title: Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers.
abstract: OBJECTIVE
  To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Vancouver, Canada during 2006-8.
  
  
  METHODS
  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.
  
  
  METHODS
  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 (aOR(physicalviolence)) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aOR(rape)) 1.73, 1.09 to 3.12); inability to access drug treatment (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); confiscation of drug use paraphernalia by police without arrest (aOR(physicalviolence) 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aOR(clientviolence) 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.
authors: British Columbia Centre for Excellence in HIV/AIDS St Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada. kshannon@cfenet.ubc.ca
authors: Kate
authors: K
authors: Shannon
authors: T
authors: T
authors: Kerr
authors: S A
authors: SA
authors: Strathdee
authors: J
authors: J
authors: Shoveller
authors: J S
authors: JS
authors: Montaner
authors: M W
authors: MW
authors: Tyndall
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D011477:Sex Work / Q000706:statistics & numerical data*; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult