Women Sex Workers Research Articles

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.

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.

Oferta de la prueba del VIH en fluido oral en actividades de acercamiento y consulta de los resultados online: intervención piloto en Cataluña

IntroductionThe aim of the intervention was to describe the feasibility and cost-effectiveness of offering HIV testing in outreach interventions and subsequent consultation of the results through a secure web page. MethodsThe HIV test was offered “in situ” to men who have sex with men (MSM), migrant sex workers and trans women recruited in places of leisure and sex. Four collaborating NGOs recruited the participants and assisted them to register on the study website (www.swab2know.eu) through a tablet or the smartphone of the same participant. The samples were sent to the reference laboratory and the results were published on the website. Results834 participants (612 MSMs, 203 women sex workers and 19 trans women) were recruited. In total 22 reagent results (2.6%) were detected: 21 among MSMs (3.4%) and 1 in a trans women (5.3%). While 82.6% of MSMs consulted their outcome, only 39.9% and 26.3% of women sex workers and trans women respectively consulted their outcome ConclusionsProviding self-sampling in outreach activities, dispatch and analysis in a reference laboratory as well as online communication of test results is feasible. A high proportion of participants with a HIV reactive result were detected among MSMs and trans women.

Urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort

Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers' work/living environments in relation to gentrification exposure in Metro Vancouver (2010-2014), and modeled independent effects of gentrification exposure on reduced utilization of HIV/STI testing, sexual health, and sex worker support services. These decreases occurred despite efforts to scale-up HIV services for marginalized populations. Planning of healthcare, housing, and other support services should be responsive to shifting urban landscapes for marginalized women.

Contributors to posttraumatic stress symptoms in women sex workers.

Previous research has demonstrated that women who sell sex (women sex workers [WSWs]) consistently report high levels of posttraumatic stress symptoms. The present study explores multiple factors that may contribute to the variation in WSWs' experiences of posttraumatic stress symptoms, including workers' racial identity, experiences of discrimination and control over their working conditions, the site of selling sex, and their clients' perceived sexual entitlement and violence. The study sample consisted of 314 self-identified WSWs. Online invitations to participate in a 30-min survey were sent to WSWs in the United States and Canada who advertise their services online on sites such as Facebook, the Erotic Review, and Backpages. The hypothesized structure of associations between the variables was tested using structural equation modeling. The model accounted for 68% of the variation in the traumatic stress reported, with direct and indirect effects for workers' racial identity, the site where they sell sex, and experiences of discrimination, especially by police. Clients' violence, on the contrary, was indirectly associated with traumatic stress, as violent clients were also significantly more likely to be perceived as sexually entitled, which, in turn, was the strongest predictor of higher traumatic stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Police-related barriers to harm reduction linked to non-fatal overdose amongst sex workers who use drugs: Results of a community-based cohort in Metro Vancouver, Canada

BackgroundHigh rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing impacts overdose risk amongst sex workers who use drugs. Given this, we aimed to explore the independent effects of experiencing police-related barriers to harm reduction on non-fatal overdose amongst women sex workers who use drugs in Metro Vancouver, Canada over a 7.5-year period. MethodsData were drawn from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women sex workers in Metro Vancouver, from 2010 to 2017. Using multivariate logistic regression with generalized estimating equations (GEE), we used a confounder modeling approach to identify the independent effect of experiencing police-related barriers to harm reduction strategies on non-fatal overdose amongst sex workers using drugs within the last six months at each study visit. ResultsAmongst 624 participants, 7.7% overdosed within the last six months at baseline and 27.6% overdosed during the study period, contributing 287 non-fatal overdose events over the 7.5-year period. 68.6% reported police-related barriers to harm reduction strategies during the study. In a multivariate confounder model, exposure to police-related barriers to harm reduction strategies [AOR: 2.15, CI: 1.60–2.90] was independently associated with higher odds of non-fatal overdose after adjustment for key confounders. ConclusionsOur findings suggest that in the context of the current overdose crisis, adversarial policing practices may undermine access to lifesaving overdose prevention services and exacerbate overdose risks for marginalized women. Findings underscore the urgent need to scale-up access and remove barriers to progressive harm reduction strategies for women sex workers.

The Impacts of Intersecting Stigmas on Health and Housing Experiences of Queer Women Sex Workers in Vancouver, Canada

ABSTRACT The objective of this study was to qualitatively explore how queer women sex workers’ experiences of stigma impacted health and housing access in Vancouver, Canada. In-depth semi-structured interviews were conducted with 56 queer women sex workers in Vancouver, Canada between June 2012 and May 2013. Participants described sexual stigma in the form of discriminatory comments about their sexuality, and in the form of barriers to housing and complexities in maintaining their relationships in supported housing environments. Enacted stigma was also experienced, particularly drug use-related stigma, in healthcare settings. Consequently, some participants reported felt stigma in the form of hiding their sexuality and relationships to mitigate stigma and to gain access to services. Participants experienced a variety of stigma related to drug use, housing insecurity, and sexuality; thereby demonstrating the intersecting dimensions of stigma and structural oppressions in the lives of the queer women sex workers.

Feelings of Entrapment and Defeat Mediate the Association Between Self-Esteem and Depression Among Transgender Women Sex Workers in China.

BackgroundTransgender women sex workers have a high prevalence of depression. Low self-esteem and subsequent involuntary subordination (characterized by feelings of defeat and entrapment) are well-documented risk factors for depression. The object of the present study was to investigate the mediating effect of feelings of entrapment and defeat on the relationship between self-esteem and depression among transgender women sex workers in China.MethodsA cross-sectional study was conducted in Shenyang and Guangzhou in 2017. Participants were 198 transgender women sex workers who completed a structured questionnaire assessing background characteristics, self-esteem, feelings of entrapment and defeat, and depression. Linear regression was used to test the mediation hypotheses.ResultsOf participants, 25.25% exhibited high levels of depression. Self-esteem scores were negatively correlated with depression scores (r = −0.54, p < 0.05, R2adj = 0.23), defeat scores (r = −1.68, p < 0.05, R2adj = 0.31), and entrapment scores (r = −1.67, p < 0.05, R2adj = 0.25). In the mediation hypothesis model, entrapment (r = 0.21, p < 0.05) and defeat (r = 0.08, p < 0.05) had a complete mediating effect on the relationship between self-esteem (Spearman’s r = −0.06, p = 0.36) and depression (R2adj = 0.61).ConclusionFeelings of entrapment and defeat mediated the association between self-esteem and depression. More focus is needed on monitoring feelings of defeat and entrapment among transgender women sex workers to mitigate the risk of depression.

‘Do you really want to hear about my life?’: doing ‘feminist research’ with women in sex work in Eastern India

ABSTRACTThis article reflects on insights gathered from doing feminist research during my doctoral studies in international development. My research focused on the lives of women formerly and currently in sex work in Eastern India, and their experiences and resistance of everyday violence. I argue that the adoption of a life-history interviewing method created possibilities to move away from standard topics associated with sex work, and allowed women in sex work to discuss the dynamism and fluidity within their lives, within, before, and after sex work. I also explore how this method enabled the theme of koshto (pain) to emerge which challenges the framing of violence in sex work as exceptional. I argue that women in sex work need to feel heard and acknowledged within feminist research, not simply as subjects of knowledge gathering or to inform development discourses and interventions, but as human beings with dynamic personhoods. Finally, I share lessons learnt which can be useful to future feminist researchers researching sex work, within a current environment of ideologically polarised discussions on victimhood and agency in sex work.

Correlates of Suicidality Among A Community-Based Cohort of Women Sex Workers: The Protective Effect of Social Cohesion.

Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.

Sex workers’ responses to the HIV and AIDS epidemic in Aotearoa New Zealand

ABSTRACTThis article engages with the voices of women sex workers during the peak of the HIV and AIDS epidemic in New Zealand. The late-1980s saw the formation of the New Zealand Prostitutes’ Collective, a sex worker led organisation that contracted with the government to provide a community-based national response to HIV and AIDS. The article explores the challenges sex workers faced to sustain and implement the use of condoms in their daily professional and personal lives. These included pressure from clients to forego the use of condoms, the risk of carrying condoms amidst the threat of arrest, and the struggle to manage the use of condoms in their personal sex lives. The paper traces both the widespread support for safe sex and the fractures and tensions that emerged as many sex workers mobilised to establish a community-based response to one of the most devastating health crises of the late-twentieth century.

Mapping Workplace Neighborhood Mobility Among Sex Workers in an Urban Canadian Setting: Results of a Community-Based Spatial Epidemiological Study From 2010-2016.

Mobility among sex workers has been linked not only to improved economic and social opportunities, but also to concerns regarding displacement, criminalization, and violence. In 2014, new "end-demand" legislation criminalized new aspects of sex work in Canada (e.g., third-party advertising, purchasing) while leaving the sale of sex legal. Utilizing data from a longitudinal community-based cohort of women sex workers in Metro Vancouver (An Evaluation of Sex Workers Health Access [AESHA], 2010-2016), we used kernel density mapping to understand and identify geographic patterns of workplace neighborhood mobility (i.e., changing the primary neighborhood in which one worked in the last 6 months); multivariable logistic regression using generalized estimating equations was also used to model contextual (policing, violence, and safety) and individual correlates of workplace mobility among sex workers over the 6-year period, including potential changes in mobility patterns pre- and post-end-demand criminalization. A total of 543 sex workers were included in analyses, contributing 2,199 observations. A total of 402 (74.0%) experienced workplace neighborhood mobility during the study period. Neighborhood mobility was negatively correlated with age (adjusted odds ratio [AOR] = 0.98/year older, 95% confidence interval [CI] = [0.97, 0.99]) and positively correlated with homelessness (AOR = 1.43, 95% CI = [1.12, 1.82]), identifying as a gender/sexual minority (AOR = 1.31, 95% CI = [1.04, 1.70]), and servicing clients primarily outdoors (vs. informal indoor or in-call venues; AOR = 1.48, 95% CI = [1.21, 1.81]); police harassment (AOR = 1.19, 95% CI = [0.96, 1.48], p = .11) and changing one's neighborhood of work due to safety concerns (AOR = 1.37, 95% CI = [0.94, 2.00], p = .09) were both marginally correlated. Steps to promote safer working conditions for marginalized women in urban environments remain urgently needed, including shifts away from criminalized enforcement toward community-led initiatives and promoting access to safer indoor workspaces.

Third Parties (Venue Owners, Managers, Security, etc.) and Access to Occupational Health and Safety Among Sex Workers in a Canadian Setting: 2010-2016.

To determine the impact of engagement with third parties (i.e., managers, receptionists, or owners of in-call venues; advertisers; security; spotters; and others) on sex workers' occupational health access. We drew longitudinal data from An Evaluation of Sex Workers' Health Access, a community-based cohort of more than 900 women sex workers. We used multivariable logistic regression and generalized estimating equations to (1) examine factors correlated with accessing third-party administrative or security services and (2) evaluate the impact of third-party services on access to mobile condom distribution and sex worker and community-led services (2010-2016). Finally, we evaluated changes in accessing third-party services pre-post end-demand criminalization (2010-2017). Im/migrant sex workers (persons with any type of legal status who were born in another country; adjusted odds ratio [AOR] = 2.32; 95% confidence interval [CI] = 1.35, 3.98) had higher odds of accessing third-party services. In confounder models, third-party services were independently correlated with increased access to mobile condom distribution (AOR = 1.84; 95% CI = 1.47, 2.31) and sex worker and community-led services (AOR = 1.61; 95% CI = 1.15, 2.24). End-demand criminalization was linked to a decrease in access to third-party services (AOR = 0.79; 95% CI = 0.63, 0.99). This research suggests that access to administrative and security services from third parties increases sex workers' occupational health and safety. Policy reforms to ensure sex workers' labor rights, including access to hiring third parties, are recommended.

News Coverage of Foreign Sex Workers in Malaysia: A Critical Analysis

The growing concern over the influx of foreign women in Malaysia as sex workers, has continually gained the attention of the local media particularly the mainstream newspapers. The media, despite playing an instrumental role in bringing about social transformation, has the ability to portray the foreign women in a positive way or to discriminate against them. This study, based on qualitative analysis, represents an attempt to study a social problem particularly in the way that foreign women in sex work have been represented in Malaysia by the mainstream English-language newspapers. The analytical tools of the discourse-historical approach (DHA) are employed in the analysis of the news articles. In particular, the argumentation strategy in the DHA demonstrates that a number of topoi (i.e., the topoi of control, number, threat, and victimisation) have been employed to represent foreign sex workers in the media. Investigation of the newspaper extracts from New Straits Times and The Star generally revealed that the media have portrayed foreign women in sex work in the offender orientation frame more so than as victims. Furthermore, foreign sex workers are also positioned negatively because of their illegal migrant status, making them doubly discriminated against. Such representations directly impact the women’s lives, leading to further discrimination on the basis of their trade and illegal migrant status, denying them a voice and depriving them of their legal rights. The paper concludes by discussing the contributions of the research and emphasises the need for social justice for these marginalised women.

The impact and cost-effectiveness of combined HIV prevention scenarios among transgender women sex-workers in Lima, Peru: a mathematical modelling study

SummaryBackgroundHIV incidence remains high among transgender women in Lima, Peru, most of whom report sex work. On the basis of a stakeholder analysis and health system capacity assessment, we designed a mathematical model to guide HIV programmatic planning among transgender women sex workers (TWSW) in Lima.MethodsUsing a deterministic compartmental model, we modelled HIV transmission among TWSW, their stable partners, and their clients to estimate the impact and cost-effectiveness of combinations of interventions compared with the standard of care on reducing HIV incidence over a 10-year period. We simulated HIV transmission accounting for differences in sexual positioning in anal intercourse and condom use by partner type and fitted the model to HIV surveillance data using Latin hypercube sampling. The interventions we considered were 15% relative increase in condom use with clients and 10% relative increase with stable partners; increase in antiretroviral treatment (ART) coverage at CD4 count lower than 500 cells per mm3 and greater than or equal to 500 cells per mm3; and 15% pre-exposure prophylaxis (PrEP) coverage using generic and branded formulations. We considered a basic scenario accounting for current limitations in the Peruvian HIV services and an enhanced scenario assuming achievement of the UNAIDS 90–90-90 targets and general improvements in HIV services. The 50 best fits according to log-likelihood were used to give the minimum and maximum values of intervention effect for each combination. We used disability-adjusted life-years (DALYs) to measure the negative health outcomes associated with HIV infection that could be averted through the interventions investigated and calculated incremental cost-effectiveness ratios to compare their cost-effectiveness.FindingsUnder the basic scenario, combining the four interventions of increasing condom use with clients and stable partners, extending ART to people with CD4 count greater than or equal to 500 cells per mm3, and 15% PrEP coverage with generic drugs would avert 47% (range 27–51) of new infections in TWSW, their clients, and their stable partners over 10 years, with an incremental cost-effectiveness ratio of US$509 per DALY averted. Under the enhanced scenario, this strategy would avert 61% (44–64) of new infections among this population with an incremental cost-effectiveness ratio of $1003 per DALY averted. Under both scenarios, implementation of this strategy approaches or surpasses the 50% incidence reduction goal and would represent a cost-effective use of country resources if generic PrEP drugs are used. The total cost of implementing this strategy under the enhanced scenario would be approximately $1·2 million per year over 10 years, corresponding to 10% of the current Global Fund’s yearly contribution in Peru.InterpretationInvestments in HIV services among TWSW in Lima would be cost-effective, even under stringent cost-effectiveness criteria when accounting for setting-specific resource constraints. Notable improvements in HIV testing rates, innovative interventions to increase condom use, and reduced PrEP costs will be key to achieving the 50% incidence reduction goal. Modelling studies incorporating stakeholders’ perspectives and health system assessments can bring added value to HIV policy making.

Challenges in HIV infection control in transgender women sex workers

Challenges in HIV infection control in transgender women sex workers

PRAKTIK KEBERAGAMAAN PEREMPUAN PEKERJA SEKS DI SOSROWIJAYAN KULON YOGYAKARTA; TINJAUAN MAQA&gt;SID SYARI’AH

This study aims to describe the behavior of the women sex workers’s religious practice in Sosrowijayan Kulon, Yogyakarta using the theory of maqa&gt;sid syariah. During this education known as the city of Yogyakarta. However, it cannot be denied that the city now transformed as a tourism city. Lots of entertainment presented, one of which is known as the localization “Pasar Kembang” (sarkem). This study is a qualitative study of the field with the theory of maqa&gt;sid syariah to reveal religious identity sex workers. As for the results that researchers have found is (1) in religion practice or Behavior aspects of worship they do going contention between Maqa&gt;s}id al-Mukallaf and maqa&gt;sid syariah. In this case on Hifz}u al-Di&gt;n. Things that they believe to be the al-Hifzu In their version n in fact is a Maqa&gt;s}id Mulghah are not permitted in Islam. Either way, however they are not allowed to undergo it. (2) in the aspects of factors that make them choose the profession of sex workers, when viewed from a glass eye maqa&gt;sid syariah experience contradictions between Hifz}u al-Nafs with Hifz}u al-Nasl. In the end more won Hifz}u al-Nasl. Because basically the law adultery is haraam. So what they believe to be included in the category Maqa&gt;s}id Mulghah.

Using difference in intersectional research with im/migrant and racialized sex workers

Intersectionality attends to the interactions between social difference and power, although theoretical models vary in their emphasis on one or the other. Difference-centred models often distinguish between processes of constructing social difference, systems that institutionalize social difference and identities that include social difference. This article discusses the analytical expectations that can emerge in intersectional research that focus on difference, by analysing the use and construction of difference by im/migrant and racialized women in sex work. The first analytical expectation is the distinction between salience and difference when starting from the lived realities and voices of individuals, groups and communities. The second analytical expectation concerns the interaction between two intersectional methodologies, between identities and lived experiences, and processes of constructing difference.

Becoming cosmopolitan women while negotiating structurally limited choices: The case of Korean migrant sex workers in Australia

International labor mobility holds the promise that one can become a cosmopolitan citizen of the world. But this interpretation of mobility rarely features in research and media focused on Asian women who travel and engage in sex work. In both arenas, the dominant narrative is that migrant sex workers are poor, the victims of sex trafficking, and pose a risk to public health. This narrative is laced with Orientalist overtones of the Asian sex worker as the alluringly exotic ‘other’, passive and particularly vulnerable, and in need of rescue. However, the interviews of 11 Korean women sex workers based in Sydney, Australia, challenge this narrative. These women engaged in a transnational quest to become cosmopolitan citizens of the world, albeit making logical choices from structurally limited options shaped by their multiple identities as women, sex workers, and Korean, and their relative precarious position in the Australian labor market. Their stories highlight how migration and work can be an agentic process of self-expression and self-actualization of identity. This identity has emerged against the backdrop of shifting meanings and practices of social reproduction in Korea, a country that has experienced a highly compressed transition from developing, to modern capitalist state. Theoretically, the article draws on post-colonial feminist theory to shed light into the conflicting views on migrant sex workers in existing research, by focusing on the women’s voices, which have been neglected or silenced.

Queering the ‘straight’ line: men’s talk on paying for sex

ABSTRACTThis paper presents a qualitative analysis of interviews conducted with eight men who identified as clients of women sex workers, but who also spoke about paying to secretly explore their sexual desires for trans women and men. I draw on queer theory to approach the question of how, and to what extent, men’s paid sexual encounters functioned as sites where they could resist the constraints of compulsory heterosexuality and navigate more fluid sexual identities. Highlighting the complex nature and meanings of paying for sex, I argue that the secrecy of the paid sexual encounter provided a space for ‘breaking out’ of the confines of heterosexuality whilst simultaneously being the very thing that allowed men to stay ‘in line’ with what was expected of them within the heteronormative realities of their everyday lives.

“People like us”: spatialised notions of health, stigma, power and subjectivity among women in street sex work

Most spatially-oriented studies about health, safety and service provision among women in street sex work have taken place in large urban cities and document how the socio-legal and moral surveillance of geographical spaces constrain their daily movements and compromise their ability to care for themselves. Designed to contribute new knowledge about the broader socio-cultural and environmental landscape of sex work in smaller urban centres, we conducted qualitative interviews and social mapping activities with thirty-three women working in a medium-sized Canadian city. Our findings demonstrate a socio-spatial convergence regarding service provision, violence, and stigma, which is common in sex trading spaces that double as service landscapes for poor populations. Women in this study employ unique agential strategies to navigate these competing forces, many of which draw upon the multivalent uses of different urban spaces to optimise service access, reduce the propensity for violence, and manage their health with dignity. Their use of the spatialised term ‘everywhere’ as an idiom of distress regarding issues of power, agency and their desire to take part in wider civic discourse are also explored. These data contribute new insights about spatialised notions of health, stigma, agency, and subjectivity among women in sex work and how they manage ‘risky’ environments.