Piloting a ‘spatial isolation’ index: The built environment and sexual and drug use risks to sex workers

Abstract

Background Employing innovative mapping and spatial analyses of individual and neighborhood environment data, we examined the social, physical and structural features of overlapping street-based sex work and drug scenes and explored the utility of a ‘spatial isolation index’ in explaining exchanging sex for drugs and exchanging sex while high. Methods Analyses drew on baseline interview and geographic data (Jan/10-Oct/11) from a large prospective cohort of street and off-street sex workers (SWs) in Metropolitan Vancouver and external publically-available, neighborhood environment data. An index measuring ‘spatial isolation’ was developed from seven indicators measuring features of the built environment within 50m buffers (e.g. industrial or commercial zoning, lighting) surrounding sex work environments. Bivariate and multivariable logistic regression was used to examine associations between the two outcomes (exchanged sex for drugs; exchanged sex while high) and the index, as well as each individual indicator. Results Of 510 SWs, 328 worked in street-based/outdoor environments (e.g. streets, parks, alleys) and were included in the analyses. In multivariable analysis, increased spatial isolation surrounding street-based/outdoor SWs’ main places of servicing clients as measured with the index was significantly associated with exchanging sex for drugs. Exchanging sex for drugs was also significantly positively associated with an indicator of the built environment suggesting greater spatial isolation (increased percent of parks) and negatively associated with those suggesting decreased spatial isolation (increased percent commercial areas, increased count of lighting, increased building footprint). Exchanging sex while high was negatively associated with increased percent of commercial zones but this association was removed when adjusting for police harassment. Conclusions The results from our exploratory study highlight how built environment shapes risks within overlapping street-based sex work and drug scenes through the development of a novel index comprised of multiple indicators of the built environment available through publicly available data, This study informs the important role that spatially-oriented responses, such as safer-environment interventions, and structural responses, such as decriminalization of sex work can play in improving the health, safety and well-being of SWs.

Sexual Violence, Condom Negotiation, and Condom Use in the Context of Sex Work

“…1,41 In many criminalizing or stigmatizing settings, sex work is effectively pushed toward more hidden areas where there is less protection from violence. 22 The perpetrators in this study may have been aware of the structural vulnerability within which these women work and used the opportunity to force sex. In such settings of criminalization or stigma, individual methods of protection, such as condom negotiation and use may be rushed.…”

“…1 In settings where stigma or laws criminalizing sex work or aspects of sex work exist, sex workers may be forced to have sex in locations where safety may be compromised, condom use during sex work may be forfeited or rushed to avoid attracting police attention, or condom distribution by HIV prevention programs may be compromised. 1,21,22 Although sex work is criminalized in Togo, it is not in neighboring Burkina Faso. There are, however, other structural risks for commercial sex, including pimping being illegal and significant stigmatization of sex work in Burkina Faso.…”

Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation

“…(Wurth, Schleifer, McLemore, Todrys, & Amon, 2013) Harms within the risk environment may be most pronounced for FSW-PWIDs who work and live in the nexus of these risk environments and who may be more hidden in their sex work and drug use so as to avoid encounters with police. (Deering et al, 2013)…”

Integrating place into research on drug use, drug users’ health, and drug policy

“…Deering et al’s (2014) innovative integration of geospatial data on sex workers’ activity spaces with existing data on the local built environment allowed the team to explore novel questions about spatial isolation and drug-related risks. Deering et al, (2014) mapped the locations where sex workers in Vancouver, Canada communicated with and served clients, and created buffers with radii of 50 meters around each point.…”

“…Deering et al, (2014) mapped the locations where sex workers in Vancouver, Canada communicated with and served clients, and created buffers with radii of 50 meters around each point. Drawing on past conceptual and empirical work on the built environment, they then integrated existing administrative data about features of the built environment (e.g., presence of light posts; road length) to create a new measure of the spatial isolation of each individualized risk space.…”