Access to Health Care Services among Young People Exchanging Sex in Detroit
Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.
KeywordsHealth care access Sex work Transportation Housing instability Health disparities
This work was supported by the Ford Foundation Youth, Sexuality, Health and Rights Initiative. The first author was supported the University of Michigan Medical Scientist Training Program (NIGMS T32GM07863) during portions of this work. Special acknowledgement is due to Allison Brenner for her thoughtful comments on many drafts of this manuscript.
- 3.Thukral J, Ditmore M. Revolving door: an analysis of street-based prostitution in New York City: Sex Workers Project at the Urban Justice Center;2003.Google Scholar
- 5.Phillips R, Benoit C. Social determinants of health care access among sex industry workers in Canada. In: Kronenfeld JJ, editor. Health care services, racial and ethnic minorities and underserved populations: patient and provider perspectives. Bingley: Emerald Insight; 2005. p. 79–104.Google Scholar
- 20.Kendall C, Kerr LRFS, Gondim RC, Werneck GL, Macena RHM, Pontes MK, et al. An empirical comparison of respondent-driven sampling, time location sampling, and snowball sampling for behavioral surveillance in men who have sex with men, Fortaleza, Brazil. AIDS Behav. 2008;12(S1):97–104.CrossRefGoogle Scholar
- 24.Fuzzy-Set/Qualitative Comparative Analysis 2.0 [computer program]. Tucson, Arizona: Department of sociology, University of Arizona; 2006.Google Scholar
- 25.Ragin CC. User's guide to fuzzy-set qualitative comparative analysis. 2008. http://www.u.arizona.edu/~cragin/fsQCA/download/fsQCAManual.pdf. Accessed February 9, 2016.
- 28.McCray T. Delivering healthy babies: transportation and healthcare access. Plan Pract Res. 2000;15(1/2):17–29.Google Scholar
- 29.Thukral J, Ditmore M, Murphy A. Behind closed doors: an analysis of indoor sex work in New York City: Sex Workers Project at the Urban Justice Center;2005.Google Scholar