Safer indoor sex work spaces promote health and safety of street-involved women

Safer indoor sex work spaces provide important and potentially life-saving benefits to sex workers including reduced exposure to violence and HIV and improved relationships with police, according to a study published by the Gender and Sexual Health Initiative of the BC Centre for Excellence in HIV/AIDS (BC-CfE) and the University of British Columbia (UBC).

The qualitative evaluation study published today in the America Journal of Public Health interviewed 39 women living in low-threshold, supportive housing programs for sex workers in poverty and using drugs. These programs, operated by Atira Women's Resource Society and RainCity Housing and Support Society in Vancouver, Canada, offer an innovative harm reduction model that promotes the health and safety of the most marginalized sex workers.

Security measures include women-only buildings (residents, staff), supportive guest policies (clients sign-in at front desk), video cameras onsite, staff available to call police in case of violence, and health and safety resources onsite, including bad date sheets and condoms. Based on the success of the programs to date, these models have now been extended to reach more sex workers across a number of housing programs in Vancouver.

Sex workers interviewed in the study had all previously worked on the street and described how supportive housing programs increased their control over negotiating sex work transactions, including the capacity to refuse unwanted services, negotiate condom use and avoid violent predators. Women's accounts contrast the safety afforded by these environments with their very limited options to controlling their safety when seeing clients in cars, alleys and clients' homes.

"This research shows that safer indoor sex work spaces dramatically reduce the risks to the health and safety of sex workers," says Dr. Kate Shannon, senior author of the study, director of BC-CfE's Gender and Sexual Health Initiative and assistant professor of medicine at UBC. "We have previously shown that displacement and lack of safer indoor options for street-based sex workers are directly associated with elevated rates of violence and HIV risk. The evidence is clear: We need to scale up access to safer sex work spaces and remove legal barriers to their formal implementation and evaluation."

The publication of the study follows the landmark decision by the Ontario Court of Appeal that allows sex workers to legally work in safer indoor spaces starting next year. The court concluded that laws preventing sex workers from working together under one roof or hiring security staff fail to protect sex workers and exacerbate harms. While the decision is not currently binding outside Ontario, if upheld by the Supreme Court of Canada the government will be forced to ensure the laws are brought in line with the evidence.

"We have created policies and practices that support women's choice and ensure their health and safety are protected," says Amelia Ridgway, Manager of RainCity Housing. "Women have the right to govern their own bodies. We believe that housing is a human right and this is about providing women with the most basic human rights around protection from violence within a harm reduction framework."

"This is about promoting and protecting the basic rights of women who do sex work and live in poverty," adds Janice Abbott, CEO of Atira Women's Resource Society. "The contradictory nature of Canada's criminalized prostitution laws is that sex workers in higher-end neighbourhoods can operate largely free of persecution out of their own apartments, but the most marginalized women in sex work continue to be criminalized and victimized by restrictive and arbitrary policies and enforcement."

The women interviewed said safer sex work spaces reduce some of the anonymity and isolation that mark street-level transactions, allowing onsite staff and workers to identify violent predators. They added that safer spaces where sex workers can bring clients indoors support increased solidarity between sex workers and promotes their ability to self-regulate safer industry standards.

An important finding of the study is improved relations between sex workers and police. "As evidence has shown time and time again, current criminalized laws and enforcement of these laws create an adversarial relationship between sex workers and police," says Dr. Shannon. "These findings align with the new guidelines by Vancouver Police Department to not harass or arrest sex workers."

As one sex worker in the study explains: "On the corner, doing it in the car, I used to be scared all the time, paranoid about cops, scared of getting charged. It is a lot easier now. I can come and go [to this safer space], and cops actually say hi to me. It is different." Another sex worker adds, "Now police just check me out and help me be safe."

"We need to view safer sex work spaces as an evidence-based public health imperative," concludes Dr. Perry Kendall, BC's Provincial Health Officer. "This research clearly demonstrates that safer sex work models bring street-based sex workers indoors and away from violent predators, and support their access to health, security and safety."

"Safer sex work spaces support better health and safety, period," said Dr. Patricia Daly, Chief Medical Health Officer, Vancouver Coastal Health. "We need to ensure that evidence-based safer sex work models are supported, and where possible expanded, to reach marginalized individuals."