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.

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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.

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Correspondence to Andrea K. Knittel.

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Knittel, A.K., Graham, L.F., Peterson, J. et al. Access to Health Care Services among Young People Exchanging Sex in Detroit. J Urban Health 96, 452–468 (2019).

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  • Health care access
  • Sex work
  • Transportation
  • Housing instability
  • Health disparities