The Corner, formerly known as ‘Boys R Us’, is a Vancouver drop-in support and referral program that provides a safe space for men and gender-diverse (including transgender, non-binary, and Two-Spirit) people who work or have worked in the sex trade.
Participants gather weekly to eat, socialize, and access community-based resources and services, including workshops, discussion groups, harm reduction, HIV testing and other sexual health services. The Corner is provided through a partnership between AIDS Vancouver, Vancouver Coastal Health and the Health Initiative for Men, and is dedicated to responding to the needs and challenges of its participants.
Given that sex work remains stigmatized and criminalized in Canada, sex workers face particular barriers to accessing the health services they need. A Vancouver-based study of men involved in sex work identified drug or alcohol use as a common health-related concern, but noted that when accessing care about these issues, men often felt judged and their concerns minimized.
As part of our community health practicum, we spent time at The Corner to focus on understanding the primary health and education needs of the people who access this service.
We first conducted a focus group with The Corner’s participants to learn more about their needs and experiences with the health care system. We then conducted a workshop on resources that may help participants when they encounter judgment or rejection within the health care system. These resources included:
- HealthLink BC’s 811 information and advice phone line.
- Resources for social worker-staffed health promotion teams.
- Information about the patient care quality office of Vancouver Coastal Health.
Many focus group participants shared stories about how they felt stigmatized and experienced a lack of empathy from health care staff. Barriers to accessing health
care for this population were common, and concerns included “We are a burden to the health care system” and “If they know you’re using drugs, they treat you differently”.
While overall feedback from participants was positive, it was clear that work is needed to combat stigma in health care environments. Participants frequently met with judgement and discrimination when they sought help for their health concerns.
Implications for practice
The stigma and discrimination that occurs in health care settings can deter people from accessing necessary health services. Sex workers and others that are impacted by HIV regularly face judgment in health care and other service settings, and may not feel safe to disclose involvement in sex work, the gender(s) of sex partners, or substance use.
It is essential that all people find safety in our health care system so they can feel confident that they will be treated with respect and dignity. It is up to us, as health care providers, to explore our attitudes and beliefs and how they impact the care we provide. Our health care system needs to be safer, more welcoming and most importantly, respectful.
We suggest three steps that health providers and community health workers can take to mitigate stigma and discrimination in health care:
- Act to reduce stigma by increasing awareness of what it is, how it manifests, and its impact on people and health care interactions.
- Build an organizational culture that is committed to combating stigma, in part by promoting staff health and well-being. Research shows that this is an effective way to target stigma and address the structural aspects ingrained in the health care system.
- Simple resources, such as the one we developed for The Corner (below), can help empower people to find alternatives when they are not getting the care they need. All individuals have a right to receive the health care when they need it and without judgement.
We thank our mentors Travis Salway and Gwen Lister, and our clinical instructor Elaine Jones, for their support and guidance. We also thank the staff, volunteers, and participants of The Corner for welcoming us into their space and sharing their experiences with us.
- Bowen RR. Squaring Up: Experiences of Transition from Off-Street Sex Work to Square Work and Duality-Concurrent Involvement in Both-in Vancouver, BC. Canadian Review of Sociology, 2015, 52(4), 429–449.
- Benoit C, Belle-Isle L, Smith M, Phillips R, Shumka L, Atchison C, Flagg J. Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program. International Journal for Equity in Health, 2017, 16, 1–16.
- Avert. (2018). HIV STIGMA AND DISCRIMINATION. Retrieved from https://www.avert.org/professionals/hiv-social-issues/stigma-discrimination
For more information
Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare. Healthcare Management Forum, 2017, 30(2), 111-116. doi:10.1177/0840470416679413
Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: What works? Journal of the International AIDS Society, 2009, 12(1), 15. doi:10.1186/1758-2652-12-15