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

Figures & data

Table 1. Baseline individual and structural factors stratified by precarious immigration status among sex workers in Metro Vancouver, Canada who completed the migration supplement (n = 758), AESHA 2010–2018.

Characteristic	Total (N = 758) n (%)	Precarious status		P
		Yes (N = 69) n (%)	No (N = 689) n (%)
Individual factors
Age, median (IQR)	35.0 (28.0–43.0)	38 (30.0–43.0)	34.0 (27.0–42.5)	0.049
Ethnicity
White	270 (35.6)	1 (1.5)	269 (39.0)	–
Indigenous	341 (45.0)	1 (1.5)	340 (49.4)	–
Chinese/Taiwanese	97 (12.8)	60 (86.9)	37 (5.4)	–
Other ethnic minority	50 (6.6)	7 (10.1)	43 (6.2)	<.001
Gender and/or sexual minority**	283 (37.3)	11 (15.9)	272 (39.5)	<.001
Non-injection drug use^†	580 (76.5)	5 (7.3)	575 (83.5)	<.001
Injection drug use^†	353 (46.6)	1 (1.5)	352 (51.1)	<.001
Good self-rated health	502 (66.2)	58 (84.1)	444 (64.4)	0.001
Years working in sex work, median (IQR)	12 (5–21)	1 (0–1)	13 (6–22)	<.001
Structural determinants
Completed high school	373 (49.2)	59 (85.5)	314 (45.6)	<.001
Time since migration to Canada
Canadian-born	636 (83.9)	0 (0.0)	636 (92.3)	–
Recent im/migrant (within last 5 years)	43 (5.7)	43 (62.3)	0 (0.0)	–
Long-term im/migrant (>5 years)	68 (9.0)	18 (26.1)	50 (7.3)	<.001
Homelessness^†	270 (35.6)	0 (0.0)	270 (39.2)	<.001
Unstable housing^†	634 (83.6)	35 (50.7)	599 (86.9)	<.001
Average monthly income ($ CAD)^†, median (IQR)	2500 (1330–5300)	2900 (1800–4000)	2400 (1210–5430)	0.429
Financially supports dependents	197 (26.0)	39 (56.5)	158 (22.9)	<.001
Primary place servicing clients^†
Outdoor/public space	337 (44.5)	1 (1.5)	336 (48.8)
Informal indoor venue (e.g. bars, hotels)	247 (32.6)	3 (4.4)	244 (35.4)
In-call sex work venue (e.g. massage parlour, micro-brothel)	157 (20.7)	65 (94.2)	92 (13.4)	<.001
Sexual risk
Client condom refusal^†	54 (7.1)	7 (10.1)	47 (6.8)	0.322
Number of condoms carried per shift^†, median (IQR)	6.0 (4.0–10.0)	4.0 (2.0–10.0)	6.0 (4.0–10.0)	<.001
Difficulty accessing condoms while working^†	78 (10.3)	3 (4.4)	75 (10.9)	0.0873
Physical/sexual violence from clients^†	154 (20.3)	3 (4.4)	151 (21.9)	<.001
Police presence affected where participant worked^†	364 (48.0)	2 (2.9)	362 (52.5)	<.001
Police harassment excluding arrest^†	267 (35.2)	6 (8.7)	261 (37.9)	<.001

Notes: All data refer to n (%) of participants unless otherwise specified.

^†In the last 6 months.

**LGBTQ2S vs cisgender and heterosexual.

Table 2. Confounder model of the independent effect of precarious immigration status on client condom refusal among sex workers in Metro Vancouver, Canada (n = 758), AESHA 2010–2018.

Exposure	Outcome: experienced client condom refusal^†
	Unadjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)
Precarious status^†	1.98 (1.16–3.38)^‡‡	2.53 (1.37–4.68)^‡‡

Notes: Confounders identified through bivariate analysis and included in the final model were years in sex work, recent physical/sexual client violence^†, and difficulty accessing condoms while working^†.

^†Time-updated measures (serial measures at each study visit using last 6 months as reference point).

^‡‡Significantly associated at p ≤  0.05.

Table 3. Confounder model of the independent the effect of exposure to end-demand law reform on client condom refusal among sex workers with and without precarious immigration status in Metro Vancouver, Canada (n = 758), AESHA 2010–2018.

Exposure	Outcome: experienced client condom refusal^†
	Unadjusted Odds Ratio (95% CI)		Adjusted Odds Ratio (95% CI)
	Secure status	Precarious status	Secure status	Precarious status
Post end-demand law reform period	0.53 (0.36–0.78)^‡‡	3.24 (1.02–10.32)^‡‡	1.17 (0.77–1.78)	4.35 (1.21–15.66)^‡‡

Notes: Confounders identified through bivariate analysis and included in the final model were age, years in sex work, average monthly income^†, recent physical/sexual client violence^†, whether police presence affected where the participant worked^†, and difficulty accessing condoms while working^†.

^†Time-updated measures (serial measures at each study visit using last 6 months as reference point).

^‡‡Significantly associated at p  ≤ 0.05.