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Machat S, McBride B, Murphy A, Mo M, Goldenberg S, Krüsi A. AN EVALUATION OF INDOOR SEX WORKERS' PSYCHOSOCIAL OCCUPATIONAL HEALTH AND SAFETY IN METRO VANCOUVER, CANADA. OCCUPATIONAL HEALTH SCIENCE 2024; 8:383-406. [PMID: 39148898 PMCID: PMC11323036 DOI: 10.1007/s41542-023-00169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2023] [Accepted: 11/01/2023] [Indexed: 08/17/2024]
Abstract
Criminalization of sex work is linked to increased risk of violence and lack of workplace protections for sex workers. Most jurisdictions globally prohibit some or all aspects of sex work with New Zealand constituting a notable exception, where sex work has been decriminalized and regulated via OHS guidelines. We used the Guide to Occupational Health and Safety in the New Zealand Sex Industry (NZ Guide) as an analytical framework to examine the lived-experiences of psychosocial OHS conditions of indoor sex workers in Metro Vancouver under end-demand criminalization. We drew on 47 semi-structured interviews, conducted in English, Mandarin, and Cantonese in 2017-2018, with indoor sex workers and third parties providing services for them. Participants' narratives were analyzed using a coding framework based on the NZ Guide's psychosocial factors section, including safety and security from violence and complaints processes, which highlighted specific OHS shortcomings in the context of end-demand sex work legislation in indoor sex work environments. Participants identified a significant lack of OHS support, including a lack of safety training, right to refuse services, and access to justice in the context of labour rights violations or fraud, robbery or violence. Our findings emphasize the benefits of full decriminalization of sex work to facilitate sex workers' access to OHS through development and implementation of OHS guidelines designed by and for the indoor sex industry. OHS guidelines should focus on labour rights and protections, including development of sex workers' right to refuse services and access to justice.
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Affiliation(s)
- Sylvia Machat
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Bronwyn McBride
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Alka Murphy
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Minshu Mo
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
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Pearson J, Machat S, McDermid J, Goldenberg SM, Krüsi A. An Evaluation of Indoor Sex Workers' Sexual Health Access in Metro Vancouver: Applying an Occupational Health & Safety Lens in the Context of Criminalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1857. [PMID: 36767222 PMCID: PMC9914303 DOI: 10.3390/ijerph20031857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The criminalization of sex work has been consistently shown to undermine workers' Occupational Health and Safety (OHS), including sexual health. Drawing on the 'Guide to OHS in the New Zealand Sex Industry' (the Guide), we assessed barriers to sexual health best practices among indoor sex workers in Metro Vancouver, Canada, in the context of ongoing criminalization. Part of a longstanding community-based study, this analysis drew on 47 qualitative interviews (2017-2018) with indoor sex workers and third parties. Participants' narratives were analyzed drawing on a social determinants of health framework and on the Guide with specific focus on sexual health. Our findings suggest that sex workers and third parties utilize many sexual health strategies, including use of Personal Protective Equipment (PPE) and peer-driven sexual health education. However, participant narratives demonstrate how structural factors such as criminalization, immigration, and stigma limit the accessibility of additional OHS best practices outlined in the Guide and beyond, including access to non-stigmatizing sexual health assessments, and distribution of diverse PPE by third parties. Our current study supports the need for full decriminalization of sex work, including im/migrant sex work, to allow for the uptake of OHS guidelines that support the wellbeing and autonomy of all sex workers.
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Affiliation(s)
- Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Sylvia Machat
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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McBride B, Goldenberg SM, Murphy A, Wu S, Mo M, Shannon K, Krusi A. Protection or police harassment? Impacts of punitive policing, discrimination, and racial profiling under end-demand laws among im/migrant sex workers in Metro Vancouver. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100048. [PMID: 35558140 PMCID: PMC9089446 DOI: 10.1016/j.ssmqr.2022.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In 2014, Canada implemented end-demand sex work legislation which leaves the sale of sex under some circumstances legal. However, immigration policies based on discourses positioning sex work as exploitation and migration as trafficking continue to criminalize many im/migrant sex workers. Despite community reports of punitive policing, limited research has explored how police interactions with im/migrant sex workers have impacted labour conditions since this legislative shift. As part of a longstanding community-based Vancouver study, we drew on the conceptual framework of slow violence to analyze 20 in-depth interviews with sex workers born outside Canada. Despite rhetoric positioning im/migrant sex workers as victims deserving protection, participants described experiences of punitive, racialized, and stigmatizing police treatment. Fear of being 'outed' as a sex worker and living with precarious immigration status undermined participants' ability to seek police protections; yet when they did seek assistance after experiencing violence/theft, police were unsupportive or discriminatory. Our findings suggest that policies depicting im/migrant sex workers as victims act not to protect them, but to justify targeted repressive, racist policing that severely undermines women's occupational safety. Our results illustrate the harms of policies conflating sex work with trafficking; demonstrate the inherent opposition between legislative aims to protect those who sell sexual services and to abolish the sex industry; and interrogate who the state affirms as a deserving victim. The full decriminalization of sex work, removal of prohibitions on sex work among im/migrants, and community-led alternatives to the criminal justice system are urgently needed to uphold im/migrant sex workers' labour rights.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Burnaby, BC, Canada V5A 1S6
| | - Shira M. Goldenberg
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Burnaby, BC, Canada V5A 1S6
| | - Alka Murphy
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
| | - Sherry Wu
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
| | - Minshu Mo
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
- Faculty of Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3
| | - Andrea Krusi
- Centre for Gender & Sexual Health Equity, c/o St Paul’s Hospital, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6
- Faculty of Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3
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Machat S, Lyons T, Braschel M, Shannon K, Goldenberg S. Internet solicitation linked to enhanced occupational health and safety outcomes among sex workers in Metro Vancouver, Canada 2010-2019. Occup Environ Med 2022; 79:373-379. [PMID: 35149596 DOI: 10.1136/oemed-2021-107429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/18/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Examine the independent association between online solicitation and sex workers' (SWs') occupational health and safety (OHS), particularly violence and work stress. METHODS Data were drawn from a cohort of women SWs (N=942, 2010-2019) in Vancouver, Canada. Analyses used descriptive statistics and bivariate and multivariable logistic and linear regression using generalised estimating equations (GEE); explanatory and confounder modelling approaches were used. RESULTS 33.9% (n=319) of participants solicited online and 14.1% (n=133) primarily solicited online in the last 6 months in at least one study visit. In multivariable GEE analysis, factors associated with primarily soliciting online included younger age (adjusted OR (AOR) 0.95 per year older, 95% CI 0.93 to 0.97), sexual minority status (AOR 2.57, 95% CI 1.61 to 4.10), gender minority status (AOR 3.09, 95% CI 1.80 to 5.28), higher education (AOR 2.13, 95% CI 1.34 to 3.40), higher sex work income (AOR 1.03 per $100 weekly, 95% CI 1.01 to 1.06), being an im/migrant to Canada (AOR 2.40, 95% CI 1.26 to 4.58) and primarily servicing in informal indoor workspaces (AOR 3.47, 95% CI 2.32 to 5.20). In separate GEE confounder models, primarily soliciting online significantly (1) reduced odds of physical/sexual workplace violence (AOR 0.64, 95% CI 0.39 to 1.06) and (2) reduced work stress (β coefficient -0.93, 95% CI -1.59 to -0.26). DISCUSSION/CONCLUSIONS Younger workers, gender/sexual minorities, im/migrants and those in informal indoor spaces had higher odds of soliciting online. Confounder models indicate access to online solicitation methods may support enhanced OHS. Decriminalisation of sex work-including advertising via online platforms-remains necessary to support SWs' OHS.
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Affiliation(s)
- Sylvia Machat
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Tara Lyons
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.,Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Melissa Braschel
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Kate Shannon
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada .,School of Public Health, San Diego State University, San Diego, California, USA
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Pearson J, Shannon K, McBride B, Krüsi A, Machat S, Braschel M, Goldenberg S. Sex work community participation in criminalized environments: a community-based cohort study of occupational health impacts in Vancouver, Canada: 2010-2019. Int J Equity Health 2022; 21:18. [PMID: 35139867 PMCID: PMC8826666 DOI: 10.1186/s12939-022-01621-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sex work criminalization and occupational stigma pose barriers to sex workers’ access to support services, including community participation — engagement with sex work specific community organizing at both formalized and grassroots capacities. In light of gaps in evidence regarding impacts of community participation on sex workers’ occupational health in higher-income settings, we evaluated engagement in community participation and associations with occupational sexual health outcomes among sex workers in Vancouver, Canada. Methods Prospective data from a community-based cohort of 943 women sex workers in Vancouver, British Columbia (2010–2019). We used logistic regression with generalised estimating equations (GEE) to model correlates of community participation, and a confounder modeling approach to examine the association of community participation on sexually transmitted infection (STI) seropositivity. Results Among participants, 38.1% were Indigenous, 31.4% identified as women of colour (e.g., East Asian, Southeast Asian, Black) and 29.3% were im/migrants to Canada. Over a quarter (28.3%, n = 267) serviced in informal indoor spaces, while 38.0% (n = 358) serviced clients in outdoor/public and 31.4% (n = 296) in formal in-call spaces. 8.9% of participants reported sex work community participation at least once over the 9-year study. In multivariable GEE analysis, Indigenous (adjusted odds ratio(aOR) 1.71, 95% confidence interval (CI) 0.88–3.32) and trans women (aOR 4.69, 95%CI 2.43–9.06) had higher odds of community participation; women of colour had lower odds (aOR 0.18, 95%CI 0.06–0.57). In a multivariable GEE confounder model, community participation was independently associated with lower odds of STI seropositivity (aOR 0.66, 95% CI0.45–0.96). Conclusion Sex workers who engaged in sex work community participation faced reduced odds of STI seropositivity. Building off reserach evaluating community interventions in low and middle income contexts, our study provides some of the first quantitative evidence on community participation among sex workers in Canada, and is the first to examine this in relation to sexual health outcomes. This research demonstrates the need to scale up community participation access for sex workers, via linguistically diverse community spaces, anti-stigma initiatives, and decriminalization to reduce barriers faced by racialized sex workers and support occupational health and rights for all sex workers.
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Affiliation(s)
- Jennie Pearson
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Bronwyn McBride
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sylvia Machat
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA.
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McBride B, Shannon K, Murphy A, Wu S, Erickson M, Goldenberg SM, Krüsi A. Harms of third party criminalisation under end-demand legislation: undermining sex workers' safety and rights. CULTURE, HEALTH & SEXUALITY 2021; 23:1165-1181. [PMID: 32744171 PMCID: PMC7855821 DOI: 10.1080/13691058.2020.1767305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
After Canada's laws criminalising sex work were struck down by the Supreme Court for violating sex workers' rights and new end-demand legislation was passed in 2014. These new laws however continue to criminalise sex work third parties (i.e. venue owners/managers) who gain material benefits, despite evidence that managed in-call venues can provide important protections for sex workers. As part of a longstanding community-based study in Vancouver, this analysis drew on 25 in-depth interviews with third parties who provide services for indoor sex workers. We explored how end-demand third party criminalisation shapes indoor sex workers' working conditions, health and safety. We found that most third parties were women and current/former sex workers, problematising assumptions of third parties as exploitative male "pimps". Third parties provided client screening, security and sexual health resources for sex workers, yet end-demand laws restricted condom availability and access to police protections in case of violence, thereby undermining sex workers' health and safety. Our findings highlight that third party criminalisation under end-demand legislation reproduces the unsafe working conditions under the previous laws deemed unconstitutional by Canada's highest court. Legislative reforms to decriminalise all aspects of the sex industry, including sex workers' right to work with third parties, are urgently needed.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Alka Murphy
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Sherry Wu
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Margaret Erickson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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The Plight of Female Cameroonian Migrant Sex Workers in N'Djamena, Chad: A Case of Intersectionality. J Immigr Minor Health 2021; 24:430-436. [PMID: 34003411 PMCID: PMC8854133 DOI: 10.1007/s10903-021-01216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/02/2022]
Abstract
In most countries, sex-work is criminalized and frowned upon. This leads to human rights abuses, especially for migrant female sex workers. The burden is heavier on migrant female sex-workers whose gender and foreign citizenship intersect to produce a plethora of adverse health, social, and legal outcomes. This phenomenological study explores the intersectionality of individual factors leading to human rights abuses among migrant Cameroonian female sex workers in N’Djamena, Chad. Ten female sex workers and two key-informants were interviewed, and being a small sample, they gave detailed information about their experiences. The data was later analyzed using thematic analysis. Participants narrated experiences of social exclusion, exposure to diverse abuses, and health risks due to gender, immigrant status, and illegality of sex work. The experiences of female migrant sex workers, within contexts of sex work criminalization, are exacerbated by the intersectionality of these factors. Women endure several vulnerabilities in many African countries, more so when they have to survive on sex work as foreigners in a country where the act is illegal.
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McBride B, Shannon K, Braschel M, Mo M, Goldenberg SM. Lack of full citizenship rights linked to heightened client condom refusal among im/migrant sex workers in Metro Vancouver (2010-2018). Glob Public Health 2021; 16:664-678. [PMID: 31902279 PMCID: PMC7673672 DOI: 10.1080/17441692.2019.1708961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
In Canada, im/migrant sex workers face stigma, health access barriers, and overlapping marginalisation, with end-demand law reforms in 2014 postulated to exacerbate these inequities. Yet, little quantitative evidence on how immigration status shapes HIV/STI risk exists. Drawing on community-based longitudinal cohort data (AESHA, 2010-2018), we used multivariable confounder models with logistic regression to model (1) the independent effect of precarious immigration status (any status revocable under criminal charges: permanent residency/temporary residency/undocumented) on client condom refusal, and (2) the moderating effect of precarious status on the relationship between condom refusal and exposure to end-demand law reform (2015-2018). Over this 8-year study involving 758 sex workers in Metro Vancouver, 16.0% were im/migrants, of whom 57% had precarious immigration status at baseline. 16.5% of participants experienced client condom refusal. Precarious immigration was associated with increased odds of facing condom refusal (adjusted odds ratio [AOR] 2.53, 95% confidence interval [CI] 1.37-4.68), and these odds were heightened post-end-demand law reforms (AOR 4.35, 95%CI 1.21-15.66). Our findings suggest that lack of citizenship rights may enhance barriers to safer sex negotiation and increase HIV/STI risk among sex workers, highlighting the need for sex work and immigration policy reforms.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Minshu Mo
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Goldenberg S, Liyanage R, Braschel M, Shannon K. Structural barriers to condom access in a community-based cohort of sex workers in Vancouver, Canada: influence of policing, violence and end-demand criminalisation. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:301-307. [PMID: 32184290 PMCID: PMC7850467 DOI: 10.1136/bmjsrh-2019-200408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Sex workers (SWs) face a disproportionate burden of HIV/sexually transmitted infections (STIs), violence and other human rights violations. While recent HIV prevention research has largely focused on the HIV cascade, condoms remain a cornerstone of HIV prevention, requiring further research attention. Given serious concerns regarding barriers to condom use, including policing, violence and 'end-demand' sex work criminalisation, we evaluated structural correlates of difficulty accessing condoms among SWs in Vancouver over an 8-year period. METHODS Baseline and prospective data were drawn from a community-based cohort of women SWs (2010-2018). SWs completed semi-annual questionnaires administered by a team that included lived experience (SWs). Multivariable logistic regression using generalised estimating equations (GEE) modelled correlates of difficulty accessing condoms over time. RESULTS Among 884 participants, 19.1% reported difficulty accessing condoms during the study. In multivariable GEE analysis, exposure to end-demand legislation was not associated with improved condom access; identifying as a sexual/gender minority (adjusted odds ratio (aOR) 1.62, 95% CI 1.16 to 2.27), servicing outdoors (aOR 1.52, 95% CI 1.17 to 1.97), physical/sexual workplace violence (aOR 1.98, 95% CI 1.44 to 2.72), community violence (aOR 1.79, 95% CI 1.27 to 2.52) and police harassment (aOR 1.66, 95% CI 1.24 to 2.24) were associated with enhanced difficulty accessing condoms. CONCLUSIONS One-fifth of SWs faced challenges accessing condoms, suggesting the need to scale-up SW-tailored HIV/STI prevention. Despite the purported goal of 'protecting communities', end-demand criminalisation did not mitigate barriers to condom access, while sexual/gender minorities and those facing workplace violence, harassment or those who worked outdoors experienced poorest condom accessibility. Decriminalisation of sex work is needed to support SWs' labour rights, including access to HIV/STI prevention supplies.
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Affiliation(s)
- Shira Goldenberg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Ruchi Liyanage
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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