Women in the sex trade whose economic and social base are urban streets face multiple dangers of predation, isolation, and illness. A Mobile Access Project (MAP) to provide emergency medical help, peer counseling, condoms and clean needles, resource information and referral, and a place of respite and safety was initiated for sex trade workers in Vancouver, British Columbia, Canada. We conducted surveys with 100 women sex workers who accessed MAP services and reviewed MAP logbooks to document use of services. We assessed the impact of MAP through review of data from a concurrent cohort study of injection drug users and a survey of 97 women at a drop-in center in the Downtown Eastside. Over 90% of MAP clients reported that the van made them feel safer on the street. Sixteen percent of surveyed MAP clients recalled a specific incident in which the van's presence protected them from a physical assault and 10% recalled an incident when its presence had prevented a sexual assault. Distribution of needles and condoms has increased steadily since the implementation of MAP. Eighty percent of women surveyed at a drop-in center in the Downtown Eastside had received services from MAP. The peer-led Mobile Access Project has emerged as a viable harm reduction strategy for serving the immediate health and trauma-related needs of women engaged in street-level sex work.

Many studies of exit from sex work are inspired by role theory, where people experience a lack of attachment to a role; are faced with individual, interactional, and structural challenges; contemplate transition and exit a role; and then struggle to establish postrole identities and new lives. This framework has been used to explicate the factors and experiences of those who leave or attempt to leave the sex industry; however, it is limited because studies present sex work as a harmful and dangerous profession that people are trapped in, escaping, or have survived. In this paper, I discuss Vancouver's history of violence against sex workers and I review research on sex work exiting and bring forward recommendations for the design of exit program based on the experiences of 22 active and former off-street sex workers from Vancouver, British Columbia. I describe study participants who include Sex-Work-No-More participants who would not return to the industry, Sex-Work-Maybe participants who consider reinvolvement, and Dual-Life participants who are employed in sex work and conventional work simultaneously. These participants uniquely challenge narrow, binary understandings of involvement and transition because they discuss their use of deception to obtain resources needed to make change; the support that clients have provided; their strategic engagement in sex work as a means to exit; their considerations of reentry; and for some, their dual employment. In light of new legislation that criminalizes activities related to sex work-the Protection of Communities and Exploited Persons Act-and the Federal government announcement of $20 million dollars for the creation of exit services nationwide, hearing from sex workers is essential to advancing agendas in this area.

As part of a larger study examining the effects of the design of the off-street sex industry on sex worker's health and safety practices, eight sex work experts who had experience as sex workers and as advocates and service providers were interviewed to garner their community engagement expertise in shaping the research. During narrative interviews, these experts discussed how stigma influenced their personal lives and their social justice work among sex workers. Their insights into stigma are unique to the literature because our experts simultaneously confronted direct instances of stigma that were a part of their personal and professional lives, sometimes concealing their sex work histories during the course of their professional support and advocacy work. As a result of this concealment, and because of how sex workers are sometimes mistreated, experts experienced stigma vicariously (indirectly) when their own sex work histories were not apparent. As a result of these experiences, participants became proficient at managing discrediting information about themselves when in the presence of those they mistrusted. They supported sex workers through stigmatising ordeals by using knowledge gained from these intersecting direct and vicarious experiences stigma, continuously building capacity within themselves and among other sex workers to resist stigma.

There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018–2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine  the association with transgender/non-binary identities). Ethnically/racially minoritized sex workers (26.4%) reported more police encounters partly due to increased representation in street settings (51.4% vs 30.7% off-street, p = 0.002). After accounting for street setting, ethnically/racially minoritized sex workers had higher odds of recent arrest (adjusted odds ratio 2.8, 95% CI 1.3–5.8), past imprisonment (aOR 2.3, 95% CI 1.1–5.0), police extortion (aOR 3.3, 95% CI 1.4–7.8), and rape (aOR 3.6, 95% CI 1.1–11.5). LGB-identifying sex workers (55.4%) were more vulnerable to rape (aOR 2.4, 95% CI 1.1–5.2) and emotional violence. Sex workers identifying as ethnically/racially minoritized (aOR 2.1, 95% CI 1.0–4.5), LGB (aOR 2.0, 95% CI 1.0–4.0), or who use drugs (aOR 2.0, 95% CI 1.1–3.8) were more likely to have experienced emotional violence than white-identifying, heterosexual or those who did not use drugs. Experience of any recent police enforcement was associated with increased odds of rape (aOR 3.6, 95% CI 1.3–8.4) and emotional violence (aOR 4.9, 95% CI 1.8–13.0). Findings show how police enforcement disproportionately targets ethnically/racially minoritized sex workers and contributes to increased risk of rape and emotional violence, which is elevated among sexual and ethnically/racially minoritized workers.

Background National Ugly Mugs (NUM) is a UK-wide violence prevention and victim support charity that provides a mechanism for sex workers to share safety information and obtain support for harms that they may experience during the course of their work. Over the past several years, NUM has witnessed a decline in sex workers willing to access police as part of their recovery journeys after experiencing victimisation. In 2012, 28% of those reporting to NUM chose to engage with the legal system; in 2020, this was down to 7.7% amongst off-street independent workers. Statistics for 2021 indicate a continuation of this downward trend. Furthermore, anonymous consent to share information with police also declined from 95% in 2012 to 69% in 2020. Methods NUM conducted a survey of 88 sex working members in 2020. This information combined with our data on victimisation provides insights of the factors that deter sex workers from involving police as part of their justice-seeking efforts. Results Survey results reveal that sex workers feel alienated and untrusting of police and courts. Conclusions The implications of sex workers not sharing information about dangerous individuals with police and choosing not to participate in court processes signal significant flaws in our legal system regarding safe and inequitable access and pose dangers for all of us.