Sex work community participation in criminalized environments: a community-based cohort study of occupational health impacts in Vancouver, Canada: 2010–2019

Abstract

Background Sex work criminalization and occupational stigma pose barriers to sex workers’ access to support services, including community participation — engagement with sex work specific community organizing at both formalized and grassroots capacities. In light of gaps in evidence regarding impacts of community participation on sex workers’ occupational health in higher-income settings, we evaluated engagement in community participation and associations with occupational sexual health outcomes among sex workers in Vancouver, Canada. Methods Prospective data from a community-based cohort of 943 women sex workers in Vancouver, British Columbia (2010–2019). We used logistic regression with generalised estimating equations (GEE) to model correlates of community participation, and a confounder modeling approach to examine the association of community participation on sexually transmitted infection (STI) seropositivity. Results Among participants, 38.1% were Indigenous, 31.4% identified as women of colour (e.g., East Asian, Southeast Asian, Black) and 29.3% were im/migrants to Canada. Over a quarter (28.3%, n = 267) serviced in informal indoor spaces, while 38.0% (n = 358) serviced clients in outdoor/public and 31.4% (n = 296) in formal in-call spaces. 8.9% of participants reported sex work community participation at least once over the 9-year study. In multivariable GEE analysis, Indigenous (adjusted odds ratio(aOR) 1.71, 95% confidence interval (CI) 0.88–3.32) and trans women (aOR 4.69, 95%CI 2.43–9.06) had higher odds of community participation; women of colour had lower odds (aOR 0.18, 95%CI 0.06–0.57). In a multivariable GEE confounder model, community participation was independently associated with lower odds of STI seropositivity (aOR 0.66, 95% CI0.45–0.96). Conclusion Sex workers who engaged in sex work community participation faced reduced odds of STI seropositivity. Building off reserach evaluating community interventions in low and middle income contexts, our study provides some of the first quantitative evidence on community participation among sex workers in Canada, and is the first to examine this in relation to sexual health outcomes. This research demonstrates the need to scale up community participation access for sex workers, via linguistically diverse community spaces, anti-stigma initiatives, and decriminalization to reduce barriers faced by racialized sex workers and support occupational health and rights for all sex workers.

Prevalence and structural correlates of HIV and STI testing among a community-based cohort of women sex workers in Vancouver Canada

“…Research has shown that im/migrant sex workers often fear that accessing sexual health services or disclosing their work to healthcare providers could result in negative impacts on their workplace (e.g., police raids) or ability to work [ 55 , 57 , 56 , 60 ]. Finally, recent research suggests im/migrant workers are less likely to engage in sex worker community organizing and sex work-specific services [ 24 ], which have been linked to improved sexual health outcomes [ 24 ].…”

“…Building on previous AESHA research [ 24 ], this analysis sought to measure prevalence and correlates of HIV/STI testing at enrollment. The outcome for this analysis was a binary (Yes/No) variable measuring if a participant had received HIV or STI testing within the six months prior to their baseline visit.…”

“…However, they have been infrequently explored in relation to HIV and STI testing access and outcomes. At the same time, community mobilization interventions such as sex worker-led and tailored outreach, drop-in spaces, and other services (e.g., advocacy, anti-stigma campaigns) have been shown to confer significant reductions in HIV and STI incidence and risks among sex workers [ 21 – 24 ], yet have been infrequently examined in relation to HIV/STI testing utilization. Finally, despite general evidence of racial and im/migration-related disparities in HIV/STI services utilization [ 25 – 27 ], few epidemiologic studies have investigated racial and im/migration-related inequities in HIV/STI testing among women sex workers globally.…”

Barriers to Governmental Income Supports for Sex Workers during COVID-19: Results of a Community-Based Cohort in Metro Vancouver

“…Though facing ongoing inequities, policing and gentrification, organizers within the DTES have been successful in scaling up low-barrier supports, including harm reduction and safe supply services during the ongoing overdose pandemic, as well as sex work-specific services. Community level factors, such as utilization of and engagement with such services have been previously shown to support sex workers' occupational health, safety, and wellbeing (Pearson et al 2022). Throughout the COVID-19 pandemic as well, sex work organizations have been highly successful in pivoting their services in order to reach diverse communities of sex workers, despite lockdowns and service interruptions (Benoit and Unsworth 2022;Lam 2020b;PACE Society 2020;St.…”

Association between interrupted access to sex work community services during the COVID-19 pandemic and changes in sex workers’ occupational conditions: findings from a community-based cohort study in Vancouver, Canada

“…Further, community empowerment-based approaches have been linked to increased sex worker collectivisation, solidarity and condom use, and reduced HIV and STI transmission, highlighting both the community-level and broader public health impacts of the services provided by sex work community organisations. 17 18 However, many such organisations were forced to close doors and/or scale back services during pandemic lockdowns. While community groups globally swiftly set up emergency hardship funds and informal forms of mutual aid to their members during COVID-19—demonstrating solidarity and resilience amid the public health crisis 5 6 9 10 13 19–21 —limited empirical research has examined the impacts of interrupted access to sex worker-specific community services among sex workers during COVID-19.…”