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

BMJ 2009; 339 doi: (Published 11 August 2009) Cite this as: BMJ 2009;339:b2939
  1. Kate Shannon, assistant professor12,
  2. T Kerr, assistant professor12,
  3. S A Strathdee, professor and chair3,
  4. J Shoveller, professor2,
  5. J S Montaner, professor and director12,
  6. M W Tyndall, associate professor12
  1. 1British Columbia Centre for Excellence in HIV/AIDS St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
  2. 2Faculty of Medicine, University of British Columbia Vancouver, BC V6T 1Z3, Canada
  3. 3Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, CA 92093-0507, USA
  1. Correspondence to: K Shannon kshannon{at}
  • Accepted 8 March 2009


Objective To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution.

Design Prospective observational study.

Setting Vancouver, Canada during 2006-8.

Participants Female sex workers 14 years of age or older (inclusive of 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, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aORphysicalviolence) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aORrape) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aORclientviolence) 2.13, 1.26 to 3.62; aORphysicalviolence 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aORclientviolence 1.50, 1.08 to 2.57); prior assault by police (aORclientviolence 3.45, 1.98 to 6.02; aORrape 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aORphysicalviolence 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aORclientviolence 2.13, 1.26 to 3.62).

Conclusions Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender based violence against street based female sex workers. Socio-legal policy reforms, improved access to housing and drug treatment, and scale up of violence prevention efforts, including police-sex worker partnerships, will be crucial to stemming violence against female sex workers.


  • Acknowledgements: We thank our community partner, the WISH Drop-In Centre Society, and other community collaborators, research staff, and co-investigators of the Maka Project Partnership. We acknowledge the statistical and data management support provided by Calvin Lai and Ruth Zhang.

  • Contributors: KS conceptualised the study, developed the data analysis plan, and wrote the original draft of the manuscript. TK, SAS, JS, JSM, and MWT provided content expertise and critical feedback on the analyses and interpretation, and read and approved the final version for submission.

  • Funding: This research was primarily funded through an operating grant from the HIV/AIDS Community-Based Research Program of the Canadian Institutes of Health Research. KS, TK, and JS are supported by the Canadian Institutes of Health Research. TK and MWT are supported by the Michael Smith Foundation for Health Research. JSM is supported through an Avant-Garde Award from the National Institute on Drug Abuse of the National Institutes of Health. The funders had no role in study design, data collection, or in analysis and interpretation of the results, and this paper does not necessarily reflect views or opinions of the funders.

  • Competing interests: None declared.

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