Access to Health Care Services among Young People Exchanging Sex in Detroit

  • Andrea K. Knittel
  • Louis F. Graham
  • Jerry Peterson
  • William Lopez
  • Rachel C. Snow
Article

Abstract

Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.

Keywords

Health care access Sex work Transportation Housing instability Health disparities 

Notes

Acknowledgements

This work was supported by the Ford Foundation Youth, Sexuality, Health and Rights Initiative. The first author was supported the University of Michigan Medical Scientist Training Program (NIGMS T32GM07863) during portions of this work. Special acknowledgement is due to Allison Brenner for her thoughtful comments on many drafts of this manuscript.

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Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  • Andrea K. Knittel
    • 1
    • 2
  • Louis F. Graham
    • 3
  • Jerry Peterson
    • 4
  • William Lopez
    • 5
  • Rachel C. Snow
    • 6
  1. 1.Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillUSA
  2. 2.Division of General Obstetrics and GynecologyUniversity of North CarolinaChapel HillUSA
  3. 3.Department of Community Health Education, School of Public Health and HealthSciencesUniversity of MassachusettsAmherstUSA
  4. 4.Ruth Ellis CenterHighland ParkUSA
  5. 5.School of Social WorkUniversity of MichiganAnn ArborUSA
  6. 6.Population and Development BranchUnited Nations Population Fund (UNFPA)NewYorkUSA

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