Page 1 Complexities of Short-term Mobility and Migration: Enhanced Opportunities, Sexual and Safety Risks, and Barriers To Care among Sex Workers in a Canadian Setting Shira M. Goldenberg, 1,2 Jill Chettiar, 1 Paul Nguyen, 1 Sabina Dobrer, 1 Julio Montaner, 2 Kate Shannon 1,2 1. Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS 2. Department of Medicine, University of British Columbia 20 th International AIDS Conference Melbourne, Australia July 22, 2014 Abstract # TUPDC0204

Page 2 I declare no conflict of interest We respectfully acknowledge that we are meeting on the traditional land of the Kulin Nation, now known by its European name of Melbourne.

Page 3 Heterogeneous impacts of migration and mobility on HIV and STIs Most studies focus on elevated risks Migrant SWs face increased HIV risk in LMIC, but not in HIC (Platt et al, 2013) No studies identified in North America Little known about recent, short-term mobility Limited information on work environment, health, and safety of SWs who engage in recent mobility/migration Migration/Mobility, Health, and Safety among Female Sex Workers (SWs)

Page 4 AESHA: Longitudinal cohort initiated in 2005; Expanded in 2010 with >800 street and off-street FSWs across Metro Vancouver, BC Collaboration with >15 community partners Eligibility: Female or transgender woman; 14 years of age+; exchanged sex for money in last month Time-location sampling and outreach to street/off-street venues Biannual interview questionnaires and HIV/STI/HCV testing Ongoing monitoring of health outcomes and access to care Funded by National Institutes of Health (NIDA), Canadian Institutes of Health Research, and MAC AIDS An Evaluation of Sex Workers’Health Access

Socio-demographics HIV/STI infection Individual Partner types* Condom negotiation with different partners* Average monthly client volume* Injection & non-injection drug use* Interpersonal/ Behavioural Primary place of solicitation & service* Housing & homelessness* Physical & sexual violence* by different partners Police harassment/arrest*, moved b/c felt unsafe* Paid a third party a portion of sex work earnings* Social/Structural Independent variables Dependent variables 1)Short-term mobility/migration (engaged in sex work or lived in another city, province or country in the past 6 months)* 2)Short-term work-related mobility (engaged in sex work in another city, province or country in the past 6 months)* Dependent variables 1)Short-term mobility/migration (engaged in sex work or lived in another city, province or country in the past 6 months)* 2)Short-term work-related mobility (engaged in sex work in another city, province or country in the past 6 months)* *Time-updated covariates of occurrences in the past 6 months; all other variables treated as fixed covariates

VariableAdjusted Odds Ratio95% Confidence Interval Age Place of solicitation Indoors Independent Condom refusal by non-commercial partners* Physical/sexual violence by clients* Experienced any barrier to health care *In last 6 months In a separate model, short-term work related mobility only was also correlated with: ~2x  odds of workplace physical/sexual violence In a separate model, short-term work related mobility only was also correlated with: ~2x  odds of workplace physical/sexual violence Factors independently correlated with short-term migration and mobility over time (N=646, ) 10.84% reported short-term mobility or migration outside Vancouver

Page 7 Discussion Over 2.5 year study, ~11% of SWs engaged in short-term mobility/migration, which is linked to: – Condom refusal + workplace violence – Younger, working in formal indoor venues, + higher income Research needed to develop and test combination interventions Potential components – SW-led outreach & community organizing Can reduce social isolation, facilitate sharing of information – Linkage to health & social supports, mobile services – Occupational health & rights for migrant/mobile SWs 7

Page 8 Acknowledgements Research & administrative support: Sarah Allan, Ofer Amram, Eva Breternitz, Jill Chettiar, Kathleen Deering, Sabina Dobrer, Julia Homer, Rhiannon Hughes, Emily Leake, Jane Li, Vivian Liu, Sylvia Machat, Meenakshi Mannoe, Jen Morris, Paul Nguyen, Rachel Nicoletti, Tina Ok, Saba Tadesse-Lee, Chrissy Taylor, Brittney Udall, Peter Vann, Jingfei Zhang Community Advisory Board/Partners: WISH, SWUAV, ORCHID/ ASIA, Options for Sexual Health, VCH, BCCDC Street Nurses, UNYA, PEERS, PACE, BCCEC, ATIRA, RainCity, Pivot Legal, PWN Funding: National Institutes of Health (NIDA R01DA028648); Canadian Institutes of Health Research (HHP-98835); MAC AIDS; Michael Smith Foundation for Health Research/Women’s Health Research Initiative; International AIDS Society Scholarship (2014) Contact information: AIDS 2014 Abstract #: TUPDC0204