Outreach makes the difference to sex workers’ health

New University of British Columbia research shows Vancouver sex workers who have contact with street nurses and mobile outreach initiatives are more likely to use healthcare services.

Those outreach organizations know it’s more difficult for sex workers to access healthcare — mainly because of stigma — so they work with them to navigate the system.

“Outreach continues to be an important way to connect and support sex workers, particularly where it’s peer-led outreach,” said Dr. Kate Shannon, one of the study’s authors and director of the gender and sexual health initiative with the B.C. Centre for Excellence in HIV/AIDS.

Researchers from that centre, along with others from the B.C. Centre for Disease Control and UBC, identified a number of barriers sex workers face to getting medical care. They found discrimination from doctors and nurses, language barriers and limited clinic hours could prevent women from accessing care, including preventative cervical screening.

The study focused on how often sex workers got Pap tests, which screen for cervical cancer, because researchers identified sex workers were at a higher risk for getting human papilloma virus — the virus that causes cervical cancer. Women who use condoms inconsistently, have higher numbers of partners,  spend more years doing sex work and are HIV-positive are at higher risk for HPV.

Two–thirds of sex workers surveyed did not report getting routine Pap tests.

But the pattern was dramatically different for sex workers who have had contact with mobile outreach programs. That group was 35 per cent more likely to report having regular Pap tests.

These new findings align with Shannon’s previous research showing peer-driven intervention helps sex workers access HIV treatment.

It also aligns with what the outreach organizations see themselves.

“We’re able to build the relationship without that barrier of stigma. In that relationship building, we can help facilitate access to doctors’ appointments or whatever else,” said Kenzie Gerrand, a support worker with PACE (Providing Alternatives, Counselling and Education), a sex–worker outreach organization.

Regular Pap tests are important for any woman of reproductive age, said Shannon, since cervical cancer is the third most common cancer among that group.

“But what we know is that, for marginalized populations, they often don’t have the same access as the general population to services,” said Shannon.  “Accessing outreach — whether that’s community outreach or a street nurses program — was a strong predictor of increasing access to care.”

Stigma is a huge barrier accessing care, said Kay Lamoth, another support worker with PACE.   She believes there is a perception that sex workers are “vectors of disease” and she blames the stigma around sex work partially on criminal laws  in Canada.

When it comes to overcoming stigma and real or perceived medical-staff discrimination, Gerrand said having a trusted peer alongside can help. PACE support workers accompany their members to medical appointments and provide bus tickets or taxi chits for transportation.

“I have a bunch of alarms set on my phone to remind certain members that they have appointments coming up,” said Gerrand.

Outreach organizations can also help sex workers overcome language barriers. Just over a quarter of the study’s sample of sex workers were migrants or new immigrants, and authors identified a need for more outreach workers who speak Mandarin or Cantonese.

Supporting Women’s Alternatives Network focuses on supporting migrant, immigrant or newcomer indoor sex workers and has staff who provide translation at doctors’ appointments.

“We do outreach to massage parlours and we let the women know what kind of services we provide,” said Alison Clancey, SWAN’s executive director. “So then it’s an opportunity for them if they were thinking about getting a Pap test or some other kind of appointment, we’re there in the moment so they could say ‘Oh yeah, I’m interested, could you make an appointment?’”

Clinic hours are another roadblock to sex workers getting medical care, according to the study. Vancouver’s Mobile Access Project Van reaches sex workers when they’re working — at night. Staff from WISH, another sex-work support organization, drive the van on a circuit from 10:30 p.m. to 6 a.m. delivering condoms, clean needles, food and coffee to an average of 250 sex workers each week. Staff don’t provide healthcare themselves, but Shannon said they can connect sex workers with services they might need.

“In the middle of the night, when services are closed, there’s just nothing. so the MAP Van becomes the only service that they’re accessing,” said Mebrat Beyene, executive director of WISH. They say the van has actually become a bridge between the women and other health services.

“If women come back to [our] drop in and access the nurse practitioner, then Paps are likely to be one of the things they do,” said Beyene.