Underreporting of Violence to Police among Women Sex Workers in Canada: Amplified Inequities for Im/migrant and In-Call Workers Prior to and Following End-Demand Legislation

Volume 22/2, December 2020, pp 257 – 270


Bronwyn McBride, Kate Shannon, Brittany Bingham, Melissa Braschel, Steffanie Strathdee, and Shira M. Goldenberg


Sex workers globally face high levels of violence. In Canada, im/migrant sex workers who work in indoor venues may be uniquely targeted by police due to immigration policies, racialized policing, and the conflation of trafficking and sex work. In 2014, Canada passed end-demand legislation that purportedly encourages sex workers to report violence to police; however, little research has evaluated its impact. Using interrupted time series and multivariable logistic regression, we examined proportions of reporting violent incidents to police among sex workers who had experienced workplace violence (2010–2017), including potential changes prior to and following end-demand legislation. We then modeled the independent effects of im/migrant status and place of work on reporting violence. Among sex workers who experienced recent violence during the 7.5-year study (n=367), 38.2% of all participants and 12.7% of im/migrants reported violence to police, and there was no significant change in violence reporting after end-demand legislation. Our results suggest that end-demand laws do not remove barriers to justice faced by sex workers and instead actually perpetuate harms, particularly for racialized im/migrant and indoor workers. Policy reforms to decriminalize sex work, address discriminatory policing, and promote access to safety and justice are urgently needed.


Globally, sex workers face egregious human rights violations, including high levels of violence, which have been linked to health and social inequities such as an elevated burden of HIV and other sexually transmitted infections and poor reproductive and mental health outcomes.[1] A 2014 global systematic review identified a staggeringly high lifetime prevalence (45–75%) of physical, sexual, or combined workplace violence against women sex workers.[2] This violence is partly fueled by perpetrators’ recognition of sex workers’ devalued social status and by the fact that sex workers often hesitate to report incidents to police due to deep-rooted mistrust and fear of criminal charges, stigma, or further abuse.[3] Importantly, research has shown that sex workers’ inability to contact police for support after experiencing violence enables perpetrators to abuse sex workers with impunity, perpetuating high levels of violence.[4]

Criminalization, violence, and access to police protections

The criminalization of sex work shapes the prevalence of workplace violence, as well as sex workers’ access to police protections.[5] A Lancet review concluded that human rights violations against sex workers are most profound where aspects of sex work are criminalized, as sex workers fear reporting violence to police due to the risk of criminal charges.[6] Globally, punitive policing of street-based and indoor sex work locations has been documented to displace sex workers to isolated environments where they are more vulnerable to violence and coercion into unprotected sex.[7] Criminalization also enables police abuses against sex workers (for example, harassment, physical and sexual assault, and forced sex under threat of arrest), which have been documented in diverse contexts and represent a clear obstacle to sex workers’ access to justice.[8]

Marginalization among racialized im/migrant and indigenous sex workers

In Canada, racialized sex workers—including black, indigenous, and other people of color, as well as visible minority immigrant and migrant (im/migrant[*]) workers—face severe health and rights inequities, and concerns have been raised regarding racialized policing and barriers to reporting violence to police.[9] Fear of authorities is amplified among racialized im/migrant sex workers, who often face discrimination, language barriers, privacy concerns, and precarious legal status.[10] Importantly, sex work is explicitly criminalized among temporary residents and im/migrants with open work permits (permits legally authorizing the holder to work in any type of employment, except for sex work) under Canadian immigration policy.[11] Im/migrant sex workers in Canada are also more likely to work in in-call sex work venues (for example, massage parlors and micro-brothels) than in outdoor and public spaces (for example, streets and parks), and venue raids by authorities have been documented to enhance sex workers’ vulnerability to violence and further undermine their access to recourse.[12] Emerging evidence from Europe suggests that racialized im/migrant sex workers in in-call venues may be targeted by authorities under end-demand legislative models (also known as the Nordic or neo-abolitionist models). End-demand ideology represents sex workers as victims of gender-based violence by conflating sex work (defined as the consensual exchange of sex services) with victimization and sex trafficking (defined as forced sexual labor). As a result, end-demand legislative models criminalize sex work clients and third parties, such as venue owners and managers, which has contributed to punitive policing of indoor sex work venues.[13] While community reports have highlighted enhanced marginalization and policing among racialized im/migrant and indoor sex workers in Canada, quantitative evidence on access to violence reporting among these groups is needed, particularly given recent legislative reforms.[14]

In Canada, indigenous women face twelvefold greater odds of being murdered or missing relative to non-indigenous women, and these odds are exacerbated among sex workers.[15] Indigenous sex workers continue to report deep mistrust of Canadian law enforcement. This stems from colonial abuses, including racialized policing of and child apprehension among indigenous peoples, police failures to respond to missing and murdered indigenous women (including sex workers), and the historical legacy of the residential school system (that is, government-sponsored schools to assimilate indigenous children into Euro-Canadian culture from 1880 to 1996).[16] While the severe structural violence affecting indigenous women in Canada remains the subject of a national inquiry and numerous reports, indigenous sex workers continue to face disproportionate violence, and their access to justice merits investigation.[17]

Canadian end-demand legislative framework

After Canada’s previous sex-work laws were struck down by the Supreme Court in 2013 for violating sex workers’ rights to security of person, end-demand legislation (the Protection of Communities and Exploited Persons Act) was enacted in 2014, leaving the sale of sex legal while criminalizing clients and third-party activities (such as gaining material benefit from the sale of others’ sex services and advertising for others’ sex services). This legislation emphasizes “the exploitation inherent in prostitution, and risks of violence posed to those who engage in it” and encourages sex workers to report violence to police.[18] By representing all sex work as inherently exploitative and victimizing, this legislation also conflates consensual sexual labor with sex trafficking and intersects with prohibitive immigration policies to render racialized im/migrant sex workers susceptible to heightened scrutiny from authorities.[19] Since 2014, anti-trafficking raids across Canada have resulted in the arrest of, charges against, and detention and deportation of im/migrant sex workers.[20] Concerningly, im/migrant sex workers have avoided contacting authorities even after violent robberies due to fear of arrest, charges, police harassment, and discrimination.[21] Im/migrant sex workers have reported that workers’ inability to call police due to fear of criminal charges and police prejudice against sex workers promotes violence by predators.[22]

Despite high levels of violence faced by sex workers in criminalized contexts and the implementation of end-demand legislative regimes in a number of countries, little quantitative research has examined sex workers’ ability to report violence to police in the context of end-demand legislation or its structural determinants. This study aimed to (1) examine the proportions of sex workers in Vancouver who reported violence to police, including potential changes in reporting practices prior to and following the implementation of end-demand laws (2010–2013 vs. 2015–2017); (2) examine structural correlates of reporting violence; and (3) model the independent associations between im/migrant status and place of work, respectively, with the reporting of violence.


We drew longitudinal data from a community-based open prospective cohort entitled “An Evaluation of Sex Workers Health Access,” which initiated recruitment in 2010 and is based on collaborations with community organizations serving women, sex workers, and people living with HIV.[23] Eligibility criteria include identifying as a cisgender or transgender woman, having exchanged sex for money in the last month at enrollment, and providing written informed consent. Time-location sampling was used to recruit youth and women aged 14+ through outreach to outdoor (for example, streets and alleys), in-call (for example, massage parlors, and micro-brothels), and informal indoor (for example, hotels and bars) locations and online solicitation spaces across Metro Vancouver. Women with lived experience (current/former sex workers) have occupied various roles (for example, as interviewers, project nurses, researchers, and others) on the project team since the AESHA study’s inception, and our interviewer and outreach team includes multilingual staff. After providing their informed consent, participants completed interviewer-administered questionnaires in English, Mandarin, or Cantonese on sociodemographics, work environments, structural factors, and health access, at baseline and semiannual follow-up visits. Participants received $40 CAD upon each visit for their expertise and time. The study received ethical approval from the research ethics boards at Providence Health Care/University of British Columbia and Simon Fraser University.

Independent variables

To examine potential associations with reporting violence to police, we explored variables at the individual, workplace, and structural levels. Childhood trauma was a time-fixed variable measured via a modified 25-item version of the scale known as CTQ-SF and imputed with the sample median where missing.[24] Time-fixed structural factors included educational attainment (high school completion vs. less than high school), im/migrant to Canada (yes vs. no), and ethnicity (white vs. indigenous [First Nations/Métis/Inuit] vs. another visible minority [for example, Chinese]). All other variables were time updated at each semiannual follow-up, examining events occurring during the previous six months. Time-updated individual factors included age, non-injection substance use (for example, cocaine and hallucinogens, but excluding cannabis and alcohol), and ever receiving any mental health diagnoses. Structural factors included physical violence (having been strangled, beaten, locked or trapped in a car or room, assaulted with a weapon, drugged, or kidnapped) or sexual violence (rape or sexual assault) from a client or predator posing as a client; having been threatened or physically assaulted by residents or businesses near the workplace; experiencing homelessness or unstable housing (such as sleeping at a family member’s or friend’s); and the use of sex-worker support services (for example, drop-in spaces). Work environment factors included primary place soliciting clients (in-call venue vs. independently off-street [self-advertising] vs. from a street or public space) and primary place serving clients (informal indoor venue [for example, a hotel or client’s place] vs. in-call venue [for example, massage parlor] vs. outdoor or public spaces [such as a park or car]). A final structural variable was the time period surrounding the implementation of end-demand legislation (2010–2013 vs. 2015–2017). Given that the end-demand bill was introduced in January 2014 and passed into law in December 2014, we dropped 2014 from our analyses due to potential variation in law enforcement during this time. We also excluded the first three months of 2015 to account for exposure measures referring to the preceding six months.

Outcome variable

Our primary outcome was a time-updated measure of reporting verbal, physical, or sexual workplace violence to police in the last six months at each semiannual study visit. Workplace violence was defined as involving any of the following: verbal harassment or threats, stalking, abduction or kidnapping, rape or sexual assault, strangulation, physical assault, being locked or trapped in a car or room or thrown out of a moving car, assault with a weapon, or being drugged by clients or predators posing as clients. We measured the frequency of reporting violence to police using a Likert scale (“always,” “usually,” “sometimes,” “occasionally,” and “never” to such violence at each six month interval), which we dichotomized as yes (always/usually/sometimes/occasionally) vs. no (never). For interrupted time series analysis, the outcome was summarized as semiannual proportions based on interview date.

Statistical analyses

For objective 1, we used interrupted time series analysis to examine semiannual proportions of reporting violence to police and to evaluate the impact of end-demand legislation on these proportions. We divided the study period into pre- and post-end-demand law (2010–2013 vs. 2015–2017). To test for autocorrelation over time, we used the Durbin-Watson test and examined autocorrelation and partial autocorrelation function plots.[25] No autocorrelation was detected, and outliers (N=2) were excluded from analysis. Finally, we used segmented linear regression analysis to evaluate any changes in level and trend following the introduction of end-demand legislation, controlling for preexisting trends.

For objective 2, we used descriptive statistics and bivariate logistic regression with generalized estimating equations (GEE) and an exchangeable correlation structure to investigate factors correlated with reporting violence to police, as well as any potential changes in the odds of reporting violence prior to or following the legislative shift.

For objective 3, we constructed two separate multivariable confounder models to examine the independent associations between im/migrant status and place of work, respectively, with reporting violence. All potential confounders identified through bivariate analysis were included in these models and the pre- and post-end-demand legislation variable. Using the variable selection process described by George Maldonado and Sander Greenland, confounders that altered the association of interest by <5% were systematically removed in a manual backward stepwise manner to determine the most parsimonious model.[26] The study period was January 2010–August 2017, excluding January 2014–March 2015, and the sample was restricted to observations where participants had experienced recent workplace violence. We used a complete case approach (in other words, we excluded study visits with any missing data). All analyses were performed using SAS version 9.4 and R version 3.5.0, and all p-values are two-sided.


Our study included 367 participants (711 observations). In time series analysis, the median number of observations at each time point was 69 (IQR: 20–86).

Objective 1: Proportions of reporting violence to police

At the beginning of the study period, the prevalence of reporting violence was estimated at 26.0% (95% confidence interval [CI] 17.9–34.1%), and no significant trends were observed before the legislative shift (-0.4% semiannually, 95% CI -2.2–1.4%) (Figure 1). Following the implementation of end-demand legislation, no immediate change in the prevalence of reporting violence was observed (level change 4.2%, 95% CI -11.1–19.4%), and there was no significant difference in the trend of reporting violence (0.0% semiannually, 95% CI -4.7–4.7%).

Objective 2: Correlates of reporting violence to police

Of 367 participants who experienced any verbal, physical, or sexual workplace violence incidents over the study period, 38.2% (n=140) of all participants and only 12.7% (n=7) of im/migrants reported violence to police during the last six months at any point over the seven-and-a-half-year study (Figure 2), contributing a total 195 reporting events out of 711 violent incidents. Over half of the sample (53.4%) experienced only one violent incident, 22.9% experienced two, and 23.7% experienced more than two. Of 131 events of rape and sexual assault, 57.3% (n=75) were unreported.

Among a subsample of 147 participants who answered questions about why they did not report violence, 34.0% reported not trusting police to help. Participants’ reasons for not reporting to police were generally similar pre- and post-end-demand law (Table 1), with more participants reporting that they did not report violent incidents due to previous negative experiences with police after the implementation of end-demand legislation.

At baseline, participants’ median age was 33.2 (IQR: 27.9–41.5). Nearly half (44.7%) were of indigenous ancestry, 17.2% identified as another visible minority, and 15.0% were im/migrants born outside of Canada. Among im/migrant participants, most represented racialized backgrounds, with 54.6% identifying as Chinese, 9.1% as indigenous (that is, First Nations, Inuit, or Métis born outside Canada), 3.6% as Filipina, and only 10.9% as white.

Almost half (46.6%) of participants worked primarily in outdoor or public spaces; 35.7% worked in informal indoor spaces, and 14.7% worked in in-call venues (Table 2).

In bivariate GEE analyses, reporting violence to police was negatively associated with im/migrant status (odds ratio [OR] 0.25, 95% CI 0.12–0.54), identifying as a non-indigenous visible minority (vs. white) (OR 0.33, 95% CI 0.16–0.67), and working in in-call venues (vs. outdoor or public spaces) (OR 0.18, 95% CI 0.07–0.46); and positively associated with recent non-injection drug use (OR 2.81, 95% CI 1.45–5.45) and higher childhood trauma scores (OR 1.01/additional point on scale, 95% CI 1.00–1.02). There were no significant changes in odds of reporting violence after the implementation of end-demand legislation (OR 0.93, 95% CI 0.53–1.63) (Table 3). Notably, no im/migrant participants and no in-call workers indicated that they had reported violence to police in the post-end-demand legislation period.

Objective 3: Independent effects of im/migrant status and place of work on reporting violence to police

In multivariable GEE confounder models, im/migrant status (adjusted odds ratio [AOR] 0.42, 95% CI 0.19–0.93) (Table 4) and working in an in-call venue (vs. outdoor or public space) (AOR 0.27, 95% CI 0.09–0.78) (Table 5) were independently associated with reduced odds of reporting violence after adjustment for confounders, including the implementation of end-demand laws and other key individual and structural confounders (such as substance use, mental health diagnoses, and types of violence experienced).


In this seven-and-a-half-year community-based cohort study, 38% of all women and only 12.7% of im/migrant women who experienced violence reported any of these incidents to police, highlighting severe gaps in this aspect of sex workers’ access to police protections. Racialized im/migrant and indoor sex workers faced significantly lower odds of reporting violence, and there was no significant improvement in reporting violence after the implementation of end-demand legislation, despite the law’s stated aim of “encouraging those who sell their own sexual services to report incidents of violence.”[27] This is a critical finding given that Canadian end-demand legislation centers on the protection of vulnerable communities, represents sex workers as victims needing protection, and explicitly purports to encourage sex workers to seek police protections. The fact that we observed no significant change in sex workers’ access to police protection is an unacceptable outcome of this legislation. Further, the association that we documented between racialized im/migrant status and lower odds of reporting violence is alarming given the ongoing human rights violations faced by sex workers who experience physical and sexual violence in Canada and elsewhere.

Our findings are consistent with evidence from France, where, following the passage of end-demand laws in 2016, 70% of sex workers reported no improvement in or a deterioration of relationships with police, and 42% reported facing heightened violence.[28] In other places that have introduced end-demand models representing sex workers as victims, sex workers continue to experience police harassment and stigma, and discrimination influences police officers’ willingness to protect sex workers.[29] In Sweden, sex workers have faced police harassment and forced evictions from their homes despite laws stating that “victims of prostitution do not risk any legal repercussions,” and Norwegian sex workers avoid reporting crimes due to fear of being evicted and facing stigma from police.[30] Our participants were no more likely to report violence under end-demand legislation, which is particularly concerning given strong evidence that sex workers’ inability to access protection after experiencing violence enables impunity for perpetrators, thereby perpetuating ongoing human rights violations against sex workers.[31] Our finding that nearly two-thirds of sex workers did not report recent violence is consistent with studies from Nairobi and Tijuana, which found that 85.5% and 86% of sex workers, respectively, did not report recent violence to police under various regimes of sex work criminalization and regulation.[32]

In our study, im/migrant status was associated with 58% lower odds of reporting violence to police. This finding is consistent with previous research from our group highlighting how racialized im/migrants often report heightened economic and legal vulnerability and how stigma, privacy concerns (such as police putting sex work on one’s criminal record or one’s family finding out), and risk of immigration status revocation (the loss of official immigration status and risk of deportation) represent powerful barriers to seeking police protections in the context of im/migrant sex work.[33] In Hong Kong, im/migrant sex workers fear reporting violence due to concerns of deportation.[34] Under end-demand legislation, undocumented sex workers in France face pressure to report clients and threats of deportation if they do not comply, and sex workers in Sweden, Norway, and the United Kingdom have faced surveillance and deportations, contributing to their avoidance of authorities.[35] Further, the conflation of sex work and trafficking under the Norwegian end-demand law have resulted in media-accompanied anti-trafficking raids of massage parlors, in which racialized im/migrant sex workers’ privacy was violated through their exposure on national television.[36] Our findings are consistent with evidence that fear of privacy breaches, criminal charges, or immigration status revocation present major barriers to racialized im/migrant sex workers’ willingness to interact with authorities, which restricts their ability to report violent incidents to police.

Our study identified 73% lower odds of reporting violence among in-call sex workers (vs. workers in public or street-based locations). Canadian end-demand laws criminalize third-party material benefits, and this de facto criminalization of managed in-call sex work spaces has been linked to indoor sex workers’ and venue owners’ avoidance of reporting violent robberies due to fear of criminal charges.[37] Our finding that in-call sex workers had lower odds of reporting violence is concerning given robust evidence that in-call venues with supportive management can provide critical health and safety supports to sex workers and are among the safest work environments.[38] Racialized im/migrants in particular are more likely to work in in-call venues and face discriminatory policing, which may further enhance their reluctance to report violence.

Alongside inequities in access to violence reporting for racialized im/migrants, other visible minorities were also significantly less likely to report violence to police. Previous work has documented barriers to violence reporting among ethnic minority women in Canada, suggesting that broader issues of racialization, barriers to accessing police protections, and outcomes of reporting violence warrant greater research and policy attention for racialized and criminalized women.[39] While we also identified a high proportion of unreported violence among indigenous women, differences in violence reporting based on indigenous ancestry were not statistically significant. Indigenous sex workers are more likely to work outdoors in Vancouver’s Downtown Eastside, a heavily policed neighborhood featuring a high density of social service organizations and bystanders who may call police. It is possible that this context contributes to more frequent reporting of violence to police among indigenous sex workers compared to non-indigenous participants. Indigenous sex workers in British Columbia report mistrust of authorities due to decades of harassment, neglect, and police inaction in responding to missing and murdered indigenous women, including sex workers. The majority of indigenous sex workers in Vancouver report recent police harassment and workplace violence, and indigenous sex workers with direct family members who experienced colonial violence (through attending government-sponsored residential schools created to assimilate indigenous populations) face higher rates of police abuse.[40] The high representation of indigenous women in street-based sex work, their continued exposure to violence, and ongoing barriers to justice suggest that sex work criminalization in Canada continues to reinforce the marginalization of indigenous women. In light of the National Inquiry into Missing and Murdered Indigenous Women and its calls to action, our findings underscore the urgency of policy reforms toward addressing colonial racialized and gendered violence to increase safety and access to meaningful justice among indigenous sex workers.

Our findings suggest that police mistrust is a pervasive factor in shaping whether sex workers report violence. Research from diverse criminalized contexts has documented inadequate police responses, ranging from neglect to enacting violence (for example, financial extortion and physical or sexual assault), which inform sex workers’ distrust of police.[41] Globally, arrest and intimidation by police fosters adversarial relationships, decreases sex workers’ likelihood of reporting violence, and drives sex workers to isolated environments, increasing their vulnerability.[42] Concerningly, studies from Canada, Ivory Coast, and India have documented associations between police harassment and increased odds of violence among sex workers.[43] This evidence and our findings suggest that police abuses and stigmatizing treatment represent immense barriers for sex workers in reporting violence and enhance their vulnerability to aggressors.[44]

Key recommendations

Our findings suggest that legislative changes are needed to remove the legal barriers and punitive policing that restrict sex workers’ access to recourse and safer occupational conditions and to dismantle authorities’ belief that sex workers are unworthy of protection.[45] While Canadian end-demand laws represent sex workers as exploited persons meriting protection, our study found no evidence of sex workers’ increased access to police protections; rather, sex workers continue to face disrespectful treatment and threats of arrest when seeking assistance from police and thus attempt to avoid police interactions, as previously documented.[46] Scholars have asserted that end-demand legislation’s dual goals of “ending demand” for sexual services and of protecting sex workers as a vulnerable community are at odds with each other.[47] These competing goals were captured by Conservative senator Donald Plett during initial hearings for the legislation, who said, “Of course, we don’t want to make life safe for prostitutes; we want to do away with prostitution. That’s the intent of the bill.” This disconnect must be addressed through legislative changes to sex-work laws in Canada that prioritize sex workers’ access to police protections, safety, and rights.

Given our study findings and other research demonstrating that criminalization restricts sex workers’ ability to report violence to police, legislative reforms to fully decriminalize all aspects of sex work are urgently needed in Canada. Efforts must promote access to justice for racialized im/migrant and visible minority sex workers facing heightened structural vulnerability; community-based programs offering culturally safe, confidential labor and legal resources have been shown to gain im/migrant sex workers’ trust and promote their rights and should be expanded.[48] Interventions blending trauma-informed supports and links to services (for example, police sensitivity training and community liaisons to enable anonymous violence reporting) are also recommended.[49]

Strengths and limitations

This study relies on observational data, which cannot be used to infer causality; additionally, our analyses rely on self-reported data, which may be subject to recall, social desirability, or misclassification biases. Our frontline team includes multilingual and experiential staff (current and former sex workers) who build rapport with participants through ongoing outreach, which is likely to mitigate social desirability bias. This study is unique in its use of prospective methods to examine proportions and correlates of reporting violence to police among sex workers, including through the use of an interrupted time series, which allowed us to control for secular trends within the data and was particularly well suited to evaluating the consequences of a “naturally occurring” intervention (such as a legislative shift).[50]


Our study identified severe gaps in sex workers’ ability to report violence to police, with no significant change in reporting violence after the implementation of end-demand sex work legislation, and with enhanced inequities documented for racialized im/migrant and in-call workers. These results suggest that end-demand laws that shift the focus of criminalization away from sex workers toward clients and third parties do not alleviate existing barriers to police protections for sex workers, particularly among im/migrant and in-call workers. Sex workers have the right to live and work free from violence, and addressing violence against sex workers should be prioritized by policy bodies in Canada and globally. Legislative reforms to fully decriminalize sex work and tailored efforts to promote access to police protections, particularly for racialized minority, im/migrant, and in-call workers, are recommended as a means to upholding sex workers’ human and labor rights. These changes are particularly vital within the current context of sweeping calls for enhanced attention to anti-racism efforts, as well as policy reforms to address police brutality and the harassment of marginalized and racialized communities.

Bronwyn McBride, PhD, is a Postdoctoral Fellow at Simon Fraser University and at the Centre for Gender and Sexual Health Equity, Vancouver, Canada.

Kate Shannon, PhD, is a Professor at the University of British Columbia and Executive Director at the Centre for Gender and Sexual Health Equity, Vancouver, Canada.

Brittany Bingham, PhD, is Director of Indigenous Research at the Centre for Gender and Sexual Health Equity and Vancouver Coastal Health Aboriginal Health, Vancouver, Canada.

Melissa Braschel, MSc, is a Statistician and Data Manager at the Centre for Gender and Sexual Health Equity, Vancouver, Canada.

Steffanie Strathdee, PhD, is Associate Dean at the University of California San Diego School of Medicine, San Diego, USA.

Shira M. Goldenberg, PhD, is an Assistant Professor at Simon Fraser University and Director of Research Education at the Centre for Gender and Sexual Health Equity, Vancouver, Canada.

Please address correspondence to Shira M. Goldenberg. Email: dr.goldenberg@cgshe.ubc.ca.

Competing interests: None declared.

Copyright © 2020 McBride, Shannon, Bingham, Braschel, Strathdee, and Goldenberg. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.


[*] The term “migrant sex worker” often refers to individuals who do not hold citizenship or permanent residency (for example, temporary or undocumented workers) in a country. Community-based organizations (such as SWAN Vancouver) have proposed “im/migrant sex worker” as a broader term that is more inclusive of the diverse persons (regardless of immigration status) who were born in another country and now work in sex work in Canada. Our study uses “im/migrant” to be inclusive of all possible forms of immigration status.

[1] K. Deering, A. Amin, J. Shoveller, et al., “A systematic review of the correlates of violence against sex workers,” American Journal of Public Health 104/5 (2014), pp. e42–e54; K. Shannon and J. Csete, “Violence, condom negotiation, and HIV/STI risk among sex workers,” Journal of the American Medical Association 304/5 (2010), pp. 573–574; C. Lyons, A. Grosso, F. Drame, et al., “Physical and sexual violence affecting female sex workers in Abidjan, Côte d’Ivoire: Prevalence, and the relationship with the work environment, HIV, and access to health services,” Journal of Acquired Immune Deficiency Syndromes 75/1 (2017), pp. 9–17; M. Decker, A. Crago, S. Chu et al., “Human rights violations against sex workers: Burden and effect on HIV,” Lancet 385/9963 (2015), pp. 186–199.

[2] Deering et al. (see note 1).

[3] W. T. Oppal, Forsaken: The report of the missing women commission of inquiry executive summary (2012). Available at http://www.missingwomeninquiry.ca/wp-content/uploads/2010/10/Forsaken-ES-web-RGB.pdf; S. Strega, C. Janzen, J. Morgan, et al., “Never innocent victims,” Violence Against Women 20/1 (2014), pp. 6–25; Global Network of Sex Work Projects, The impact of criminalisation on sex workers’ vulnerability to HIV and violence (2017). Available at http://www.nswp.org/sites/nswp.org/files/impact_of_criminalisation_pb_prf01.pdf; PION, CEDAW 2017:-Shadow report by PION (2017). Available at https://www.nswp.org/resource/pion-norway-cedaw-shadow-report; S. Lim, S. Peitzmeier, C. Cange, et al., “Violence against female sex workers in Cameroon,” Journal of Acquired Immune Deficiency Syndromes 68 (2015), pp. S241–S247.

[4] S. Dewey and T. St. Germain, “‘It Depends on the cop’: Street-based sex workers’ perspectives on police patrol officers,” Sexuality Research and Social Policy 11/3 (2014), pp. 256–270; Lim et al. (see note 3); D. Ganju and N. Saggurti, “Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India,” Culture, Health and Sexuality 1058 (2017), pp. 1–15; E. Lam, Behind the rescue: How anti-trafficking investigations and policies harm migrant sex workers (Toronto, 2018); S. M. Goldenberg, A. Krusi, E. Zhang, et al., “Structural determinants of health among im/migrants in the indoor sex industry,” PLOS ONE 12/1 (2017), e0170642.

[5] Deering et al. (see note 1).

[6] Decker et al. (see note 1); Shannon and Csete (see note 1); W. C. W. Wong, E. Holroyd, and A. Bingham, “Stigma and sex work from the perspective of female sex workers in Hong Kong,” Sociology of Health and Illness 33/1 (2011), pp. 50–65; Global Network of Sex Work Projects (see note 3).

[7] Oppal (see note 3); A. Krüsi, K. Pacey, L. Bird, et al., “Criminalisation of clients: Reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada; A qualitative study,” BMJ Open 4/6 (2014); Global Network of Sex Work Projects (see note 3); E. Klambauer, “Policing roulette: Sex workers’ perception of encounters with police officers in the indoor and outdoor sector in England,” Criminology and Criminal Justice 18/3 (2018), pp. 255–272; J. Levy and P. Jakobsson, “Sweden’s abolitionist discourse and law: Effects on the dynamics of Swedish sex work and on the lives of Sweden’s sex workers,” Criminology and Criminal Justice 14/5 (2014), pp. 593–607.

[8] M. Decker, E. Pearson, S. Ilangasekare, et al., “Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator,” BMC Public Health 13 (2013); Global Network of Sex Work Projects (see note 3); H. M. Ndondo, S. Maseko, and S. Ndlovu, “Sexual and physical violence against sex workers: A qualitative survey to explore experiences of violence perpetrated by police among sex workers in Victoria Falls, Zimbabwe, 2012,” Sexually Transmitted Infections 89 (2013), pp. 3–4; Lim et al. (see note 3); Deering et al. (see note 1).

[9] B. Bingham, P. Duff, P. Nguyen, et al., “Historical racialized policies independently correlated with police harassment of indigenous sex workers: The socio-structural context of hiv risk in urban Canada,” Canadian Journal of Infectious Diseases and Medical Microbiology (2013); Lam (see note 4).

[10] W. C. W. Wong, E. Holroyd, E. Chan, et al., “’One country, two systems’: Sociopolitical implications for female migrant sex workers in Hong Kong,” BMC International Health and Human Rights 8 (2008); Wong et al. (2011, see note 6); T. Rocha-Jiménez, K. Brouwer, J. Silverman, et al., “Migration, violence, and safety among migrant sex workers: A qualitative study in two Guatemalan communities,” Culture, Health and Sexuality 18/9 (2016), pp. 965–979; Lam (see note 4); N. Vuolajärvi, “Governing in the name of caring: The Nordic model of prostitution and its punitive consequences for migrants who sell sex,” Sexuality Research and Social Policy (2018), pp. 1–15.

[11] Government of Canada, Immigration and refugee protection regulations. Available at https://laws-lois.justice.gc.ca/PDF/SOR-2002-227.pdf.

[12] L. Platt, P. Grenfell, C. Bonell, et al., “Risk of sexually transmitted infections and violence among indoor-working female sex workers in London: The effect of migration from Eastern Europe,” Sexually Transmitted Infections 87/5 (2011), pp. 377–384; S. Weine, A. Golobof, M. Bahromov, et al., “Female migrant sex workers in Moscow: Gender and power factors and HIV Risk,” Women and Health 53/1 (2013), pp. 56–73; Wong et al. (see note 10); V. Bungay, M. Halpin, P. Halpin, et al., “Violence in the massage parlor industry: Experiences of Canadian-born and immigrant women,” Health Care for Women International 33/3 (2012), pp. 262–284; V. Bungay, K. Kolar, S. Thindal, et al., “Community-based HIV and STI prevention in women working in indoor sex markets,” Health Promotion Practice 14/2 (2013), pp. 247–255; Lam (see note 4).

[13] Levy and Jakobsson (see note 7); PION (see note 3); Vuolajärvi (see note 10).

[14] Lam (see note 4); K. Mackenzie and A. Clancey, “Im/migrant sex workers, myths and misconceptions: realities of the anti-trafficked,” SWAN Vancouver Society (2015).

[15] National Inquiry into Missing and Murdered Indigenous Women and Girls, Reclaiming power and place: The final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls, volume 1b (2019).

[16] Bingham et al. (see note 9); National Inquiry into Missing and Murdered Indigenous Women and Girls (see note 15); Oppal (see note 3).

[17] S. Hunt, “Representing colonial violence: Trafficking, sex work, and the violence of law,” Atlantis (2016).

[18] Department of Justice, Technical paper: Bill C-36, Protection of Communities and Exploited Persons Act (2014). Available at http://www.justice.gc.ca/eng/rp-pr/other-autre/protect/p1.html; Parliament of Canada, C-36 (41-2): Royal Assent – Protection of Communities and Exploited Persons Act (2014).

[19] Parliament of Canada (see note 18).

[20] Lam (see note 4); S. Leblanc, “Milton massage parlour raid leads to charges,” Hamilton Spectator (2016). Available at http://www.thespec.com/news-story/6397386-milton-massage-parlour-raid-leads-to-charges; D. Hempstead, “11 women face possible deportation after massage parlour raids,” Ottawa Sun (May 8, 2015). Available at http://www.ottawasun.com/2015/05/08/11-women-face-possible-deportation-after-massage-parlour-raids.

[21] B. McBride and A. Murphy, “Harms of third party criminalization on working conditions for indoor sex workers in the post-PCEPA era,” in Law and Society Association Annual Meeting (Washington, DC, 2019); Goldenberg et al. (see note 4).

[22] Goldenberg et al. (see note 4).

[23] K. Shannon, V. Bright, S. Allinott, et al. 2007, “Community-based HIV prevention research among substance-using women in survival sex work: The Maka Project Partnership,” Harm Reduction Journal 4/20 (2007).

[24] D. P. Bernstein, J. Stein, M. Newcomb, et al., “Development and validation of a brief screening version of the childhood trauma questionnaire,” Child Abuse and Neglect (2003).

[25] J. Lopez Bernal, S. Cummins, and A. Gasparrini, “Interrupted time series regression for the evaluation of public health interventions: A tutorial,” International Journal of Epidemiology (2017); J. Durbin and G. S. Watson, “Testing for serial correlation in least squares regression.III,” Biometrika (1971).

[26] G. Maldonado and S. Greenland, “Simulation study of confounder-selection strategies,” American Journal of Epidemiology 138/11 (1993), pp. 923–936.

[27] Department of Justice (see note 18).

[28] H. Le Bail and C. Giametta, What do sex workers think about the French Prostitution Act? (2018). Available at https://www.medecinsdumonde.org/sites/default/files/ENGLISH-Synthèse-Rapport-prostitution-BD.PDF.

[29] Levy and Jakobsson (see note 7); PION (see note 3); Le Bail and Giametta (see note 28); M. Deckeret al. (see note 1); Klambauer (see note 7).

[30] PION (see note 3); Levy and Jakobsson (see note 7).

[31] Lim et al. (see note 3); D. Ganju and N. Saggurti (see note 4); Global Network of Sex Work Projects (see note 3); Goldenberg et al. (see note 4).

[32] R. Prakash, P. Bhattacharjee, A. Blanchard, et al., “Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya,” African Journal of AIDS Research 17/2 (2018), pp. 99–108; Y. Katsulis, A. Durfee, V. Lopez, et al., “Predictors of workplace violence among female sex workers in Tijuana, Mexico,” Violence Against Women, 21/5 (2015), pp. 571–597.

[33] S. Anderson, K. Shannon, J. Li, et al., “Condoms and sexual health education as evidence: Impact of criminalization of in-call venues and managers on migrant sex workers access to HIV/STI prevention in a Canadian setting,” BMC International Health and Human Rights 16/1 (2016), pp. 1–10; Goldenberg et al. (see note 4).

[34] Wong et al. (2011, see note 6).

[35] Levy and Jakobsson (see note 7); PION (see note 3); Klambauer (see note 7); Le Bail and Giametta (see note 28).

[36] PION (see note 3).

[37] Lam (see note 4); McBride and Murphy (see note 21); Goldenberg et al. (see note 4).

[38] C. Bruckert and T. Law, Beyond pimps, procurers and parasites: Mapping third parties in the incall/outcall sex industry (Ottawa, 2013); S. J. Semple, S. Strathdee, A. Srikrishnan, et al., “Social and behavioral characteristics of Gharwalis who operate brothels in the Ganga-Jamuna area of Nagpur, India,” AIDS Care 25/4 (2013), pp. 438–442; B. McBride, S. M. Goldenberg, A. Murphy, et al., “Third parties (venue owners, managers, security, etc.) and access to occupational health and safety among sex workers in a Canadian setting: 2010–2016,” American Journal of Public Health (2019), pp. e1–e7.

[39] C. Benoit, L. Shumka, R. Phillips, et al., Issue brief: Sexual violence against women in Canada (2015). Available at https://www.swc-cfc.gc.ca/svawc-vcsfc/issue-brief-en.pdf.

[40] Bingham et al. (see note 9).

[41] Klambauer (see note 7); Dewey and St. Germain (see note 4); Lim et al. (see note 3).

[42] J. Erausquin, E. Reed, and K. Blankenship, “Police-related experiences and HIV risk among female sex workers in Andhra Pradesh, India,” Journal of Infectious Diseases 204/5 (2011), pp. S1223–S1228; Krüsi et al. (see note 7); Wong et al. (2011, see note 6); Global Network of Sex Work Projects (see note 3).

[43] Lyons et al. (see note 1); K. Shannon, T. Kerr, S. Strathdee, et al., “Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers,” BMJ 339 (2009); Erausquin et al. (see note 42).

[44] Dewey and St. Germain (see note 4); Erausquin et al. (see note 42); Ndondo et al. (see note 8); Lim et al. (see note 3); Lyons et al. (see note 1).

[45] Klambauer (see note 7); Strega et al. (see note 3); A. Krüsi, T. Kerr, C. Taylor, et al., “‘They won’t change it back in their heads that we’re trash’: The Intersection of sex work-related stigma and evolving policing strategies,” Sociology of Health and Illness 38/7 (2016), pp. 1137–1150.

[46] Y. Karim, “Ottawa street-based sex workers and the criminal justice system: Interactions under the new legal regime” (University of Ottawa, 2017).

[47] C. Bruckert, “Protection of Communities and Exploited Persons Act: Misogynistic law making in action,” Canadian Journal of Law and Society 30/1 (2014), pp. 1–3.

[48] Lam (see note 4); Mackenzie and Clancey (see note 14).

[49] Klambauer (see note 7).

[50] R. B. Penfold and F. Zhang, “Use of interrupted time series analysis in evaluating health care quality improvements,” Academic Pediatrics 13/6 (2013), pp. S38–S44.