Centre for Gender and Sexual Health Equity, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.
Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Int J Equity Health. 2022 Feb 9;21(1):18. doi: 10.1186/s12939-022-01621-8.
Sex work criminalization and occupational stigma pose barriers to sex workers' access to support services, including community participation - engagement with sex work specific community organizing at both formalized and grassroots capacities. In light of gaps in evidence regarding impacts of community participation on sex workers' occupational health in higher-income settings, we evaluated engagement in community participation and associations with occupational sexual health outcomes among sex workers in Vancouver, Canada.
Prospective data from a community-based cohort of 943 women sex workers in Vancouver, British Columbia (2010-2019). We used logistic regression with generalised estimating equations (GEE) to model correlates of community participation, and a confounder modeling approach to examine the association of community participation on sexually transmitted infection (STI) seropositivity.
Among participants, 38.1% were Indigenous, 31.4% identified as women of colour (e.g., East Asian, Southeast Asian, Black) and 29.3% were im/migrants to Canada. Over a quarter (28.3%, n = 267) serviced in informal indoor spaces, while 38.0% (n = 358) serviced clients in outdoor/public and 31.4% (n = 296) in formal in-call spaces. 8.9% of participants reported sex work community participation at least once over the 9-year study. In multivariable GEE analysis, Indigenous (adjusted odds ratio(aOR) 1.71, 95% confidence interval (CI) 0.88-3.32) and trans women (aOR 4.69, 95%CI 2.43-9.06) had higher odds of community participation; women of colour had lower odds (aOR 0.18, 95%CI 0.06-0.57). In a multivariable GEE confounder model, community participation was independently associated with lower odds of STI seropositivity (aOR 0.66, 95% CI0.45-0.96).
Sex workers who engaged in sex work community participation faced reduced odds of STI seropositivity. Building off reserach evaluating community interventions in low and middle income contexts, our study provides some of the first quantitative evidence on community participation among sex workers in Canada, and is the first to examine this in relation to sexual health outcomes. This research demonstrates the need to scale up community participation access for sex workers, via linguistically diverse community spaces, anti-stigma initiatives, and decriminalization to reduce barriers faced by racialized sex workers and support occupational health and rights for all sex workers.
性工作的刑事定罪和职业污名将性工作者获得支持服务的机会（包括社区参与——以正式和基层能力参与特定于性工作的社区组织）。鉴于在高收入环境中，关于社区参与对性工作者职业健康的影响的证据存在差距，我们评估了加拿大温哥华的性工作者参与社区活动的情况以及与职业性健康结果的关联。
对不列颠哥伦比亚省温哥华的一个基于社区的 943 名女性性工作者队列的前瞻性数据（2010-2019 年）。我们使用广义估计方程（GEE）的逻辑回归模型来对社区参与的相关性进行建模，并采用混杂因素建模方法来检验社区参与与性传播感染（STI）血清阳性之间的关联。
在参与者中，38.1%为原住民，31.4%为有色人种（例如东亚人、东南亚人、黑人），29.3%为加拿大移民。超过四分之一（28.3%，n=267）在非正规室内场所提供服务，而 38.0%（n=358）在户外/公共场所提供服务，31.4%（n=296）在正规电话服务场所提供服务。在 9 年的研究中，8.9%的参与者至少报告过一次性工作社区参与。在多变量 GEE 分析中，原住民（调整后的优势比（aOR）1.71，95%置信区间（CI）0.88-3.32）和跨性别女性（aOR 4.69，95%CI 2.43-9.06）的社区参与可能性更高；有色人种的可能性较低（aOR 0.18，95%CI 0.06-0.57）。在多变量 GEE 混杂因素模型中，社区参与与较低的 STI 血清阳性率独立相关（aOR 0.66，95%CI0.45-0.96）。
参与性工作社区活动的性工作者感染性传播感染的可能性较低。在评估中低收入国家社区干预措施的研究的基础上，我们的研究提供了加拿大性工作者社区参与的一些首批定量证据，也是第一个研究社区参与与性健康结果之间关系的研究。这项研究表明，需要通过语言多样化的社区空间、反污名倡议和非刑事化来扩大性工作者获得社区参与的机会，以减少种族化性工作者面临的障碍，并支持所有性工作者的职业健康和权利。
