Abstract
BackgroundSex 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.MethodsProspective 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.ResultsAmong 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).ConclusionSex 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.
Highlights
In global contexts, sex work “community empowerment” models have been defined as community-driven approaches where sex workers “leverage collective power to address structural, behavioral and biomedical priorities” [1]
Such models have been outlined by the World Health Organization (WHO) [2], while acknowledging that sex workers’ access to community empowerment models and sexual health services need to be supported through decriminalization [3]
Our findings show that sex workers who identified as Indigenous and as trans women, and those living within the City of Vancouver had higher odds of community participation, while women of colour and im/migrant sex workers had lower odds of community participation, suggesting that they may experience barriers due to compounding criminalization as both sex workers and racialized im/migrant workers
Summary
Sex work “community empowerment” models have been defined as community-driven approaches where sex workers “leverage collective power to address structural, behavioral and biomedical priorities” [1]. Such models have been outlined by the World Health Organization (WHO) [2], while acknowledging that sex workers’ access to community empowerment models and sexual health services need to be supported through decriminalization [3]. As well, ongoing criminalization, stigma, and a lack of funding often hinder the collectivisation of sex workers and further expansion of community supports [21] Due to such limitations, existing supports may not be accessible or suited to diverse sex work communities, and these gaps may exacerbate existing health inequities faced by sex workers. 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
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