Sex Workers Addressing Treatment

Substance misuse among women sex workers is a complex issue, given the heterogeneity of both substance misusers and sex workers and the stigma they both bear. Media depictions of drug-addicted prostitutes fuel the notion that sex work and substance misuse are inextricably and problematically linked in the urban environment. Hallgrimsdottir et. al., (2008, p. 129) surveyed the Victoria Times Colonist from 1980 to 2004 and see sex workers being positioned as “vectors of contagion (medical, criminal, and moral).” McNaughton and Sanders (2007) note the predominance of discourses supporting the elimination of street sex work to ensure ‘clean streets’ and ‘safe communities.’ Kantola and Squires (2004) describe the role of public nuisance discourse in the UK in constructing substance-misusing sex workers as health and social problems that must be removed or moved. This discursive environment constrains sex workers’ access to health services and safe working environments (Bellis et. al., 2007; Jeal & Salisbury, 2004). Accessing and successfully completing substance misuse treatment presents a particular challenge for sex workers, given the stigmas attached to substance misuse and sex work, the interrelationship between substance use and sex work, and the sometimes addictive quality of sex work itself (Casey & Paterson, 2008). This paper explores these barriers and challenges by reviewing the literature and reporting on recent research conducted with Canadian sex workers. It describes the development and evaluation of an innovative sex-worker-specific treatment model that shows promise for reducing the harms incurred through substance misuse and sex work. The research was conducted by the Canadian National Coalition of Experiential Women (CNCEW), which also developed the treatment program and contracted with an independent researcher (Rutman) for the program evaluation. All activities were funded by Status of Women Canada. CNCEW is a consortium of women activists committed to the advancement of equality and human rights for sex workers. All members have direct experience in sex work and/or as sexually exploited youth