The Power of Stigma and its Impact on Drug Use among Sex Workers

A headshot of Cecilia Benoit

Why are people involved in sex work more likely to use “hard” drugs such as cocaine and heroin than someone working as a server in a restaurant? Is it because they are “immoral” or “bad” people, or is it because their occupation is more stigmatized? If our society directed less stigma or judgment toward this group, would there be less use of hard drugs and smaller differences in substance use between sex workers and servers? Our research seems to indicate yes.

Stigma, which involves the use of defamatory labels and discriminatory actions by individuals and social institutions, is directly linked with poor physical and mental health outcomes for people who perceive that they have been stigmatized. Drug use can also be a way to cope with stigma.

Some people working in the sex industry use drugs to cope with the negative self-image and social isolation engendered by occupational stigmas, or to self-medicate in the presence of physical, mental, or emotional health challenges. The use of these “hard” drugs is also socially less acceptable, making it an additional source of stigma for the individuals using them.

We investigated the link between perceived stigma and substance use with interview and survey data from a study of three service work occupations: sex work, food and beverage serving, and hair styling and barbering. We found1 that workers from all three of these occupations reported negative societal perceptions of their jobs and experienced stigma in their interactions with the public and with health care professionals. However, perceived stigma was significantly more common and more intense for people working in the sex industry, and a larger number of these workers told us that they had come to accept perceptions that their work was disreputable. Most importantly, a high level of perceived stigma was associated with a higher level of use of “hard drugs”. Interestingly, we found that stigma did not influence the use of “softer” substances such as alcohol or marijuana.

Perceived stigma is an important factor that helps us understand differences in substance use. It is no coincidence that the occupation in our study most associated with hard drug use was also the occupation most frequently associated with immorality and criminality.

So, how do we work to reduce the stigma associated with sex work? One way is by including people with lived experience when shaping policy that affects the sex industry. Their voices and insights will be essential for designing harm reduction strategies that challenge prostitution laws and other policies that keep people working in the sex industry disciplined, controlled and excluded, and that contribute to a powerful stigma that encourages the use of addictive substances.

1Benoit, C., McCarthy, B. & Jansson, M. (In press). Stigma, service work, and substance use: A two-city, two-country comparative analysis. Sociology of Health & Illness.

Cecilia BeoitMikael Jannsonbill mccarthy
Authors: Dr.Cecilia Benoit, Scientist, Centre for Addictions Research of BC;  Dr. Mikael Jansson, Scientist, Centre for Addictions Research of BC; Bill McCarthy, Chair, Department of Sociology, UC Davis.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Sex and Drugs Blog Series: An Introduction

A headshot of Eric Roth

It is my pleasure to introduce and provide an overview for the next Centre for Addictions Research of BC theme in the Matters of Substance blog series. This upcoming theme is succinctly and provocatively entitled, Sex and Drugs. Our contributors will look at the intersection between substance use, sexual behaviour, pleasure and risk from a variety of perspectives and in a broad set of contexts. While all blogs are based on empirical data, authors also consider emerging theories attempting to explain substance use-sexual behaviour linkages.

Scanning upcoming blog titles I discern at least two major themes corresponding to current research on this topic. The first examines the relationship between sexual behaviour and the rationale for, and consequences of, associated substance use, while the second examines patterns and levels of substance use by sexual orientation. Upcoming blogs in the first theme examine the role of stigma in sex workers’ substance use patterns, the relationship between stimulant use and sexual compulsivity, also called sexual addiction, among gay and bisexual men (GBM), the advent and adoption of “sex drugs”, both legal and non-mood-altering (e.g. erectile dysfunction drugs such as Viagra®) and illicit and psychoactive (e.g. amyl nitrates or poppers) used to heighten sexual performance and/or pleasure, the role of drugs at GBM group sex parties, linkages between smoking and HIV, and a site-specific example of substance use and sexual behaviour in remote labour-based sites.

In the second theme, blogs examine linkages between substance use and sexual patterns for gay, bisexual, lesbian and transgendered populations. In doing so, they utilize a variety of Canadian data bases, including the SEX NOW national survey for GBM, the Centre for Addiction Research of BC’s High Risk Population Surveys, and a sample of transgendered men enrolled in the Vancouver Momentum Health Study for GBM.

Some upcoming blogs focus on defining and delineating levels and patterns of substance and sex related risk. At the same time, contributors are also cognizant of the far less discussed research topic of rewards, whether real, or just as importantly perceived, linking substance use with sexual behaviour. An excellent recent example of this was provided the Lorvick et al. (2013) study reporting San Francisco women’s perceptions of increased desire, power, and agency experienced when combining methaphetamine use with unprotected vaginal intercourse. Such studies emphasize that researchers today must recognize “sex positive” as well as “sex negative” aspects of substance use to fully understand this relationship. With this in mind, I invite you to follow our Sex and Drugs blog series, and to share with us your thoughts about the materials presented here.

eric roth

Author: Dr. Eric Roth, Scientist, Centre for Addictions Research of BC; Professor, Department of Anthropology, University of Victoria

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC