HIV/STI prevention, unmet health needs, and work stress among im/migrant sex workers in Metro Vancouver

• Main Author: Sou, Julie Chong-Yee
• Language: English
• Published: University of British Columbia 2016
• Online Access: http://hdl.handle.net/2429/59477

Background: Im/migrant women often face barriers to conventional labour markets in destination countries, and are disproportionately represented in precarious employment arrangements, including sex work. Apart from sexual health, research examining broader health concerns of im/migrant sex workers (SWs) remains scarce. This thesis sought to investigate the relationship between im/migration experiences and (1) inconsistent condom use with clients, (2) unmet health needs, and (3) dimensions of work stress among SWs. Methods: This thesis utilized data from “An Evaluation of Sex Workers Health Access” (AESHA), a community-based prospective cohort of SWs in Metro Vancouver. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were used to model correlates of inconsistent condom use among im/migrant SWs only (Objective 1) and unmet health needs among all SWs (Objective 2). Multivariable confounder models using linear regression with GEE were developed to examine independent relationships between im/migration experience and dimensions of work stress (Objective 3). Results: In Objective 1, multivariable GEE analysis conducted among 182 im/migrant SWs enrolled in AESHA from January 2010 and February 2013 revealed that difficulty accessing condoms was the strongest predictor of inconsistent condom use (Objective 1). In Objective 2, among 742 im/migrant and Canadian-born SWs enrolled from January 2010 to February 2014, multivariable GEE analysis found that recent and long-term im/migration, police harassment and arrest, and lifetime abuse/trauma were associated with greater unmet health needs. In Objective 3, among 545 SWs enrolled from January 2010 to September 2014, multivariable confounder GEE modeling revealed that recent and long-term im/migrant SWs faced decreased work stress related to job demands compared to their Canadian-born counterparts, after adjustment for key confounders. Conclusions: Findings suggest that im/migration experience is a key driver of HIV/STI prevention, healthcare access, and work stress among SWs. Importantly, im/migration experiences intersect with other structural factors – working conditions, violence, policing, sex work criminalization– to shape the health and safety of im/migrant SWs. Culturally appropriate, low-barrier health and support services should be made accessible to im/migrant SWs. Sex work decriminalization along with supporting collectivization efforts within the workplace are also recommended to improve working conditions, health, and human rights for im/migrant SWs. === Medicine, Faculty of === Population and Public Health (SPPH), School of === Graduate