1421The protective association of social cohesion on sex workers' experiences of violence and access to tailored services: findings of a community-based cohort in Vancouver, Canada (2010-2019)


Co-auteurs

J. Pearson * (1,2), K. Shannon (3,2), D. Kerrigan (4), A. Krüsi (2,3), M. Brachel (2), S. Goldenberg (5,2,6) (1) University of British Columbia, Interdisciplinary Studies Graduate Program, Vancouver, Canada, (2) Centre for Gender and Sexual Health Equity, Vancouver, Canada, (3) University of British Columbia, Department of Medicine, Vancouver, Canada, (4) George Washington University, Department of Prevention and Community Health, Washington, DC, United States, (5) San Diego State University, Division of Epidemiology and Biostatistics, School of Public Health, San Diego, United States, (6) Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada


Abstract

BACKGROUND: While community mobilization and social cohesion have been identified as key drivers of HIV prevention and improved safety for sex workers in the global south, we know less about social cohesion's impacts on safety and access to community-driven HIV prevention services in North America and under partial-criminalization models. COVID-19, in addition, has highlighted the critical need and role of community supports. Our aim was to measure recent (in the last six months) social cohesion (perceptions of mutual aid, trust and support) and its association with (1) sexual/physical violence, and (2) engagement with sex work-specific services (e.g., drop-in spaces, HIV/harm reduction outreach) among women sex workers in Metro Vancouver, Canada.



METHODS: Prospective data (January 2010-August 2019) were drawn from an open cohort, operated by experiential and community-based staff, of 900+ women sex workers across diverse work environments (An Evaluation of Sex Workers'' Health Access). We used multivariable logistic regression confounder models with generalized estimating equations (GEE) for repeated measures to examine the association between social cohesion and recent outcomes of (1) physical/sexual violence and (2) use of sex work-specific services, over a ten-year period.
RESULTS: The study sample included 860 sex workers, of whom 315 (36.6%) were Indigenous and 283 (32.9%) Black/Women of Colour. Overall, 36.4% identified as a sexual minority and 8.0% as gender-diverse. At baseline, the median social cohesion score was 19 (IQR 15-22), out of a possible 36. In bivariable GEE analysis, increased social cohesion was associated with formal indoor work environments, good self-rated health, and working with other sex workers as a safety strategy, and was negatively associated with living with HIV. In separate multivariable GEE confounder models, social cohesion was independently associated with lower odds of recent physical/sexual violence (Adjusted Odds Ratio (aOR) 0.99 per point on scale, 95% Confidence Interval (CI) 0.97, 1.00) and increased odds of recently using sex work-specific services (aOR 1.02 per point on scale, 95% CI 1.00, 1.04).
CONCLUSIONS: The findings affirm community calls to fully decriminalize sex work to better promote sex workers' social cohesion, physical safety and access to tailored, sex work-specific sexual health and HIV services.