Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study.

BACKGROUND: Young adult sex workers may benefit from sexual and reproductive health care services; however, little research has examined their access experiences. This study aimed to assess barriers to and facilitators of access to sexual and reproductive health care among young adult sex workers, and identify practices suggested by participants to improve services. METHODS: This was a community-based mixed-methods study of adults aged 18-29 years who were currently or had previously been engaged in sex work, conducted in Toronto in 2017-2018. The study was guided by a Youth Advisory Committee of 4 youth with lived experience of sex work. Participants completed an online survey, or participated in a focus group or a one-on-one interview; all 3 modalities included parallel questions about barriers to and facilitators of access to sexual and reproductive health care. We summarized quantitative data using descriptive statistics and identified qualitative themes using thematic analysis, followed by triangulation of the 2 strands. RESULTS: There were 54 survey respondents (response rate 48%) and 17 participants in the qualitative phase (14 in focus groups and 3 in interviews), for a total sample size of 71. Survey respondents reported suboptimal access to sexual and reproductive health care, with 8 (15%) reporting no regular source of care, and only 6 (11%) reporting that they disclose their sex work experience to providers. Actual or expected stigma regarding sex work on the part of providers was the dominant barrier to care, whereas nonjudgmental providers, particularly those who themselves have sex work experience, was a key facilitator. Participants suggested 7 practices to improve access to sexual and reproductive health care. INTERPRETATION: Young adult sex workers face many barriers to accessing sexual and reproductive health care. Including people with sex work experience in the development of solutions will maximize the capacity to address the needs of this underserved population.

Men's sexual orientation and health in Canada.

OBJECTIVES: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity. METHODS: Utilizing the Canadian Community Health Survey data (Cycle 2.1, 2003; n = 49,901), we conducted multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. For all multivariate models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada. RESULTS: When compared to heterosexual men, gay and bisexual men did not report more respiratory conditions; had lower rates of obesity and overweight BMI; and reported more mood/anxiety disorders, and a history of lifetime suicidality. Gay and bisexual men did not report higher rates of daily smoking or risky drinking, however, gay men reported an almost six-fold increase in STD diagnoses when compared to heterosexual men. CONCLUSION: This study represents the largest-known population-based data analysis on health risks and behaviours among men of varying sexual orientations. These findings raise important concerns regarding the impact of sexual orientation on mental and sexual health. Limitations of this data set, including those associated with measurement of sexual orientation, are discussed. Further research is required to understand the mechanisms that influence these health resiliencies and disparities.

Perceived determinants of mental health for bisexual people: a qualitative examination.

OBJECTIVES: We examined the determinants of mental health, as perceived by bisexual people, in order to begin understanding the disparities in the rates of mental health problems reported by bisexual people versus those reported by heterosexual people, and, in many studies, gay men and lesbians. METHODS: Our community-based participatory action research project comprised focus groups and semistructured interviews with 55 bisexual people across the province of Ontario, Canada. RESULTS: Perceived determinants of emotional well-being identified by participants could be classified as macrolevel (social structure), mesolevel (interpersonal), or microlevel (individual). In the context of this framework, monosexism and biphobia were perceived to exert a broad-reaching impact on participants' mental health. CONCLUSIONS: Like other marginalized populations, bisexual people perceive experiences of discrimination as important determinants of mental health problems. Additional research is required to examine the relationships between these perceived determinants of emotional well-being and specific mental health outcomes and to guide interventions, advocacy, and support for bisexual people.

Women's sexual orientation and health: results from a Canadian population-based survey.

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.