Cecilia Benoit

Community-Academic Research on Hard-to-Reach Populations: Benefits and Challenges

In this article, the authors examine some of the benefits and challenges associated with conducting research on hard-to-reach/hidden populations: in this instance, sex workers. The population studied was female and male sex workers working in different sectors of the sex industry in a medium-size Canadian metropolitan area. The authors describe the need for close community-academic cooperation, given the hidden and highly stigmatized nature of the target population that was investigated and the local context in which the research project was embedded. The authors discuss the main benefits and challenges of the research collaboration for the various parties involved, including the community partner organization, indigenous research assistants, and academic research team. They conclude with a discussion of strategies to help overcome the main challenges faced during the research endeavor.

In search of a Healing Place: Aboriginal women in Vancouver's Downtown Eastside

Research on general health service delivery in urban areas of Canada shows that Aboriginal people face formidable barriers in accessing culturally appropriate and timely care. Over the past decade, Urban Aboriginal Health Centres (UAHCs) have emerged to address the unmet health concerns of Aboriginal people living in metropolitan areas of the country. The purpose of this research was to address the gap in social science literature on how the health care concerns of Aboriginal women are being met by UAHCs. The research aimed to give voice to Aboriginal women by asking them whether the appropriate professional services and educational programs they need to address their health care needs were being provided in the inner city. A case-study approach was used whereby three separate focus groups were conducted with Aboriginal women who were clients of the Vancouver Native Health Society (VNHS), its sister organization, Sheway, or residents of Vancouvers Downtown Eastside (DTES). In addition, twenty-five semi-structured interviews were conducted with VNHS staff, health providers, government representatives, and community leaders in health care (total n=61). The findings indicate that despite efforts from various quarters to articulate the health and social concerns of the countrys marginalized populations, such has not been the case for Aboriginal women living in one of Canadas most prosperous cities. Many Aboriginal women expressed a strong desire for a Healing Place, based on a model of care where their health concerns are addressed in an integrated manner, where they are respected and given the opportunity to shape and influence decision-making about services that impact their own healing.

In for the Long Haul: Knowledge Translation Between Academic and Nonprofit Organizations

Although scientists are continually refining existing knowledge and producing new evidence to improve health care and health care delivery, far too little scientific output finds its way into the tool kits of practitioners. Likewise, the questions that clinicians would like to be answered all too rarely get taken up by researchers. In this article we focus on knowledge translation challenges accompanying a longitudinal research program with nonprofit organizations providing direct and indirect health and social services to disadvantaged groups in one region of Canada. Three essential factors influencing authentic and reciprocal knowledge transfer and utilization between nonprofit service providers and researchers are discussed: strong institutional partnerships, the use of skilled knowledge brokers, and the meaningful involvement of frontline personnel.

Sporting Girls, Streetwalkers, and Inmates of Houses of Ill Repute: Media Narratives and the Historical Mutability of Prostitution Stigmas

This article examines the mutability of symbolic sanctions— or stigmas—applied to sex industry work by examining newspaper narratives in one medium-sized Canadian city over two time periods: 1870–1910 and 1980–2004. The articles purpose is first to get a sense of what the authors call the ecology of stigmas—their relation to the temporal and spatial contexts in which they are produced—and second to give needed historical context to them and the representational tropes that currently dominate media, policy, and academic discussions about prostitution. This article finds significant continuities and discontinuities between media representations during the two study periods. In particular, prostitution stigmas are constituted out of cross-articulations of narratives around containment, culpability, and contagion across the twentieth century, but the ideational contents and empirical referents of these narratives reflect the intersection of sex industry contexts with historically specific concerns around gender, sexuality, race, and social status. Stigmas of the sex industry, rather than being constant, reveal themselves to be both deeply ecological and accommodating to a range of concerns about female sexuality and normative behavior that are sensitive to historical time.

Social factors linked to postpartum depression: A mixed-methods longitudinal study

Background: There is a large body of research on the mental well-being of childbearing women focusing on the prevalence rates of antenatal and postpartum depression, and associated risk factors. However, there is a paucity of research on postpartum depression in its social context and in relation to the lived experience of the mother. Aims: To investigate the association between social factors, the organization of maternity care services, and the prevalence of depression among a purposive sample of new mothers at 3 – 4 weeks and 4 – 6 months post-partum. Method: Longitudinal, mixed-methods research design. Results: Our quantitative analyses demonstrate that income and postpartum depression were linked and there was also an association between satisfaction with the birth experience and depression at 3 – 4 weeks postpartum. Thematic analysis of the qualitative interview data revealed two main sources of dissatisfaction: disruption of birth plans and inadequate support from maternity providers. Discussion & limitations: We discuss some of the benefits and limitations of our mixed-methods longitudinal study and directions for further research. Declaration of interests: None.

Social Service Professional or Market Expert? Maternity Care Relations under Neoliberal Healthcare Reform

Recent developments in the organization and practice of healthcare, driven by the introduction of (quasi-) markets and privatization, are altering traditional forms of professionalism found in high- and middle-income countries. Yet there remains debate about whether these neoliberal trends are universal or country specific, and whether they have any effect (positive or negative) on health service delivery. This article develops a comparative analysis that focuses on changes in maternity service systems in four countries in Northern Europe and the Americas with primarily publicly financed healthcare systems: the UK, Finland, Chile and Canada. The article begins with a discussion of the continuum of professional forms found in the post-Second World War period and their relationship to different kinds of welfare states. It then focuses on the impact of recent neoliberal reforms on the ideological projects of the medical and allied health professions in the four case examples. The results show that variation across time and place is mainly the result of structural/economic factors and that various forms of professional discourses are the result of the public/private ways that healthcare systems are organized. The article concludes with suggestions for further comparative sociological research.

Sex Work: A Comparative Study

Explanations of adult involvement in sex work typically adopt one of two approaches. One perspective highlights a variety of negative experiences in childhood and adolescence, including physical and sexual abuse, family instability, poverty, associations with “pimps” and other exploiters, homelessness, and drug use. An alternative account recognizes that some of these factors may be involved, but underscores the contribution of more immediate circumstances, such as current economic needs, human capital, and employment opportunities. Prior research offers a limited assessment of these contrasting claims: most studies have focused exclusively on people working in the sex industry and they have not assessed the independent effects of life course variables central to these two perspectives. We add to this literature with an analysis that drew on insights from life course and life-span development theories and considered the contributions of factors from childhood, adolescence, and adulthood. Our comparative approach examined predictors of employment in sex work relative to two other low-income service or care work occupations: food and beverage serving and barbering and hairstyling. Using data from a study of almost 600 workers from two cities, one in Canada and the other in the United States, we found that both immediate circumstances and negative experiences from early life are related to current sex work involvement: childhood poverty, abuse, and family instability were independently associated with adult sex work, as were limited education and employment experience, adult drug use, and marital status.

Stigma, sex work, and substance use: a comparative analysis

Stigma is a widely used concept in social science research and an extensive literature claims that stigmatisation contributes to numerous negative health outcomes. However, few studies compare groups that vary in the extent to which they are stigmatised and even fewer studies examine stigmas independent and mediating effects. This article addresses these gaps in a comparative study of perceived stigma and drug use among three low-income feminised service occupations: sex work, food and alcoholic beverage serving, and barbering and hairstyling. An analysis of longitudinal data shows positive associations between sex work, perceived stigma, and socially less acceptable drug use (for example, heroin and cocaine), and that stigma mediates part of the link between sex work and the use of these drugs. Our overall findings suggest that perceived stigma is pronounced among those who work in the sex industry and negatively affects health independently of sex work involvement.

Social Determinants of Health Care Access Among Sex Industry Workers in Canada

Drawing on closed and open-ended interview data (n=79), this paper explores the health care experiences of a purposive sample of sex industry workers in a medium-sized metropolitan area of British Columbia, Canada. The respondents reported high average health care utilization and many reported satisfactory access to health care, including a positive relationship with a regular health provider. However, several respondents reported feeling intimidated and shamed in health care settings (felt stigma) and many choose to withhold information relevant to their health care due to fear of discrimination (enacted stigma) by health professionals.

Benefits and constraints of intimate partnerships for HIV positive sex workers in Kibera, Kenya.

IntroductionResearch on the intimate partnerships of female sex workers (FSWs) tends to focus on the risks associated with these relationships. This paper takes as its starting point that the situation of FSWs is better understood by including knowledge of the benefits of their intimate partnerships. Specifically, we employ the conceptual framework provided by emergent research examining intimacy as a complex fusion of affective and instrumental dimensions among sex workers. This perspective allows us to frame information about FSWs’ intimate partnerships within a behaviour-structural approach that is helpful for identifying how intimate partnerships can be a source of both benefit as well as increased risk to FSWs.MethodsOur results are based on a mixed-methods study carried out in the summer of 2011 in Kibera, Kenya. We conducted face-to-face interviews (n=30) with a non-probability sample of FSWs stratified by age who self-identified as Human Immune Virus positive (HIV+). We asked about participants’ involvement in current and past intimate partnerships, and whether these relationships had a positive or negative impact on their health and well‒being.ResultsParticipants currently in intimate partnerships had fewer clients and thus lower incomes than those without intimate partnerships. Participants presently with partners were also more likely to receive some financial support from partners, to report lower intimate partner violence, and to narrate higher partner emotional support and greater assistance with medications. These participants were also more likely to have disclosed their sex work and HIV+ statuses to their partners. Intimate partnerships, on the other hand, showed increased risk of economic vulnerability and emotional dependence for FSWs. This became especially problematic for those participants in fragile relationships. Despite these variations, none of the differences between the two groups were statistically significant.ConclusionsIntimacy and transactional relations are bound up with one another and intersect with the structural realities and vulnerabilities; this is the case for sex workers in well-resourced and resourced-constrained countries alike. Rather than treating intimate partnerships as distinct from transactional relationships, FSWs’ relationships should be viewed on a continuum of risk and support.