Elena Cama, Kacey Martin, Loren Brener, Mish Pony, Carla Treloar, Greta Desgraves, Timothy Broady
Sex workers in Australia face considerable stigma, particularly in health care, which may have significant impacts on their access to care. This study has important implications for informing stigma reduction initiatives targeted at health workers who provide care to sex workers.
BACKGROUND: Despite extensive evidence of the negative impacts of stigma on sex worker wellbeing, less research explores the link between stigma and reduced access to health care. This paper explores sex work stigma and its association with reduced access to health care among sex workers in Australia.
METHODS: Sex workers (n = 689) were recruited through sex worker organisations to complete an online survey measuring experiences of stigma and discrimination generally and in health care, including experiences of stigmatising practices known to affect sex workers (e.g. inappropriate comments, offers of unnecessary sexual health checks), as well as reduced access to health care due to stigma. Analyses explored associations between stigma and reduced access to care, controlling for socio-demographic variables, connection to the sex worker community, personal wellbeing, and social support.
RESULTS: Most sex workers had experienced stigma in the previous year, with 97% reporting experiencing any stigma and 88% experiencing negative treatment by health workers. Common stigmatising practices experienced by sex workers were inappropriate comments from health workers (70%), health workers diagnosing sex work as the problem (65%), suggestions/advice to leave sex work (65%), and offers of unnecessary sexual health checks (55%). Sex workers reported engaging in strategies to avoid experiencing stigma in health care, including not disclosing their sex work (93%) and looking for alternative health services (91%). Sex workers who had lower personal wellbeing, lower social support, experienced poor treatment from health workers, had greater connection to the sex worker community, and who were older in age reported greater reductions in their health care access due to stigma.
CONCLUSIONS: Sex workers in Australia face considerable stigma, particularly in health care, which may have significant impacts on their access to care. This study has important implications for informing stigma reduction initiatives targeted at health workers who provide care to sex workers.