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Drawing on closed and open-ended interview data (n=79), this paper explores the health care experiences of a purposive sample of sex industry workers in a medium-sized metropolitan area of British Columbia, Canada. The respondents reported high average health care utilization and many reported satisfactory access to health care, including a positive relationship with a regular health provider. However, several respondents reported feeling intimidated and shamed in health care settings (felt stigma) and many choose to withhold information relevant to their health care due to fear of discrimination (enacted stigma) by health professionals.

The purpose of this study was to examine the prevalence of social suffering among a non-random sample of Canadian women working in socially and economically marginalized “frontline” service occupations. Participants identified a number of health concerns that they link to the everyday suffering they endure – i.e. feeling inadequate, incompetent, lonely, self-conscious, disenfranchised or dissatisfied. The complex etiology of these women's suffering bars many from finding appropriate health care. As a result, there are health disparities among our vulnerable populations. While they often articulated a desire for alternative/complementary care, the Canadian health care system does not currently fund these services and many of the women are unable to afford the out-of-pocket costs.

Social science and media depictions of youth living on our city streets typically focus on their “risk behaviours,” especially illicit drug use and unprotected sex, the social environmental challenges they face, in particular higher likelihood of sexual and physical assault and homicide (Tyler, Hoyt, & Whitbeck, 2000; Auerswald & Eyre, 2002; Pedersen & Hegna, 2003; Brooks, Milburn, Rotheram, & Witkin, 2004; Ensign & Bell, 2004; Raleigh-DuRoff, 2004; Hyde, 2005; Witkin et al., 2005) and their delinquent/criminal behaviour (Hartnagel, 1998). This focus on the multiple “risks” that street youth face has been accompanied by the search for determinants of the risk factors for street involvement, such as parental substance abuse and child neglect. Female street youth have been depicted as particularly vulnerable, partly because once on the street, they come under the control of male recruiters who make the girls drug-dependent and force them into trading sexual favours for money or in-kind goods. According to Bagley and Young (1987, p. 23), “the girl who finally tries prostitution is one who is already degraded and demoralized, in a state of psychological bondage, with grossly diminished self-confidence.” Adults who exploit these female street youth are believed to take advantage of their feelings of disconnectedness and low self-esteem and isolation (Silbert & Pines, 1981, 1982a, 1982b) and addiction to substances (Green & Goldberg, 1993). Yet, many females who were victims of childhood physical and sexual abuse do not end up on the street, nor do all those who were abused and end up on the street (male as well as female) become involved in prostitution, and, finally, many males and females who become involved in prostitution have no history of early abuse (Hagan & McCarthy, 1997).