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The impact of end-demand legislation on sex workers’ access to health and sex worker-led services: A community-based prospective cohort study in Canada

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  • Elena Argento
  • Shira Goldenberg
  • Melissa Braschel
  • Sylvia Machat
  • Steffanie A Strathdee
  • Kate Shannon

Abstract

Background: Following a global wave of end-demand criminalization of sex work, the Protection of Communities and Exploited Persons Act (PCEPA) was implemented in Canada, which has implications for the health and safety of sex workers. This study aimed to evaluate the impact of the PCEPA on sex workers’ access to health, violence, and sex worker-led services. Methods: Longitudinal data were drawn from a community-based cohort of ~900 cis and trans women sex workers in Vancouver, Canada. Multivariable logistic regression examined the independent effect of the post-PCEPA period (2015–2017) versus the pre-PCEPA period (2010–2013) on time-updated measures of sex workers’ access to health, violence supports, and sex worker/community-led services. Results: The PCEPA was independently correlated with reduced odds of having access to health services when needed (AOR 0.59; 95%CI: 0.45–0.78) and community-led services (AOR 0.77; 95%CI: 0.62–0.95). Among sex workers who experienced physical violence/sexual violence or trauma, there was no significant difference in access to counseling supports post-PCEPA (AOR 1.24; 95%CI: 0.93–1.64). Conclusion: Sex workers experienced significantly reduced access to critical health and sex worker/community-led services following implementation of the new laws. Findings suggest end-demand laws may exacerbate and reproduce harms of previous criminalized approaches to sex work in Canada. This study is one of the first globally to evaluate the impact of end-demand approaches to sex work. There is a critical evidence-based need to move away from criminalization of sex work worldwide to ensure full labor and human rights for sex workers. Findings warn against adopting end-demand approaches in other cities or jurisdictions.

Suggested Citation

  • Elena Argento & Shira Goldenberg & Melissa Braschel & Sylvia Machat & Steffanie A Strathdee & Kate Shannon, 2020. "The impact of end-demand legislation on sex workers’ access to health and sex worker-led services: A community-based prospective cohort study in Canada," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-10, April.
    • Handle: RePEc:plo:pone00:0225783
    DOI: 10.1371/journal.pone.0225783
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    References listed on IDEAS

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    1. Krüsi, A. & Chettiar, J. & Ridgway, A. & Abbott, J. & Strathdee, S.A. & Shannon, K., 2012. "Negotiating safety and sexual risk reductionwith clients in unsanctioned safer indoor sex work environments: A qualitative study," American Journal of Public Health, American Public Health Association, vol. 102(6), pages 1154-1159.
    2. Stueve, A. & O'Donnell, L.N. & Duran, R. & San Doval, A. & Blome, J., 2001. "Time-space sampling in minority communities: Results with young Latino men who have sex with men," American Journal of Public Health, American Public Health Association, vol. 91(6), pages 922-926.
    3. Shannon, K. & Strathdee, S.A. & Shoveller, J. & Rusch, M. & Kerr, T. & Tyndall, M.W., 2009. "Structural and environmental barriers to condom use negotiation with clients among female sex workers: Implications for HIV-prevention strategies and policy," American Journal of Public Health, American Public Health Association, vol. 99(4), pages 659-665.
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