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Violence prevention and municipal licensing of indoor sex work venues in the Greater Vancouver Area :… Anderson, Solanna; Jia, Jessica Xi; Liu, Vivian; Chettiar, Jill; Krüsi, Andrea; Allan, Sarah; Maher, Lisa; Shannon, Kate Feb 17, 2015

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Violence prevention and municipal licensing of indoor sex work venues in the Greater Vancouver Area: narratives of migrant sex workers, managers and business ownersSolanna Andersona, Jessica Xi Jiaa, Vivian Liua, Jill Chattiera, Andrea Krüsia, Sarah Allana, Lisa Maherb, and Kate Shannona,*aGender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, CanadabKirby Institute, UNSW Australia, AustraliaAbstractUsing a socio-ecological, structural determinants framework, this study assesses the impact of municipal licensing policies and related policing practices across the Greater Vancouver Area (Canada) on the risk of violence within indoor sex work venues. Qualitative interviews were conducted with 46 migrant/immigrant sex workers, managers and owners of licensed indoor sex work establishments and micro-brothels. Findings indicate that policing practices and licensing requirements increase sex workers’ risk of violence and conflict with clients, and result in heightened stress, an inability to rely on police support, lost income and the displacement of sex workers to more hidden informal work venues. Prohibitive licensing and policing practices prevent sex workers, managers and owners from adopting safer workplace measures and exacerbate health and safety risks for sex workers. This study provides critical evidence of the negative public health implications of prohibitive municipal licensing in the context of a criminalised and enforcement-based approach to sex work. Workplace safety recommendations include the decriminalisation of sex work and the elimination of disproportionately high fees for licenses, criminal record restrictions, door lock restrictions, employee registration requirements and the use of police as licensing inspectors.KeywordsSex work; Venues; Structural Factors; Violence; LicensingIntroductionA growing body of international research highlights vast differences in violence and other social and health inequities among female sex workers according to the legal, policy, social and physical environments within which they operate (Shannon and Csete 2010). Recognising the heterogeneity in experiences of violence among sex workers, there have been increasing calls to employ a socio-ecological and structural determinants framework to *Corresponding author: gshi@cfenet.ubc.ca. HHS Public AccessAuthor manuscriptCult Health Sex. Author manuscript; available in PMC 2016 August 01.Published in final edited form as:Cult Health Sex. 2015 August ; 17(7): 825–841. doi:10.1080/13691058.2015.1008046.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptbetter examine and address workplace violence against sex workers (Shannon et al. 2008; Blanchard and Aral 2010). This framework illustrates how harms within sex work are situated within the social and physical features of the work environment, which are a product of macro-structural factors (e.g. laws, policies) that govern how sex work organisation and indoor work environments (e.g. venues) operate to promote or constrain health and safety. Rather than reify workplace violence against sex workers as an intrinsic ‘risk of the trade’ or hold sex workers themselves responsible for violence prevention, a socio-ecological structural perspective highlights the critical role of structural interventions in promoting or limiting workplace safety in sex work venues and redistributes accountability for sex workplace safety to a wide range of actors, including policy makers, courts, municipalities, police, managers and clients.As features of the social environment of indoor sex work venues, third party actors, such as managers or receptionists, may play a vital safety role by establishing codes of client conduct, screening potential clients, removing violent clients and alerting workers in advance of police raids (Bruckert and Law 2013; Yi et al. 2012; Whittaker and Hart 1996; Katsulis et al. 2010). Research on Canadian (Bungay et al. 2012; Bungay et al. 2011; O'Doherty 2011), US (Nemoto et al. 2004) and Australian (Berg, Bates, and Harcourt 2011) indoor sex work venues also suggests that the ability of migrant and new immigrant workers to safely manage the work environment can be further constrained by language barriers, economic insecurity, immigration status and unfamiliarity with laws governing sex work. Finally, within the literature addressing the structural determinants of violence and harm experienced by sex workers, there is a growing body of evidence documenting the negative impact of the enforcement of criminal laws related to sex work (Rekart 2006; Shannon et al. 2008; Weitzer 2009; Sanders and Campbell 2007; Katsulis et al. 2010; Boittin 2013; Maher et al. 2011; Deering et al. 2014)To date, the majority of structural, socio-ecological research on indoor sex work venues as physical and social sites of risk promotion or reduction has been drawn from low and middle-income countries, primarily Brazil (Lippman et al. 2010), with a limited body of data from mostly legalised and regulated environments such as Las Vegas, USA (Brents and Hausbeck 2005). Research on socio-structural variation in experiences of violence and health inequities among sex workers in higher income settings has largely focused on street-based sex work scenes due to the high visibility of this segment of the sex industry (for Canadian exceptions see O'Doherty 2011; Lewis and Maticka-Tyndale 2000; Bungay et al. 2012). While it is estimated that the majority of female sex workers work in indoor venues in Canada (Hanger and Maloney 2006), as in most countries worldwide, the preponderance of public attention, academic research and health outreach focuses on street-based sex work (Weitzer 2009).In Canada, sex work is de-facto criminalised whereby the sale and purchase of sex for money are legal, but the predominant policy response and laws governing the sex industry make it virtually impossible to engage in sex work without breaking the law. Specifically restricting indoor sex work venues, the ‘bawdy house’ law prohibits workers from offering their services from fixed indoor locations where two or more workers work together and the Anderson et al. Page 2Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscript‘living on the avails’ law prevents sex workers from paying others to provide security or client-screening services or a safe location within which to work.1Despite the criminalised nature of sex work in Canada, indoor sex work establishments have long existed in the form of licensed massage parlours, beauty salons, body rub studios and unlicensed micro-brothels. Many Canadian cities sell costly licenses and enforce regulations (e.g. criminal record restrictions, employee registration, uniform requirements, etc.) through fines and police raids (Craig 2011). While experiences of violence reportedly vary greatly among sex workers within indoor settings (Bungay et al. 2012), we have a limited understanding of the structural roots of this variation. This study addresses this gap by evaluating the impact of municipal licensing policies and related policing practices on sex worker safety and the risk of violence in indoor sex work venues.This study is located in the Greater Vancouver Area of Canada, which includes 22 urban municipalities and a population of two million people. Forty percent of residents are immigrants to Canada (Canada 2011), with Asian immigrants constituting over 65% of new immigrants (Canada 2009). The criminalisation and stigma of sex work makes it very difficult to determine the exact number of indoor sex workers or sex work venues in the region. However, estimates indicate that there are hundreds of licensed indoor venues and unlicensed micro-brothels in the Greater Vancouver (Remple et al. 2007). For the purposes of this study, micro-brothels are defined as unlicensed sex work venues run collectively by two or more workers, usually operating in a rented or privately owned apartment or house. By contrast, in a licensed venue, sex work takes place surreptitiously under the auspices of a legal business, such as a beauty salon, an acupressure clinic, massage parlour or body rub studio. While this study investigated the experiences of workers and managers operating in ‘in-call’ sex work venues with two or more workers, indoor sex work can also take place in a worker or clients’ private residencies or in informal ‘outcall’ venues such as hotels, and can be coordinated either by an independent worker or a escort agency (Lewis et al. 2005).MethodsThis qualitative study is situated within a larger US National Institutes of Health-funded longitudinal qualitative and ethnographic project investigating the features of the physical, social and policy environments shaping sexual health, violence, HIV/STI risks and access to care of sex workers in metropolitan Vancouver. The research builds on community partnerships developed since 2004 with a Community Advisory Board comprised of over 15 community, sex work and health support agencies. The origins and development of this project and its community partnerships are described in detail elsewhere (Shannon et al. 2007). The qualitative project runs alongside a longitudinal cohort of over 800 street and off-street sex workers across Vancouver, known as AESHA (An Evaluation of Sex Workers Health Access). Workers, managers and business owners were invited to participate through outreach to sex work venues and online. Eligibility criteria for the current study were: 1) currently working in an indoor sex work venue (within the last 30 days), either as a worker 1In December 2013, the Supreme Court of Canada struck down all criminal code provisions related to sex work, giving the Canadian government a year to bring the laws in line with their decision. Data for this study was collected in 2011, prior to these legal shifts.Anderson et al. Page 3Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptor manager/owner or both and for sex workers only; 2) female gender (inclusive of transgender women), 3) immigrant or migrant (e.g. born outside Canada); 4) aged 14 years or older, and d) exchanged sex for money in the last month in an indoor venue. Participants were purposively selected to reflect a range of worker and manager/owner experiences, representing municipalities with different licensing and policing regimes, as well as a variety of licensed (e.g. acupressure, body rub studio, etc.) and unlicensed (e.g. micro-brothel) venues.Semi-structured interviews were conducted in Mandarin or English by a trained female interviewer, using an interview guide invoking broad discussions of participants’ experiences in the sex work industry, views on licensing, and interactions with police, city officials, co-workers, managers and owners. The interview guide was piloted and revised prior to implementation. Interviews were conducted in a location selected by the participant (usually a private room in their workplace) and lasted between 30 and 120 minutes, were audio-recorded, translated into English when necessary, transcribed and checked for accuracy. In line with our ethics approval (details below), participants could chose to complete interviews in one of our research offices or any other safe place as identified by the participant. In all cases, participants chose to conduct interviews at their workplace. All participants provided informed consent by reading and signing plain-language (Mandarin/English) consent forms that outlined the purpose of the study, voluntary nature of participation, confidentiality, risks and benefits of participation and where to address further questions. Anonymity and confidentiality were maintained through the use of code names and the removal of personal identifiers from all documents. The study operates under ethical approval granted by the Providence Healthcare/University of British of Colombia Research Ethics Board and participants were remunerated with a CAD $30 honorarium.After reading and re-reading the field notes and transcripts several times, interview transcripts were coded (SA) for emergent categories in Atlas.ti 7 using a detailed codebook, developed and refined by five members of the researcher team (SA, JJ, VL, AK, KS), based on themes inductively generated from the data or identified in related literature. We defined violence as ‘incidences of physical, sexual and psychological violence related to sex work, including verbal conflicts and robbery, perpetrated by clients, managers, police or other sex workers’. After coding for recurring content themes, quotations related to the risk of violence were conceptually categorised in relation to structural determinants of risk and protection (Shannon et al. 2014). The analysis, interpretation and policy recommendations were checked for validity through consultation with a massage parlour worker and a manager, both of whom had many years of experience working across a variety of municipalities and licensing contexts (e.g. body rub, micro-brothel, massage parlour). These participants were invited to offer feedback on the study findings, explained orally and summarised in a three-page document, translated into Mandarin. In addition to drawing on interview data on participants experiences of the licensing process, fees, fines and interactions with police and city inspectors, we collected data through our ethnographic fieldwork on venues (e.g. licenses posted on the venue walls), and conducted an online policy document review of licensing stipulations for all venues, found on Greater Vancouver Area municipal websites (Surrey 1999; Burnaby 2001; Richmond 2006; North Vancouver Anderson et al. Page 4Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscript2013; Vancouver 2013a), in order to compile the list of fees, fines, and stipulations displayed in Table 1.ResultsOf the 46 participants, 23 were sex workers and 23 were managers/owners, of whom 15 were both workers and managers/owners. All participants had migrated or immigrated from Asia (45 from China; 1 from Thailand) for economic or family reasons and, with the exception of one cisgender male manager/owner, all participants identified as cisgender female. Participants had lived in the Greater Vancouver Area for an average of 8.6 years and had a median age of 42 years (interquartile range: 24 to 54). Participants were sampled from five different municipalities, working either in venues operating without a license (micro-brothels) or under one of five different licenses. Municipal licensing regimes across the Greater Vancouver Area differ in terms of licensing requirements, licenses available, cost of license, and penalties and fines for license infractions. Table 1: ‘Licensing and Indoor Sex Work Venues in the Greater Vancouver Area’ outlines some of the key characteristics of the licenses participants work under.Licensing and the physical features of indoor sex work venuesDoor lock restrictions—Unlike other businesses (e.g. health enhancement centres, beauty salons, etc.), body rub licenses require that the front doors of the business remain unlocked during opening hours, ostensibly to give police and city inspectors unencumbered access to premises. This requirement limits a manager's ability to screen clients and leaves workers extremely vulnerable to robbery and unwanted or violent clients:If we lock [the doors], we will be fined $500, and on re-offence even be shutdown ... If we don't lock the doors, there is a high risk of robbery. And also, the customers I don't want to accept, like those that have been drinking, those in groups, I can't refuse them (Participant QE2, Worker/Owner, Body Rub Salon, Burnaby).The front door is locked ... so I can see what kind of client comes in, and be certain that the client isn't aggressive in anyway. I feel safer this way (Participant QE42, Worker, Body Rub Studio, Richmond).While the manager/owner collects a flat fee (usually $60) from clients before entering the massage room, clients make an additional payment (‘tips’) directly to the worker for specific sexual services. Participants reported that, in addition to preventing violence and robbery, door locks offer added assurance of client payment for sexual services: “The advantage of being able to lock the door is, in case of facing a problematic client who refuses to pay, having the door closed may prevent the client from fleeing the parlour” (Participant 38, Worker, Body Rub Salon, Burnaby). As macro-structural factors (e.g. laws, policies) shape the physical features of indoor sex work venues, licensing bans on door locking decrease workplace safety by punishing managers with fines or license revocation if they attempt to protect workers from theft or unwanted clients.Anderson et al. Page 5Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptRegulations on lighting and windows—Licenses for body rub salons or studios also require bright lighting and unobstructed windows or doors into the massage rooms. This venue-based physical requirement generates considerable stress, fear of exposure and lack of privacy for workers, which can undermine a worker's capacity to manage their risk environment.[I]f we could cover the windows, then the worker would be safe and healthy, because she's no longer worried. And she wouldn't be in a rush, to provide extra services to get customers to ejaculate sooner and leave. (Participant 2, Worker/Owner, Body Rub Salon, Burnaby).I think it is unreasonable to ask us not to hang towels in front of windows. It not only invades my privacy but also my clients’ (Participant 38, Worker, Body Rub Salon, Burnaby).Licensing and the social features of indoor sex work venuesSafety and risk management benefits of owner/managers with experience—A municipal license regime can significantly influence managerial practices within indoor sex work venues by determining the necessary qualifications of the business’ license holder. Although some Greater Vancouver Area licenses require that the license holder demonstrate therapeutic skill (e.g. massage therapy), there is no requirement that owners or managers of indoor sex work venues have experience, skill, knowledge or training in sex work, sexual health or violence prevention. On the contrary, several licenses stipulate that the license holder cannot have a record of a conviction of a sex work related offense. This requirement has the potential to discriminate against experienced sex workers, who are invariably more likely to have sex work related convictions, compared to those with limited or no experience of sex work.Although current licensing regimes do not require license holders to have sex work experience or knowledge and training in sexual health or violence prevention, participants in our study repeatedly highlighted the health and safety benefits of owner/managers who have direct experience:If I had any issues, whether it's inside the rooms, or if we were short on condoms, [the current owners] would always listen to me ... because they've worked in the trade. The parlours before, [the owners] hadn't. It's completely different ... even if we were in danger, we weren't able to call the police (Participant 28, Worker, Beauty Salon, North Vancouver).I think it's better for the manager to have previous experience. She will have a better judgement on clients and ... she would know how to better protect the working women (Participant 3, Worker, Beauty and Wellness, Vancouver).If the manager worked as a working woman before, she will tell us about safe sex practices. If she has no prior experience, she will not (Participant 45 Worker, Body Rub Studio, Richmond).Anderson et al. Page 6Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptWorkers reported that owner/managers without sex work experience were more likely to pressure workers to provide higher risk services (e.g. sex without a condom) and undervalue the physical demands of sex work. Owner/managers who had not previously worked in the sex industry conceded that their lack of experience limited their ability to train workers or provide job-related health and safety information:I only have limited knowledge [about safety, hygiene, difficult clients], because I don't work myself ... I only started learning after I bought this business ... Since the girls have that experience, I might as well let them teach each other (Participant 29, Owner, Body Rub Studio, Richmond).Safety and risk management benefits of working with others—As a social feature of indoor sex work venues, participants reported that co-workers play an important role in collectively deterring violence, de-escalating conflict and sharing information about dangerous clients.Working here, there are a few women working together; if anything happened, they just scream and all the other women would be there. We can at least hold him off (Participant 10, Worker/Owner, Body Rub Salon, Burnaby).This place is safe in every aspect ... there is always more than one person working in the parlour... the clients wouldn't do anything to us. (Participant 35, Worker, Health and Wellness, Vancouver)Current licensing regimes in the Greater Vancouver Area do not encourage license holders to ensure that more than one person is present to deter and assist in case of violence, robbery, or client conflict. In fact, several participants reported that larger, busier parlours were more likely to attract police raids, often resulting in fines and license revocation, despite the safety benefits of working alongside others in a larger parlour. Some participants expressed reservations, however, about the possibility of licensing that required the presence of multiple employees during operating hours, noting that this could infringe on the flexibility of workers and their ability to leave the workplace to pick up children from school or run errands.Licensing as a potential source of safety—While participants criticised existing prohibitive licensing requirements, many reported that working in a licensed business enhanced overall workplace safety. In contrast to working on the street or in unlicensed spaces (e.g. client's homes, hotels or micro-brothels), workers in licensed venues perceived that they were less vulnerable to robbery and more likely to be treated professionally and respectfully by clients: “I feel safe ... [t]he parlour has a business license, a government-issued license, so it is protected” (Participant 39, Worker, Body Rub Salon, Burnaby). Comparing the safety of working in a licensed venue to working in a micro-brothel, another participant stated:[I]f you're working here, at the very least ... there is a license. Even though it's not a sexual service license, it is at least a license, so that the clients won't mess around (Participant 10, Worker/Owner, Body Rub Salon, Burnaby).Anderson et al. Page 7Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptIn addition to deterring client violence, one participant maintained that her employee license registration protected her from police harassment: “I don't worry about the police, and they would not have any questions of me, since I am registered with City Hall” (Participant 43, Worker, Body Rub Studio, Richmond).Stigma, privacy and employee registration—While a license's symbolic authority can reduce the risk of workplace violence, licenses that require individual employee registration can also increase workers’ risk of social harm. Given the social stigma surrounding sex work, participants stressed the importance of occupational privacy and a reluctance to register with city hall or have their photographs or addresses recorded by the police:[I]f I have to be registered as a worker of this industry, I would be too ashamed ... I have just been doing this work for one or two years to cover my basic expenses, I don't want to have a record for doing this work. (Participant 38, Worker, Body Rub Salon, Burnaby).Workers feared that individual registration of names and addresses would restrict future employment opportunities. As one participant explained, “any form of record may affect us when looking for other jobs down the road” (Participant 38, Worker, Body Rub Salon, Burnaby). More immediately, workers sought to avoid registration in order to prevent police harassment at their homes and the disclosure of their work to the public or family members. In the words of one worker, “I'm afraid of working in Richmond because I don't want to be registered as a sex worker and [have this] affect the life of my child” (Participant 33, Worker, Beauty & Wellness, Vancouver).Those currently working under business licenses that require employee registration also expressed frustration over the burdensome and expensive registration process. Rather than professionally integrate workers within the standard municipal licensing of other businesses, the registration process heightened many workers’ sense of marginalisation: “I don't think [registration and criminal record checks] are necessary and it makes me feel there is prejudice against working women” (Participant 45, Worker, Body Rub Studio, Richmond). Owners also found it difficult to adhere to strict registration requirements in light of high, worker-driven rates of staff turnover in the industry. As many workers prefer to set their own work schedules and/or rotate among parlours to seek out new clients or safer workplaces, owners struggled both financially and logistically to register and pay registration fees ($124 per worker) for constantly shifting staff.Licensing, policing and the social environment of indoor sex work venuesImpact of police raids on safety and violence—Although sexual services are sold in businesses operating under a wide variety of licenses, those owners who register for costly licenses that most align with sex work services (e.g. Body Rub Salons) attract the most frequent police raids, city inspections and fines and license revocations for violations of the Anderson et al. Page 8Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptlicense's burdensome requirements.2 Many owners felt betrayed by municipalities that charged $3,000 to $9,000 annually for body rub licenses.It is quite unfair to have such differences in license fees ... Right now, it seems that everyone is running this type of sex business: micro-brothels, beauty salons, acupuncture clinics ... and yet only massage parlours are heavily targeted [by police] (Participant 46, Owner, Body Rub Studio, Richmond).In addition to providing police with a list of venues to target for inspection and raids, existing licensing regimes reinforce and exacerbate police targeting of sex workers and managers within a criminalised environment. Participants observed that, during raids, police target sex workers and managers through license-related fines and license revocations, as opposed to attempting to curtail sex work through the more direct but onerous process of obtaining a warrant, collecting evidence, laying criminal charges and bringing a case to court.I think that bylaw [requiring unobstructed doorways into the massage rooms] is not good at all. [When we were raided, the police]... gave me a ticket not for the sex; they gave a ticket ... [because] I covered the window of the door with a towel (Participant 28, Worker, Beauty Salon, North Vancouver).By targeting body rub salons for licensing violations and closing parlours, fining owners, and scaring away clients, police make it harder for workers to use licensed indoor venues as a safe workplace. Frequent police inspections also undermine the income security of workers and owners:As soon as we opened, the police came and caused a ruckus all around us, which immediately affected our business: We never saw anyone [any clients] after that (Participant 5, Beauty and Wellness, Worker/Owner, Vancouver).In addition to negatively impacting sex workers’ income security, police raids increase workplace stress and the likelihood of police harassment. Many participants ranked the psychological stress of police raids as the most difficult part of their work.After the massage, [the client and I] began to have sex, and halfway through intercourse, the police came in. There was about five of them ... all the police were looking at me naked ... staring at me, and I felt embarrassed (Participant 28, Worker, Beauty Salon, North Vancouver).I'm afraid that they would put [the police raid] up in the news, so then everyone would know ... I've heard that this would definitely affect my [Immigration] status. The biggest concern is that my child ... or my family finds out (Participant 21, Worker, Acupressure, Surrey).Police raids, usually conducted without translators, compound pressures experienced by workers who, as a migrants and new immigrant workers, must manage considerable stress 2In addition to requirements discussed above regarding door locks, windows and bright lighting, some body rub licenses include strict clothing requirements, for example, that worker's shirtsleeves extend past their elbows (Surrey 1999; Richmond 2006)Anderson et al. Page 9Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptrelated to economic insecurity, language barriers, immigration obstacles and social isolation resulting from the stigma of sex work.Violence and the inability to rely on police support—The business costs of losing clients and workers due to police attention and the fear of fines or license revocation motivated many owners to forbid workers to call the police in the event of client violence:I am not afraid of contacting the police, but most owners do not want you to, because they are afraid of troubles, or attention ... that results in license checks (Participant 38, Worker, Body Rub Salon, Burnaby).Consequently, workers cannot rely on calling police for support or protection in response to violent attacks:[After] we caught the client strangling the working woman, we didn't call police because we were afraid (Participant 33, Worker, Beauty and Wellness, Vancouver).[A client] was penetrating me – it was very painful ... he was treating me very violently. I asked him to be more gentle and he refused, and he insisted I finish service ... The manager outside didn't help me, and we also couldn't call the police. (Participant 28, Worker, Beauty Salon, North Vancouver).At the same time, the uncertain legal and regulatory status of these businesses as premises for sex work can enable clients to coerce workers into providing free or unsafe services by threatening to report a parlour to the police:If anything happens, it's difficult or impossible to report anything to the police because we're working illegally. We can't really seek protection. [Clients] can still call the police on us if they want to threaten us (Participant 44, Worker, Body Rub Studio, Richmond).Policing, licensing & displacement—While all our participants expressed a safety-motivated preference for working in licensed venues, burdensome licensing regimes and stress and lost income caused by police raids can displace workers to informal work venues, such as micro-brothels, a worker's home or outcalls in a hotel.If massage parlours are always being inspected and shut down ... [this will] lead to an increase of micro-brothels. In comparison, massage parlours provide a safe environment. The micro-brothels will not call the police if anything bad happens because they are illegal.’ (Participant 46, Body Rub Studio, Richmond).Another micro-brothel owner/worker explained that, while she would prefer to work in a licensed massage parlour for safety reasons, difficulties posed by city inspections and criminalisation meant that this was not an option:In a [licensed] parlour there are more people, so relatively speaking it is a bit safer. [Then why do you operate here by yourself?] No, I do want to open a parlour, but I fear that it's a lot of hassle: city hall inspections, being shut-down, or other things ... We would face many losses, because ultimately it isn't a legal trade (Participant 13, Worker/Owner, Micro-Brothel, Vancouver)Anderson et al. Page 10Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptSimilarly, in order to avoid the expensive and invasive requirements of body rub licenses, many workers opt to work in licensed venues such as beauty salons, spas or acupressure clinics, which are less likely to attract police scrutiny: “since it is known that businesses with massage license may be targeted by the city and police, then people will look for other business venues to do this work, like spas” (Participant 38, Worker, Body Rub Salon, Burnaby). While operating under other licenses shields workers from police raids, the incongruity between a business’ license and the services offered increases the potential for conflict between clients and workers regarding service expectations.Once a client comes in, it is ... difficult to tell whether they are simply looking for beauty and spa services or if they would want to demand more. We may be exhausted and accept clients into a room and start a massage only to realise that they might expect us to offer those types of services (Participant 31, Owner, Health and Wellness, Vancouver).Within this ambiguity, workers assume the full burden of negotiating services and safety conditions, such as condom use, with clients, in the absence of explicit managerial or venue-based support (e.g. the manager providing condoms and/or communicating condom use expectations to clients), which heightens the risk of conflict and situational violence between workers and clients (Lowman 2000; O'Doherty 2011). As we report elsewhere, managers of licensed sex work venues often restrict workers’ access to condoms and sexual health services, out of fear that police or city inspectors will use these as evidence of criminal activity or license violation (Anderson et al. forthcoming).DiscussionThis is one of the first comprehensive examinations of how municipal licensing regimes shape the safety of indoor sex work transactions in a higher income setting where most aspects of sex work are criminalised. Findings indicate that current policing practices and prohibitive licensing requirements increase sex workers’ risk of violence, robbery and conflict with clients, and result in increased stress, an inability to rely on police support, lost income and the displacement of sex workers to more hidden work venues, such as micro-brothels, or less explicitly licensed venues such as spas and beauty salons. We found that licenses with descriptions that most closely aligned with sex work services (e.g. body rub) had more onerous requirements and were more likely to attract police raids, all of which increased the risk of workplace violence. By contrast, sex work venues operating under standard licenses (e.g. beauty salons, health enhancement centres) attracted less police attention and allowed managers and workers greater autonomy in promoting workplace safety.Drawing on a structural determinants framework (Shannon et al. 2014), our findings suggest that features of indoor sex work environments, including physical layout, safety measures and manager-sex worker relations, are determined by the overriding structures of licensing and criminalisation, which leave managers, owners and workers with little autonomy to create safer working conditions. As noted in a number of narratives, managers are often forced to adopt measures that place sex workers at increased risk for violence either as a direct result of licensing (e.g. restrictions on locking front doors) or as a means to avoid Anderson et al. Page 11Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptincreased scrutiny by licensing and policing authorities (e.g. managerial policies that prohibit calls to police in response to client-perpetrated violence). Corroborating O'Doherty's (2010) and Bungay et al's (2011) research on indoor sex work in Vancouver, our findings suggest that violence is not an inherent risk of sex work; rather, the risk of violence varies according to the socio-structural factors (e.g. laws, licensing) that shape the social, physical and economic characteristics of the workplace. Furthermore, while efforts to control, regulate or prohibit sex work persist the world over, researchers have identified sex worker autonomy and the ability to control one's work environment and manage related risks as the single most important determinant of workplace safety (Lewis et al. 2005; O'Doherty 2011; Krüsi et al. 2012). Given the correlation between autonomy and workplace safety, the negative safety consequences of punitive and restrictive licensing regimes found in this study are unfortunately predictable.Despite the adverse impacts of prohibitive licensing regimes and policing practices, our findings also indicate that municipal licensing, alongside legislative change (e.g. sex work decriminalisation), have the potential to dismantle some of the stigma associated with sex work. While participants were critical of prohibitive licensing regimes, many maintained that they were less vulnerable to violence and more likely to be treated professionally and respectfully by clients while working in a licensed business. By legitimising sex work within a normalised business context, licensing disrupts the dominant ‘discourse of disposability’ (Lowman 2000) that underlies violence against sex workers. Insofar as a business license symbolically dismantles the stigma and marginalisation that engenders violence against sex workers, licensing regimes can reshape the structural framework of sex work and serve an important intervention to support violence prevention. We echo the caution put forward by Bruckert and Hannem (2013), however, in noting that sex-work specific regulation regimes can structurally reinforce the stigma attached to sex work, particularly when based on ideologically driven misassumptions about the health and safety risks of sex work. Furthermore, our findings confirm existing research on sex work regulation and decriminalisation models (Donovan et al. 2012) and suggest that the violence prevention capacity of a licensing regime is severely undermined if businesses are unable to promote the true nature of services offered or if licensing includes prohibitive requirements, such as high annual fees or worker registration, which exclude or displace workers to more hidden sex work venues.These findings should be interpreted in light of the following limitations. This sample drew from female-identified foreign-born migrant and immigrant sex workers (with one male manager/owner). Canadian-born sex workers may have different experiences (Bungay et al. 2012) and greater research and outreach efforts are needed to understand and respond to the safety needs of male sex workers, as well as sex workers working in more hidden, informal venues, such as private homes, hotels and micro-brothels. Finally, due to potential self-selection sampling bias, this study may underestimate the impact of policing and licensing on safety and the risk of violence in indoor sex work venues. Several participants reported that managers and workers who have had negative experiences with police are more likely to decline interactions with health outreach workers or researchers.Anderson et al. Page 12Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptConclusionIn December 2013, the Supreme Court of Canada made a historic decision to strike down all criminal code provisions related to sex work in Canada, giving the Canadian government a year to bring the laws in line with their decision (e.g. December 2014). Ultimately, the decriminalisation of sex work in Canada would position municipalities to more formally regulate indoor sex work establishments, as has happened in New Zealand and New South Wales, Australia. Many municipal licensing regimes in Canada essentially regulate sex work as it would in a legalised environment (e.g. Nevada); that is, through regulation specific to sex work business, such as the body rub licenses studied here and escort licensing studied elsewhere (Lewis et al. 2005; Maticka-Tyndale et al. 1999; van der Meulen and Durisin 2008). Increasing evidence suggests that such sex-work-specific regulation models are punitive to sex workers and may increase harms, including displacing more marginalised sex workers underground (McCarthy et al. 2012; Sullivan 2010; Kilvington, Day, and Ward 2001; Weitzer 2009). Similarly, both the licensing of escorts in Windsor, Canada (Lewis and Maticka-Tyndale 2000) and massage parlours in Vancouver (Bungay et al. 2011) has been found to increase city and police surveillance of sex workers, with negative health and safety impacts.As a result, and in line with calls by global health bodies such as WHO and UNAIDS, the full decriminalisation of sex work (as in New Zealand and New South Wales, Australia) has been proposed, in which sex work would be subject to the same regulatory and workplace health and safety standards applied to other businesses and professions. Research on the decriminalisation of sex work in New South Wales, Australia suggests that sex worker health and safety is best promoted when sex work venues are regulated like other businesses as ‘home occupations’, rather than regulated separately as sex-worker-specific ‘brothels’ (Crofts and Prior 2012). Our study supports this model, providing critical evidence of how prohibitive municipal licensing explicitly targeting and regulating sex work indoor venues limit sex workers, managers and owners from adopting safer workplace measures and directly exacerbates health and safety risks for sex workers.Recent moves in the City of Vancouver suggest some momentum towards change, including the creation of a city-wide Sex Work Taskforce, intended to redress some of the negative consequences of the existing licensing regime (Vancouver 2013). While substantial municipal licensing and federal legal reform remains in the hands of policy makers, this research offers critical evidence to inform reforms that may better promote health and safety in sex work venues. Specifically, our results suggest the elimination of obstacles that displace workers from licensed venues, including disproportionately high fees for licenses, criminal record restrictions, door lock restrictions and employee registration requirements. Accounting for the pervasiveness of stigma against sex workers (Lazarus et al. 2012; Weitzer 2009) our findings warn against the use of sex worker registration systems, which limit a worker's ability to work with a sense of personal security and privacy and to move between venues to achieve better working conditions. Finally, as police raids on sex work venues prevent sex workers from being able to call the police in the event of client violence, we support the use of city inspectors with translators, rather than police, to conduct any necessary license inspections. This recommendation is also sustained by research on Anderson et al. Page 13Cult Health Sex. Author manuscript; available in PMC 2016 August 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptsupportive venue-based interventions in a range of low and middle income setting, including many Asian countries as well as Brazil and Dominican Republic, which indicates that the success of such policies depends on the cessation of police targeting of sex work venues (Jeffreys and Su 2011; Hong, Poon, and Zhang 2011; Kerrigan et al. 2003; Lippman et al. 2010). The negative impact of police raids are of particular concern within some migrant and immigrant communities, in which language barriers and immigration status concerns may result in increased vulnerability to police harassment and alienation from police services (Nemoto et al. 2004). Finally, in light of the potential for sex work regulations to infringe on sex worker rights, our research highlights the critical importance of including sex workers in the design of any policy or legal shift that may impact upon their work.ReferencesAnderson S, Xi Jia J, Goldenberg S, Liu V, Chattier J, Krüsi A, Shannon K. Forthcoming. Condoms and sexual health education as evidence: Criminalization of sex work managers & in-call venues impacts migrant sex workers' access to HIV/STI prevention in a Canadian setting. Berg, R.; Bates, J.; Harcourt, C. South Eastern Sydney and Illawarra Health Region gap analysis: Vulnerable sex workers. South Eastern Sydney and Illawarra Area Health Service; Sydney: 2011. Blanchard JF, Aral SO. Emergent properties and structural patterns in sexually transmitted infection and HIV Research. Sexually Transmitted Infections. 2010; 86(Suppl 3):iii4–iii9. [PubMed: 21098056] Boittin ML. 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Page 17Table 1Licensing and Indoor Sex Work Venues in the Greater Vancouver AreaMunicipalityLicenseParticipants in StudyAnnual FeeFines for InfractionsSelect RequirementsVancouverHealth Enhancement Centre13$242$500 - $10,000*Applicant and employees must:-Have knowledge of therapeutic technique-Have no sex-work related criminal charges**-Not engage in acts or offers of prostitutionVancouverBeauty and Wellness6$307$250 - $10,000*- Premises must be used for beauty and wellness through skin, hair and body treatments.VancouverMicro-Brothel (unlicensed)2n/an/an/aVancouverAcupuncturist1$129$250 - $10,000*No specific requirements listedBurnabyBody Rub Salon12$3,000-Entrance must be unlocked when business is open-Police must be permitted to enter at all times-Employees must carry ID at all times.-Rooms must not have locking devices & must be equipped with a window visible form reception area, with lighting of at least 550 lux.RichmondBody Rub Studio7$3,542 (Studio); $124 (ea. employee)$50 - $2000-Owner must register employee names, address and picture ID and inform inspector of any employee changes within 24 hours-Rooms must not have locking devices, must be equipped with a window visible form reception area, with lighting of at least 550 lux.-Employees must wear clothing covering between the neck and top of the knee, sleeves must reach below the elbows;-Employees must not have convictions for sex work related criminal charge (e.g. SS. 210, 211, 212, or 213)SurreyHealth Enhancement Centre - Acupressure4$170Applicant and employees must:-Have knowledge of therapeutic technique-Have no sex-work related criminal charges-Not engage in acts or offers of prostitution.North VancouverBeauty Salon1$150No specific requirements listed*Fine for each offence, or per day if the offence is of a continuing nature.**In December 2013, the City of Vancouver removed specific reference to sex work charges, instead including a provision applying to all businesses, stipulating that licenses holders must comply with all municipal, provincial and federal legislation including criminal code (City of Vancouver 2013).Cult Health Sex. Author manuscript; available in PMC 2016 August 01.


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