title: Criminalisation of clients: reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada-a qualitative study.
abstract: OBJECTIVE
  To explore how criminalisation and policing of sex buyers (clients) rather than sex workers shapes sex workers' working conditions and sexual transactions including risk of violence and HIV/sexually transmitted infections (STIs).
  
  
  METHODS
  Qualitative and ethnographic study triangulated with sex work-related violence prevalence data and publicly available police statistics.
  
  
  METHODS
  Vancouver, Canada, provides a unique opportunity to evaluate the impact of policies that criminalise clients as the local police department adopted a sex work enforcement policy in January 2013 that prioritises sex workers' safety over arrest, while continuing to target clients.
  
  
  METHODS
  26 cisgender and 5 transgender women who were street-based sex workers (n=31) participated in semistructured interviews about their working conditions. All had exchanged sex for money in the previous 30 days in Vancouver.
  
  
  METHODS
  Thematic analysis of interview transcripts and ethnographic field notes focused on how police enforcement of clients shaped sex workers' working conditions and sexual transactions, including risk of violence and HIV/STIs, over an 11-month period postpolicy implementation (January-November 2013).
  
  
  RESULTS
  Sex workers' narratives and ethnographic observations indicated that while police sustained a high level of visibility, they eased charging or arresting sex workers and showed increased concern for their safety. However, participants' accounts and police statistics indicated continued police enforcement of clients. This profoundly impacted the safety strategies sex workers employed. Sex workers continued to mistrust police, had to rush screening clients and were displaced to outlying areas with increased risks of violence, including being forced to engage in unprotected sex.
  
  
  CONCLUSIONS
  These findings suggest that criminalisation and policing strategies that target clients reproduce the harms created by the criminalisation of sex work, in particular, vulnerability to violence and HIV/STIs. The current findings support decriminalisation of sex work to ensure work conditions that support the health and safety of sex workers in Canada and globally.
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Krüsi
authors.affiliation: Pivot Legal Society, Vancouver, British Columbia, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Pacey
authors.affiliation: Sex Workers United Against Violence, Vancouver, British Columbia, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Bird
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Sex Workers United Against Violence, Vancouver, British Columbia, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Chettiar
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Allan
authors.affiliation: Pivot Legal Society, Vancouver, British Columbia, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Bennett
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia.
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Shannon
mesh_terms: D000328:Adult; D002170:Canada; D003416:Criminal Law; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D016495:Police; D036301:Qualitative Research; D011477:Sex Work / Q000331:legislation & jurisprudence*; D060386:Sex Workers / Q000331:legislation & jurisprudence*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*; D035862:Vulnerable Populations; D055815:Young Adult
keywords: HIV/AIDS; Law; Sex work; Sexual Health; Violence