title: Structural determinants of inconsistent condom use with clients among migrant sex workers: findings of longitudinal research in an urban canadian setting.
abstract: BACKGROUND
  Migrant women in sex work experience unique risks and protective factors related to their sexual health. Given the dearth of knowledge in high-income countries, we explored factors associated with inconsistent condom use by clients among migrant female sex workers over time in Vancouver, BC.
  
  
  METHODS
  Questionnaire and HIV/sexually transmitted infection testing data from a longitudinal cohort, An Evaluation of Sex Workers Health Access, were collected from 2010 to 2013. Logistic regression using generalized estimating equations was used to model correlates of inconsistent condom use by clients among international migrant sex workers over a 3-year study period.
  
  
  RESULTS
  Of 685 participants, analyses were restricted to 182 (27%) international migrants who primarily originated from China. In multivariate generalized estimating equations analyses, difficulty accessing condoms (adjusted odds ratio [AOR], 3.76; 95% confidence interval [CI], 1.13-12.47) independently correlated with increased odds of inconsistent condom use by clients. Servicing clients in indoor sex work establishments (e.g., massage parlors) (AOR, 0.34; 95% CI, 0.15-0.77), and high school attainment (AOR, 0.22; 95% CI, 0.09-0.50) had independent protective effects on the odds of inconsistent condom use by clients.
  
  
  CONCLUSIONS
  Findings of this longitudinal study highlight the persistent challenges faced by migrant sex workers in terms of accessing and using condoms. Migrant sex workers who experienced difficulty in accessing condoms were more than 3 times as likely to report inconsistent condom use by clients. Laws, policies, and programs promoting access to safer, decriminalized indoor work environments remain urgently needed to promote health, safety, and human rights for migrant workers in the sex industry.
authors.affiliation: From the *Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; †School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; ‡Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada; and §University of California San Diego School of Medicine, San Diego, CA.
authors.forename: Julie
authors.initials: J
authors.lastname: Sou
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Jane
authors.initials: J
authors.lastname: Li
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
authors.forename: Shira M
authors.initials: SM
authors.lastname: Goldenberg
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008137:Longitudinal Studies; D011446:Prospective Studies; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population