The impact of end-demand legislation on sex workers’ access to health and sex worker-led services: A community-based prospective cohort study in Canada

Abstract

Background Following a global wave of end-demand criminalization of sex work, the Protection of Communities and Exploited Persons Act (PCEPA) was implemented in Canada, which has implications for the health and safety of sex workers. This study aimed to evaluate the impact of the PCEPA on sex workers' access to health, violence, and sex worker-led services. Methods Longitudinal data were drawn from a community-based cohort of~900 cis and trans women sex workers in Vancouver, Canada. Multivariable logistic regression examined the independent effect of the post-PCEPA period (2015-2017) versus the pre-PCEPA period (2010-2013) on time-updated measures of sex workers' access to health, violence supports, and sex worker/community-led services. Results The PCEPA was independently correlated with reduced odds of having access to health services when needed (AOR 0.59; 95%CI: 0.45-0.78) and community-led services (AOR 0.77; 95%CI: 0.62-0.95). Among sex workers who experienced physical violence/sexual violence or trauma, there was no significant difference in access to counseling supports post-PCEPA (AOR 1.24; 95%CI: 0.93-1.64). Conclusion Sex workers experienced significantly reduced access to critical health and sex worker/community-led services following implementation of the new laws. Findings suggest end-PLOS ONE |

Structural barriers to condom access in a community-based cohort of sex workers in Vancouver, Canada: influence of policing, violence and end-demand criminalisation

“…SWs and third parties (eg, managers) often avoid carrying or storing sufficient condoms due to fear that this will be used as evidence of criminalised activities;27 31 given the continued criminalisation of third-party activities under ‘end-demand’, such concerns are likely to persist 22. Additionally, SWs may avoid interacting with health or outreach services due to stigma and fear of legal ramifications 20 23 27 31. Decriminalisation would enable SWs and workplaces to carry, store and use HIV/STI prevention supplies without fear of criminalisation.…”

“…Because this legislation was introduced in 2014, we excluded this year from analysis due to variation in how the laws may have been enforced, as well as the first 3 months of 2015 to account for measures referring to the previous 6 months. This measure was selected since the new laws primarily target clients and third parties rather than SWs, alongside evidence that SWs’ health outcomes and access are often greatly shaped by fear/anxiety related to SW laws (eg, avoidance of accessing services or working in certain venues/areas due to fear of criminalisation) 23 26 27. Questions on criminalisation and policing included experiences of police harassment without arrest (eg, threatened with arrest/detainment/fine, verbally harassed, physically assaulted, propositioned to exchange sex) and police arrest.…”

“…This new legislation conflates sex work with trafficking19 and was enacted despite concerns that it could recreate or worsen harms faced under previous laws 18 20. Research has shown that laws and enforcement targeting the purchase of sex may encourage rushed sexual transactions to avoid police; increase police surveillance; cause displacement to new work environments; increase pressure to see more dangerous clients; impede access to third-party supports; and reduce access to healthcare and community-based supports 19 21–23…”

Female Sex Workers’ Perceptions of Front-line Police Officer’s Ability to Ensure Their Safety in St. John's, Newfoundland

“…This model was initially implemented in an effort to eliminate the sex industry by criminalizing buyers and shielding sex workers from criminal liability. Ultimately, this approach has failed to reduce the number of individuals entering the industry and has exacerbated existing stigma and safety concerns (Giametta, Le Bail and Leicester, 2018;Argento et al, 2020). Indeed, recent research into the impacts of Canada's end-demand model suggests that it is ineffective; changes are required to improve the working conditions of Canadian sex workers (Bruckert and Hannem, 2013;Krüsi, Kerr et al, 2016;Argento et al, 2020).…”

Global Burden of Violence and Other Human Rights Violations Against Sex Workers

“…Research evaluating the impact of Canada's new end-demand laws (Protection of Communities and Exploited Persons Act; PCEPA) in Vancouver found that sex workers had significantly reduced access to health and community-led services as a result of the implementation of end-demand criminalisation [50]. Qualitative findings from Sweden and Canada underscore that criminalising clients reproduces the harms of full criminalisation models [51,52].…”