Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers

doi:10.1136/bmj.b2939

Published 11 August 2009, doi:10.1136/bmj.b2939
Cite this as: BMJ 2009;339:b2939

Research

Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers

Kate Shannon, assistant professor¹^,2, T Kerr, assistant professor¹^,2, S A Strathdee, professor and chair³, J Shoveller, professor², J S Montaner, professor and director¹^,2, M W Tyndall, associate professor¹^,2

¹ British Columbia Centre for Excellence in HIV/AIDS St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada , ² Faculty of Medicine, University of British Columbia Vancouver, BC V6T 1Z3, Canada , ³ Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, CA 92093-0507, USA

Correspondence to: K Shannon kshannon{at}cfenet.ubc.ca

Objective To examine the prevalence and structural correlatesof gender based violence against female sex workers in an environmentof criminalised prostitution.

Design Prospective observational study.

Setting Vancouver, Canada during 2006-8.

Participants Female sex workers 14 years of age or older (inclusiveof transgender women) who used illicit drugs (excluding marijuana)and engaged in street level sex work.

Main outcome measure Self reported gender based violence.

Results Of 267 female sex workers invited to participate, 251women returned to the study office and consented to participate(response rate of 94%). Analyses were based on 237 female sexworkers who completed a baseline visit and at least one follow-upvisit. Of these 237 female sex workers, 57% experienced genderbased violence over an 18 month follow-up period. In multivariatemodels adjusted for individual and interpersonal risk practices,the following structural factors were independently correlatedwith violence against female sex workers: homelessness (adjustedodds ratio for physical violence (aOR_{physicalviolence}) 2.14,95% confidence interval 1.34 to 3.43; adjusted odds ratio forrape (aOR_rape) 1.73, 1.09 to 3.12); inability to access drugtreatment (adjusted odds ratio for client violence (aOR_{clientviolence})2.13, 1.26 to 3.62; aOR_{physicalviolence} 1.96, 1.03 to 3.43);servicing clients in cars or public spaces (aOR_{clientviolence}1.50, 1.08 to 2.57); prior assault by police (aOR_{clientviolence}3.45, 1.98 to 6.02; aOR_rape 2.61, 1.32 to 5.16); confiscationof drug use paraphernalia by police without arrest (aOR_{physicalviolence}1.50, 1.02 to 2.41); and moving working areas away from mainstreets owing to policing (aOR_{clientviolence} 2.13, 1.26 to 3.62).

Conclusions Our results demonstrate an alarming prevalence ofgender based violence against female sex workers. The structuralfactors of criminalisation, homelessness, and poor availabilityof drug treatment independently correlated with gender basedviolence against street based female sex workers. Socio-legalpolicy reforms, improved access to housing and drug treatment,and scale up of violence prevention efforts, including police-sexworker partnerships, will be crucial to stemming violence againstfemale sex workers.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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