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

McBride, Bronwyn; Shannon, Kate; Braschel, Melissa; Mo, Minshu; Goldenberg, Shira M.

2020-01-04

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In Canada, im/migrant sex workers face stigma, health access barriers, and overlapping marginalization, with end-demand law reforms in 2014 postulated to exacerbate these inequities. Yet, little quantitative evidence on how immigration status shapes HIV/STI risk exists. Drawing on community-based longitudinal cohort data (AESHA, 2010–2018), we used multivariable confounder models with logistic regression to model 1) the independent effect of precarious immigration status (any status revocable under criminal charges: permanent residency/temporary residency/undocumented) on client condom refusal, and 2) the moderating effect of precarious status on the relationship between condom refusal and exposure to end-demand law reform (2015-present). Over this 8-year study involving 758 sex workers in Metro Vancouver 16.0% were im/migrants, of whom 57% had precarious immigration status at baseline. 16.5% of participants experienced client condom refusal. Precarious immigration was associated with increased odds of facing condom refusal (adjusted odds ratio [AOR] 2.53, 95% confidence interval [CI] 1.37–4.68), and these odds were heightened post-end-demand law reforms (AOR 4.35, 95%CI 1.21–15.66). Our findings suggest that lack of citizenship rights may enhance barriers to safer sex negotiation and increase HIV/STI risk among sex workers, highlighting the need for sex work and immigration policy reforms.