Experiences of Violence and Head Injury Among Women and Transgender Women Sex Workers

Women and transgender women sex workers have similar experiences of housing instability, childhood trauma, and victimization to populations with high rates of traumatic brain injury (TBI), such as people experiencing homelessness and incarceration; yet, there is little research on TBI among sex workers. We conducted a mixed method study using qualitative interviews and the Ohio State University TBI Identification Method to understand experiences of violence and head injury with 10 participants recruited from Elizabeth Fry Toronto. Head injuries which resulted in loss of consciousness, or a change in conscious state, a report of feeling dazed or a gap in memory, were classified as traumatic brain injuries. All other injuries to the head which did not meet these criteria were classified as head injuries. Ninety percent of participants reported at least one lifetime TBI, and all participants reported at least one head injury related to violence in sex work. Findings indicate the need to educate sex workers on the seriousness of head injuries and the importance of treatment. Participants spoke of widespread stigma and discrimination as barriers to care, which may be mitigated by enhanced training with an anti-oppressive framework in the health care sector and in law enforcement. Participants felt that peer support workers could best deliver education and create awareness of TBI among people involved in sex work. The magnitude of violence and TBI in this population indicates the need for future research to determine actual prevalence of TBI and appropriate screening tools combined with educational programs.