Exploring the social structural dynamics of health barriers and determinants of women in Vancouver's survival sex trade: an ethnographic study

A decade ago, HIV infection among downtown eastside residents exceeded those in any other part of the “developed” world. Current neighbourhood HIV prevalence estimates range between 19 and 22 per cent, and is reported higher amongst individuals who inject drugs. Risk of HIV infection is particularly profound for women who are young, coping with violence and multiple addictions, and whose survival necessitates work in the commercial sex industry. Women and girls are politically, socially and biologically more vulnerable to HIV infection. Many women in the community, including the majority of those who are part of the sex work economy, do access various health and social services, such as clinics, point-of-care and emergency services, as well as needle exchange programs. The use of condoms is also prevalent. Despite this, the rates of HIV infection remain high, particularly among sex workers who are also less likely to be treated for HIV/AIDS. Regardless of income generating strategies, HIV infected women in the community face multiple barriers to continuity of care. Suze Berkhout was previously funded by MSFHR for her early PhD work in HIV risk behaviours and health service needs among women in Vancouver’s inner city. Employing qualitative research methods and philosophical analysis, her research critically examines the impact of common stereotypes, life histories, and institutional norms and values on women’s health care experiences, in order to unravel the paradox surrounding the health and well-being of vulnerable women. Rather than suggest that women who appear to systematically “”choose”” poor health are irrational or irresponsible, Berkhout’s study seeks to understand what health trade-offs women may make in the context of their lives. For example, day-to-day concerns such as housing, food or caring for others may take precedence over health concerns. Likewise, women’s previous experiences in the health system may themselves perpetuate mistrust toward health providers, leading to delays and discontinuation of medical care. Berkhout’s findings will enable health care providers to better reflect on and respond to the experiences of patients within the health care system. Ultimately, her work could lead to more appropriate and responsive care for socially and economically disadvantaged women.