Food insecurity (the limited or uncertain availability of nutritionally adequate, safe foods, or the inability to acquire foods in a socially acceptable way) is increasingly being seen as a critical determinant of health globally. Research has shown food insecurity is highly related to gender, and current food assistance programming in Metro Vancouver is rarely designed for women, lesbian, gay, bisexual, trans, queer, and two-spirit (LGBTQ2S), and youth. There has been little research focused on marginalized youth, particularly street-involved sex workers in high-income countries like Canada.
To fill this gap, Daniella Baretto, an MSc student with the Gender and Sexual Health Initiative (GSHI) at BC-CfE and the University of British Columbia (UBC), sought to understand how food insecurity impacts sexual risk negotiation for marginalized youth in sex work in Metro Vancouver. Daniella brings a strong youth lens to her work with GSHI, having worked for eight years with the YouthCO HIV/Hepatitis C (HCV) Society.
The GSHI community-based research (CBR) team conducted semi-annual interviews with 220 youth up to 29 years of age between 2010 and 2013. This research is part of AESHA (An Evaluation of Sex Workers Health Access), an ongoing CBR project studying the working conditions, health access and safety among women and trans persons in the sex industry led by GSHI and UBC, in collaboration with community partners. AESHA includes ongoing outreach to street and indoor sex work venues by a diverse experiential and multi-lingual community team.
Of the 220 youth up to 29 years of age:
– One-third (31%) identified as a gender/sexual minority (LGBTQ2S)
Over the four-year study period, the majority of youth were moderately-to-severely food insecure:
– 67% reported struggling with acquiring money for food
– 72% were worried about food running out and
– 14% had exchanged sex directly for food
Over the follow-up period, the prevalence of food insecurity among marginalized youth was more than nine times the national average of 8.3%. Youth who struggled with money for food had twice the odds of client condom refusal (being pressured to not use a condom), demonstrating the relationship between food insecurity and sexual risk negotiation for HIV and other STIs amongst youth.
This research calls attention to the need for public policies for food support as part of sexual health promotion. It suggests HIV and other STI programming should be gender – and youth-centred, address food insecurity, sexual health education, and focus on gender/sexual minority and indigenous youth. It also supports the critical need for laws and polices (including decriminalization of sex work) to support sex workers’ human rights, agency, safety in negotiating condom use and the ability to access health services and food.