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Lyu Y, Choong A, Chow EPF, Seib KL, Marshall HS, Unemo M, de Voux A, Wang B, Miranda AE, Gottlieb SL, Mello MB, Wi T, Baggaley R, Marshall C, Abu-Raddad LJ, Abara WE, Chen XS, Ong JJ. Vaccine value profile for Neisseria gonorrhoeae. Vaccine 2024; 42:S42-S69. [PMID: 38123397 PMCID: PMC11169088 DOI: 10.1016/j.vaccine.2023.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 12/23/2023]
Abstract
Neisseria gonorrhoeae infection (gonorrhoea) is a global public health challenge, causing substantial sexual and reproductive health consequences, such as infertility, pregnancy complications and increased acquisition or transmission of HIV. There is an urgency to controlling gonorrhoea because of increasing antimicrobial resistance to ceftriaxone, the last remaining treatment option, and the potential for gonorrhoea to become untreatable. No licensed gonococcal vaccine is available. Mounting observational evidence suggests that N. meningitidis serogroup B outer membrane vesicle-based vaccines may induce cross-protection against N. gonorrhoeae (estimated 30%-40% effectiveness using the 4CMenB vaccine). Clinical trials to determine the efficacy of the 4CMenB vaccine against N. gonorrhoeae are underway, as are Phase 1/2 studies of a new gonococcal-specific vaccine candidate. Ultimately, a gonococcal vaccine must be accessible, affordable and equitably dispensed, given that those most affected by gonorrhoea are also those who may be most disadvantaged in our societies, and most cases are in less-resourced settings. This vaccine value profile (VVP) provides a high level, holistic assessment of the current data to inform the potential public health, economic and societal value of pipeline vaccines. This was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations. All contributors have extensive expertise on various elements of the N. gonorrhoeae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using published data obtained from peer-reviewed journals or reports.
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Affiliation(s)
- Yiming Lyu
- University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Annabelle Choong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Victoria 3053, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria 3053, Australia.
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Helen S Marshall
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Magnus Unemo
- WHO CC for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden; Institute for Global Health, University College London (UCL), London, UK.
| | - Alex de Voux
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town 7700, South Africa.
| | - Bing Wang
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Angelica E Miranda
- Department of Social Medicine, Universidade Federal do Espirito Santo, Av. Fernando Ferrari, 514 - Goiabeiras, Vitória - ES 29075-910, Brazil.
| | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Caroline Marshall
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Laith J Abu-Raddad
- Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Box 24144, Doha, Qatar.
| | - Winston E Abara
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Xiang-Sheng Chen
- National Center for STD Control of China CDC, 12 Jiangwangmiao Street, Nanjing 210042, China.
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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Michaud L, McDermid J, Bailey A, Singh Kelsall T. Decriminalization or police mission creep? Critical appraisal of law enforcement involvement in British Columbia, Canada's decriminalization framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104478. [PMID: 38879942 DOI: 10.1016/j.drugpo.2024.104478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
The unregulated drug toxicity crisis in British Columbia (BC), Canada, has claimed over 14,000 lives since 2016. The crisis is shaped by prohibitionist policies that has led to the contamination of the unregulated drug supply, resulting in a surge of fatal and non-fatal overdose events. The criminalization of drug users exacerbates this situation, pushing individuals into carceral systems for the possession of and/or social practices related to drug use. This commentary examines the involvement of policing in the development, and throughout the first 15 months of its implementation, of BC's decriminalization framework. We highlight concerns regarding police discretion, the expansion of scope, and the interweaving of carceral logics into policies that purport to be public health-oriented.
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Affiliation(s)
- Liam Michaud
- Graduate Program in Socio-Legal Studies, York University, Toronto, ON, Canada
| | - Jenn McDermid
- Interdisciplinary studies program, University of British Columbia, Vancouver, BC, Canada
| | - Aaron Bailey
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, Vancouver, BC, Canada
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Harris MTH, Laks J, Hurstak E, Jain JP, Lambert AM, Maschke AD, Bagley SM, Farley J, Coffin PO, McMahan VM, Barrett C, Walley AY, Gunn CM. "If you're strung out and female, they will take advantage of you": A qualitative study exploring drug use and substance use service experiences among women in Boston and San Francisco. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209190. [PMID: 37866442 PMCID: PMC11040599 DOI: 10.1016/j.josat.2023.209190] [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: 01/18/2023] [Revised: 05/12/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant disparities in substance use severity and treatment persist among women who use drugs compared to men. Thus, we explored how identifying as a woman was related to drug use and treatment experiences. METHODS The study recruited participants for a qualitative interview study in Boston and San Francisco from January-November 2020. Self-identified women, age ≥ 18 years, with nonprescribed opioid use in the past 14 days were eligible for inclusion. The study team developed deductive codes based on intersectionality theory and inductive codes generated from transcript review, and identified themes using grounded content analysis. RESULTS The study enrolled thirty-six participants. The median age was 46; 58 % were White, 16 % were Black, 14 % were Hispanic, and 39 % were unstably housed. Other drug use was common with 81 % reporting benzodiazepine, 50 % cocaine, and 31 % meth/amphetamine use respectively. We found that gender (i.e., identifying as a woman) intersected with drug use and sex work practices and exacerbated experiences of marginalization. Violence was ubiquitous in drug use environments. Some women reported experiences of gender-based violence in substance use service settings that perpetuated cycles of trauma and reinforced barriers to care. Substance use services that were women-led, safe, and responsive to women's needs were valued and sought after. CONCLUSION Women reported a cycle of trauma and drug use exacerbated by oppression in substance use services settings. In addition to increasing access to gender-responsive care, our study highlights the need for greater research and examination of practices within substance use service settings that may be contributing to gender-based violence.
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Affiliation(s)
- Miriam T H Harris
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jordana Laks
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Emily Hurstak
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jennifer P Jain
- School of Nursing and Department of Community Health Systems at the University of California, San Francisco, CA 94143, USA.
| | - Audrey M Lambert
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Ariel D Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
| | - John Farley
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Phillip O Coffin
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Vanessa M McMahan
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Cynthia Barrett
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA 02118, USA.
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4
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Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
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Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, 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, United States.
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Hallett N, Christie C, Docherty-Smith J, Welborn H, Wright H, Molloy E, Chandan JS, Croxford S, Taylor J, Bradbury-Jones C. Healthcare interventions for sex workers: protocol for a scoping review. BMJ Open 2023; 13:e074983. [PMID: 37558442 PMCID: PMC10432664 DOI: 10.1136/bmjopen-2023-074983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Sex workers, who provide sexual or erotic acts in exchange for payment, often experience multiple disadvantages, including mental ill health and substance misuse. Mainstream healthcare services are generally not configured to facilitate engagement with sex workers and therefore, services are needed that are accessible to this population. The aim of this scoping review is to understand the evidence base for approaches, services and interventions that are aimed at addressing sex workers' health needs. METHODS AND ANALYSIS Nine databases, CINAHL, Embase, EThOS, Google Scholar, Health Management Information Consortium, MEDLINE, ProQuest Dissertations and Theses, PsycINFO and Web of Science (Core Collection), will be searched, with results limited to English language publications and those published from 2003 onwards. De-duplication, study selection and data extraction will be conducted using Covidence software. Included studies will describe or evaluate approaches, services or interventions that address the health needs of sex workers who offer services that involve physical contact with a client. ETHICS AND DISSEMINATION No ethical review is needed. The final report will be shared with Birmingham City Council as part of ongoing work and will be disseminated by peer-reviewed publication. STUDY REGISTRATION Open Science Framework (doi: 10.17605/OSF.IO/N7WSX).
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Affiliation(s)
- Nutmeg Hallett
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Jack Docherty-Smith
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Heather Welborn
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hannah Wright
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleanor Molloy
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sara Croxford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - Julie Taylor
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Caroline Bradbury-Jones
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Allen ST, White RH, Nestadt DF, Tomko C, Decker MR, Sherman SG. Who Asks About HIV/STI Status?: An Analysis of Women Who Sell Sex and Inject Drugs. AIDS Behav 2023; 27:1666-1673. [PMID: 36318423 DOI: 10.1007/s10461-022-03898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 05/16/2023]
Abstract
Communication about HIV and sexually transmitted infections (STI) is a cornerstone of risk reduction, yet there is a dearth of research that examines communication patterns among persons with dual risks for HIV/STI acquisition, such as women who sell sex and inject drugs (WSSID). We used logistic regression to identify factors associated with WSSID (N = 211) in Baltimore, Maryland always asking new clients about their HIV/STI status. Most WSSID were non-Hispanic White (73%) and 74% reported current homelessness. 50% of WSSID reported always asking new clients about their HIV/STI status. Experiencing depressive symptoms (adjusted odds ratio [aOR]: 0.53; 95% confidence interval [CI]: 0.29, 0.96) and having condomless sex with clients (aOR 0.31; 95% CI: 0.17, 0.57) were inversely associated with WSSID always asking new clients about their HIV/STI status. Recent entry into sex work (aOR 2.99; 95% CI: 1.30, 6.87) was positively associated with always asking new clients about their HIV/STI status. Enhancing HIV/STI communication in combination with engagement in other risk mitigation strategies may decrease disease incidence among WSSID.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Danielle F Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., 21205, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
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Argento E, Shannon K, Fairbairn N, Moreheart S, Braschel M, Goldenberg S. Increasing trends and incidence of nonfatal overdose among women sex workers who use drugs in British Columbia: The role of criminalization-related barriers to harm reduction. Drug Alcohol Depend 2023; 244:109789. [PMID: 36753803 PMCID: PMC10773461 DOI: 10.1016/j.drugalcdep.2023.109789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Structurally marginalized women who use drugs experience disproportionately elevated health and social inequities that require specialized responses to mitigate risk of overdose. This study aimed to longitudinally investigate incidence and predictors of first nonfatal overdose among women sex workers who use drugs. METHODS Data (2010-2019) were drawn from AESHA (An Evaluation of Sex Workers Health Access), a community-based, prospective, open cohort of > 900 women sex workers in Metro Vancouver, Canada. Incidence was examined and Cox regression modelled time-updated predictors of first nonfatal overdose. Time series analysis examined annual trends. RESULTS Among 273 eligible participants, 23% (n = 63) reported a first nonfatal overdose over follow-up with an incidence density of 5.87/100 person-years. In multivariable analysis, independent predictors of time to nonfatal overdose were police-related barriers to harm reduction (Adjusted Hazard Ratio [AHR]=2.62; 95% confidence interval [CI] 1.51-4.54), binge alcohol use (AHR=2.28; 95%CI 1.16-4.45), opioid use (AHR=2.23; 95%CI 1.15-4.33), and crystal methamphetamine use (AHR=2.07; 95%CI 1.27-3.39). Time series analysis demonstrated a significantly increasing trend in first nonfatal overdose, with annual proportions increasing 0.59% (95%CI 0.39-0.78%) every year, on average. CONCLUSIONS This study provides strong longitudinal evidence from the longest-standing cohort of sex workers in North America. Nonfatal overdose in this setting is a critical public health concern. Criminalization-related barriers to harm reduction strongly predicted nonfatal overdose. Structural changes to legal and policing practices alongside gender-sensitive addiction services are urgently needed.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; BC Centre on Substance Use, 1045 Howe St., Vancouver, BC V6Z 1Y6, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; BC Centre on Substance Use, 1045 Howe St., Vancouver, BC V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC 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, 5500 Campanile Drive, San Diego, CA 92182-4162, USA.
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Ferreira DG, Veras MA, Saggese GSR, Guimarães MDC, Magno L, Dourado I, Maia Macena RH, Leal AF, Kendall C, Mércham-Hamann E, Bermúdez XPD, Knauth D, Sansigolo Kerr LR. Prevalence, Characteristics, and Factors Associated With Sexual Violence in Adulthood Among Brazilian MSM. Am J Mens Health 2022; 16:15579883221142173. [PMID: 36527370 PMCID: PMC9768831 DOI: 10.1177/15579883221142173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Most studies of sexual violence are with women, and although men who have sex with men (MSM) is the group of the men that has been most investigated for sexual violence, there are still several questions to be answered about sexual violence and sexual revictimization among MSM. This study aimed to estimate the prevalence of sexual violence in different stages of life and identify factors associated with sexual violence in adulthood among Brazilian MSM. We conducted an analysis with data from the study conducted in 2016 with 4,176 MSM from 12 Brazilian cities recruited through respondent-driven sampling (RDS), who answered a survey to a set of questions, among which some specific about sexual violence. Most participants were under 25 years old (56.5%), with more than 12 years of schooling (71.2%), mixed race (40.8%), single (86.2%), and belonging to some religion (50.9%). The lifetime prevalence of sexual violence was 20.3%. In our analyses, having experienced sexual violence in childhood and adolescence increased the odds of experiencing sexual violence in adulthood (prevalence ratio ratios [PRR] 4.93 (95% CI [1.99, 12.21]), as did experiencing physical violence (PRR 1.99; 95% CI [1.07, 3.71]) and receiving money for sex (PRR 2.26; 95% CI [1.17, 4.36]). In addition to violence in childhood and adolescence being risk factors for sexual violence in adulthood, we also observed that half of the sample experienced sexual violence repeatedly, characterizing sexual revictimization. It is important that health services are prepared to receive boys and men victims in order to reduce the chances of revictimization and other outcomes.
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Affiliation(s)
- Denis Gonçalves Ferreira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil,Denis Gonçalves Ferreira, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr., 61—São Paulo 01221-020, Brazil.
| | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Andréa Fachel Leal
- Instituto de Filosofia e Ciências Humanas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Edgar Mércham-Hamann
- Programa de Pós Graduação em Saúde Coletiva, Universidade de Brasília, Brasilia, Brasil
| | | | - Daniela Knauth
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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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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Crago AL, Bruckert C, Braschel M, Shannon K. Violence against sex workers: Correlates and Changes under 'End-Demand' legislation in Canada: A five city study. Glob Public Health 2022; 17:3557-3567. [PMID: 35787234 DOI: 10.1080/17441692.2022.2092181] [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] [Indexed: 02/07/2023]
Abstract
Canada is among several countries to have implemented 'end-demand' criminalization frameworks for sex work. Drawing on interviews with sex workers (n = 200) in five cities, we employed multivariate logistic regression to identify associations with workplace violence. We also analysed descriptive data on trafficking and on workplace violence under end-demand legislation. In the past 12 months, being unable to call 911 in a safety emergency at work for fear of police detection (Adjusted Odd Ratio AOR: 4.307, 95% Confidence Interval CI: 1.697 -10.927), being unable to screen clients due to fear of police detection (AOR: 2.175, 95% CI: 1.074 -4.405), having experienced anti-sex work housing policy/eviction (AOR: 2.031, 95% CI: 0.897-4.598), and being Indigenous (Adjusted Odd Ratio (AOR): 2.167, 95% Confidence Interval (CI): 1.060-4.428) were all independently associated with workplace violence in the past 12 months. Of those who worked prior to the law change (n = 167), a majority of respondents (80.24% (134)) reported that violence in the workplace had increased or stayed the same compared to the previous criminalization model and 87.43% (n = 146) reported it was harder or the same to get help in an emergency.
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Affiliation(s)
| | - C Bruckert
- Department of Criminology, University of Ottawa, Ottawa, Canada
| | - M Braschel
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
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McDermid J, Murphy A, McBride B, Wu S, Goldenberg SM, Shannon K, Krüsi A. How client criminalisation under end-demand sex work laws shapes the occupational health and safety of sex workers in Metro Vancouver, Canada: a qualitative study. BMJ Open 2022; 12:e061729. [PMID: 36414310 PMCID: PMC9685237 DOI: 10.1136/bmjopen-2022-061729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES In 2014, Canada implemented end-demand sex work legislation that criminalises clients and third parties (eg, managers, security personnel, etc) involved in sex work. The focus of this analysis is to explore how the criminalisation of clients shapes the occupational health and safety of sex workers. DESIGN As part of a longstanding community-based study (An Evaluation of Sex Workers' Health Access), this analysis draws on 47 in-depth qualitative interviews with indoor sex workers and third parties. Informed by an intersectional lens and guided by a structural determinants of health framework, this work seeks to characterise the impact of client criminalisation in shaping the occupational health and safety of indoor sex workers. SETTING Indoor sex work venues (eg, massage parlour, in-call, brothel, etc) operating in Metro Vancouver, Canada. PARTICIPANTS 47 predominately racialised sex workers and third parties working in indoor environments between 2017 and 2018. RESULTS While participants highlighted that the majority of their client interactions were positive, their narratives emphasised how end-demand criminalisation impeded their occupational safety. The criminalisation of clients was linked to reduced ability to negotiate the terms of sexual transactions, including type of service, price and sexual health. Client preference for cash payments to maintain anonymity led to increased risk of robbery and assault due to knowledge of high cash flow in sex work venues and a reluctance to seek police protection. Workers also noted that client fear of being prosecuted or 'outed' by police enhanced feelings of shame, which was linked to increased aggression by clients. CONCLUSION Policies and laws that criminalise clients are incompatible with efforts to uphold the occupational health and safety and human rights of sex workers. The decriminalisation of sex work is urgently needed in order to support the well-being and human rights of all those involved in the Canadian sex industry.
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Affiliation(s)
- Jennifer McDermid
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
- Simon Fraser University, Burnaby, Columbia, Canada
| | - Alka Murphy
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
| | - Bronwyn McBride
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
- Simon Fraser University, Burnaby, Columbia, Canada
| | - Sherry Wu
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
| | - Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, Columbia, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, Columbia, Canada
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Goldenberg SM, Perry C, Watt S, Bingham B, Braschel M, Shannon K. Violence, policing, and systemic racism as structural barriers to substance use treatment amongst women sex workers who use drugs: Findings of a community-based cohort in Vancouver, Canada (2010-2019). Drug Alcohol Depend 2022; 237:109506. [PMID: 35753282 PMCID: PMC9381028 DOI: 10.1016/j.drugalcdep.2022.109506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a high prevalence of substance use among women sex workers (SWs), rigorous social epidemiologic data on substance use treatment experiences among SWs remains limited. Given these gaps and the disproportionate burden of criminalization borne by Indigenous SWs, we evaluated (1) structural correlates of unsuccessful attempts to access substance use treatment; and (2) the interaction between policing and Indigenous ancestry on unsuccessful attempts to access treatment among SWs who use drugs. METHODS Prospective data were from an open community-based cohort of women SWs (2010-2019) in Vancouver, Canada. Bivariate and multivariable logistic regression with generalized estimating equations(GEE) assessed correlates of unsuccessful attempts to access treatment. A multivariable GEE confounder model examined the interaction between Indigenous ancestry and policing on unsuccessful attempts to access treatment. RESULTS Amongst 645 SWs who used drugs, 32.1 % reported unsuccessful attempts to access substance use treatment during the 9.5-year study. In multivariable GEE analysis, unsuccessful substance use treatment access was associated with identifying as a sexual/gender minority (AOR: 1.90, 95 %CI:1.37-2.63), opioid use (AOR: 1.43, 95 %CI: 1.07-1.91), and exposure to homelessness (AOR: 1.72; 95 %CI:1.33-2.21), police harassment (AOR: 1.48, 95 %CI:1.03-2.13), workplace violence (AOR: 1.80, 95 %CI: 1.31-2.49) and intimate partner violence (AOR: 2.11, 95 %CI:1.50-2.97). In interaction analysis, Indigenous SWs who experienced police harassment faced the highest odds of unsuccessful attempts to access substance use treatment (AOR: 2.59, 95 %CI:1.65-4.05). CONCLUSION Findings suggest a need to scale-up culturally-safe, trauma-informed addictions, gender-based violence, and sex worker services, alongside dismantling of systemic racism across and beyond health and addictions services.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, USA,Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Chelsey Perry
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Brittany Bingham
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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13
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de Lima AMP, Magno L, Luppi CG, Szwarcwald CL, Grangeiro A, Santana EP, Dourado I. Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil. AIDS Behav 2022; 26:4082-4092. [PMID: 35687186 DOI: 10.1007/s10461-022-03734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/01/2022]
Abstract
Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.
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Affiliation(s)
- Acácia Mayra Pereira de Lima
- Institute of Collective Health, Federal University of Bahia, Av. Basílio da Gama, s/n, Canela Campus do Canela, Salvador, Bahia, CEP: 40110-040, Brazil.
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Av. Basílio da Gama, s/n, Canela Campus do Canela, Salvador, Bahia, CEP: 40110-040, Brazil.,Department of Life Sciences, State University of Bahia, Campus 1, Salvador, Bahia, Brazil
| | - Carla Gianna Luppi
- Department of Preventive Medicine, Federal University of São Paulo, Botucatu, São Paulo, Brazil
| | - Célia Landmann Szwarcwald
- Institute of Scientific Communication and Information in Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alexandre Grangeiro
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Elis Passos Santana
- Institute of Collective Health, Federal University of Bahia, Av. Basílio da Gama, s/n, Canela Campus do Canela, Salvador, Bahia, CEP: 40110-040, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Av. Basílio da Gama, s/n, Canela Campus do Canela, Salvador, Bahia, CEP: 40110-040, Brazil
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Ryan P, McGarry K. 'I miss being honest': sex workers' accounts of silence and disclosure with health care providers in Ireland. CULTURE, HEALTH & SEXUALITY 2022; 24:688-701. [PMID: 33528310 DOI: 10.1080/13691058.2021.1879271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
In this paper, female sex workers tell stories of their interactions with health care providers (HCP) in four cities in the Republic of Ireland. While Irish society has made great progress in listening to the sexual stories of women that were historically silenced (e.g. stories of abortion, sexual abuse), sex workers have not benefited from this new climate. Regularly silenced by parliamentarians and non-governmental organisations who speak upon their behalf, sex workers are consigned within a narrative of victimhood and coercion. This paper draws from a participant action research study conducted in 2019-20 and explores women's motivations in whether to disclose their sex work, and the strategies deployed to conceal it while seeking access to sexual health care. These strategies included traveling beyond their own communities for health care and STI home testing. The paper identifies women, particularly, migrants who felt their precarious position made it impossible for them to be truthful about their sex work to health care providers, exposing them to greater health risk. The paper understands this marginality within a context of structural violence where sex worker health is shaped by institutional power relations creating unequal health outcomes but is also challenged by stories of solidarity.
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Affiliation(s)
- Paul Ryan
- Sociology, Maynooth University, Maynooth, Ireland
| | - Kathryn McGarry
- Applied Social Studies, Maynooth University, Maynooth, Ireland
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15
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McBride B, Shannon K, Pearson J, Krüsi A, Braschel M, Goldenberg SM. Seeing pre-screened, regular clients associated with lower odds of workplace sexual violence and condom refusal amidst sex work criminalization: findings of a community-based cohort of sex workers in Metro Vancouver, Canada (2010-2019). BMC Public Health 2022; 22:519. [PMID: 35296270 PMCID: PMC8928629 DOI: 10.1186/s12889-022-12903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Research that accurately represents how characteristics of sex work clients relate to sex workers’ labour conditions is crucial for informing evidence-based legislation which upholds sex workers’ human rights. As little quantitative research has examined how seeing regulars (repeat clients) impacts sex workers’ occupational safety, particularly under ‘end-demand’ criminalization in Canada, our study aimed to explore how seeing mostly regulars shapes workplace sexual violence and client condom refusal. Methods We drew on longitudinal data from a community-based open cohort of 900+ sex workers in Vancouver, recruited via time-location sampling during day and late-night outreach to indoor, outdoor, and online solicitation spaces. We used logistic regression analyses and multivariable GEE confounder models to 1) describe correlates of seeing mostly pre-screened, regular clients, 2) identify associations between seeing mostly regulars and odds of experiencing occupational outcomes of workplace sexual violence and client condom refusal, and 3) examine the interaction between seeing mostly regulars and work environment on workplace sexual violence and client condom refusal. Results Participants’ median age was 35, and 55.6% had completed high school. Over the 9-year study (n=925), 20.9% (193) experienced 282 events of workplace sexual violence and 40.2% (372) faced 702 events of client condom refusal. In multivariable GEE confounder models, seeing mostly regulars was associated with reduced odds of sexual violence (AOR 0.73, 95%CI 0.53-1.02, p=0.067) and client condom refusal (AOR 0.70, 95%CI 0.57-0.86). In multivariable GEE confounder models examining the additive interaction between seeing mostly regulars and work environment, participants who saw mostly regulars and primarily worked in outdoor or informal indoor venues faced significantly lower odds of experiencing workplace sexual violence (AOR 0.69, 95%CI 0.49-0.95) and client condom refusal (AOR 0.64, 95%CI 0.52 -0.80) relative to those who worked in the same venues and did not see mostly regulars. Conclusion Our findings highlight protective effects of seeing pre-screened regulars within a criminalized setting. Removal of ‘end-demand’ client criminalization is needed to enable sex workers to effectively screen clients, support HIV/STI prevention, and advance sex workers’ human 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, V6Z1Y6, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T1Z3, Canada
| | - Jennie Pearson
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T1Z3, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada
| | - Shira M Goldenberg
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada. .,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, Hardy Tower - Room 119, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.
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16
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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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17
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Benner BE. HIV Vulnerability Among Survival Sex Workers Through Sexual Violence and Drug Taking in a Qualitative Study From Victoria, Canada, With Additional Implications for Pre-exposure Prophylaxis for Sex Workers. FRONTIERS IN SOCIOLOGY 2022; 6:714208. [PMID: 35047587 PMCID: PMC8762116 DOI: 10.3389/fsoc.2021.714208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
Objective: This qualitative study investigates how social and structural forces mediate vulnerability to HIV infection and transmission among survival sex workers, their clients, and their non-commercial, intimate partners-with especial focus on sexual violence and drug taking. Method: I employed an adapted grounded theory approach to conducting and analyzing (n = 9) open-ended, in-depth interviews with a convenience sample of currently working (and recently exited) survival sex workers from a community setting in Victoria, Canada. Findings: Participants revealed important contexts and conditions under which they were vulnerable to HIV infection. At the behavioural level, participants were aware of how HIV could be transmitted (condomless sex and sharing drug equipment), yet participants voiced strongly how structural and systemic features (for instance, client violence, the need for drugs, and "bad date" referrals) could squeeze and constrain their agency to take up safer practices, mediating their optimal HIV health and safety. Some participants reported strained relationships with police because of previous drug involvement. Conclusion: Survival sex workers constitute a health population vulnerable to HIV infection, and ensuring there could be a supportive (outreach) community replete with HIV resources is paramount. The availability of safer sex and drug equipment play important roles in HIV behavioural prevention efforts. However, uptake of pre-exposure prophylaxis (PrEP) at no cost in the Canadian province of British Columbia could be an important and beneficial structural intervention for non-injection drug taking cis-female sex workers in this study who are presently ineligible for no cost PrEP.
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Affiliation(s)
- Bryan Eric Benner
- Department of Sociology, University of Victoria, Victoria, BC, Canada
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18
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Motsoeneng M. South African female sex workers’ interactions with law enforcement: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.2001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Molefi Motsoeneng
- Scholarship of Teaching and Learning, Central University of Technology, Free State, Bloemfontein, South Africa
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De Shalit A, van der Meulen E, Guta A. Social service responses to human trafficking: the making of a public health problem. CULTURE, HEALTH & SEXUALITY 2021; 23:1717-1732. [PMID: 32896219 DOI: 10.1080/13691058.2020.1802670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
Human trafficking has received considerable attention from policymakers, researchers and service providers globally, with resulting interventions often positioning trafficking as something that simply exists. Drawing on Bacchi's 'What's the Problem Represented to be?' approach, this article proposes that trafficking is continually made through efforts designed to eradicate it. We conducted 22 interviews with representatives from social service organisations funded by the government of Ontario, Canada, for anti-trafficking programming. These interviews provide insight into how trafficking is being represented and with what effects. Our findings suggest that organisational initiatives often rely on individualised health-related interventions, such as trauma-informed counselling and other mental health support, to address trafficking. In the process, various sex work activities are deemed 'symptoms' of trafficking, and perceived pathways to engaging in sex work (such as drug use/dependence, a history of trauma and low self-esteem) are produced as 'causes' or 'risk factors'. We contend that by pathologising sex work and sex workers, organisations are employing a contradictory neoliberal paternalism to advance a public health representation of human trafficking that simultaneously responsibilises and disenfranchises purported victims.
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Affiliation(s)
| | | | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
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20
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Lavalley J, Collins AB, Mayer S, Gaudette L, Krüsi A, McNeil R, Boyd J. Negotiating sex work and client interactions in the context of a fentanyl-related overdose epidemic. CULTURE, HEALTH & SEXUALITY 2021; 23:1390-1405. [PMID: 32895026 PMCID: PMC8609966 DOI: 10.1080/13691058.2020.1785550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Despite awareness of the role of drug use in shaping sex worker/client interactions, these dynamics remain poorly understood in the context of illicit fentanyl-driven overdose epidemics. This study examined sex workers' experiences negotiating client interactions amidst a toxic drug supply in Vancouver, Canada. Findings draw from two ethnographic studies. The first, conducted between December 2016 and May 2017, examined the rapid implementation of several low-threshold supervised consumption sites. The second investigated experiences of women accessing a women-only site from May 2017 to June 2018. Data included 200 hours of fieldwork and in-depth semi-structured interviews with 34 street-based sex workers who use illicit drugs. Data were analysed thematically with attention to the risk environment. Participants described providing harm reduction services to clients as a means to reduce overdose-related risks, thus increasing sex workers' hidden labour. Participants, comments regarding criminalisation and stigma surrounding drug use and sex work indicated a reticence to report overdoses, thereby potentially increasing the risks of overdose-related harms, including death. There is an urgent need for sex worker-led overdose prevention strategies that prioritise health and safety of sex workers and their clients with specific attention to how the criminalisation of particular drugs, practices and people contributes to overdose-related risks.
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Affiliation(s)
- Jennifer Lavalley
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Interdisciplinary Studies Graduate Program, University of
British Columbia, Vancouver, BC, Canada
| | - Alex B. Collins
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Faculty of Health Sciences, Simon Fraser University,
Burnaby, BC, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Interdisciplinary Studies Graduate Program, University of
British Columbia, Vancouver, BC, Canada
| | - Laurel Gaudette
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
| | - Andrea Krüsi
- Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC,
Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
- Program in Addiction Medicine, Yale School of Medicine, New
Haven, CT, USA
- General Internal Medicine, Yale School of Medicine, New
Haven, CT, USA
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
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21
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Argento E, Strathdee SA, Shoveller JA, Braschel M, Shannon K. Correlates of Suicidality Among A Community-Based Cohort of Women Sex Workers: The Protective Effect of Social Cohesion. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:9709-9724. [PMID: 31431099 PMCID: PMC7608559 DOI: 10.1177/0886260519870167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.
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Affiliation(s)
- Elena Argento
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | | | - Jean A. Shoveller
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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22
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Amram O, Shannon K, Braschel M, Machat S, Moreheart S, Lyons T, Goldenberg SM. Mapping Workplace Neighborhood Mobility Among Sex Workers in an Urban Canadian Setting: Results of a Community-Based Spatial Epidemiological Study From 2010-2016. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7917-7939. [PMID: 31064252 PMCID: PMC7574847 DOI: 10.1177/0886260519846858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mobility among sex workers has been linked not only to improved economic and social opportunities, but also to concerns regarding displacement, criminalization, and violence. In 2014, new "end-demand" legislation criminalized new aspects of sex work in Canada (e.g., third-party advertising, purchasing) while leaving the sale of sex legal. Utilizing data from a longitudinal community-based cohort of women sex workers in Metro Vancouver (An Evaluation of Sex Workers Health Access [AESHA], 2010-2016), we used kernel density mapping to understand and identify geographic patterns of workplace neighborhood mobility (i.e., changing the primary neighborhood in which one worked in the last 6 months); multivariable logistic regression using generalized estimating equations was also used to model contextual (policing, violence, and safety) and individual correlates of workplace mobility among sex workers over the 6-year period, including potential changes in mobility patterns pre- and post-end-demand criminalization. A total of 543 sex workers were included in analyses, contributing 2,199 observations. A total of 402 (74.0%) experienced workplace neighborhood mobility during the study period. Neighborhood mobility was negatively correlated with age (adjusted odds ratio [AOR] = 0.98/year older, 95% confidence interval [CI] = [0.97, 0.99]) and positively correlated with homelessness (AOR = 1.43, 95% CI = [1.12, 1.82]), identifying as a gender/sexual minority (AOR = 1.31, 95% CI = [1.04, 1.70]), and servicing clients primarily outdoors (vs. informal indoor or in-call venues; AOR = 1.48, 95% CI = [1.21, 1.81]); police harassment (AOR = 1.19, 95% CI = [0.96, 1.48], p = .11) and changing one's neighborhood of work due to safety concerns (AOR = 1.37, 95% CI = [0.94, 2.00], p = .09) were both marginally correlated. Steps to promote safer working conditions for marginalized women in urban environments remain urgently needed, including shifts away from criminalized enforcement toward community-led initiatives and promoting access to safer indoor workspaces.
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Affiliation(s)
- Ofer Amram
- Washington State University, Spokane, USA
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Melissa Braschel
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sylvia Machat
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sarah Moreheart
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Tara Lyons
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Shira M Goldenberg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
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23
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Strega S, Shumka L, Hallgrímsdóttir HK. The "Sociological Equation": Intersections Between Street Sex Workers' Agency and Their Theories about Their Customers. JOURNAL OF SEX RESEARCH 2021; 58:694-705. [PMID: 33104390 DOI: 10.1080/00224499.2020.1830260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Street sex work is deeply stratified, embedded in power imbalances and inequities; workers are multiply marginalized, relative to customers, in terms of race, class and gender. At the same time, these imbalances should not be equated with worker powerlessness. In this paper, we seek to counter the existing limited and polarized conceptualizations of agency that dominate the sex work literature by providing an assessment of the ways in which female street sex workers seek to realize and exercise agency and enact strategies of resistance despite the violence ubiquitous in their work. We draw from worker narratives collected through individual and focus group interviews in five Canadian cities to highlight the nuanced and layered ways in which workers, collectively and individually, apply reasoning and argumentation to the risks represented by customers, as well as to other aspects of their working environment. Workers offered three significant theories related to which men buy sex on the street and why (some) men buy sex; we describe how they employ these to negotiate the conditions of their work, nesting our findings within a broader socio-cultural analysis of the risks workers experience as they navigate complex, highly politicized working environments. Finally, we show how workers appropriate hegemonic masculinity discourses as well as intersecting race, class and gender discourses to inform their rationales for choosing some customers over others, setting our discussion within existing literature on male sex work customers.
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Affiliation(s)
- Susan Strega
- School of Social Work, University of Victoria, Unceded Territories of the WS'ANEC'
| | - Leah Shumka
- Equity and Human Rights Office, University of Victoria
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24
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Tomko C, Nestadt DF, Rouhani S, Silberzahn BE, Haney K, Park JN, Galai N, Logie CH, Sherman SG. Confirmatory Factor Analysis and Construct Validity of the Internalized Sex Work Stigma Scale among a Cohort of Cisgender Female Sex Workers in Baltimore, Maryland, United States. JOURNAL OF SEX RESEARCH 2021; 58:713-723. [PMID: 32401075 PMCID: PMC7666019 DOI: 10.1080/00224499.2020.1755821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Internalized sex work stigma among cisgender female sex workers (FSW) is produced within contexts of social marginalization and associated with a range of ill-effects, including psychological distress, and lower rates of healthcare-seeking. This study seeks to uncover latent domains of the new Internalized Sex Work Stigma Scale (ISWSS) using data from 367 FSW in Baltimore, Maryland, USA. The sample was 56% white with high substance use (82% smoked crack cocaine, 58% injected any drug). The average ISWSS score was 34.8 (s.d. = 5.8, possible range: 12-48) and internal consistency was high (0.82). Confirmatory factor analysis revealed four subscales: worthlessness, guilt and shame, stigma acceptance, and sex work illegitimacy. Internal consistency of subscales was high (0.69-0.90); the scale also demonstrated construct validity with depression and agency. In bivariate logistic regressions, higher ISWSS, worthlessness, shame and guilt, and acceptance scores predicted higher odds of rushing client negotiations due to police. In unadjusted multinomial regressions, feeling respected by police predicted lower ISWSS, worthlessness, guilt and shame, acceptance, and illegitimacy scores. Identified factors are congruent with existing literature about how FSW manage sex work-specific stigma. Understanding the unique dimensions and impacts of internalized sex work stigma can inform interventions and policy to reduce morbidities experienced by FSW.
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Affiliation(s)
- Catherine Tomko
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle Friedman Nestadt
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saba Rouhani
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bradley E. Silberzahn
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine Haney
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Noya Galai
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Statistics, University of Haifa, Haifa, Israel
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Susan G. Sherman
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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25
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Armstrong L. 'I Can Lead the Life That I Want to Lead': Social Harm, Human Needs and the Decriminalisation of Sex Work in Aotearoa/New Zealand. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 18:941-951. [PMID: 34178178 PMCID: PMC8211717 DOI: 10.1007/s13178-021-00605-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sex work is commonly understood to be a risky occupation. Sex work law debates coalesce around the issue of harm, with differing perspectives regarding what constitutes harm, how harm is produced and what needs to change to mitigate it. While sex work is often portrayed as inherently harmful, sex workers and researchers have challenged this assumption, calling attention to the relationship between harm and policies in place. Criminalisation, in its many and varied forms, is thought to exacerbate harms that can occur in sex work, while decriminalisation is understood as creating conditions conducive to minimising harm. However, the decriminalisation of sex work remains rare, and more research which examines how decriminalisation works in relation to harms is critical. This paper uses the concept of social harm to unpack the implications of sex work policies and examine the experiences of sex workers in New Zealand, where sex work is decriminalised. METHODS Semi-structured in-depth interviews were conducted with 46 sex workers in New Zealand in 2018 and 2020 across two studies focused on examining experiences and perceptions of stigma and discrimination in this context. The interviews were thematically analysed using NVivo data analysis software. RESULTS The experiences of participants demonstrate how involvement in sex work had improved their lives in multiple ways. Participants described the importance of sex work in improving their quality of life by ensuring that they could better meet their everyday needs, the autonomy this afforded them and how decriminalisation helped to enable this. The validating impact of decriminalisation in acknowledging sex workers as people with rights is also evident in participant's experiences. CONCLUSIONS Social harm is a framework that can help illuminate socio-economic harms which influence pathways into sex work for some people and the compounding harms of criminalising regimes. The benefits of engaging in sex work are often overlooked in policy debates. Although sex work is not easy work, engaging in sex work can have positive impacts on the lives of people who pursue it. Full decriminalisation of sex work is the only responsible option for societies seeking to reduce harm.
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Affiliation(s)
- Lynzi Armstrong
- School of Social and Cultural Studies, Victoria University of Wellington, PO Box 600, Wellington, 6140 New Zealand
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26
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Lyons T, Krüsi A, Edgar E, Machat S, Kerr T, Shannon K. The Impacts of Intersecting Stigmas on Health and Housing Experiences of Queer Women Sex Workers in Vancouver, Canada. JOURNAL OF HOMOSEXUALITY 2021; 68:957-972. [PMID: 31774383 DOI: 10.1080/00918369.2019.1694337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to qualitatively explore how queer women sex workers' experiences of stigma impacted health and housing access in Vancouver, Canada. In-depth semi-structured interviews were conducted with 56 queer women sex workers in Vancouver, Canada between June 2012 and May 2013. Participants described sexual stigma in the form of discriminatory comments about their sexuality, and in the form of barriers to housing and complexities in maintaining their relationships in supported housing environments. Enacted stigma was also experienced, particularly drug use-related stigma, in healthcare settings. Consequently, some participants reported felt stigma in the form of hiding their sexuality and relationships to mitigate stigma and to gain access to services. Participants experienced a variety of stigma related to drug use, housing insecurity, and sexuality; thereby demonstrating the intersecting dimensions of stigma and structural oppressions in the lives of the queer women sex workers.
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Affiliation(s)
- Tara Lyons
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sylvia Machat
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Connelly L, Kamerāde D, Sanders T. Violent and Nonviolent Crimes Against Sex Workers: The Influence of the Sex Market on Reporting Practices in the United Kingdom. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP3938-NP3963. [PMID: 29926764 DOI: 10.1177/0886260518780782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Previous research has shown that sex workers experience extremely high rates of victimization but are often reluctant to report their experiences to the police. This article explores how the markets in which sex workers operate in the United Kingdom impact upon the violent and nonviolent crimes they report to a national support organization and their willingness to report victimization to the police. We use a secondary quantitative data analysis of 2,056 crime reports submitted to the U.K. National Ugly Mugs (NUM) scheme between 2012 and 2016. The findings indicate that although violence is the most common crime type reported to NUM, sex workers operating in different markets report varying relative proportions of different types of victimization. We also argue that there is some variation in the level of willingness to share reports with the police across the different sex markets, even when the types of crime, presence of violence, and other variables are taken into account. Our finding that street sex workers are most likely to report victimization directly to the police challenges previously held assumptions that criminalization is the key factor preventing sex workers from engaging with the police.
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28
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Bardwell G, Fleming T, McNeil R, Boyd J. Women's multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: a qualitative study. BMC WOMENS HEALTH 2021; 21:51. [PMID: 33530987 PMCID: PMC7856712 DOI: 10.1186/s12905-021-01196-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Background North America is amidst an opioid overdose epidemic. In many settings, particularly Canada, the majority of overdose deaths occur indoors and impact structurally vulnerable people who use drugs alone, making targeted housing-based interventions a priority. Mobile applications have been developed that allow individuals to solicit help to prevent overdose death. We examine the experiences of women residents utilizing an overdose response button technology within a supportive housing environment. Methods In October 2019, we conducted semi-structured qualitative interviews with 14 residents of a women-only supportive housing building in an urban setting where the overdose response button technology was installed. Data was analyzed thematically and framed by theories of structural vulnerability. Results While participants described the utility and disadvantages of the technology for overdose response, most participants, unexpectedly described alternate adoptions of the technology. Participants used the technology for other emergency situations (e.g., gender-based violence), rather than its intended purpose of overdose response. Conclusions Our findings highlight the limitations of current technologies while also demonstrating the clear need for housing-based emergency response interventions that address not just overdose risk but also gender-based violence. These need to be implemented alongside larger strategies to address structural vulnerabilities and provide greater agency to marginalized women who use drugs.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Yale School of Medicine, 367 Cedar Street, New Haven, CT, 06510, USA
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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29
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McBride B, Shannon K, Bingham B, Braschel M, Strathdee S, Goldenberg SM. Underreporting of Violence to Police among Women Sex Workers in Canada: Amplified Inequities for Im/migrant and In-Call Workers Prior to and Following End-Demand Legislation. Health Hum Rights 2020; 22:257-270. [PMID: 33390711 PMCID: PMC7762889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sex workers globally face high levels of violence. In Canada, im/migrant sex workers who work in indoor venues may be uniquely targeted by police due to immigration policies, racialized policing, and the conflation of trafficking and sex work. In 2014, Canada passed end-demand legislation that purportedly encourages sex workers to report violence to police; however, little research has evaluated its impact. Using interrupted time series and multivariable logistic regression, we examined proportions of reporting violent incidents to police among sex workers who had experienced workplace violence (2010-2017), including potential changes prior to and following end-demand legislation. We then modeled the independent effects of im/migrant status and place of work on reporting violence. Among sex workers who experienced recent violence during the 7.5-year study (n=367), 38.2% of all participants and 12.7% of im/migrants reported violence to police, and there was no significant change in violence reporting after end-demand legislation. Our results suggest that end-demand laws do not remove barriers to justice faced by sex workers and instead actually perpetuate harms, particularly for racialized im/migrant and indoor workers. Policy reforms to decriminalize sex work, address discriminatory policing, and promote access to safety and justice are urgently needed.
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Affiliation(s)
- Bronwyn McBride
- Postdoctoral Fellow at Simon Fraser University and at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Kate Shannon
- Professor at the University of British Columbia and Executive Director at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Brittany Bingham
- Director of Indigenous Research at the Centre for Gender and Sexual Health Equity and Vancouver Coastal Health Aboriginal Health, Vancouver, Canada
| | - Melissa Braschel
- Statistician and Data Manager at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Steffanie Strathdee
- Associate Dean at the University of California San Diego School of Medicine, San Diego, USA
| | - Shira M. Goldenberg
- Assistant Professor at Simon Fraser University and Director of Research Education at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
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30
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Sharma R, Pooyak S, Jongbloed K, Zamar D, Pearce ME, Mazzuca A, Schechter MT, Spittal PM. The Cedar Project: Historical, structural and interpersonal determinants of involvement in survival sex work over time among Indigenous women who have used drugs in two Canadian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:103012. [PMID: 33166826 DOI: 10.1016/j.drugpo.2020.103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. METHODS The Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016 . Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. RESULTS Among 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50-2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36-2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22-2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18-2.28), used crack daily (ARR: 2.85; 95% CI: 2.36-3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98-3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15-2.05) were more likely to be involved in sex work. CONCLUSION Indigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.
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Affiliation(s)
- Richa Sharma
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Sherri Pooyak
- AHA Centre/ Canadian Aboriginal AIDS Network, 6520 Salish Dr, Vancouver, BC, V6N 2C7
| | - Kate Jongbloed
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - David Zamar
- BC Children's Hospital Research Institute, 950 W28th Ave, Vancouver, BC, V5Z 4H4
| | - Margo E Pearce
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4
| | - April Mazzuca
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Martin T Schechter
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Patricia M Spittal
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3.
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Singer R, Crooks N, Johnson AK, Lutnick A, Matthews A. COVID-19 Prevention and Protecting Sex Workers: A Call to Action. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2739-2741. [PMID: 33057832 PMCID: PMC7556610 DOI: 10.1007/s10508-020-01849-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 05/11/2023]
Affiliation(s)
- Randi Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., Chicago, IL, 60612, USA.
| | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Amy K Johnson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Alicia Matthews
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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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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White RH, Park JN, Galai N, Decker MR, Allen ST, Footer KHA, Sherman SG. Short-term interruptions to sex work among a prospective cohort of street-based cisgender female sex workers in Baltimore. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102858. [PMID: 32726687 DOI: 10.1016/j.drugpo.2020.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Street-based female sex workers (FSW) often cycle in and out of sex work engagement. For many FSW, substance use plays a critical role in sex work entry, continuation, and interruptions. We examined individual, interpersonal, and structural correlates of short-term interruptions of sex work among street-based FSW in an urban environment. METHODS Data were from 205 FSW in Baltimore, MD, USA followed as part of an observational prospective cohort study between April 2016-Februrary 2018. The primary outcome was short-term interruptions of sex work (stopping sex work) over the past 3 months, asked every 3 months over a 12-month follow-up. We assessed the relationship between individual, structural, and interpersonal factors for each woman's prior visit and current visit with short-term sex work interruptions. We employed modified Poisson regression with Generalized Estimating Equations to identify correlates of short-term interruptions of sex work. RESULTS Eighty-two women (40%) reported stopping sex work over the past 3 months at least once during follow-up. Past drug treatment (adjusted incidence rate ratio [aIRR] 1.40; 95% CI: 1.06-1.86) and not having used drugs in the past 3 months (aIRR 2.70; 95% CI: 1.96-3.71) were positively associated with short-term interruption to sex work. Past intimate partner violence (IPV) (aIRR 0.52; 95% CI: 0.31-0.86) and current homelessness (aIRR 0.61; 95% CI: 0.41-0.91) were negatively associated with short-term interruption. Results were inconclusive for the association between recent prostitution arrest and short-term interruptions to sex work (IRR 0.86; 95% CI: 0.40-1.86). CONCLUSION The study suggests that similar to other professions, women leave sex work for numerous reasons. Substance use cessation and participation in drug treatment programs may contribute to short-term interruptions of sex work by reducing reliance on sex work for income among street-based FSW. Structural vulnerabilities including homelessness and IPV are driving continued street-based sex work, speaking to the need for holistic structural interventions.
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Affiliation(s)
- Rebecca Hamilton White
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E6608, Baltimore, MD 21205, USA; Department of Statistics, University of Haifa, 199 Aba Khushi Street, Mount Carmel, Haifa 3498838, Israel.
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4142, Baltimore, MD 21205, USA.
| | - Sean T Allen
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Katherine H A Footer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
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Footer KHA, Silberzahn BE, Lim S, Huettner S, Kumar VA, Loeffler D, Peitzmeier SM, Sherman SG. "An ethnographic exploration of factors that drive policing of street-based female sex workers in a U.S. setting - identifying opportunities for intervention". BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:12. [PMID: 32410616 PMCID: PMC7227297 DOI: 10.1186/s12914-020-00232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
Background Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health and human rights evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape harmful policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods Drawing on ethnographic methods, 280 h of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health and human rights goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which harmful police practices towards sex work operate. Conclusions A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the rights and health of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
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Affiliation(s)
- Katherine H A Footer
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Bradley E Silberzahn
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sahnah Lim
- New York University School of Medicine, Department of Population Health and Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Steven Huettner
- Johns Hopkins School of Medicine, Department of Pediatrics, 5200 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victor A Kumar
- Johns Hopkins Krieger School of Arts and Sciences, Department of Anthropology, 466 Mergenthaler Hall, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Derek Loeffler
- Baltimore City Police Department, Northwestern District, 5271 Reistertown Road, Baltimore, MD, 21215, USA
| | - Sarah M Peitzmeier
- Johns Hopkins Bloomberg School of Publissc Health, Department of Population, Family, and Reproductive Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
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Harms of Workplace Inspections for Im/Migrant Sex Workers in In-Call Establishments: Enhanced Barriers to Health Access in a Canadian Setting. J Immigr Minor Health 2020; 21:1290-1299. [PMID: 30652237 DOI: 10.1007/s10903-019-00859-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Given shifting sex work criminalization and enforcement in Canada, this study examined worrying about workplace inspections by authorities amongst indoor sex workers in Vancouver (2014-2017). Data were drawn from a community-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate factors associated with worry about inspections. 23.9% of participants experienced workplace inspections; 51.6% worried about inspections. In multivariable analyses, worrying about inspections was associated with recent im/migration [adjusted odds ratio (AOR) 3.13; 95% confidence interval (CI) 1.77-5.53], police harassment (AOR 3.49; 95% CI 1.92-6.34), and workplace violence (AOR 1.66, 95% CI 1.09-2.51). In a multivariable confounder model, worry was independently associated with barriers to health access (AOR 1.45, 95% CI 1.06-1.98). Im/migrant indoor workers are disproportionately impacted by concerns about workplace inspections, which was independently linked to enhanced barriers to health access. Current criminalization measures may exacerbate health inequities among im/migrant sex workers.
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Argento E, Goldenberg S, Braschel M, Machat S, Strathdee SA, Shannon K. The impact of end-demand legislation on sex workers' access to health and sex worker-led services: A community-based prospective cohort study in Canada. PLoS One 2020; 15:e0225783. [PMID: 32251452 PMCID: PMC7135091 DOI: 10.1371/journal.pone.0225783] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Following a global wave of end-demand criminalization of sex work, the Protection of Communities and Exploited Persons Act (PCEPA) was implemented in Canada, which has implications for the health and safety of sex workers. This study aimed to evaluate the impact of the PCEPA on sex workers' access to health, violence, and sex worker-led services. METHODS Longitudinal data were drawn from a community-based cohort of ~900 cis and trans women sex workers in Vancouver, Canada. Multivariable logistic regression examined the independent effect of the post-PCEPA period (2015-2017) versus the pre-PCEPA period (2010-2013) on time-updated measures of sex workers' access to health, violence supports, and sex worker/community-led services. RESULTS The PCEPA was independently correlated with reduced odds of having access to health services when needed (AOR 0.59; 95%CI: 0.45-0.78) and community-led services (AOR 0.77; 95%CI: 0.62-0.95). Among sex workers who experienced physical violence/sexual violence or trauma, there was no significant difference in access to counseling supports post-PCEPA (AOR 1.24; 95%CI: 0.93-1.64). CONCLUSION Sex workers experienced significantly reduced access to critical health and sex worker/community-led services following implementation of the new laws. Findings suggest end-demand laws may exacerbate and reproduce harms of previous criminalized approaches to sex work in Canada. This study is one of the first globally to evaluate the impact of end-demand approaches to sex work. There is a critical evidence-based need to move away from criminalization of sex work worldwide to ensure full labor and human rights for sex workers. Findings warn against adopting end-demand approaches in other cities or jurisdictions.
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Affiliation(s)
- Elena Argento
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Sylvia Machat
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Boyd J, Lavalley J, Czechaczek S, Mayer S, Kerr T, Maher L, McNeil R. "Bed Bugs and Beyond": An ethnographic analysis of North America's first women-only supervised drug consumption site. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102733. [PMID: 32247720 DOI: 10.1016/j.drugpo.2020.102733] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/14/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Attention to how women are differentially impacted within harm reduction environments is salient amidst North America's overdose crisis. Harm reduction interventions are typically 'gender-neutral', thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service settings and limiting some women's access. Such dynamics highlight the significance of North America's first low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive), SisterSpace, in Vancouver, Canada. This study explores women's lived experiences of this unique harm reduction intervention. METHODS Ethnographic research was conducted from May 2017 to June 2018 to explore women's experiences with SisterSpace in Vancouver's Downtown Eastside, an epicenter of Canada's overdose crisis. Data include more than 100 hours of ethnographic fieldwork, including unstructured conversations with structurally vulnerable women who use illegal drugs, and in-depth interviews with 45 women recruited from this site. Data were analyzed in NVivo by drawing on deductive and inductive approaches. FINDINGS The setting (non-institutional), operational policies (no men; inclusive), and environment (diversity of structurally vulnerable women who use illegal drugs), constituted a space affording participants a temporary reprieve from some forms of stigma and discrimination, gendered and social violence and drug-related harms, including overdose. SisterSpace fostered a sense of safety and subjective autonomy (though structurally constrained) among those often defined as 'deviant' and 'victims', enabling knowledge-sharing of experiences through a gendered lens. CONCLUSION SisterSpace demonstrates the value and effectiveness of initiatives that engage with socio-structural factors beyond the often narrow focus of overdose prevention and that account for the complex social relations that constitute such initiatives. In the context of structural inequities, criminalization, and an overdose crisis, SisterSpace represents an innovative approach to harm reduction that accounts for situations of gender inequality not being met by mixed-gender services, with relevance to other settings.
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Affiliation(s)
- Jade Boyd
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Jennifer Lavalley
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sandra Czechaczek
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, 2052, Australia and Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Ryan McNeil
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street New Haven CT 06510, USA; General Internal Medicine, Yale School of Medicine, 367 Cedar Street New Haven CT 06510, USA
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Goldenberg SM, Amram O, Braschel M, Moreheart S, Shannon K. Urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort. Health Place 2020; 62:102288. [PMID: 32479365 PMCID: PMC7574814 DOI: 10.1016/j.healthplace.2020.102288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 01/07/2023]
Abstract
Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers' work/living environments in relation to gentrification exposure in Metro Vancouver (2010-2014), and modeled independent effects of gentrification exposure on reduced utilization of HIV/STI testing, sexual health, and sex worker support services. These decreases occurred despite efforts to scale-up HIV services for marginalized populations. Planning of healthcare, housing, and other support services should be responsive to shifting urban landscapes for marginalized women.
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Affiliation(s)
- Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888, University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
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Orchard T, Murie A, Salter K, Elash HL, Bunch M, Middleton C, Benoit C. Balance, Capacity, and the Contingencies of Everyday Life: Narrative Etiologies of Health Among Women in Street-Based Sex Work. QUALITATIVE HEALTH RESEARCH 2020; 30:518-529. [PMID: 31216937 DOI: 10.1177/1049732319855967] [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] [Indexed: 06/09/2023]
Abstract
There is an abundance of health research with women in street-based sex work, but few studies examine what health means and how it is practiced by participants. We embrace these tasks by exploring how a convenience sample of sex workers (n = 33) think about and enact health in their lives. Findings reveal pluralistic notions of health that include neoliberal, biomedical, and lay knowledge. Health is operationalized through clinic/hospital visits and self-care practices, which emerge as pragmatic behaviors and ways to resist or compensate for exclusionary treatment in health care systems. Participants also use symbols of biomedical authority to substantiate their lay interpretations of certain conditions, revealing complex forms of moral reasoning in their health etiologies. We conclude that doing health and constructing rich narratives about it are constituent elements of the women's everyday praxis and subjectivities in relation to the broader socioeconomic and political worlds of which they are a part.
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Affiliation(s)
| | | | | | | | - Mary Bunch
- York University, Toronto, Ontario, Canada
| | | | - Cecilia Benoit
- University of Victoria, Victoria, British Columbia, Canada
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40
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Lyons CE, Schwartz SR, Murray SM, Shannon K, Diouf D, Mothopeng T, Kouanda S, Simplice A, Kouame A, Mnisi Z, Tamoufe U, Phaswana-Mafuya N, Cham B, Drame FM, Aliu Djaló M, Baral S. The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nat Commun 2020; 11:773. [PMID: 32071298 PMCID: PMC7028952 DOI: 10.1038/s41467-020-14593-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022] Open
Abstract
Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011-2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.
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Affiliation(s)
- Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Sheree R Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins School of Public Health, Hampton House 624 N. Broadway 8th Floor, Baltimore, MD, 21205, USA
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Daouda Diouf
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, Institut Africain de Santé Publique, 12 BP 199, Ouagadougou, Burkina Faso
| | | | - Abo Kouame
- Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Zandile Mnisi
- Health Research Department, Strategic Information Division, Ministry of Health, Cooper Centre Office 106, Mbabane, Eswatini
| | - Ubald Tamoufe
- Metabiota. Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, 15939, Yaoundé, Cameroon
| | - Nancy Phaswana-Mafuya
- DVC Research and Innovation Office, North-West University, Potchefstroom Campus, Private Bag X6001 Potchefstroom, 2520, Potchefstroom, South Africa
| | - Bai Cham
- Actionaid, Banjul The Gambia, MDI Road, Kanifing South PMB 450, Serrekunda PO Box 725, Banjul, The Gambia
| | - Fatou M Drame
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
- Gaston Berger University, Department of Geography, School of Social Sciences. BP: 234 - Saint-Louis, Nationale 2, route de Ngallèle, St. Louis, Senegal
| | - Mamadú Aliu Djaló
- Enda Santé, Guiné-Bissau. Bairro Santa Luzia, Rua s/n, CP 1041, Bissau, Guinea-Bissau
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Hall J, Donelle L, Laliberte Rudman D, Baumann J, Weaver H, Jones R, Moulton-Sauve M, Jenkins K, Trudell A. "It Is Important for Everyone as Humans to Feel Important, Right?" Findings from a Community-Based Participatory Needs Assessment with Street-level Sex Workers. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:33-46. [PMID: 32156199 DOI: 10.1080/19371918.2020.1733163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A community-based participatory research design informed the development and conduct of a needs assessment with street-level sex workers within a mid-sized city in Ontario, Canada. The research question was: What would help street-level sex workers to live with enhanced safety and dignity within their community? Twenty-four women who accessed a peer-driven drop-in center (SafeSpace) participated in in-depth interviews. Observational data of items requested by women who accessed SafeSpace were also documented over a 6-month time period. The overarching theme of relationships was identified as vital to participants' ability to live and work with enhanced safety and dignity in their community. Subthemes included: Informal/formal surveillance: Relationships to public space(s); Nowhere to go for us: Relationships with/in community services; and You're given the time you need: Relationships in a peer-driven drop-in center for/with/by sex workers. Our findings demonstrate how central relationships are, particularly peer, to enhancing or diminishing sex workers' sense of dignity, self-worth, safety, and enhanced their access to services.
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Affiliation(s)
- Jodi Hall
- School of Nursing, Faculty of Health, Community Studies and Public Safety, London, ON, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, School of Health Studies, Faculty of Health Sciences, FIMS/Nursing Building (FNB), Western University, London, ON, Canada
| | - Debbie Laliberte Rudman
- School of Occupational Therapy & Occupational Science Field, Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
| | | | | | | | | | - Karen Jenkins
- School of Nursing, Western-Fanshawe Collaborative BScN Program, Faculty of Health Science, Human Services and Nursing, London, ON, Canada
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Goldenberg S, Watt S, Braschel M, Hayashi K, Moreheart S, Shannon K. Police-related barriers to harm reduction linked to non-fatal overdose amongst sex workers who use drugs: Results of a community-based cohort in Metro Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102618. [PMID: 31838244 DOI: 10.1016/j.drugpo.2019.102618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND High rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing impacts overdose risk amongst sex workers who use drugs. Given this, we aimed to explore the independent effects of experiencing police-related barriers to harm reduction on non-fatal overdose amongst women sex workers who use drugs in Metro Vancouver, Canada over a 7.5-year period. METHODS Data were drawn from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women sex workers in Metro Vancouver, from 2010 to 2017. Using multivariate logistic regression with generalized estimating equations (GEE), we used a confounder modeling approach to identify the independent effect of experiencing police-related barriers to harm reduction strategies on non-fatal overdose amongst sex workers using drugs within the last six months at each study visit. RESULTS Amongst 624 participants, 7.7% overdosed within the last six months at baseline and 27.6% overdosed during the study period, contributing 287 non-fatal overdose events over the 7.5-year period. 68.6% reported police-related barriers to harm reduction strategies during the study. In a multivariate confounder model, exposure to police-related barriers to harm reduction strategies [AOR: 2.15, CI: 1.60-2.90] was independently associated with higher odds of non-fatal overdose after adjustment for key confounders. CONCLUSIONS Our findings suggest that in the context of the current overdose crisis, adversarial policing practices may undermine access to lifesaving overdose prevention services and exacerbate overdose risks for marginalized women. Findings underscore the urgent need to scale-up access and remove barriers to progressive harm reduction strategies for women sex workers.
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Affiliation(s)
- Shira Goldenberg
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Abel G. The Problem with Sex Work Policies. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1925-1929. [PMID: 30560343 DOI: 10.1007/s10508-018-1366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Gillian Abel
- Department of Population Health, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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Barreto D, Shoveller J, Braschel M, Duff P, Shannon K. The Effect of Violence and Intersecting Structural Inequities on High Rates of Food Insecurity among Marginalized Sex Workers in a Canadian Setting. J Urban Health 2019; 96:605-615. [PMID: 30039301 PMCID: PMC6890872 DOI: 10.1007/s11524-018-0281-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food security is both a basic human right and a public health necessity. Despite known gendered contexts of food insecurity, there is a dearth of research on prevalence and factors driving increased food insecurity for sex workers in a criminalized setting. The current study longitudinally examines the prevalence and structural and individual factors associated with increased odds of food insecurity among street and off-street sex workers in a Canadian urban setting. Prospective analyses drew on data from a community-based longitudinal cohort of cis and trans women in street and off-street sex work in An Evaluation of Sex Workers Health Access (2010-2014). The primary outcome was a time-updated measure of food insecurity, using the Radimer-Cornell scale. We used bivariable and multivariable logistic regression using generalized estimating equations to prospectively model correlates of food insecurity over a five-year period. Of 761 cis and trans women sex workers, 72.4% (n = 551) were food insecure over the study period. Over a third (35.2%, n = 268) identified as Indigenous and a quarter, 25.6% (n = 195) were of a gender/sexual minority. Within the 11.0% (n = 84) of women living with HIV, 96.4% (n = 81) were food insecure over the follow-up period. In multivariable analysis, Indigenous ancestry (AOR = 1.58 [95% CI 1.18, 2.10]), unstable housing (AOR = 1.27 [95% CI 1.03, 1.57]), stimulant use (AOR = 1.97 [95% CI 1.57, 2.45]), heroin use (AOR = 1.72 [95% CI 1.36, 2.19]), mental health diagnosis (AOR = 2.38 [95% CI 1.85, 3.05]), recent violence (AOR = 1.54 [95% CI 1.24, 1.91]), means of food access: reliant on food services only vs. self-sufficient (AOR = 1.78 [95% CI 1.38, 2.29]), and means of food access: both vs. self-sufficient (AOR = 2.29 [95% CI 1.84, 2.86]) were associated with food insecurity. In separate multivariable models, both recent and lifetime physical and/or sexual violence remained independently associated with food insecurity (AOR 1.54 [95% CI 1.24, 1.91]; AOR 4.62 [95% CI 2.99, 7.14], respectively). Almost all study participants living with HIV reported being food insecure. These intersecting risks demonstrate the negative impacts associated with living with HIV, experiencing food insecurity and/or physical or sexual violence. This study also highlights the potential for interventions that address structural inequities (e.g., decriminalizing sex work) to have crosscutting impacts to reduce barriers to accessing necessities (including food) or health and social services (e.g., methadone; primary care).
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Affiliation(s)
- Daniella Barreto
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jeannie Shoveller
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Machat S, Shannon K, Braschel M, Moreheart S, Goldenberg SM. Sex workers' experiences and occupational conditions post-implementation of end-demand criminalization in Metro Vancouver, Canada. Canadian Journal of Public Health 2019; 110:575-583. [PMID: 31183630 DOI: 10.17269/s41997-019-00226-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES In 2014, Canada introduced end-demand criminalization (the Protection of Communities and Exploited Persons Act (PCEPA)), criminalizing purchase of sexual services while leaving the sale of sex legal. We assessed factors correlated with self-reported changes in working conditions post-PCEPA among sex workers (SWs) in Metro Vancouver. METHODS Post-PCEPA data for one year were drawn from a community-based cohort of SWs. We analyzed self-reported changes in working conditions among 299 participants who worked prior to PCEPA and were asked about working conditions post-PCEPA. Multivariate GEE analysis evaluated factors correlated with negative changes post-PCEPA, including reduced capacity to screen clients and reduced access to workspaces/clients. RESULTS Most (72.2%) experienced no change in working conditions, and 26.4% reported negative changes (e.g., reduced ability to screen clients or reduced access to workspaces/clients). Reporting negative changes was correlated with being an im/migrant to Canada (adjusted odds ratio (AOR) 2.79, 95% CI 1.59-4.92) and recent physical workplace violence (AOR 4.01, 95% CI 1.12-14.40). In sub-analysis, physical/sexual workplace violence (AOR 3.77, 95% CI 1.17-12.16) and living in the suburbs of Richmond/Burnaby (AOR 2.81, 95% CI 1.15-6.84) correlated with reduced screening capacity; incarceration (AOR 2.98, 95% CI 1.04-8.57) and being an im/migrant (AOR 2.39, 95% CI 1.14-4.99) correlated with reduced access to workspaces/clients. CONCLUSIONS Most SWs reported no change in working conditions and one quarter reported negative changes, suggesting that PCEPA may be failing to advance sex workers' safety. Im/migrants, women experiencing workplace violence, and those facing criminalization were most likely to report negative impacts. Decriminalization of all aspects of sex work is needed to support well-being, health, and safety.
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Affiliation(s)
- Sylvia Machat
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira M Goldenberg
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA.
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Sou J, Shannon K, Shoveller J, Duff P, Braschel M, Dobrer S, Goldenberg SM. Impacts of im/migration experience on work stress among sex workers in Vancouver, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:344-353. [PMID: 30565164 PMCID: PMC6551268 DOI: 10.17269/s41997-018-0161-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Despite the precarious and unsafe working conditions frequently experienced by sex workers (SWs) and im/migrant workers, there remains a paucity of research on work-related stress and links to duration of im/migration residency among SWs. This study analyzes the relationship between duration of residency and two dimensions of work stress among SWs in Metro Vancouver. METHODS Data were drawn from a longitudinal cohort of women SWs across Metro Vancouver (2010-2014). Multivariable confounder models with generalized estimating equations were developed to examine the independent effects of duration of residency on decision authority and job demands, after adjusting for confounders. RESULTS Of 545 SWs, 9.7% were recent im/migrants, 13.9% were long-term im/migrants, and 76.2% were non-migrants. In comparison to non-migrant SWs, recent (β coefficient - 1.02, 95% CI - 1.57 to - 0.47) and long-term im/migrants (β coefficient - 0.87, 95% CI - 1.36 to -0.38) faced decreased work stress related to job demands after adjustment for key confounders. Decision authority did not retain a significant independent association after adjusting for the same factors. CONCLUSION Job demands varied significantly by duration of residency. This may be explained by changing working conditions and experiences over the course of arrival and settlement among im/migrant SWs, as well as the role of formal work environments in supporting im/migrant SWs' well-being. Given high rates of work stress related to job demands and low decision authority among all SWs, decriminalization of sex work, improved occupational standards, and culturally sensitive interventions to promote collectivization and improved access to working conditions remain needed.
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Affiliation(s)
- Julie Sou
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sabina Dobrer
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira M Goldenberg
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Barker B, Hadland SE, Dong H, Shannon K, Kerr T, DeBeck K. Increased burden of suicidality among young street-involved sex workers who use drugs in Vancouver, Canada. J Public Health (Oxf) 2019; 41:e152-e157. [PMID: 30007367 PMCID: PMC6636686 DOI: 10.1093/pubmed/fdy119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/16/2018] [Accepted: 06/14/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The risks of suicidality among street-involved youth who use drugs and engage in sex work are not well described. This study sought to evaluate if street-involved youth who engage in sex work were at an elevated risk for attempting suicide. METHODS Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth who use drugs in Vancouver, Canada. Multivariable generalized estimating equation analyses were employed to examine whether youth who engaged in sex work were at elevated risk of attempting suicide, controlling for possible confounders. RESULTS Between September 2005 and May 2015, 1210 youth were recruited into the cohort, of whom, 173 (14.3%) reported recently attempting suicide at some point during the study period. In multivariable analysis, youth who engaged in sex work were significantly more likely to report a recent suicide attempt (adjusted odds ratio = 1.93; 95% confidence interval: 1.28-2.91). CONCLUSIONS Street-involved youth who engage in sex work were observed to be at a significantly higher risk for suicidality. Systematic discrimination and unaddressed trauma may contribute to the observed increased burden of suicidality among this population. Interventions that support the mental health and well-being of street-involved youth who engage in sex work are urgently needed.
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Affiliation(s)
- Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Room 270 - 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, Canada
| | - Scott E Hadland
- Department of Pediatrics, Boston Medical Center, 850 Harrison Ave., Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall, Room 322, Boston, MA, USA
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada
| | - Kate Shannon
- Division of AIDS, Department of Medicine, University of British Columbia, #667-1081 Burrard Street, Vancouver, BC, Canada
- Gender and Sexual Health Initiative, St. Paul’s Hospital, #608-1081 Burrard St., Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, #667-1081 Burrard Street, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- School of Public Policy, Simon Fraser University, SFU Harbour Centre, 515 West Hastings Street, Vancouver, BC, Canada
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Beaujolais B, Kaloga M, Karandikar S, Gezinski LB, Kadambari P, Maskey K. Client-Perpetrated Violence Toward Female Sex Workers in Kathmandu. Violence Against Women 2019; 26:249-267. [PMID: 30843761 DOI: 10.1177/1077801219832117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explores the experiences of client-perpetrated violence toward female sex workers in Kathmandu, Nepal. Individual interviews were conducted with 30 female sex workers. Data were analyzed using qualitative coding methods and thematic development. Two main themes emerged. Contexts in which client-perpetrated violence corresponded with (a) conditions associated with exchange of services, and (b) alcohol use. The first theme involved five factors: negotiating condom use, number of clients, requesting payment, length of service time, and negotiating sex acts. Alcohol use by clients and/or sex workers exacerbated violence. Implications for practice and research are discussed.
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Affiliation(s)
| | - Marissa Kaloga
- The Economic and Community Development Institute, Columbus, OH, USA
| | | | | | | | - Kipa Maskey
- Nepal School of Social Work, Kathmandu, Nepal
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Argento E, Goldenberg S, Shannon K. Preventing sexually transmitted and blood borne infections (STBBIs) among sex workers: a critical review of the evidence on determinants and interventions in high-income countries. BMC Infect Dis 2019; 19:212. [PMID: 30832596 PMCID: PMC6399876 DOI: 10.1186/s12879-019-3694-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
Background Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries. Methods We searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited. Results Research demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted. Conclusions The high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.
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Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med 2018; 15:e1002680. [PMID: 30532209 PMCID: PMC6289426 DOI: 10.1371/journal.pmed.1002680] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur. METHODS AND FINDINGS We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. CONCLUSIONS Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.
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