HIV Insight: Exploring the Experience of Chronic Pain among Female Survival Sex Workers

BACKGROUND:

The prevalence of self-identified chronic pain in Canadian adults is approximately one in five people. Marginalization and addictions have been shown to complicate chronic pain in vulnerable populations. This study aimed to understand the experience of chronic pain among female Survival Sex Workers in Vancouver's downtown eastside (DTES).

METHODS:

This study used an exploratory qualitative analysis with in-depth, semi-structured interviews. Members of PACE Society who self-identified as a current or former Survival Sex Worker and who had a chronic pain experience known to PACE support workers were invited to participate. Interviews were conducted, audio recorded and transcribed. The investigators met to read the transcripts and discuss emerging themes. The process continued until no new themes were observed.

RESULTS:

Participants ranged in age from 42 to 56 years old and all self- identified as females and Survival Sex Workers. Eleven of thirteen interviews were analyzed for themes. Drug use for pain management, both prescribed and illicit, was the most important theme. Poverty, the need to continue working and the lack of stable housing were barriers to adequately addressing the source of chronic pain. Participants felt judged for living in the downtown eastside, being a drug user and/or being Aboriginal and only two participants had been referred to a pain specialist. All participants were involved in support networks made up of other Sex Workers and all spoke of a sense of community and survival.

CONCLUSIONS:

Our study emphasizes the complex nature of chronic pain and addictions among a uniquely marginalized population. The study is unique in that it contributes the perspectives of a traditionally "hard-to-reach" population and demonstrates that Sex Workers should not only participate in but should lead development and implementation of research and programs for managing chronic pain in the setting of addiction.

Women described multiple systemic barriers in managing their chronic pain including judgment and poverty. The most common theme was that of judgment in the form of stigma. They felt judged for being from a certain area,

You know, people think they’re all scum down here, but you know what, that’s - they didn’t start here. You know, this is just a place they ended up... And some of them don’t know how to get out of it.(Participant 2)

First Nations women felt discriminated against for having a certain ethnic background. Others felt labeled for having a substance dependence. “Like once you’re labeled as an addict, like, in – in so many physicians’ eyes, that’s all you are and that’s all you’re out to get” (Participant 10).

Other common themes that emerged under the topic of barriers were those associated with poverty and the effect of low-income and inadequate housing on managing a chronic condition. Income came primarily from sex work and was largely supplement by disability, welfare and pension payments when unable to work. Prescribed lifestyle changes and therapies for chronic pain were described as inaccessible or unaffordable. One woman recalled, “I should be going to physio but I can’t afford it. You’re only allowed so many a year and then you have to pay the user fee. Who’s gonna pay that?” (Participant 12) while others cited acupuncture and massage as being inaccessible due to the cost.

Women expressed frustration over the cost of prescription medications, especially those that were not covered or those who’s coverage was delayed.

You have to pay 200 dollars for fucking medications. It’s not covered by medical or status. 200 bucks. You can take your fuckin’ meds and shove it up your ass, you’re going to tell me that it’s not covered(Participant 3)

Housing conditions that were affordable were often inadequate. One woman described, “fleas in the carpet, mice in the stove, um, cockroaches in the bathroom. Oh it was a horrible place, and I got stuck staying there for 2 years” (Participant 2).

Women expressed frustration accessing the emergency department as a resource for pain due to stigma as well as frustration with building a relationship with a physician knowing their histories as both a Sex Worker and an addict. One participant felt so rejected that it was easier for her to reject herself, saying,

I don’t wanna go back through not being listened to again, do you know what I mean there, right?... If you can reject it first before somebody rejects you, it’s easier to shut it down. It’s that wall you put up, right? (Participant 4)

Full article at: http://goo.gl/LURUuq