Canada: Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV Prevention Strategies and Policy

The study authors sought to assess the relationship between environmental-structural factors and client condom-use negotiation among female sex workers in Vancouver, British Columbia.

Using baseline data from a 2006 community-based cohort of female sex workers, the researchers mapped the clustering of "hot spots" for being pressured into unprotected sex by a client and investigated sexual HIV risk. Multivariate logistic modeling was employed to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sex.

Multivariate analyses indicated being pressured into having unprotected sex was independently associated with having an individual zoning restriction (odds ratio [OR]=3.39; 95 percent confidence interval [CI]=1.00, 9.36), working away from main streets due to policing (OR=3.01; 95 percent CI=1.39, 7.44), borrowing a used crack pipe (OR=2.51; 95 percent CI=1.06, 2.49), client-perpetuated violence (OR=2.08; 95 percent CI=1.06, 4.49), and servicing clients in cars or in public places (OR=2.00; 95 percent CI=1.65, 5.73).

"Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties," the authors concluded.

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