Kat Kolar

Condom use as situated in a risk context: women's experiences in the massage parlour industry in Vancouver, Canada

Investigation into condom use in sex work has aroused interest in health promotion and illness prevention. Yet there remains a dearth of inquiry into condom use practices in the indoor sex industry, particularly in North America. We performed a thematic analysis of one aspect of the indoor sex work by drawing on data from a larger mixed-methods study that investigated womens health issues in the massage parlour industry in Vancouver, Canada. Using a risk context framework, condom use was approached as a socially situated practice constituted by supportive and constraining dynamics. Three analytic categories were identified: (1) the process of condom negotiation, (2) the availability of condoms and accessibility to information on STI and (3) financial vulnerability. Within these categories, several supportive dynamics (industry experience and personal ingenuity) and constraining dynamics (lack of agency support, client preferences, limited language proficiency and the legal system) were explored as interfacing influences on condom use. Initiatives to encourage condom use must recognise the role of context in order to more effectively support the health-promoting efforts of women in sex work.

Community-based HIV and STI prevention in women working in indoor sex markets.

Community research into women’s experiences in the indoor commercial sex industry illustrated an urgent need for sexually transmitted infection (STI) and HIV education, prevention, testing, and treatment and culturally appropriate services to support the sexual and reproductive health of commercial sex workers (CSWs). This work also revealed that a high number of immigrant—primarily Asian—women are involved in the indoor sex industry. In response, the authors developed a community–academic research partnership to design and implement a blended outreach research program to provide STI and HIV prevention interventions for indoor CSWs and their clients. This Community Health Worker Model HIV Prevention and Health Promotion Program incorporated health education, primary care referrals, STI testing using self-swab techniques, and a point-of-care HIV screening test. Here the authors report on program implementation, design, and the experiences of participants and team members and provide research and vaccination recommendations for future work in this area. This work work affirms that community-based service providers can be a key entry point for indoor CSWs to access health care and sexual health promotion and education and may be a solution to missed opportunities to provide culturally and contextually appropriate education and services to this population.

Coping strategies of street-involved youth: exploring contexts of resilience

Literature on how street-involved youth (SIY) cope with risky environments remains very limited. This exploratory study investigates SIYs coping strategies, employing the ‘contexts of resilience’ framework (where resilience is understood as a process that changes over time and by environment) to situate an inductive thematic analysis of interviews with 10 current and former SIY. Three themes are explored: social distancing; experiences of violence; and self-harm and suicidality. The first two themes illustrate the double-edged nature of some coping strategies. While social distancing could contribute to isolation from social supports and violent self-defense to retaliatory harm, without alternative resources to prevent victimization these strategies must be acknowledged as reasoned responses to the risks associated with a violent milieu. Strategies assumed to be maladaptive among more normative youth may be among the limited resources available for SIY to utilize in attempts to make positive changes in their lives. The final theme explores self-harm and suicidality as indicative of social and structural needs and shows how in the SIY context such behaviors may not signify an outcome of non-resilience. The adaptation of assessments of coping strategies to be congruent with evaluative contexts should be applied to resilience research addressing other marginalized populations.

Timeline Mapping in Qualitative Interviews: A Study of Resilience With Marginalized Groups

Growing interest in visual timeline methods signals a need for critical engagement. Drawing on critical emancipatory epistemologies in our study exploring resilience among marginalized groups, we investigate how the creation of visual timelines informs verbal semistructured interviewing. We consider both how experiences of drawing timelines and how the role of the timeline in interviews varied for South Asian immigrant women who experienced domestic violence, and street-involved youth who experienced prior or recent violent victimization. Here we focus on three overarching themes developed through analysis of timelines: (a) rapport building, (b) participants as navigators, and (c) therapeutic moments and positive closure. In the discussion, we engage with the potential of visual timelines to supplement and situate semistructured interviewing, and illustrate how the framing of research is central to whether that research maintains a critical emancipatory orientation.

A nuanced view of normalisation: Attitudes of cannabis non-users in a study of undergraduate students at three Canadian universities

Abstract Aims: To critically investigate the extent of normalisation of the use of cannabis by undergraduate students. To examine the extent of peer accommodation, this paper focuses on attitudes of students who abstain. It sheds light on social meanings of the practice by exploring non-users’ reasons for abstaining in addition to their attitudes, perceptions and experiences of use among their peers. Methods: Respondents were recruited to participate in interviews through an online survey of undergraduate students in social science classes at three Canadian universities. Findings: Peer accommodation of the use of cannabis requires that users exercise due caution and discretion and be respectful of the choices of non-users not to use. Non-users’ attitudes, however, still reflect longstanding cultural assumptions about drug use as a deviant behaviour. Attitudes towards the use of cannabis reflect norms and expectations about gender among other culturally constructed social statuses and roles. Conclusions: Future research should continue to investigate nuances of the differentiated normalisation process. A better understanding of the cultural transformation of cannabis, and other drugs in common use by youth, requires more exploration of the emerging social context and attitudes of users and non-users of the drug.

Recruitment of Sex Buyers: A Comparison of the Efficacy of Conventional and Computer Network-Based Approaches

In this article we draw upon data from a large-scale mixed methods investigation of clients of commercial sex workers in Canada to illustrate the potential value that understanding and integrating computer and network technology has for enhancing access to, and participation from, marginalized and stigmatized populations. In particular, we present qualitative data from analysis of our research field notes as well as an analysis of quantitative data from response monitoring and feedback features built into the actual data collection process to help support our argument that, for some populations, network technology–based recruitment strategies should be recognized as the preferred recruitment option. In addition, we discuss the potential utility and application of viral solicitation, a newly emerging computer network-based nonprobability technique, for contacting and securing the participation of stigmatized and marginalized research participants. Our recruitment of sex buyers through web-based listserves was the most successful participant solicitation strategy, generating 63.18% (n = 544) of our survey respondents. Conventional recruitment (advertising in print-based media and in adult-oriented businesses) generated few participants (2.90%, n = 25). Viral solicitation acted as an important low-cost supplemental means of recruitment, generating a further 164 survey participants (19.05% of survey participants).

Sexual safety practices of massage parlor-based sex workers and their clients

The Outreach and Research in Community Health Initiatives and Development (ORCHID) project examines social and structural factors that contribute to HIV/AIDS risk among women working in Vancouvers indoor sex industry and their clients. From 2006 to 2009, two mixed method studies were undertaken in ORCHID: one exploring experiences of women working in the indoor sex industry, mainly in massage parlors, and the other exploring experiences of men as sex “buyers.” Both studies emphasize sexual health and safety, risk and protective behaviors, and related contextual factors. No analyses examining the sexual health and safety practices of massage parlor-based sex workers and clients exist in the Canadian context. To address this gap, we analyze two survey datasets – with 118 sex workers and 116 clients. Upon comparing demographics of sex workers and clients, we discuss their condom use and sexually transmitted infections (STI) and HIV testing practices. Sex workers and clients reported high rates of condom use for vaginal/anal intercourse. While both groups reported lower rates of condom use for oral sex during sex transactions, clients did so to a greater extent (p < 0.001). Condom use with noncommercial sex partners was reported to be less consistent by both groups. STI testing was higher among sex workers than clients (p < 0.001). Initiatives targeting clients of massage parlor-based sex workers for STI education and testing are needed. Future research should investigate how different types of relationships between sex workers and clients impact their sexual safety practices.

“It’s Really No Big Deal”: The Role of Social Supply Networks in Normalizing Use of Cannabis by Students at Canadian Universities

ABSTRACT Cannabis (marijuana) has undergone a normalizing process as indicated by high use rates, social tolerance, and broader cultural acceptance of its use in many countries. Users also maintain access through extended friendship networks that facilitate the cultural diffusion of the practice. The social nature of supply is herein theorized in terms of Goffman’s understanding of activities that function to preserve a sense of normalcy as a collective achievement enabling predictable constructions of reality. Based on in-depth interviews with undergraduate students, we explore how social networks of supply—characterized by casual access, reciprocity, and sharing—contribute to shared meanings about using marijuana as an unremarkable or “normal” thing to do.

Engineering behaviour change in an epidemic: the epistemology of NIH-funded HIV prevention science

Social scientific and public health literature on National Institutes of Health-funded HIV behavioural prevention science often assumes that this body of work has a strong biomedical epistemological orientation. We explore this assumption by conducting a systematic content analysis of all NIH-funded HIV behavioural prevention grants for men who have sex with men between 1989 and 2012. We find that while intervention research strongly favours a biomedical orientation, research into the antecedents of HIV risk practices favours a sociological, interpretive and structural orientation. Thus, with respect to NIH-funded HIV prevention science, there exists a major disjunct in the guiding epistemological orientations of how scientists understand HIV risk, on the one hand, and how they engineer behaviour change in behavioural interventions, on the other. Building on the extant literature, we suggest that the cause of this disjunct is probably attributable not to an NIH-wide positivist orientation, but to the specific standards of evidence used to adjudicate HIV intervention grant awards, including randomised controlled trials and other quantitative measures of intervention efficacy.

Study Drugs “Don’t Make You Smarter” Acceptability Evaluations of Nonmedical Prescription Stimulant Use Among Undergraduate Students

Despite the growing literature on nonmedical prescription drug use among students in North America, existing research does not investigate the potential convergences of nonusing student attitudes on drug acceptability with those of their stimulant-using peers. Analysis of 36 interviews with nonmedical stimulant prescription drug-using and nonusing undergraduate students in Canada provides insight into evaluations of drug acceptability within a competitive, top-tier research university context. Interviews are analyzed thematically with attention to practices students engage in to assess nonmedical stimulant use, and discourses students use to position the acceptability of such use. Interview results illustrate commonalities in how using and non-using students weigh the risks and advantages of nonmedical prescription stimulant use in relation to the pursuit of scholastic success. These findings are used to critically engage with the construct of drug acceptability, as conceptualized in the drug normalization framework of Howard Parker and colleagues. To conclude, recommendations are made for future research, and implications for university policies are considered.