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

By:   Caroline Allen, Alka Murphy, Sheri Kiselbach, Stephanie VandenBerg, and Ellen Wiebe

PACE Society, British Columbia, Vancouver, Canada

Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

Department of Family Practice, University of British Columbia, Vancouver, Canada

Stephanie VandenBerg, Email: moc.liamg@einahpets.grebnednav.

  

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‘There Is Fear But There Is No Other Work’: A Preliminary Qualitative Exploration of the Experience of Sex Workers in Eastern Democratic Republic of Congo

Two decades of conflict and insecurity have had a devastating impact on many in the Democratic Republic of Congo (DRC), including marginalised groups such as sex workers. In the province of North Kivu, many residents face desperate conditions that render them vulnerable to exploitation and abuse. As a result, many turn to the sex trade in what can often be described as ‘survival sex’. 

This small-scale qualitative study explores the experience of urban sex workers in the eastern region of the DRC. Sex workers were recruited at their place of business and asked to participate in a semi-structured interview. Eight participants were recruited, including seven women and one man. Our analysis identified several themes: (1) economic hardship as a catalyst for joining the sex trade, (2) significant work-related violence and (3) a paucity of available resources or assistance. 

Responses to specific prompts indicated that sex workers do not trust law enforcement and there are significant barriers to both medical care and local resources. Further studies of this vulnerable population and its needs are encouraged in order to develop programmes that provide the means to manage the hazards of their work and obtain an alternative source of income.

Purchase full article at: http://goo.gl/WyBI8C

By: Brendan Kiernan^a*, Ranit Mishori^b & Maurice Masoda^c

^a Georgetown University School of Medicine, Washington, USA

^b Global Health Initiatives, Department of Family Medicine, Georgetown University School of Medicine, Washington, USA

^c Department of Family Medicine, Heal Africa Hospital, Goma, Democratic Republic of Congo

  

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Stimulants & Cannabis Use among a Marginalized Population in British Columbia, Canada: Role of Trauma & Incarceration

High rates of substance use, especially cannabis and stimulant use, have been associated with homelessness, exposure to trauma, and involvement with the criminal justice system. This study explored differences in substance use (cannabis vs. stimulants) and associations with trauma and incarceration among a homeless population. 

Data were derived from the BC Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada. Measures included sociodemographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ), and the Mini International Neuropsychiatric Interview (MINI) Plus. 

Stimulant users were more likely to be female (43%), using multiple substances (3.2), and engaging in survival sex (14%). Cannabis users had higher rates of lifetime psychotic disorders (32%). Among the incarcerated, cannabis users had been subjected to greater emotional neglect (p < .05) and one in two cannabis users had a history of lifetime depressive disorders (p < .05). Childhood physical abuse and Caucasian ethnicity were also associated with greater crack cocaine use. 

One explanation for the results is that a history of childhood abuse may lead to a developmental cascade of depressive symptoms and other psychopathology, increasing the chances of cannabis dependence and the development of psychosis.

Purchase full article at: http://goo.gl/gbKBoN

By: Saddichha S1, Werker GR2, Schuetz C3, Krausz MR3.

• 1Melbourne Health, Sunshine, Victoria, Australia saddichha@gmail.com.
• 2Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Canada.
• 3Department of Psychiatry, University of British Columbia, Canada.  

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"Right Here is the Gateway": Mobility, Sex Work Entry & HIV Risk Along the Mexico-U.S. Border

Women comprise an increasing proportion of migrants. Many voluntarily migrate for sex work or practice survival sex, while others may be trafficked for sexual exploitation. To investigate how the context of mobility shapes sex work entry and HIV risk, we conducted in-depth interviews with formerly trafficked women currently engaged in sex work (n=31) in Tijuana, Mexico and their service providers (n=7) in Tijuana and San Diego, USA from 2010–2011. 

Women’s experiences of coerced and deceptive migration, deportation as forced migration, voluntary mobility, and migration to a risk environment illustrate that circumstances driving and resulting from migration shape vulnerability to sex trafficking, voluntary sex work entry, and HIV risk. 

Findings suggest an urgent need for public health and immigration policies that provide integrated support for deported and/or recently arrived female migrants. Policies to prevent sex trafficking and assist trafficked females must also consider the varying levels of personal agency involved in migration and sex work entry.

Read more at: http://ht.ly/S77Kz 

By: SM Goldenberg,* JS Silverman,* D Engstrom,*** I Bojorquez-Chapela,** and SA Strathdee*

^**Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, México

^***

^**Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, México

^***

*Division of Global Public Health, University of California, La Jolla, CA, USA
**Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, México
***School of Social Work, San Diego State University, San Diego, CA, USA

*Division of Global Public Health, University of California, La Jolla, CA, USA

*Division of Global Public Health, University of California, La Jolla, CA, USA