Condoms and sexual health education as evidence: impact of criminalization of in-call venues and managers on migrant sex workers access to HIV/STI prevention in a Canadian setting

Abstract

BackgroundDespite a large body of evidence globally demonstrating that the criminalization of sex workers increases HIV/STI risks, we know far less about the impact of criminalization and policing of managers and in-call establishments on HIV/STI prevention among sex workers, and even less so among migrant sex workers.MethodsAnalysis draws on ethnographic fieldwork and 46 qualitative interviews with migrant sex workers, managers and business owners of in-call sex work venues in Metro Vancouver, Canada.ResultsThe criminalization of in-call venues and third parties explicitly limits sex workers’ access to HIV/STI prevention, including manager restrictions on condoms and limited onsite access to sexual health information and HIV/STI testing. With limited labour protections and socio-cultural barriers, criminalization and policing undermine the health and human rights of migrant sex workers working in –call venues.ConclusionsThis research supports growing evidence-based calls for decriminalization of sex work, including the removal of criminal sanctions targeting third parties and in-call venues, alongside programs and policies that better protect the working conditions of migrant sex workers as critical to HIV/STI prevention and human rights.

Structural Determinants of Inconsistent Condom Use With Clients Among Migrant Sex Workers

“…These findings are supported by previous research indicating the importance of adequate condom access in the workplace for condom use among sex workers 6,29 , and are particularly important given the stigma associated with sex work and cultural barriers faced by migrant SWs in accessing condoms outside the workplace. In recent qualitative work in Vancouver 16 and elsewhere in Canada 32 , the increasingly criminalized nature of sex work (e.g., bill C-36 enacted in 2014 to criminalize third party advertisement of services and purchasing by clients 33 ) has been shown to undermine and will likely exacerbate access to condoms for migrant SWs. Due to the bill’s provision against third parties and unannounced police raids where condoms can be used as evidence for sex work, managers may be more reluctant to offer condoms on premises, restrict number of condoms permitted, refuse free condoms delivered by health outreach workers and enforce strict rules for storage and disposal 16 .…”

“…In recent qualitative work in Vancouver 16 and elsewhere in Canada 32 , the increasingly criminalized nature of sex work (e.g., bill C-36 enacted in 2014 to criminalize third party advertisement of services and purchasing by clients 33 ) has been shown to undermine and will likely exacerbate access to condoms for migrant SWs. Due to the bill’s provision against third parties and unannounced police raids where condoms can be used as evidence for sex work, managers may be more reluctant to offer condoms on premises, restrict number of condoms permitted, refuse free condoms delivered by health outreach workers and enforce strict rules for storage and disposal 16 . Since condom access and structural drivers such as criminalization have not been explored in-depth among migrant SWs, there remains a need for cohort studies to evaluate the impacts of evolving structural determinants on sexual health and safety among migrant SWs over time.…”

“…However, qualitative research has identified a number of persistent barriers to the sexual health and safety of migrant workers in indoor establishments including stigma, competition between workers, limited English proficiency, and police and immigration crackdowns 14–16 . Moreover, while previous epidemiological research on HIV/STI risks among migrant SWs has emphasized the experiences of migrants in low and middle-income settings 1,3,5,17–20 , research in North America remains extremely limited 1 .…”

“…Our team’s previous work has shown that among SWs, migration is linked to some health-protective factors (e.g., higher condom use; lower drug use), but also enhanced structural risks (e.g., language barriers, barriers to health care access; high levels of police raids and crackdowns; stigma) 3,5,16 . Given significant heterogeneity in evidence pertaining to the health and well-being of migrant SWs, and limited research examining structural determinants in particular, the objective of this study was to examine structural determinants of STI/HIV risk measured as inconsistent condom use by clients, among international migrant SWs in Metropolitan Vancouver, British Columbia.…”

Perception Difference on Sexually Transmitted Infections Between Domestic and Foreign Ship Crews (A Study at Merak Port of Banten)

“…According to Centers for Disease Control and Prevention (CDC) in 2010, the proper use of condoms will reduce the risk of contracting STI and HIV. Condom use and sexual health education among sex work venues is a significant predictor of HIV risk reduction [13] [14]. According to the Theory of Health Belief Model (HBM), the possibility of individuals taking precautions depends directly on the outcome of two beliefs or health beliefs: perceived threat of injury and illness and benefits and costs [15].…”