O13.6\u2005Precarious legal immigration status linked to client condom refusal among sex workers in metro vancouver (2010–2018)

Abstract

Background Under new Canadian sex work laws (PCEPA) passed in 2014, sex workers with precarious legal status face exacerbated criminalization, yet little quantitative evidence exists on how legal immigration status shapes HIV/STI risk. This study aimed to model the effect of precarious status on client condom refusal; and the potential moderating effect of precarious status on the relationship between condom refusal and the post-PCEPA law reform period. Methods Longitudinal data were drawn from AESHA, a community-based cohort of 900+ sex workers in Vancouver (2010–2018). A multivariable confounder model using logistic regression with generalized estimating equations was developed to model the independent effect of precarious status (any immigration status that is revocable under criminal charges: permanent residency, temporary residency, and undocumented) on recent client condom refusal (forcing unprotected sex or intentionally breaking the condom) over the study period. A second multivariable confounder model examined the moderating effect of precarious status on the relationship between condom refusal and the post-PCEPA law reform period (2015-present). Results Over the 8-year study (n=758), 9.1% of participants had precarious status and 16.5% experienced condom refusal, with a total 196 events of condom refusal reported. In multivariable analysis adjusted for confounders, precarious status was independently associated with increased odds of facing condom refusal (adjusted odds ratio [AOR] 2.53, 95% confidence interval[CI] 1.37–4.68). In a second multivariable confounder model, legal status moderated the relationship between condom refusal and the post-PCEPA law reform period: among women with non-precarious status, odds of condom refusal were not significantly different post-PCEPA (AOR 1.17, 95%CI 0.77–1.78), whereas women with precarious status faced 4-fold increased odds of condom refusal post-PCEPA (4.35, 95%CI 1.21–15.66). Conclusion Laws criminalizing sex work among im/migrants in Canada enhance vulnerability among those with precarious status through presenting barriers to safer sex and increasing HIV/STI risk, highlighting urgent need for sex work and immigration policy reforms. Disclosure No significant relationships.