Negotiating Safety and Sexual Risk Reduction With Clients in Unsanctioned Safer Indoor Sex Work Environments: A Qualitative Study

Abstract

Objectives To examine how unique, low-barrier housing programs for women that are functioning as unsanctioned quasi-brothels under special needs housing regulations in a Canadian urban setting influence risk negotiation with clients in sex work transactions. Methods We conducted 39 semi-structured qualitative interviews and 6 focus groups with women who live in low-barrier, supportive housing for marginalized sex workers with substance use issues. All interviews were transcribed verbatim and thematically analyzed. Results Women's accounts revealed that unsanctioned quasi-brothels promoted increased control over negotiating sex transactions, including the capacity to refuse unwanted services, negotiate condom use and avoid violent perpetrators. Despite the lack of formal legal and policy support for brothels in Canada, the environmental-structural supports afforded by these unsanctioned, quasi-brothels, including surveillance cameras and support from staff or police in removing violent clients, were linked to improved police relations and facilitated the institution of informal peer-safety mechanisms. Conclusions This study draws attention to the potential role of brothels as venues for public health and violence prevention interventions and points to the critical importance of removing the socio-legal barriers preventing the formal implementation of such programs.

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

“…Although sex workers were no longer being targeted directly by the police, the enforcement environment that continued to target clients during our study period appeared to put pressure on sex workers to rush the screening. Initial screening of prospective clients, such as checking bad date sheets, and negotiating the terms of the transaction, such as where it will take place, the fee, and condom use, is essential to protect the safety of sex workers [7,11,13,[23][24][25], and among the key evidence cited by the Supreme Court of Canada in striking down the old criminal laws. When negotiations are rushed or forgone, sex workers are known to face significantly increased risk of violence, abuse, and condom refusal, which can result in HIV/STIs [7,11,13,[23][24][25]34].…”

“…For example, sex workers experienced pressure from potential clients to quickly negotiate terms of the sexual transactions. This served to impede sex worker's ability to screen clients for potential weapons or intoxication and check 'bad date' sheets for past violent clients, which are well documented techniques for sex workers to reduce harms such as risk of violence, abuse and HIV/STIs [7,11,13,[23][24][25].…”

The role of nurse practitioners in outreach services and facilitating access for marginalized adult women in British Columbia

“…Although timely access to health care remains a priority in Canada, studies indicate that Canadians are less likely than citizens of other countries to have same-day access to health care services, and that the wait for these services can take, on average, six days before they are to see their health care providerwhich leaves many Canadians resorting to hospital emergency departments for their primary health care (Schoen et al , 2007). Numerous studies indicate that, if you are a marginalized woman in Canada, your access to health care is compromised ten-fold (Bloch, Razmotits, & Giambrone, 2011;Browne et al, 2012;Goodman, 2006;Krusi et al , 2012;Kurtz, Nyberg, Van Den Tillaart, & Mills, 2008;Lazarus et al , 2012;Loppie & Wien, 2009;Salmon, Livingston, Browne, & Pederson, 2009;Tappet al, 2011).…”

“…In 1996, when three homeless men froze to death in Toronto, hostels were organized to house the homeless during poor weather conditions (Hardill, 2006). Other outreach centers across Canada provide access for marginalized populations to obtain harm reduction supplies, which essentially include clean needles, condoms, food, water, and telephone access (Krusi et al, 2012 Vancouver in 2003, has resulted in a decrease in the incidents of overdoses and the transmission of blood-borne diseases, and, an increase the retention rates for people in detox and treatment facilities, along with an increase in the exposure of the marginalized population to the health care system (Small, 2012). It has also been shown that the InSite program has resulted in a reduction in injections taking place in public places, has kept dirty needles off the streets, and has reduced the use of emergency services, while increasing access to health care providers (namely nurses) and other resources, and generally keeping people alive (Jozaghi & Andresen, 2013).…”

“…Numerous studies indicate that marginalized adult women encounter significant barriers in the process of gaining access to health care or services in both Canada and the United States (Bloch eta, 2011 ;Boeri et al , 2011 ;Browne et al, 2012;Krusi et al , 2012;Kurtz et al, 2005;Kurtz et al , 2008 ;Loppie & Wien, 2009;Peters, 2012;Salmon et al , 2009;Zweig, Schlichter, & Burt, 2002). The barriers they encounter are either multifactorial or there are simply no services available (Boeri et al , 2011;Kurtz et al, 2005).…”