The effect of gender-based violence on food security among a prospective cohort of women sex workers in Metro Vancouver, British Columbia

Transcription

1 The effect of gender-based violence on food security among a prospective cohort of women sex workers in Metro Vancouver, British Columbia Daniella Barreto a, Jeannie Shoveller a,b, Putu Duff a,b, Melissa Braschel, Kate Shannon a,b a. Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul s Hospital, Vancouver, BC b. Department of Medicine, University of British Columbia, Vancouver, BC

2 BACKGROUND Violence against sex workers Canadian law criminalizes sex work clients Endangers sex workers Forces SWs to work in hidden areas Sex workers face disproportionate levels of violence Photo: D. Barreto Sex workers are a WHO key population for HIV Violence against WLWH is associated with adverse HIV-related health outcomes

3 BACKGROUND Food Insecurity The inability to access an adequate quantity and quality of food in socially acceptable ways Food insecurity affects ~8.3% of general Canadian population, approximately 3 million people When sex workers means of acquiring money is criminalized, food security is also threatened

4 There is limited quantitative understanding the association between gender-based violence and food insecurity in women SW populations

5 Study Objective Prospectively examine correlates of food insecurity, including the impact of gender-based violence, among women sex workers in Metro Vancouver, Canada

6 An Evaluation of Sex Workers Health Access Longitudinal evaluation begun in 2010, examining the physical, social and policy environment shaping sexual health, HIV vulnerability and access to care Cohort includes close to 1000 street and off-street sex workers across Metro Vancouver Builds on community-based research partnerships since 2004, and is guided by a Community Advisory Board of over 15 community/ sex work organizations Includes ongoing outreach to indoor and outdoor sex work venues by experiential and non-experiential team members and trained nursing staff

7 An Evaluation of Sex Workers Health Access Eligibility = Women (trans inclusive), 14 years of age+, who have exchanged sex for money in last month Participants invited through outreach to strolls, sex work venues (e.g. massage parlours, micro-brothels, in-call locations) and online Baseline and semi-annual follow-up, including guided interview questionnaires and HIV/STI/HCV testing by nursing staff Funded by US NIH, CIHR

8 Study Sample N=761 Women, trans inclusive 14+ Exchanged sex for money within the last 30 days Study period:

9 Statistical Analyses Bivariate and multivariable logistic regression using generalized estimating equations (GEE) for binary outcomes 2 explanatory models to include Recent gender-based violence Lifetime gender-based violence

10 Statistical Analyses Outcome measure: Food Insecurity Defined as responding often true or sometimes true to at least one item on the food insecurity scale, using the last 6 months as a reference point

11 Radimer-Cornell Food Security Questions I worry about whether my food will run out before I get money to buy more I am often hungry but I don t eat because I can t afford enough food I eat less than I think I should because I don t have enough money for food The food that I bought just didn t last and I didn t have money to buy more

12 Descriptive Statistics Of 761 sex workers: Average age 35 (IQR: 28-42) 11% living with HIV 35% self-reported Indigenous ancestry 81% unstable housing in the last 6 months 48% ever diagnosed with mental health condition 79% ever experienced physical and/or sexual violence

13 Food Insecurity in AESHA Over the study period, 72% reported food insecurity 28% 72% Of the 84 sex workers living with HIV, 96% reported food insecurity 4% Photo: D. Barreto 96%

14 Gender-based violence in AESHA i.e. physical and/or sexual violence 95% had ever experienced gender-based violence 48% had experienced recent gender-based violence In bivariate analysis, exposure to lifetime violence was associated with 12 times the odds of food insecurity

15 Sex workers who had ever experienced gender based violence had more than 4.5 times the odds of food insecurity than sex workers who had not This is among the first longitudinal studies to document a significant association between gender-based violence and food insecurity in a SW population Association may be explained by convergence of: Social marginalization Unsafe working conditions Income insecurity Limited access to food

16 Policy and Program Implications Increase government social assistance Poverty is expensive; justice not charity HIV outreach program funding HIV treatment implications Working towards elimination of gender-based violence Federal Strategy on Gender-Based Violence Particular focus on programming accessible to Indigenous women Culturally relevant programming Photo: D. Barreto Evidence-based decriminalization of sex work Increase sex worker s safety

17 Acknowledgements Research & administrative support: Sarah Moreheart, Jennifer Morris, Brittany Udall, Sylvia Machat, Jane Li, Minshu Mo, Jennfer McDermid, Tave Cole, Jamie Adams, Anita Dhanoa, Ray Crow, Rachel Nicoletti, Emily Leake, Natalie Blair, Melissa Braschel, Peter Vann, Patricia McDonald Erin Seatter Community Advisory Board: WISH, SWUAV, SWAN, PACE, HUSTLE/ HiM, Options for Sexual Health, VCH, BCCDC Street Nurses, ATIRA, RainCity, Pivot Legal Society, PWN, YouthCO, Canadian HIV/AIDS Legal Network Funding: US National Institutes of Health, Canadian Institutes of Health Research, MacAIDS