Mobility, violence, and the health of sex workers

Despite research on the health and safety of mobile and migrant populations in the formal and informal sectors globally, limited information is available regarding the working conditions, health, and safety of sex workers who engage in short-term mobility and migration. The objective of this study was to longitudinally examine work environment, health and safety experiences linked to short-term mobility/migration (i.e., worked or lived in another city, province or country) among sex workers in Vancouver, Canada, over a two-and-a-half year study period (2010-2012). We examined longitudinal correlates of short-term mobility/migration (i.e., worked or lived in another city, province or country over the three-year follow-up period) among 646 street and off-street sex workers in a longitudinal community-based study (AESHA). Of 646 sex workers, 10.84% (n=70) worked or lived in another city, province or country during study. In a multivariate GEE model, short-term mobility/migration was independently correlated with older age (Adjusted Odds Ratio (AOR): 0.95, 95% Confidence Interval (CI): 0.92-0.98), soliciting clients in indoor (in-call) establishments (AOR: 2.25, 95% CI: 1.27-3.96), intimate partner condom refusal (AOR: 3.00, 1.02-8.84) and barriers to health care (AOR: 1.77, 95% CI: 1.08-2.89). In a second multivariate GEE model, short-term mobility for sex work (i.e., worked in another city, province or country) was correlated with client physical/sexual violence (AOR: 1.92, 95% CI: 1.02-3.61). In this study, mobile/migrant sex workers were more likely to be younger, work in indoor sex work establishments, and earn higher income, suggesting that short-term mobility for sex work and migration increase social and economic opportunities. However, mobility and migration also correlated with reduced control over sexual negotiation with intimate partners and reduced health care access, and mobility for sex work was associated with enhanced workplace sexual/physical violence, suggesting that mobility/migration may confer risks through less control over work environment and isolation from health services. Structural and community-led interventions, including policy support to allow for more formal organizing of sex work collectives and access to workplace safety standards, remain critical to supporting health, safety and access to care for mobile and migrant sex workers.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofReviewedFacultyUnknow