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Vergara CI, Solymosi R. Correlates of Client-Perpetrated Violence Against Female Sex Workers in Bogotá. Violence Against Women 2024; 30:743-767. [PMID: 36482734 PMCID: PMC10854203 DOI: 10.1177/10778012221142919] [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] [Indexed: 12/22/2023]
Abstract
This paper aims to estimate the prevalence of client-perpetrated violence against female sex workers (FSWs) in Bogotá and to understand what structural and environmental factors are associated with such victimization. The project used secondary data from interviews with 2,684 FSWs. Multivariable binary logistic regression was used to test for associations with client-perpetrated violence. Findings reveal that factors such as experiencing police harassment and social stigma were positively associated with client-perpetrated violence. Situational factors such as providing services in motels, hotels, on the street, and in cars were also associated with increased odds of becoming a victim of violence.
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Affiliation(s)
| | - Reka Solymosi
- Department of Criminology, University of Manchester, Manchester, UK
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2
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Wilson A, Jin Y, Xiao C, Yan H, Yu B, Zhai M, Li J, Wang Y. A Confounding Discourse Analysis of Vietnamese Sex Workers' Talk in the City of Kaiyuan, China. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2683-2700. [PMID: 36607518 DOI: 10.1007/s10508-022-02503-4] [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: 03/16/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Vietnamese female sex workers (VFSWs) cross the border into Kaiyuan City, Yunnan Province yearly. However, very little is known about both the health and psychological issues VFSWs experience. The objectives of this study were to explore the dominant discourses that emerged from the VFSWs' talk. The interviews occurred between May 2018 and June 2018 with 20 VFSWs who worked in Kaiyuan City, China. The English translated transcripts were analyzed using an eclectic feminist method of discourse analysis. Two discourses emerged. First, "Agency when working in Karaoke Bars and other Indoor Venues", and second, "Negative Impacts on Psychological Well-being and Other Problems from Migration." As for Discourse 1, the VFSWs positioned themselves as having agency over choosing their clientele as well as agency over what they were willing to negotiate with their clients to establish boundaries of their bodies. As for the Discourse 2, while there was a discourse of agency in their work there was also a contrasting, confounding discourse around the negative impact on psychological well-being and reports of stress as a migrant worker. Discourse 1 and Discourse 2 are confounding. When analyzed together, the discourses suggest that the impacts on psychological well-being may be more related to the migrant status of the women, supporting the notion of systemically influenced agency.
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Affiliation(s)
- Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Zhuhai, China
| | | | - Hong Yan
- School of Public Health, Wuhan University, Wuhan, 430071, China.
| | - Bin Yu
- School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Mengxi Zhai
- School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Jiayu Li
- School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, South China Normal University, Ministry of Education, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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3
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Goldenberg SM, Pearson J, Moreheart S, Nazaroff H, Krüsi A, Braschel M, Bingham B, Shannon K. Prevalence and structural correlates of HIV and STI testing among a community-based cohort of women sex workers in Vancouver Canada. PLoS One 2023; 18:e0283729. [PMID: 36996154 PMCID: PMC10062647 DOI: 10.1371/journal.pone.0283729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In light of the stark inequities in HIV and sexually transmitted infections (STIs) experienced by women sex workers, empirical evidence is needed to inform accessible and sex worker-friendly models of voluntary, confidential and non-coercive HIV and STI testing. We evaluated the prevalence and structural correlates of HIV/STI testing in the last 6 months in a large, community-based cohort of women sex workers in Vancouver, Canada. METHODS Data were drawn from an open community-based open cohort of women sex workers (January 2010-August 2021) working across diverse street, indoor, and online environments in Vancouver, Canada. Using questionnaire data collected by experiential (sex workers) and community-based staff, we measured prevalence and used bivariate and multivariable logistic regression to model correlates of recent HIV/STI testing at enrollment. RESULTS Of 897 participants, 37.2% (n = 334) identified as Indigenous, 31.4% as Women of Color/Black (n = 282), and 31.3% (n = 281) as White. At enrollment, 45.5% (n = 408) reported HIV testing, 44.9% (n = 403) reported STI testing, 32.6% (n = 292) reported receiving both HIV and STI testing, and 57.9% (n = 519) had received an HIV and/or STI test in the last 6 months. In adjusted multivariable analysis, women accessing sex worker-led/specific services had higher odds of recent HIV/STI testing, (Adjusted Odds Ratio (AOR): 1.91, 95% Confidence Interval (CI): 1.33-2.75), whereas Women of Color and Black women (AOR: 0.52, 95%CI: 0.28-0.98) faced significantly lower odds of recent HIV/STI testing. CONCLUSIONS Scaling-up community-based, sex worker-led and tailored services is recommended to enhance voluntary, confidential, and safe access to integrated HIV/STI testing, particularly for Women of Color and Black Women. Culturally safe, multilingual HIV/STI testing services and broader efforts to address systemic racism within and beyond the health system are needed to reduce inequities and promote safe engagement in services for racialized sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Hannah Nazaroff
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Brittany Bingham
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Indigenous Health, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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4
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Pearson J, Machat S, McDermid J, Goldenberg SM, Krüsi A. An Evaluation of Indoor Sex Workers' Sexual Health Access in Metro Vancouver: Applying an Occupational Health & Safety Lens in the Context of Criminalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1857. [PMID: 36767222 PMCID: PMC9914303 DOI: 10.3390/ijerph20031857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The criminalization of sex work has been consistently shown to undermine workers' Occupational Health and Safety (OHS), including sexual health. Drawing on the 'Guide to OHS in the New Zealand Sex Industry' (the Guide), we assessed barriers to sexual health best practices among indoor sex workers in Metro Vancouver, Canada, in the context of ongoing criminalization. Part of a longstanding community-based study, this analysis drew on 47 qualitative interviews (2017-2018) with indoor sex workers and third parties. Participants' narratives were analyzed drawing on a social determinants of health framework and on the Guide with specific focus on sexual health. Our findings suggest that sex workers and third parties utilize many sexual health strategies, including use of Personal Protective Equipment (PPE) and peer-driven sexual health education. However, participant narratives demonstrate how structural factors such as criminalization, immigration, and stigma limit the accessibility of additional OHS best practices outlined in the Guide and beyond, including access to non-stigmatizing sexual health assessments, and distribution of diverse PPE by third parties. Our current study supports the need for full decriminalization of sex work, including im/migrant sex work, to allow for the uptake of OHS guidelines that support the wellbeing and autonomy of all sex workers.
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Affiliation(s)
- Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Sylvia Machat
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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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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West BS, Henry BF, Agah N, Vera A, Beletsky L, Rangel MG, Staines H, Patterson TL, Strathdee SA. Typologies and Correlates of Police Violence Against Female Sex Workers Who Inject Drugs at the México-United States Border: Limits of De Jure Decriminalization in Advancing Health and Human Rights. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8297-NP8324. [PMID: 33261533 PMCID: PMC8166925 DOI: 10.1177/0886260520975820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Decriminalization of sex work is increasingly promoted as a structural measure to improve the health of vulnerable groups. In México, sex work is not illegal, but knowledge of policies' street-level impact is limited. This study describes typologies of police violence against female sex workers who inject drugs (FSWID), identifying risk and protective factors for violence exposure to inform policy responses. Survey data were collected during 2008-2010 among HIV-negative FSWID in a behavioral intervention in Tijuana and Ciudad Juarez (N = 584). Latent class analysis identified typologies of police violence in the past 6 months: asked for money, money taken, syringes taken, asked for sex, and sexually assaulted. Structural equation modeling (SEM) predicted latent class membership using sociodemographic, behavioral and risk environment factors, controlling for age, education, marital status, and city. Recent police violence was reported by 68% of FSWID, with three typologies emerging: Low (36.6%); Material (47.8%): having money/syringes taken or being asked for money; and Material/Sexual (15.7%): material violence and being asked for sex or sexually assaulted. In multivariable SEM, Material Violence was associated with: being jailed [adjusted Odds Ratio (aOR) = 4.34], HIV testing (aOR = 2.18), and trading sex indoors (aOR = 1.66). Factors associated with Material/Sexual Violence included: being jailed (aOR = 41.18), injecting with clients (aOR = 3.12), earning more money for sex without a condom (aOR = 2.88), being raped by a client (aOR = 2.13), drinking with clients (aOR = 2.03), receiving substance use treatment (aOR = 1.95), being <18 when first trading sex (aOR = .43), trading sex outdoors (aOR = .53), and poor working conditions (aOR = .56). Despite de jure decriminalization of sex work, police violence against FSWID at the México-United States border is pervasive with implications for sex- and drug-related harms. Closing gaps in policy implementation and mitigating material/sexual violence from police is imperative to decreasing economic vulnerability, risk of overdose and HIV, and improving engagement in HIV and harm reduction services.
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Affiliation(s)
| | | | - Niloufar Agah
- University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- University of California San Diego, La Jolla, CA, USA
| | - Leo Beletsky
- University of California San Diego, La Jolla, CA, USA
| | | | - Hugo Staines
- Universidad Autónoma de Ciudad Juárez, Chihuahua, México
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O'Doherty L, Carter G, Lutman-White E, Caswell R, Jackson LJ, Feder G, Heron J, Morris R, Brown K. Multi-disciplinary Evaluation of Sexual Assault Referral Centres (SARCs) for better Health (MESARCH): protocol for a 1-year cohort study examining health, well-being and cost outcomes in adult survivors of sexual assault attending SARCs in England. BMJ Open 2022; 12:e057449. [PMID: 35613767 PMCID: PMC9131084 DOI: 10.1136/bmjopen-2021-057449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Sexual violence is commonplace and has serious adverse consequences for physical and mental health. Sexual Assault Referral Centres (SARCs) are viewed as a best practice response. Little is known about their effectiveness and cost-effectiveness. Long-term data on the health and well-being of those who have experienced rape and sexual assault are also lacking. METHODS AND ANALYSIS This is a mixed-methods protocol for a 1-year cohort study aiming to examine the health and well-being in survivors of sexual violence after attending a SARC in England. Quantitative measures are being taken at baseline, 6 and 12 months. Post-traumatic stress (PTS) is the primary outcome (target N=270 at 12-month follow-up). Secondary measures include anxiety, depression, substance use and sexual health and well-being. Using mixed-effects regression, our main analysis will examine whether variation in SARC service delivery and subsequent mental healthcare is associated with improvement in trauma symptoms after 12 months. An economic analysis will compare costs and outcomes associated with different organisational aspects of SARC service delivery and levels of satisfaction with care. A nested qualitative study will employ narrative analysis of transcribed interviews with 30 cohort participants and 20 survivors who have not experienced SARC services. ETHICS AND DISSEMINATION The research is supported by an independent study steering committee, data monitoring and ethics committee and patient and public involvement (PPI) group. A central guiding principle of the research is that being involved should feel diametrically opposed to being a victim of sexual violence, and be experienced as empowering and supportive. Our PPI representatives are instrumental in this, and our wider stakeholders encourage us to consider the health and well-being of all involved. We will disseminate widely through peer-reviewed articles and non-academic channels to maximise the impact of findings on commissioning of services and support for survivors. TRIAL REGISTRATION NUMBER ISRCTN30846825.
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Affiliation(s)
- Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Grace Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | | | - Rachel Caswell
- Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Gene Feder
- Community Based Medicine, University of Bristol, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | - Richard Morris
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Katherine Brown
- Department of Psychology, Sports Science and Geography, University of Hertfordshire, Hatfield, UK
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Machat S, Lyons T, Braschel M, Shannon K, Goldenberg S. Internet solicitation linked to enhanced occupational health and safety outcomes among sex workers in Metro Vancouver, Canada 2010-2019. Occup Environ Med 2022; 79:373-379. [PMID: 35149596 DOI: 10.1136/oemed-2021-107429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/18/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Examine the independent association between online solicitation and sex workers' (SWs') occupational health and safety (OHS), particularly violence and work stress. METHODS Data were drawn from a cohort of women SWs (N=942, 2010-2019) in Vancouver, Canada. Analyses used descriptive statistics and bivariate and multivariable logistic and linear regression using generalised estimating equations (GEE); explanatory and confounder modelling approaches were used. RESULTS 33.9% (n=319) of participants solicited online and 14.1% (n=133) primarily solicited online in the last 6 months in at least one study visit. In multivariable GEE analysis, factors associated with primarily soliciting online included younger age (adjusted OR (AOR) 0.95 per year older, 95% CI 0.93 to 0.97), sexual minority status (AOR 2.57, 95% CI 1.61 to 4.10), gender minority status (AOR 3.09, 95% CI 1.80 to 5.28), higher education (AOR 2.13, 95% CI 1.34 to 3.40), higher sex work income (AOR 1.03 per $100 weekly, 95% CI 1.01 to 1.06), being an im/migrant to Canada (AOR 2.40, 95% CI 1.26 to 4.58) and primarily servicing in informal indoor workspaces (AOR 3.47, 95% CI 2.32 to 5.20). In separate GEE confounder models, primarily soliciting online significantly (1) reduced odds of physical/sexual workplace violence (AOR 0.64, 95% CI 0.39 to 1.06) and (2) reduced work stress (β coefficient -0.93, 95% CI -1.59 to -0.26). DISCUSSION/CONCLUSIONS Younger workers, gender/sexual minorities, im/migrants and those in informal indoor spaces had higher odds of soliciting online. Confounder models indicate access to online solicitation methods may support enhanced OHS. Decriminalisation of sex work-including advertising via online platforms-remains necessary to support SWs' OHS.
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Affiliation(s)
- Sylvia Machat
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Tara Lyons
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.,Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Melissa Braschel
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Kate Shannon
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada .,School of Public Health, San Diego State University, San Diego, California, USA
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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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10
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McBride B, Shannon K, Murphy A, Wu S, Erickson M, Goldenberg SM, Krüsi A. Harms of third party criminalisation under end-demand legislation: undermining sex workers' safety and rights. CULTURE, HEALTH & SEXUALITY 2021; 23:1165-1181. [PMID: 32744171 PMCID: PMC7855821 DOI: 10.1080/13691058.2020.1767305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
After Canada's laws criminalising sex work were struck down by the Supreme Court for violating sex workers' rights and new end-demand legislation was passed in 2014. These new laws however continue to criminalise sex work third parties (i.e. venue owners/managers) who gain material benefits, despite evidence that managed in-call venues can provide important protections for sex workers. As part of a longstanding community-based study in Vancouver, this analysis drew on 25 in-depth interviews with third parties who provide services for indoor sex workers. We explored how end-demand third party criminalisation shapes indoor sex workers' working conditions, health and safety. We found that most third parties were women and current/former sex workers, problematising assumptions of third parties as exploitative male "pimps". Third parties provided client screening, security and sexual health resources for sex workers, yet end-demand laws restricted condom availability and access to police protections in case of violence, thereby undermining sex workers' health and safety. Our findings highlight that third party criminalisation under end-demand legislation reproduces the unsafe working conditions under the previous laws deemed unconstitutional by Canada's highest court. Legislative reforms to decriminalise all aspects of the sex industry, including sex workers' right to work with third parties, are urgently needed.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Alka Murphy
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Sherry Wu
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Margaret Erickson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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Rivera AV, Carrillo SA, Braunstein SL. Individual, Environmental, and Early Life Factors Associated With Client-Perpetrated Violence Among Women Who Exchange Sex in New York City, 2016. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP6065-NP6084. [PMID: 30461341 DOI: 10.1177/0886260518811422] [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] [Indexed: 06/09/2023]
Abstract
Women who exchange sex are at an increased risk of violence from both clients and nonpaying intimate partners. This study utilizes data from the 2016 New York City National HIV Behavioral Surveillance Study cycle focused on high-risk women to examine factors associated with experiencing client-perpetrated violence (CPV). Women who exchanged sex for money or drugs (n = 330) were recruited via respondent-driven sampling. Adjusted log-linked Poisson regression was used to analyze individual, environmental, and early-life factors associated with experiencing CPV in the past 12 months. Compared with women who did not experience CPV, women who experienced CPV were more likely to have a household income of <$10,000 (adjusted prevalence ratio [aPR]: 2.15; 95% confidence interval [CI]: [1.29, 3.57]), have a same-sex partnership (aPR: 2.31; 95% CI: [1.23, 4.33]), have > 2 male exchange sex partners (aPR: 2.76; 95% CI: [1.28, 5.99]), find clients on the street (aPR: 2.10; 95% CI: [1.05, 3.99]), have been refused help from or avoided the police due to exchange sex (aPR: 1.88; 95% CI: [1.06, 3.32]) and to have experienced sexual violence as a minor (aPR: 2.16; 95% CI: [1.29, 3.30]). Multilevel approaches to violence prevention among women who exchange sex, particularly those who find clients on the street, should be considered.
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Affiliation(s)
- Alexis V Rivera
- New York City Department of Health and Mental Hygiene, Long Island City, USA
| | - Sidney A Carrillo
- New York City Department of Health and Mental Hygiene, Long Island City, USA
| | - Sarah L Braunstein
- New York City Department of Health and Mental Hygiene, Long Island City, USA
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12
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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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13
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Lora WS, Desmond N, Obasi A, Kumwenda M, Taegtmeyer M, Tolhurst R, MacPherson EE. "I wanted evidence that my status had changed, so that is why I tested": experiences with HIV self-testing among female sex workers in Malawi. AIDS Care 2020; 32:206-213. [PMID: 32164420 DOI: 10.1080/09540121.2020.1739212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
HIV testing among female sex workers (FSWs) is an established global health priority. HIV self-testing (HIVST) seems to have the potential to address issues of confidentiality, privacy and convenience among this key population. HIVST, however, may result in unintended consequences as its implementation unfolds in a complex sex work context characterised by unequal power relations, stigma and high HIV prevalence. We aimed to explore the experiences of FSWs with HIVST in the context of retesting and antiretroviral usage in Blantyre, Malawi. We used an ethnographic approach to understand meanings and views around HIVST and retesting. We found high levels of retesting, especially among those on antiretroviral, two of which received "false-negative" results. We identified three broad narratives: (1) retesting in response to experiences in the sex work context, (2) retesting driven by the desire to self-monitor HIV-negative status, and (3) retesting in the hope of sero-reversion. The FSWs' experiences indicate that the implementation of HIVST in this context is complex with potential for unintended harms such as coercive testing. HIVST programmes must include clear and appropriate messaging to reduce retesting while on ART and implement strategies to address FSW concerns and anxieties about the accuracy of their HIV-positive test results.
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Affiliation(s)
- Wezzie S Lora
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Behaviour and Health, Malawi Liverpool Wellcome Trust-Clinical Research Programme, Blantyre, Malawi.,Faculty of Life Sciences, University of Liverpool, Liverpool, UK
| | - Nicola Desmond
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Behaviour and Health, Malawi Liverpool Wellcome Trust-Clinical Research Programme, Blantyre, Malawi
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moses Kumwenda
- Behaviour and Health, Malawi Liverpool Wellcome Trust-Clinical Research Programme, Blantyre, Malawi
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eleanor E MacPherson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Behaviour and Health, Malawi Liverpool Wellcome Trust-Clinical Research Programme, Blantyre, Malawi
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14
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Ranjan A, Shannon K, Chettiar J, Braschel M, Ti L, Goldenberg S. Barriers and facilitators to hepatitis B vaccination among sex workers in Vancouver, Canada: Implications for integrated HIV, STI, and viral hepatitis services. Int J Infect Dis 2019; 87:170-176. [PMID: 31404673 DOI: 10.1016/j.ijid.2019.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. METHODS Questionnaire data were drawn from a community-based cohort of SWs (2010-2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination. RESULTS Among 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32-0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27- 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14-3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26-2.97) and recent STI testing (AOR 2.95, 95% CI 1.99-4.39) correlated with recent HBV vaccination. CONCLUSIONS Im/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.
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Affiliation(s)
- Anuisa Ranjan
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Chettiar
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - Lianping Ti
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use (BCCSU), Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Global Public Health, University of California, La Jolla, CA, USA
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15
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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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16
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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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17
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McBride B, Goldenberg SM, Murphy A, Wu S, Braschel M, Krüsi A, Shannon K. Third Parties (Venue Owners, Managers, Security, etc.) and Access to Occupational Health and Safety Among Sex Workers in a Canadian Setting: 2010-2016. Am J Public Health 2019; 109:792-798. [PMID: 30897001 DOI: 10.2105/ajph.2019.304994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the impact of engagement with third parties (i.e., managers, receptionists, or owners of in-call venues; advertisers; security; spotters; and others) on sex workers' occupational health access. METHODS We drew longitudinal data from An Evaluation of Sex Workers' Health Access, a community-based cohort of more than 900 women sex workers. We used multivariable logistic regression and generalized estimating equations to (1) examine factors correlated with accessing third-party administrative or security services and (2) evaluate the impact of third-party services on access to mobile condom distribution and sex worker and community-led services (2010-2016). Finally, we evaluated changes in accessing third-party services pre-post end-demand criminalization (2010-2017). RESULTS Im/migrant sex workers (persons with any type of legal status who were born in another country; adjusted odds ratio [AOR] = 2.32; 95% confidence interval [CI] = 1.35, 3.98) had higher odds of accessing third-party services. In confounder models, third-party services were independently correlated with increased access to mobile condom distribution (AOR = 1.84; 95% CI = 1.47, 2.31) and sex worker and community-led services (AOR = 1.61; 95% CI = 1.15, 2.24). End-demand criminalization was linked to a decrease in access to third-party services (AOR = 0.79; 95% CI = 0.63, 0.99). CONCLUSIONS This research suggests that access to administrative and security services from third parties increases sex workers' occupational health and safety. Policy reforms to ensure sex workers' labor rights, including access to hiring third parties, are recommended.
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Affiliation(s)
- Bronwyn McBride
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Shira M Goldenberg
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Alka Murphy
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Sherry Wu
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Melissa Braschel
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Andrea Krüsi
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Kate Shannon
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
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18
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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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19
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Duff P, Sou J, Chapman J, Dobrer S, Braschel M, Goldenberg S, Shannon K. Poor working conditions and work stress among Canadian sex workers. Occup Med (Lond) 2018; 67:515-521. [PMID: 29016896 DOI: 10.1093/occmed/kqx092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background While sex work is often considered the world's oldest profession, there remains a dearth of research on work stress among sex workers (SWs) in occupational health epidemiological literature. A better understanding of the drivers of work stress among SWs is needed to inform sex work policy, workplace models and standards. Aims To examine the factors that influence work stress among SWs in Metro Vancouver. Methods Analyses drew from a longitudinal cohort of SWs, known as An Evaluation of Sex Workers' Health Access (AESHA) (2010-14). A modified standardized 'work stress' scale, multivariable linear regression with generalized estimating equations was used to longitudinally examine the factors associated with work stress. Results In multivariable analysis, poor working conditions were associated with increased work stress and included workplace physical/sexual violence (β = 0.18; 95% confidence interval (CI) 0.06, 0.29), displacement due to police (β = 0.26; 95% CI 0.14, 0.38), working in public spaces (β = 0.73; 95% CI 0.61, 0.84). Older (β = -0.02; 95% CI -0.03, -0.01) and Indigenous SWs experienced lower work stress (β = -0.25; 95% CI -0.43, -0.08), whereas non-injection (β = 0.32; 95% CI 0.14, 0.49) and injection drug users (β = 0.17; 95% CI 0.03, 0.31) had higher work stress. Conclusions Vancouver-based SWs' work stress was largely shaped by poor work conditions, such as violence, policing, lack of safe workspaces. There is a need to move away from criminalized approaches which shape unsafe work conditions and increase work stress for SWs. Policies that promote SWs' access to the same occupational health, safety and human rights standards as workers in other labour sectors are also needed.
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Affiliation(s)
- P Duff
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - J Sou
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, British Columbia V6T 1Z3, Canada
| | - J Chapman
- Sex Workers United Against Violence, Vancouver, British Columbia, Canada
| | - S Dobrer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - M Braschel
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - S Goldenberg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - K Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, British Columbia V6T 1Z3, Canada
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20
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Lyons T, Krüsi A, Pierre L, Small W, Shannon K. THE IMPACT OF CONSTRUCTION AND GENTRIFICATION ON AN OUTDOOR TRANS SEX WORK ENVIRONMENT: VIOLENCE, DISPLACEMENT AND POLICING. SEXUALITIES 2017; 20:881-903. [PMID: 29379380 PMCID: PMC5786169 DOI: 10.1177/1363460716676990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this study was to investigate how environmental and structural changes to a trans outdoor work environment impacted sex workers in Vancouver, Canada. The issue of changes to the work area arose during qualitative interviews with 33 trans sex workers. In response, ethnographic walks that incorporated photography were undertaken with trans sex workers. Changes to the work environment were found to increase vulnerabilities to client violence, displace trans sex workers, and affect policing practices. Within a criminalized context, construction and gentrification enhanced vulnerabilities to violence and harassment from police and residents.
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Affiliation(s)
- Tara Lyons
- Kwantlen Polytechnic University, Surrey, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Andrea Krüsi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Leslie Pierre
- Providing Alternatives, Counselling & Education (PACE) Society, Vancouver, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Simon Fraser University, Burnaby, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
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Sou J, Goldenberg SM, Duff P, Nguyen P, Shoveller J, Shannon K. Recent im/migration to Canada linked to unmet health needs among sex workers in Vancouver, Canada: Findings of a longitudinal study. Health Care Women Int 2017; 38:492-506. [PMID: 28300492 DOI: 10.1080/07399332.2017.1296842] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite universal health care in Canada, sex workers (SWs) and im/migrants experience suboptimal health care access. In this analysis, we examined the correlates of unmet health needs among SWs in Metro Vancouver over time. Data from a longitudinal cohort of women SWs (An Evaluation of Sex Workers Health Access [AESHA]) were used. Of 742 SWs, 25.5% reported unmet health needs at least once over the 4-year study period. In multivariable logistic regression using generalized estimating equations, recent im/migration had the strongest impact on unmet health needs; long-term im/migration, policing, and trauma were also important determinants. Legal and social supports to promote im/migrant SWs' access to health care are recommended.
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Affiliation(s)
- Julie Sou
- a Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, British Columbia , Canada.,b School of Population and Public Health, University of British Columbia , Vancouver, British Columbia , Canada
| | - Shira M Goldenberg
- a Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, British Columbia , Canada.,c Faculty of Health Sciences, Simon Fraser University , Burnaby, British Columbia , Canada
| | - Putu Duff
- a Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, British Columbia , Canada.,d Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver, British Columbia , Canada
| | - Paul Nguyen
- a Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, British Columbia , Canada
| | - Jean Shoveller
- b School of Population and Public Health, University of British Columbia , Vancouver, British Columbia , Canada
| | - Kate Shannon
- a Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, British Columbia , Canada.,b School of Population and Public Health, University of British Columbia , Vancouver, British Columbia , Canada.,d Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver, British Columbia , Canada
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Goldenberg SM, Krüsi A, Zhang E, Chettiar J, Shannon K. Structural Determinants of Health among Im/Migrants in the Indoor Sex Industry: Experiences of Workers and Managers/Owners in Metropolitan Vancouver. PLoS One 2017; 12:e0170642. [PMID: 28141835 PMCID: PMC5283672 DOI: 10.1371/journal.pone.0170642] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 01/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background Globally, im/migrant women are overrepresented in the sex industry and experience disproportionate health inequities. Despite evidence that the health impacts of migration may vary according to the timing and stage of migration (e.g., early arrival vs. long-term migration), limited evidence exists regarding social and structural determinants of health across different stages of migration, especially among im/migrants engaged in sex work. Our aim was to describe and analyze the evolving social and structural determinants of health and safety across the arrival and settlement process for im/migrants in the indoor sex industry. Methods We analyzed qualitative interviews conducted with 44 im/migrant sex workers and managers/owners working in indoor sex establishments (e.g., massage parlours, micro-brothels) in Metropolitan Vancouver, Canada in 2011; quantitative data from AESHA, a larger community-based cohort, were used to describe socio-demographic and social and structural characteristics of im/migrant sex workers. Results Based on quantitative data among 198 im/migrant workers in AESHA, 78.3% were Chinese-born, the median duration in Canada was 6 years, and most (86.4%) serviced clients in formal indoor establishments. Qualitative narratives revealed diverse pathways into sex work upon arrival to Canada, including language barriers to conventional labour markets and the higher pay and relative flexibility of sex work. Once engaged in sex work, fear associated with police raids (e.g., immigration concerns, sex work disclosure) and language barriers to sexual negotiation and health, social and legal supports posed pervasive challenges to health, safety and human rights during long-term settlement in Canada. Conclusions Findings highlight the critical influences of criminalization, language barriers, and stigma and discrimination related to sex work and im/migrant status in shaping occupational health and safety for im/migrants engaged in sex work. Interventions and policy reforms that emphasize human rights and occupational health are needed to promote health and wellbeing across the arrival and settlement process.
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Affiliation(s)
- Shira M. Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
- * E-mail:
| | - Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Emma Zhang
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
| | - Jill Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, B.C., Canada
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23
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Van Bavel H. Beyond exploitation: towards a nuanced understanding of agency for adolescent female sex workers - evidence from Zanzibar and Morogoro. CULTURE, HEALTH & SEXUALITY 2017; 19:76-90. [PMID: 27426679 DOI: 10.1080/13691058.2016.1207253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study examines how young women sex workers exercise agency when entering prostitution, coping with occupational health problems and accessing healthcare services. It was conducted at two sites in Tanzania: Morogoro on Tanzania's mainland and Stone Town on Zanzibar Island. A total of 19 in-depth interviews were conducted with female sex workers who were 18-years old or younger at the time of entry into prostitution and 12 key informant interviews with sex workers who were 19 or older at the time of entry into prostitution. Eight key informant interviews were held with the peer educators and staff of ZAYEDESA, a sex worker organization on Zanzibar. The findings show that agency is more constrained for adolescent sex workers compared to adult sex workers. However, younger sex workers find coping strategies to navigate within the constraints that compromise their agency, reflecting different positions on the agency spectrum, ranging from reconciliation, via negotiation, to actual individual or collective agency. Adolescent sex worker agency is often severely compromised; however, it is still present and should not be ignored. Rather, it should inspire the design and implementation of harm reduction and rehabilitative interventions that address the needs of young sex workers in their particular situation.
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Anderson S, Shannon K, Li J, Lee Y, Chettiar J, Goldenberg S, Krüsi A. Condoms and sexual health education as evidence: impact of criminalization of in-call venues and managers on migrant sex workers access to HIV/STI prevention in a Canadian setting. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:30. [PMID: 27855677 PMCID: PMC5114757 DOI: 10.1186/s12914-016-0104-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
Background Despite a large body of evidence globally demonstrating that the criminalization of sex workers increases HIV/STI risks, we know far less about the impact of criminalization and policing of managers and in-call establishments on HIV/STI prevention among sex workers, and even less so among migrant sex workers. Methods Analysis draws on ethnographic fieldwork and 46 qualitative interviews with migrant sex workers, managers and business owners of in-call sex work venues in Metro Vancouver, Canada. Results The criminalization of in-call venues and third parties explicitly limits sex workers’ access to HIV/STI prevention, including manager restrictions on condoms and limited onsite access to sexual health information and HIV/STI testing. With limited labour protections and socio-cultural barriers, criminalization and policing undermine the health and human rights of migrant sex workers working in –call venues. Conclusions This research supports growing evidence-based calls for decriminalization of sex work, including the removal of criminal sanctions targeting third parties and in-call venues, alongside programs and policies that better protect the working conditions of migrant sex workers as critical to HIV/STI prevention and human rights.
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Affiliation(s)
- S Anderson
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - K Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Medicine, Univeristy of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
| | - J Li
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Y Lee
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - J Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - S Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - A Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Medicine, Univeristy of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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Goldenberg SM, Liu V, Nguyen P, Chettiar J, Shannon K. International migration from non-endemic settings as a protective factor for HIV/STI risk among female sex workers in Vancouver, Canada. J Immigr Minor Health 2016; 17:21-8. [PMID: 24700025 DOI: 10.1007/s10903-014-0011-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given heterogeneous evidence regarding the impacts of migration on HIV/sexually transmitted infections (STIs) among female sex workers (FSWs), we explored factors associated with international migration among FSWs in Vancouver, Canada. We draw on baseline questionnaire and HIV/STI testing data from a community-based cohort, AESHA, from 2010-2012. Logistic regression identified correlates of international migration. Of 650 FSWs, 163 (25.1%) were international migrants, who primarily worked in formal indoor establishments. HIV/STI prevalence was lower among migrants than Canadian-born women (5.5 vs. 25.9%). In multivariate analysis, international migration was positively associated with completing high school, supporting dependents, and paying a third party, and negatively associated with HIV, injecting drugs and inconsistent condom use with clients. Although migrants experience lower workplace harms and HIV risk than Canadian-born women, they face concerning levels of violence, police harassment, and HIV/STIs. Research exploring structural and socio-cultural factors shaping risk mitigation and migrants' access to support remains needed.
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Affiliation(s)
- Shira M Goldenberg
- Gender and Sexual Health Initiative, St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
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Goldenberg SM, Brouwer KC, Jimenez TR, Miranda SM, Mindt MR. Enhancing the Ethical Conduct of HIV Research with Migrant Sex Workers: Human Rights, Policy, and Social Contextual Influences. PLoS One 2016; 11:e0155048. [PMID: 27159157 PMCID: PMC4861265 DOI: 10.1371/journal.pone.0155048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Migrant sex workers are often highly marginalized and disproportionately experience health and social inequities, including high prevalence of HIV, sexually transmitted infections, and human rights violations. In recent years, research involving migrant sex workers has increased, yet many knowledge gaps remain regarding how best to protect research participant rights and welfare. Our objective was to identify key challenges and opportunities related to the responsible conduct of HIV research with migrant sex workers. METHODS Focus groups and interviews conducted with 33 female sex workers ≥18 years old at the Guatemala-Mexico border from June 2013-February 2014 were analyzed. Participants were recruited through community outreach by a local HIV prevention organization to sex work establishments such as bars, hotels, street corners, and truck stops. RESULTS Key themes influencing research engagement for migrant sex workers included researcher mistrust and fear related to research participation, rooted in the social isolation frequently faced by recent migrants; intersecting concerns related to immigration status, fear of criminalization, and compliance with sex work regulations; and perceived benefits and risks of HIV/STI testing for migrants (e.g., immigration implications, stigma) represent potential barriers and opportunities for the responsible conduct of research involving migrant sex workers. CONCLUSIONS Results highlight the intersection between the human rights vulnerabilities of migrant sex workers and barriers to research participation, including social isolation of migrants and policy/legal barriers related to immigration and sex work. Findings illustrate the need for researchers to develop population-tailored procedures to address fears related to immigration and criminalization, and to reinforce positive and non-stigmatizing relationships with migrant sex workers. Community-led efforts to reduce stigma and foster community organization and supports for migrant sex workers are recommended, as are broader policy shifts that move away from punitive legal approaches towards approaches that safeguard and prioritize the human rights of migrant sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, 608–1081 Burrard Street (St. Paul's Hospital), Vancouver, BC, V6Z 1Y6, Canada
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | - Teresita Rocha Jimenez
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | | | - Monica Rivera Mindt
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
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Abstract
In light of the emphasis on enforcement-based approaches towards sex work, and the well-known negative impacts of these approaches on women's health, safety and well-being, we conducted a study to investigate the prevalence and correlates of recent incarceration among a cohort of women sex workers in Vancouver, Canada. Data were obtained from an open prospective community cohort of female and transgender women sex workers, known as An Evaluation of Sex Workers' Health Access (AESHA). Bivariate and multivariable logistic regression analyses, using generalized estimating equations (GEE), were used to model the effect of social and structural factors on the likelihood of incarceration over the 44-month follow-up period (January 2010-August 2013). Among 720 sex workers, 62.5 % (n = 450) reported being incarcerated in their lifetime and 23.9 % (n = 172) being incarcerated at least once during the study period. Of the 172 participants, about one third (36.6 %) reported multiple episodes of incarceration. In multivariable GEE analyses, younger age (adjusted odds ratio [AOR] = 1.04 per year younger, 95 % confidence interval [CI] 1.02-1.06), being of a sexual/gender minority (AOR = 1.62, 95 % CI 1.13-2.34), heavy drinking (AOR = 1.99, 95 % CI 1.20-3.29), being born in Canada (AOR = 3.28, 95 % CI 1.26-8.53), living in unstable housing conditions (AOR = 4.32, 95 % CI 2.17-8.62), servicing clients in public spaces (versus formal sex work establishments) (AOR = 2.33, 95 % CI 1.05-5.17) and experiencing police harassment without arrest (AOR = 1.82, 95 % CI 1.35-2.45) remain independently correlated with incarceration. This prospective study found a very high prevalence and frequency of incarceration among women sex workers in Vancouver, Canada, with the most vulnerable and marginalized women at increased risk of incarceration. Given the well-known social and health harms associated with incarceration, and associations between police harassment and incarceration in this study, our findings further add to growing calls to move away from criminalized and enforcement-based approaches to sex work in Canada and globally.
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Duff P, Shoveller J, Dobrer S, Ogilvie G, Montaner J, Chettiar J, Shannon K. The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale. J Epidemiol Community Health 2015; 69:666-72. [PMID: 25678713 PMCID: PMC4675653 DOI: 10.1136/jech-2014-204427] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/23/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to report on a newly developed Safer Indoor Work Environmental Scale that characterises the social, policy and physical features of indoor venues and social cohesion; and using this scale, longitudinally evaluate the association between these features on sex workers' (SWs') condom use for pregnancy prevention. METHODS Drawing on a prospective open cohort of female SWs working in indoor venues, a newly developed Safer Indoor Work Environment Scale was used to build six multivariable models with generalised estimating equations (GEE), to determine the independent effects of social, policy and physical venue-based features and social cohesion on condom use. RESULTS Of 588 indoor SWs, 63.6% used condoms for pregnancy prevention in the last month. In multivariable GEE analysis, the following venue-based features were significantly correlated with barrier contraceptive use for pregnancy prevention: managerial practices and venue safety policies (adjusted OR (AOR)=1.09; 95% CI 1.01 to 1.17), access to sexual and reproductive health services/supplies (AOR=1.10; 95% CI 1.00 to 1.20), access to drug harm reduction (AOR=1.13; 95% CI 1.01 to 1.28) and social cohesion among workers (AOR=1.05; 95% CI 1.03 to 1.07). Access to security features was marginally associated with condom use (AOR=1.13; 95% CI 0.99 to 1.29). CONCLUSIONS The findings of the current study highlight how work environment and social cohesion among SWs are related to improved condom use. Given global calls for the decriminalisation of sex work, and potential legislative reforms in Canada, this study points to the critical need for new institutional arrangements (eg, legal and regulatory frameworks; labour standards) to support safer sex workplaces.
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Affiliation(s)
- Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Sabina Dobrer
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, CANADA, V5Z 454
| | - Julio Montaner
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Jill Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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Goldenberg SM, Mindt MR, Jimenez TR, Brouwer KC, Miranda SM, Fisher. CB. Structural and Interpersonal Benefits and Risks of Participation in HIV Research: Perspectives of Female Sex Workers in Guatemala. ETHICS & BEHAVIOR 2014; 25:97-114. [PMID: 27840564 PMCID: PMC5104274 DOI: 10.1080/10508422.2014.950270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study explored perceived benefits and risks of participation in HIV research among 33 female sex workers in Tecun Uman, Guatemala. Stigma associated with sex work and HIV was a critical barrier to research participation. Key benefits of participation included access to HIV/STI prevention and testing, as well as positive and trusting relationships between sex workers and research teams. Control exerted by managers had mixed influences on perceived research risks and benefits. Results underscore the critical need for HIV investigators to develop population-tailored procedures to reduce stigma, engage managers, and reinforce trusting, reciprocal relationships between sex work communities and researchers.
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Affiliation(s)
- Shira M. Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia [608 -1081 Burrard Street (St. Paul's Hospital), Vancouver, BC, CANADA, V6Z 1Y6]
- HIV Prevention Ethics Institute, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
| | - Monica Rivera Mindt
- HIV Prevention Ethics Institute, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
- Department of Psychology, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
| | - Teresita Rocha Jimenez
- Division of Global Public Health, University of California, San Diego [9500 Gilman Drive, La Jolla, CA, USA, 92093-0507]
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California, San Diego [9500 Gilman Drive, La Jolla, CA, USA, 92093-0507]
| | - Sonia Morales Miranda
- Centro de Estudios en Salud, Unidad de VIH, Universidad del Valle de Guatemal [Vista Hermosa III, Guatamala City, GUATEMALA]
| | - Celia B. Fisher.
- HIV Prevention Ethics Institute, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
- Department of Psychology, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
- Center for Ethics Education, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
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