Purpose: Despite recent evidence that street-involved young men are as likely as young women to trade sex for money, drugs, food, shelter, or other goods, most studies of health issues and interventions have focused on young women involved in sex work; almost no research has explored these young men’s specific health needs and access to care. This study compared health services utilization among urban young men who have traded sex and those who have not.
Methods: A total of 133 young men between the ages of 19 and 25 (mean age = 21.8 years) were recruited by teams of researchers at community locations where street-involved and at-risk young men congregate throughout Vancouver, Canada. Participants completed a computer-assisted survey on iPod Touches. The survey included measures of health needs, experiences of health and social services, unmet needs (i.e., not getting care when it was needed), and reasons for foregone care. Cross-tabulations with χ2 tested differences between the two groups.
Results: Overall, 15.8% of the sample reported trading sex for money or other goods. Over half of these young men were under age 19 when they first traded sex, which in Canada is considered sexual exploitation. Those who traded sex reported significantly greater health issues, including higher rates of ADHD, depression, and substance use problems (all ps < .01); 66.7% of young men who traded sex had shared needles, compared to only 15.0% of others (χ2 = 26.11, p < .001). There was no difference in the rates of self-reported STIs. In the past year, both groups reported relatively similar rates of accessing emergency rooms (38.1% vs. 43.6%), family doctors (52.6% vs. 40.2%), and alcohol and drug counseling (22.2 vs. 18.1%). Young men who traded sex were more likely to have accessed street nurses (50.0% vs. 13.1%), mental health services (41.2% vs. 18.4%) and sexual health services (35.5% vs. 10.9%) than their peers, but they were less likely to utilize walk-in clinics (47.6% vs. 70.3%). Despite similar utilization rates, males who had traded sex were significantly more likely than the other young men to report foregoing needed care from emergency departments (36.4% unmet need among men who trade sex vs. 8.9% of others), family doctors (62.5% vs. 26.8%), mental health services (33.3% vs. 9.0%), sexual health services (33.3 vs. 8.1%) as well as alcohol and drug services (70.0 vs. 7.3%). The reasons young men who traded sex gave for not accessing these services despite having a need included: thinking the problem would go away, feeling judged, unhelpful staff and/or services, cost, and inconvenient location.
Conclusions: Greater health disparities are reported by young men who trade sex for money or goods in Vancouver, compared to other urban at-risk young men. Although young men who traded sex had similar or greater rates of health service utilization, they also reported more unmet health needs and foregone care, in part because of service responses. Health care providers may need to be sensitive to the stigma attached to young men involved in survival sex or sex work, and work to reduce potential barriers that prevent these young men from accessing critical health care services.