Stigma, Social Exclusion, and Health

Stigma, Social Exclusion and Health:
Sex Work in Canadian Society
Prepared By: Rachel Phillips, Josephine MacIntosh & Cecilia Benoit
Department of Sociology - University of Victoria
[email protected]
See Also:
Sara Spencer Foundation
Michael Smith Foundation for Health Research
Prostitutes Empowerment Education and Resource Society
Paper Objectives
Drawing on a social determinants of health
framework, explore the sex trade as a highly
marginalized occupation.
Provide a narrative summary of stigma and
social exclusion as described by persons
involved in the sex trade.
Provide recommendations for further
Existing Literature on “Prostitution”
Competing discourses in the social science literature:
Prostitution as male sexual aggression against
vulnerable women.
– Parallels found in the criminological and epidemiological
literature where deviance and “health risks” accompanying sex
work are examined, including sexually-transmitted infections
(STIs), exposure to violence, and illicit drug use.
Prostitution as freely-chosen economic activity, an
occupation – ‘just another way of making a living’.
– Focus on sex worker's rights as an emancipation and labour
issue rather than as an issue of male criminality/exploitation.
Existing Literature: Occupational Health
Determinants of occupational health:
– Autonomy/decision making authority
– Social exclusion/social support for occupation
– Work demand/reward ratio (e.g. money, status)
– Stress
– Exposure to dangerous working conditions
– Access to employee benefits and workplace protections
Occupational health indicators are rarely applied to
the sex trade, which is regarded as a highly risky form
of labour. How does stigma interface with these
domains and what is the impact on sex workers?
Methods and Data
Project initiated by community
partner: Prostitutes
Empowerment Education and
Resource Society (PEERS)
Sample Size: 201 respondents
located in the Victoria Region
collaboration; employed
experiential research assistants.
Diverse research tool including
closed ended (n=201) and openended (n=79) questions on a
range of topics.
Full Report: Dispelling Myths
and Understanding Realities
(2001). Benoit and Millar
Work Status: 147 active, 54
Gender: 160 females, 36
males, and 5 transgendered
(male to female)
Work Location: majority of
respondents had worked in a
variety of venues, including
both indoor and outdoor sex
work. The focus of the study
was on indoor workers.
Is the Sex Trade Viewed Negatively?
“Some people stereotype you and they think that a hooker
on the street, an independent escort or somebody that’s in
an agency are all the same. They’re all the same, they’re all
whores. I don’t listen to them… I was making a living and
supporting myself and children and that’s all there was to it.
It was work.” (Female, 32, agency-based)
“If you’re giving away your body for sex, then nobody looks
at it as a job. They look at you like a slut. People do look
down on you.” (Male, 27, street-based)
“Clients don’t consider what they’re doing… as wrong but
they kind of look at the people who are working like they’re
a product, you don’t have any feelings, you’re something to
be used. It’s not that we’re all dirty little whores or fuckin’
disease ridden whatever, or that we’re all nasty drug
addicts. It’s not true... what you see on TV, like the glamour
and the glitz and everything like that, it’s not true as well…
both are extremes.” (Male, 36, club-based)
How Do You View Sex Work?
“To them [clients] it’s fantasy. To me, this is reality. It’s
business. This is my money, this is my job. To me it’s not
sex. It doesn’t even seem like that because it’s so
business oriented. I’m so business oriented and the
people I deal with know that. Most of the people that I
deal with are businessmen so they have their certain
amount of time. They know what they want. They know
that I know what they want, and everybody's happy.”
(Female, 31, agency)
“When it comes down to it, I have full control over what I’m
doing. I know that I can make my own decisions, my own
rates, and I can make my own hours.” (Male, 27, home)
“A lot of people look at it like it’s really, really bad. The way
I see it, it’s not the greatest thing, but it’s not the worse
thing possible.” (Female, 28, street)
How Do You View Sex Work?
“I have a couple of opinions about it actually. In some
ways I think if there’s a woman that’s older and she
doesn’t have a problem with it, then I don’t think that
there’s anything wrong with it. She should be able to set
something up in her home and do it if she wants to.
However, I think that it’s people just getting into the sex
industry, I think it’s a real dangerous place to be. I don’t
think they’d really be there if they had high self-esteem. I
think it’s easier to get into it because there’s lots of people
who will pay for it. For me it was the easiest thing to get
into when I was young. I look around and I see that it’s the
same thing for other young people but I think that it’s kind
of exploitive. I think it’s very dangerous and it leads to a lot
of heavy drugs and destroys a lot of lives. I don’t think that
it’s meaningful employment.” (Female, 42, massage parlour, retired)
Effects on Personal Identity
“The comment that came to my attention the most was “she’s a
hooker”, that’s not right. I am a hooker, it’s my job, it is not who I
am. I thought about it and it’s been weeks, and I couldn’t take it
any more. This isn’t right. I am an individual.” (Female, 31, agency)
“Mentally, emotionally it affects everything. You become that
person and it seeps into the rest of your life. If you are going to
be in the sex trade you’ve got to have the skills to separate the
business from home…” (Female, 24, agency)
“I have a boyfriend and I promised him that I would never tell our
friends and stuff like that. Basically that’s how we leave it, I
consider myself two people. So when I’m at work I’m one person
and when I’m at home…” (Female, 20, agency)
“It was a part of my life, but people that meet me today, why
should I tell them what I did ten years ago. It’s none of their
business. When you meet me today, it’s not written on my
forehead “ex-prostitute” and I still believe there is discrimination.
It shouldn’t be, but there is discrimination.” (Female, 45, massage, retired)
Effects on Emotional Well-Being
“In my experience I have met so many people I’m close to
who can keep it in a good place and achieve their goals,
and also those who get swallowed up by the whole thing
and end up addicted to drugs or in really bad shape
emotionally, spiritually and physically.” (Male, 41, clubs)
“It’s just a job that’s it. I don’t come home and break
down, there’s been times when I’m not to happy with what
I do but…and if I stay in that head space I get depressed
and stuff like that but it’s just a job. For me that’s it.”
(Female, 25, agency)
“To do this kind of work, you have to be…a strong
woman… because sometimes it can get very degrading if
you sit around and let that get to you. I think you lose
your whole kind of headspace. To keep your humour is
very important… sometimes it’s hard because you live a
double life, people … some people know and your family
doesn’t know and it’s hard…” (Female, 29, home)
Effects on Personal Relationships
“My children don’t know what I do, as far as they know I
clean houses.” (Female, 38, home)
“I was the shame of the family [but] my brothers thought I
had nothing to be ashamed of… today it’s just one of
those things that happened in the past, it’s not talked
about.” (Female, 39, bars, retired)
“With relationships that I have ever had, the majority of
relationships I’ve ever been in I have never shared that
with them [my involvement in the sex trade]. I was
engaged for six years and he didn’t now anything about
my past.” (Female, 33, street, retired)
“I talk about it openly with others, but it is also a risk when
I do talk about it. So right now I am trying to gauge who
can accept it and who can’t and I have suffered as a result
of sharing it openly.” (Female, 34, agency, retired)
Effects on Seeking Help
“I would like to be able to sit down and say, ‘this is what I am’
and not have to worry about them putting on the gloves just to
talk to you.” (Female, 41, home)
“I’ve had four doctors tell me… they don’t want to be my doctor
any more. They’ve never given me a reason. I walked into an
appointment once with my girlfriend and they refused to see
either one of us. It… has a lot to do with the stereotypical
attitude... people generalizing certain categories together... I
think doctors don’t understand, or if they do understand they’re
avoid[ing] the whole situation altogether.” (Female, 25, street)
“I had a doctor for 36 years... He never knew that I was in the
sex trade and I never told him. I was too ashamed.”
(Female, 44, agency, retired)
“[Doctors] are pretty closed minded, they don’t respect what I
do as hard work. It’s a lot of lectures on safety. Chances are
I’m safer than you.” (Female, 44, agency)
Improving the Work
“I think society’s attitude in general needs to change.
Also an expansion of support that exists already; and
implementation of new support so that the trade is
administered with a thought of harm reduction
instead of criminality. And once that changes, and
society’s attitude changes, then I think the workers in
the trade are going to feel more control… “I think
minimum work standards would have to include
personal safety, freedom from harassment both by
law enforcement and general public, accessibility to
health care, and just an overall acceptance from
people… It’s not going to go away, so let’s improve
the situation for everyone involved.” (Male, 41, bars)
“It should be recognized as a profession.” (Female, 52, home)
Improving the Work
“It would look pretty much the same as any other
unionized organization. Giving you your medical and your
dental and your sick leave. If you have to take a couple of
days off you could get paid for it. I guess if women had to
take maternity leave, give them that as well. Full medical
coverage, so if something goes wrong you’re able to get
help.” (Male, 23, street)
“Probably some sort of clinic that’s exclusive to sex trade
workers. Something that you would have complete
confidentiality with. Something that’s a little cleaner than
what we see around here and what we’re used to. A place
that has set up therapy groups [that] you can just clean
your head with. Someone that’s been through it and been
around.” (Male, 41, bars)
Occupation is a primary social determinant of health
On the positive side, sex workers tend to report that:
– They have a reasonable amount of autonomy and decision
making authority
– The work demand/reward ratio is adequate
However, the stigma of “prostitution” means that sex workers
face an additional burden of social exclusion which contributes
– Hidden and potentially dangerous working conditions
– Individual & interpersonal stress
– Barriers to social supports (health benefits & workplace
“It’s a heavy thing mentally to deal with and live with. You
have to be prepared to shut down, close off parts of your
self and not every body can do that.” (Female, 46, street)
Ongoing Research
Interactive Service Workers Occupational Health
and Safety and Access to Health Services Study:
Victoria, BC and Sacramento, CA.
Principle Investigator: Cecilia Benoit, University of Victoria
A longitudinal comparative model is used to
overcome the limitations of cross-sectional data This
new study examines occupational experiences,
health and health care access across sex work
populations and between sex work populations and
other lower-income groups.
Ongoing Research
Courtesy Stigma: A Hidden Health Concern?
Doctoral Dissertation: Rachel Phillips.
– How are providers affected by the stigma associated with
their clients and how does this, in turn, shape the service
context and the occupational health of the service providers?
– A complementary investigation of stigma and health care
access from the perspective of service providers who serve
hidden and stigmatized populations such as sex workers is
currently in development.
These studies will add important data to the social
determinants of health model, especially regarding the
relationship between stigma, social exclusion, health
status, and health care access.
Occupation is recognized as a primary social determinant of health. People
who have more control over their work circumstances and fewer stressrelated demands on the job tend to be healthier and live longer than
individuals in riskier and more stressful work situations. People who work in
the sex industry face an additional burden of social exclusion; they tend to
be isolated from other workers and within society at large because of the
tenacious stigma associated with selling sex services. Drawing on a mixed
method study (N=201) of current and former sex workers located in various
parts of the sex industry, this paper investigates the interplay between
stigma, social exclusion and self-reported health. The findings indicate that
sex workers tend to be disadvantaged by an earlier life marked by social
and economic disadvantage, and that as adults, many continue to lack
access to crucial resources needed to improve their health outcomes. While
noting the definite advantages of sex work (often self-determined, largely
portable and offers cash-in-hand earnings), many research participants said
that their activities often involved a high degree of workplace stress, few
workplace supports, and rarely contributed to personal gratification. In
addition, many respondents indicated that the stigma of sex work
undermined both their personal relationships as well as their access to
institutional supports.