Among Female Sex Workers: Implications for HIV

Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy. Am J Public Health. 2009;99:659-665.

Shannon and colleagues investigated the relationship between environmental-structural factors and condom-use negotiation between female sex workers and clients. They used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of hot spots for being pressured into unprotected sexual intercourse by a client and assess sexual HIV. The authors then used multivariate logistic modelling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected intercourse. In multivariate analyses, being pressured to have unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR]=3.39; 95% confidence interval [CI]=1.00, 9.36), working away from main streets because of policing (OR=3.01; 95% CI=1.39, 7.44), borrowing a used crack pipe (OR=2.51; 95% CI=1.06, 2.49), client-perpetrated violence (OR=2.08; 95% CI=1.06, 4.49), and servicing clients in cars or in public spaces (OR=2.00; 95% CI=1.65, 5.73). Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers’ health, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers’ ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.

buying and selling of sexual services has never been illegal in Canada, however it is illegal to communicate in public spaces for the purposes of sexual transaction and the law prohibits ‘keeping or transporting a person to a common bawdy-house”, thus restricting legal indoor sex work. This study used the risk environment framework as its theoretical base, hypothesising that macro- and meso-level factors outside the individual affect negotiation of individual risk. Trained peer researchers, who were former or current sex workers, interviewed 205 sex workers participating in the Maka Project cohort. They were recruited at sex work strolls at staggered times and spaces along these strolls. The analysis of the effects of enforcement of Canada’s prohibitive sex-work policies reveals the need for legal and policy reforms to create safer work environments in which exploitation by clients and third parties is effectively criminalised and condom use is readily and consistently negotiated.