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.

Elena Argento,Steffanie A Strathdee,Melissa Braschel,Kate Shannon,Sylvia Machat,Shira Goldenberg,Marina Della Giusta

doi:10.1371/journal.pone.0225783

Elena Argento, Steffanie A Strathdee + Show 5 more

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https://doi.org/10.1371/journal.pone.0225783

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Abstract

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. 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. 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). Sex workers experienced significantly reduced access to critical health and sex worker/community-led services following implementation of the new laws. Findings suggest end-demand laws may exacerbate and reproduce harms of previous criminalized approaches to sex work in Canada. This study is one of the first globally to evaluate the impact of end-demand approaches to sex work. There is a critical evidence-based need to move away from criminalization of sex work worldwide to ensure full labor and human rights for sex workers. Findings warn against adopting end-demand approaches in other cities or jurisdictions.

Highlights

Global research and evidence demonstrate that criminal policies and punitive enforcementbased approaches to sex work continue to undermine the health and human rights of sex workers [1,2,3]
The Protection of Communities and Exploited Persons Act (PCEPA) was independently correlated with reduced odds of having access to health services when needed (AOR 0.59; 95% confidence intervals (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)

Summary

Introduction

Global research and evidence demonstrate that criminal policies and punitive enforcementbased approaches to sex work continue to undermine the health and human rights of sex workers [1,2,3]. Substantial evidence demonstrates that the criminalization of sex work perpetuates widespread forms of violence, stigma, and discrimination that prevent sex workers from seeking or accessing critical health and support services [4,5,6]. Where sex work is criminalized, the ability of sex workers to formally organize or work together is restricted. The hindering of collectivization among sex workers through criminalization is of critical concern given the central importance of community empowerment and enabling sex workers to negotiate safety in the workplace, as well as advocate for human rights, including access to health and safety. This study aimed to evaluate the impact of the PCEPA on sex workers’ access to health, violence, and sex worker-led services

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