Lack of full citizenship rights linked to heightened client condom refusal among im/migrant sex workers in Metro Vancouver (2010–2018)

ABSTRACT

In Canada, im/migrant sex workers face stigma, health access barriers, and overlapping marginalisation, with end-demand law reforms in 2014 postulated to exacerbate these inequities. Yet, little quantitative evidence on how immigration status shapes HIV/STI risk exists. Drawing on community-based longitudinal cohort data (AESHA, 2010–2018), we used multivariable confounder models with logistic regression to model (1) the independent effect of precarious immigration status (any status revocable under criminal charges: permanent residency/temporary residency/undocumented) on client condom refusal, and (2) the moderating effect of precarious status on the relationship between condom refusal and exposure to end-demand law reform (2015–2018). Over this 8-year study involving 758 sex workers in Metro Vancouver, 16.0% were im/migrants, of whom 57% had precarious immigration status at baseline. 16.5% of participants experienced client condom refusal. Precarious immigration was associated with increased odds of facing condom refusal (adjusted odds ratio [AOR] 2.53, 95% confidence interval [CI] 1.37–4.68), and these odds were heightened post-end-demand law reforms (AOR 4.35, 95%CI 1.21–15.66). Our findings suggest that lack of citizenship rights may enhance barriers to safer sex negotiation and increase HIV/STI risk among sex workers, highlighting the need for sex work and immigration policy reforms.

KEYWORDS:

• Migrant sex workers
• sex work
• client condom refusal
• HIV
• end-demand

Acknowledgements

We thank all those who contributed their time and expertise to this project, particularly participants, AESHA community advisory board members and partner agencies, and the AESHA team, including: Sarah Moreheart, Shannon Bundock, Brittney Udall, Jennifer Morris, Jennifer McDermid, Alka Murphy, Sylvia Machat, Sherry Wu, Bridget Simpson, Gail Madanayake, Zoe Hassall, Kate Noyes, Emma Kuntz, Akanée Yamaki, Lauren McCraw, Zoe Hassell, Jane Li, Anna Mathen, Meaghan Thumath, Lois Luo. We also thank Peter Vann and Megan Bobetsis for their research and administrative support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data

Due to our ethical and legal requirements related to protecting participant privacy and current ethical institutional approvals, all relevant data are available upon request pending ethical approval. Please submit all request to initiate the data access process to the corresponding author.

Notes

1 The term ‘migrant worker’ often refers to individuals who do not hold citizenship or permanent residency (i.e. temporary or undocumented workers) in a country; particularly with ‘migrant sex worker’. Community-based organizations (SWAN Vancouver Society, 2015) have proposed ‘im/migrant sex worker’ as a broader term inclusive of the diverse persons (regardless of immigration status) who were born in another country and now work in sex work in Canada. Our study uses ‘im/migrant’ to include all possible forms of immigration status.

Additional information

Funding

This research was supported by grants from the National Institutes of Health [grant number R01DA028648] and Canadian Institutes of Health Research.