey. Life satisfaction was assessed with the Satisfaction with Life Scale (5 items). RESULTS: Mental health was not predicted by physical activity but was predicted by sleep. Sleep at 6 months was positively related to mental health at 6 months (ß = 0.156, p < .001), and sleep at 12 months was positively related to mental health at 12 months (ß = 0.170, p < .001). The change in mental health did not occur dyadically: mental health increased for women but not for men across groups. Mental health was positively related to life satisfaction at 6 months (ß = 0.338, p < .001) and 12-months (ß = 0.277, p < .001). CONCLUSIONS: For new and established parents, getting sufficient sleep plays an important role in mental health and, in turn, life satisfaction.

Factors associated with transactional sex among a cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada.

Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6months until July2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex. Conclusions More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men.

COVID-19, Stigma, and the Ongoing Marginalization of Sex Workers and their Support Organizations.

Primary or first-hand stigma, associated with sex work, sometimes disparagingly referred to as "prostitution" or "whore" stigma, was a fundamental cause of social inequities for sex workers before the COVID-19 pandemic. In addition, courtesy stigma, or stigma by association linked with involvement with a stigmatized group, has long limited the ability of sex worker organizations to secure adequate funds to meet the needs of sex workers in their communities. In reaction to the pandemic, sex worker organizations quickly responded and in a variety of ways have been helping to ease the impact of the pandemic on sex workers in their communities. In November 2020, we interviewed 10 members of sex worker organizations from seven different communities across Canada about how they have been dealing with the immediate and longer-term impacts of the COVID-19 pandemic in their communities. Three strategic actions stood out in the interviews: (1) challenging stigma to help sex workers access government emergency funding; (2) reorganizing and adapting services to provide outreach to sex workers in their communities; and (3) advocating for continuous organizational funding. The findings show that primary stigma and courtesy stigma have further marginalized sex worker organizations and their clients during the pandemic. We conclude with participants' recommendations to address avoidable harms of COVID-19 among sex workers and to better support sex worker organizations in Canada.

Event-level outcomes of police interactions with young people in three non-metropolitan cities across British Columbia, Canada.

This study examines encounters between youth and police to identify individual, contextual, and social factors that predict the outcome of these encounters. Young people aged 16-30 years were surveyed between May 2017 and June 2018 in three non-metropolitan cities across British Columbia, Canada. Outcomes were analysed using multinomial logistic generalized estimating equations. A total of 675 encounters were reported by 360 participants. These outcomes resulted in participants being questioned (n = 227; 33.6%); given warnings (n = 132; 19.6%); being searched (n = 104; 15.4%); being given a ticket (n = 101; 15.0%); and being handcuffed or arrested (n = 111; 16.4%). Young Indigenous people (vs. white) were significantly more likely to be handcuffed or arrested (OR=3.26; 1.43, 7.43). Statistical significance held after adjusting for history of police encounters and contextual factors. Findings suggest that police discretion, which has the potential to benefit youth, may be undermined by discriminatory applications of discretion.

Effect of housework on physical activity during transitions to parenthood.

The transition to parenthood is associated with declines in moderate to vigorous physical activity (MVPA) and increases in light PA (LPA). One potential mechanism for this change in PA that occur at the onset of parenthood is housework. We examined housework load and PA levels of three cohorts of couples across 12 months recruited from Victoria, British Columbia, Canada between January 2007 and December 2011. Participants (N = 314; 102 not expecting a child, 136 expecting first-child, 76 expecting second child) completed baseline demographics and 7-day accelerometry, followed by assessments at 6 and 12 months. Hierarchical linear regression assessed the association between PA, housework, and perceptions of partner's workload. New fathers' but not new mothers' housework was positively related to their LPA at 12 months. Perceptions of partners' workload were positively related to new mothers LPA, and negatively related to new fathers MVPA at 12 months. Mediation analysis determined if perceived behavioral control accounts for the relationship between the discrepancy in housework between partners' PA. Results suggest that if a woman perceives their partner to do more housework their own PA increases, whereas for men their PA decreases. These findings highlight the importance of the division of housework on PA for both mothers and fathers.

Early Assessment of Integrated Knowledge Translation Efforts to Mobilize Sex Workers in Their Communities.

Researchers have recently increased their efforts to find more effective strategies to reduce the gap between the production of academic knowledge and its uptake in policy and practice. We focus attention on sex workers in Canada who have limited access to societal resources and are hampered by punitive laws prohibiting their work. The initial aim of our study was to work with sex worker organizations and allied agencies to develop a training program for sex workers to help them understand Canada's most recent criminal justice approach to adult sex commerce. What has emerged from our integrated knowledge translation process during the first year of the study's operation has been a change to a broader focus on mobilizing sex workers around their occupational and social rights. In this paper, we first give an overview of recent changes in Canada's prostitution laws and then report qualitative findings from interviews with members of our partner organizations. Interviewees appreciated the change in research direction and the emergent collaborative process among themselves and the authors, but also noted challenges regarding shifting research timelines, balancing power between themselves and the academic researchers, and reaching consensus on research plans among community partners themselves. We discuss the findings in relation to successful knowledge translation strategies that aim to ensure the research questions we ask, and the empirical processes we engage in, are advantageous to those we aim to benefit.

Problematic substance use or problematic substance use policies? / Consommation problématique de substances ou politiques problématiques en la matière?

This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.

Substance use in Canada cost $46 billion in 2017, with the great majority of these costs resulting from the use of tobacco and alcohol. Substance use-related costs, harms and rates of use have been increasing in Canada over the past decades for both legal and illegal substances, including those for cannabis. Canadian policies to address our most harmful substances, i.e. alcohol, cannabis and tobacco, are largely failing, despite significant opportunities to improve policies on pricing, taxation and marketing of legal substances. Canada's monitoring and surveillance efforts can be improved by developing more discerning measures of risk and maximizing the use of multiple data sources.

Au Canada, la consommation de substances a coûté 46 milliards de dollars en 2017, la grande majorité de ces coûts découlant du tabagisme et de la consommation d'alcool. Au Canada, les taux de consommation de substances ainsi que les coûts et les méfaits connexes ont augmenté au cours des dernières décennies, que ce soit pour les substances légales ou illégales, en particulier le cannabis. Les politiques canadiennes en matière de lutte contre la consommation des substances les plus nocives, soit l'alcool, le cannabis et le tabac, sont en grande partie inefficaces, malgré d'importantes possibilités d'amélioration en matière de tarification, de taxation et de commercialisation des substances légales. Il est possible d'améliorer les efforts de contrôle et de surveillance au Canada en élaborant des mesures de risque bien pensées et en maximisant l'utilisation de multiples sources de données.

'I dodged the stigma bullet': Canadian sex workers' situated responses to occupational stigma.

Stigma attached to sex workers' occupation, sometimes disparagingly referred to as 'prostitution' or 'whore' stigma, is a fundamental challenge for people in sex work. Yet sex workers are not powerless when confronting occupational stigma. We employed thematic analysis with data from in-person interviews conducted in 2012-13 with a diverse sample of 218 adult sex workers in Canada. Our participants perceived a high degree of occupational stigma, which they responded to and managed using four main strategies. First, some participants internalised negative discourses about their sex work and accepted their discredited status. Second, many controlled access to information about themselves, consciously keeping knowledge of their occupation from most people while sharing it with trusted others. Third, some participants rejected society's negative view of their occupation. Finally, some attempted to reduce the personal impact of stigma by reframing sex work to emphasise its positive and empowering elements. Participants often strategically responded to stigma contingent on the situated contexts of their work and personal life. We discuss these findings in relation to the existing knowledge base about stigma attached to sex workers' occupation as well as how these findings may direct future research on stigma strategies.

Balance, Capacity, and the Contingencies of Everyday Life: Narrative Etiologies of Health Among Women in Street-Based Sex Work.

There is an abundance of health research with women in street-based sex work, but few studies examine what health means and how it is practiced by participants. We embrace these tasks by exploring how a convenience sample of sex workers (n = 33) think about and enact health in their lives. Findings reveal pluralistic notions of health that include neoliberal, biomedical, and lay knowledge. Health is operationalized through clinic/hospital visits and self-care practices, which emerge as pragmatic behaviors and ways to resist or compensate for exclusionary treatment in health care systems. Participants also use symbols of biomedical authority to substantiate their lay interpretations of certain conditions, revealing complex forms of moral reasoning in their health etiologies. We conclude that doing health and constructing rich narratives about it are constituent elements of the women's everyday praxis and subjectivities in relation to the broader socioeconomic and political worlds of which they are a part.

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.

From risky places to safe spaces: Re-assembling spaces and places in Vancouver's Downtown Eastside.

Vancouver's Downtown Eastside (DTES) neighbourhood is commonly associated with stigmatized and criminalized activities and attendant risks and harms. Many spaces/places in this urban neighbourhood are customarily portrayed and experienced as risky and harmful, and are implicated in experiences of structural (and physical) violence and marginalization. Drawing on 50 qualitative interviews, this paper explores how spaces/places frequently used by structurally vulnerable people who use drugs (PWUD) in the DTES that are commonly associated with risk and harm (e.g., alleyways, parks) can be re-imagined and re-constructed as enabling safety and wellbeing. Study participants recounted both negative and positive experiences with particular spaces/places, suggesting the possibility of making these locations less risky and safer. Our findings demonstrate how spaces/places used by PWUD in this particular geographical context can be understood as assemblages, a variety of human and nonhuman forces - such as material objects, actors, processes, affect, temporal elements, policies and practices - drawn together in unique ways that produce certain effects (risk/harm or safety/wellbeing). Conceptualizing these spaces/places as assemblages provides a means to better understand how experiences of harm, or conversely wellbeing, unfold, and sheds light on how risky spaces/places can be re-assembled as spaces/places that enable safety and wellbeing.