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The social and structural production of violence, safety and sexual risk reduction among street-based… Krüsi Penney, Andrea 2014

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       THE  SOCIAL  AND  STRUCTURAL  PRODUCTION  OF  VIOLENCE,  SAFETY  AND  SEXUAL  RISK  REDUCTION  AMONG  STREET-­‐‑BASED  SEX  WORKERS        by       Andrea  Krüsi  Penney    BSc  (Psychology)  Kingston  University,  London,  UK  2005  MSc  (Population  and  Public  Health)  Simon  Fraser  University  2008        A  THESIS  SUBMITTED  IN  PARTIAL  FULFILLMENT  OF  THE  REQUIREMENTS  FOR  THE  DEGREE  OF    DOCTOR  OF  PHILOSOPHY    in    THE  FACULTY  OF  GRADUATE  AND  POSTDOCTORAL  STUDIES  (Interdisciplinary  Studies)    THE  UNIVERSITY  OF  BRITISH  COLUMBIA  (Vancouver)    December  2014    ©  Andrea  Krüsi  Penney,  2014         	   ii	  ABSTRACT  Background:  Globally,  sex  work  is  highly  stigmatized,  and  the  dominant  policy  approach   has   been   criminalization   and   police   enforcement.   Despite   a   growing  body   of   research   on   the   social   and   structural   determinants   of   violence,   and  sexual  risk  among  sex  workers,  less  is  known  about  the  specific  features  of  these  environments  and  the  dynamic  interplay  that  shape  the  negotiation  of  safety  and  sexual   risk   in   sex   transactions.  Therefore,   the  objective  of   this  dissertation   is   to  examine   how   social   and   structural   factors   such   as   stigma,   evolving   sex   work  legislation   and   policing   practices   intersect   to   shape   the   working   conditions   of  primarily  street-­‐‑based  sex  workers  in  Vancouver.  Methods:     This   dissertation   is   based   on   in-­‐‑depth   qualitative   interviews,   focus  groups  and  ethnographic  fieldwork  with  street-­‐‑based  sex  workers  in  Vancouver.  Drawing   on   concepts   of   structural   vulnerability   and   structural   stigma,   data  analysis  sought  to  characterize  how  evolving  social  and  structural  environments  shape  working  conditions,  health  and  safety  among  street-­‐‑based  sex  workers.    Results:   The   findings   of   this   dissertation   suggest   that   intersecting   regimes   of  criminalization   and   stigmatization   serve   to   perpetuate   labour   conditions   that  render   sex  workers   at   increased   risk   for   violence   and  poor   health,   and   further  deny  sex  workers  their  citizenship  rights  to  police  protection  and  legal  recourse.  	   iii	  Despite  police   rhetoric  of  prioritizing   the   safety  of   sex  workers,   criminalization  and   policing   strategies   that   target   clients   reproduce   the   harms   created   by   the  criminalization   of   sex   workers,   in   particular,   risks   for   violence   and   abuse.  Despite   the   lack  of   formal   legal  and  policy   support   for  brothels   in  Canada,   the  environmental-­‐‑structural   supports   afforded   by   unsanctioned,   safer   indoor   sex  work  environments,   in  the  context  of  supportive  housing  programs  for  women,  promoted  increased  control  over  negotiating  sex  work  transactions,  including  the  capacity   to   refuse  unwanted   services,  negotiate   condom  use,   and  avoid  violent  perpetrators.  Conclusion:   The   collective   work   presented   in   this   dissertation   highlights   the  complex  ways  in  which  sex  work  related  stigma,  evolving  sex  work  legislation,  policing   practices   and   sex   work   environments   intersect   to   shape   the   working  conditions  of   street-­‐‑based   sex  workers,   including   citizenship  and   labour   rights,  violence,  and  ill  health.  The  findings  of  this  dissertation  lend  further  support  to  calls  for  the  full  decriminalization  of  sex  work.         	   iv	  PREFACE  This   statement   certifies   that   the  work   contained   in   this   dissertation  was  conceived,  conducted,  and  written  by  Andrea  Krüsi  (AK).  All  empirical  research  undertaken   for   the   completion   of   this   dissertation   was   approved   by   the  University   of   British   Columbia/Providence   Health   Care   Research   Ethics   Board  (H09-­‐‑02408,   H12-­‐‑01558).   The   co-­‐‑authors   of   the   manuscripts   include:   Dr.   Kate  Shannon  (KS),  Dr.  Thomas  Kerr  (TK),  Dr.  Tim  Rhodes  (TR),  Dr.   Julio  Montaner  (JM),  Dr.  Stephanie  Strathdee  (SS),  Dr.  Darcie  Bennett  (DB),  Katrina  Pacey  (KP),  Jill   Chettiar   (JC),   Christina   Taylor   (CT),   Sarah   Allan   (SA),   Lorna   Bird   (LB),  Amelia  Ridgeway  (AR),  Janice  Abbot  (JA).  These  individuals  made  contributions  only   as   is   commensurate   with   supervisory   committee,   collegial,   or   co-­‐‑investigator  duties  and  include  sex  workers  as  well  as  community  partners  and  members  of  the  Gender  and  Sexual  Health  Initiative  (GSHI)  community  advisory  board.    The  specific  contributions  of  the  authors  are  outlined  below.  Chapter   1   and   5   are   original,   unpublished   intellectual   products   of   the  author,  with   substantive   guidance   and   input   from   co-­‐‑supervisors   (KS   and  TK)  and  members  of  the  supervisory  committee  (VS  and  TR).  A  version  of  Chapter  2  has  been  published  in  BMJ  Open.  Krüsi,  A.,  Pacey,  K.,  Bird,  L.,  Taylor,  C.,  Chettiar,  J.,  Allan,  S.,  Bennett,  D.,  Montaner,  JS.,  Kerr,  T.,  	   v	  Shannon,   K.   (2014).   Criminalization   of   clients:   reproducing   vulnerabilities   for  violence   and   poor   health   among   street-­‐‑based   sex   workers   in   Canada:   A  qualitative   study.  BMJ  Open,   4(6),   e005191.  AK,  KP,   JC,  KS   conceptualized   this  study  and  AK  oversaw  the  field  team  carrying  out  the  study.  AK,  CT  conducted  the  interviews.  AK,  JC  conducted  the  ethnographic  observation.  AK  analyzed  the  data   using   Atlas.ti   software,   wrote   the   original   draft   of   the   manuscript   and  incorporated   feedback   from  all   co-­‐‑authors.  KP,  CT,   JC,  LB,  SA,  DB,  TK,   JM,  KS  provided   content   expertise   and   critical   feedback   on   the   analyses   and  interpretation.    A   version   of   Chapter   3   is   currently   under   review   for   peer-­‐‑reviewed  publication:  Krüsi,  A.,  Kerr,  T.,  Taylor,  C.,  Rhodes,  T.,  Shannon,  K.,  ‘They  won’t  change   it   back   in   their   heads   that   we’re   trash’   The   intersection   of   sex   work  related  stigma  and  evolving  policing  strategies.  AK,  KS  designed  the  study.  AK  oversaw  the  field  team  carrying  out  the  study.  AK,  CT  conducted  the  interviews.  AK   analyzed   the   data   using   Atlas.ti   software,   wrote   the   original   draft   of   the  manuscript   and   incorporated   feedback   from   all   co-­‐‑authors.   KT,   CT,   TR,   KS  provided   content   expertise   and   critical   feedback   on   the   analyses   and  interpretation.    	   vi	  A  version  of  Chapter  4  has  been  published  in  the  American  Journal  of  Public  Health.   Krüsi,   A.,   Chettiar,   J.,   Ridgway,   A.,   Abbott,   J.,   Strathdee,   S.   A.,   &  Shannon,  K.   (2012).  Negotiating  safety  and  sexual  risk  reduction  with  clients   in  unsanctioned  safer  indoor  sex  work  environments:  a  qualitative  study.  American  Journal  of  Public  Health,  102(6),   1154-­‐‑1159.  AK,  KS,   JC   conceptualized   the   study.  AK   conducted   the   interviews   and   analysis   and  wrote   the   original   draft   of   the  manuscript.   JC,   AR,   JA,   SS   and   KS   provided   content   expertise   and   critical  feedback  on  the  analyses  and  interpretation.         	   vii	  TABLE  OF  CONTENTS  ABSTRACT  .......................................................................................................................  ii  PREFACE  .........................................................................................................................  iv  TABLE  OF  CONTENTS  ................................................................................................  vii  LIST  OF  TABLES  .............................................................................................................  ix  LIST  OF  FIGURES  ............................................................................................................  x  LIST  OF  ABBREVIATIONS  ...........................................................................................  xi  ACKNOWLEDGEMENTS  ............................................................................................  xii  DEDICATION  ...............................................................................................................  xiv  Chapter  1:  INTRODUCTION  .........................................................................................  1  1.1  Positioning  Violence  in  Sex  Work  ........................................................................  1  1.2  Literature  Review  of  Social  and  Structural  Determinants  of  Violence  and  HIV  among  Sex  Workers  ............................................................................................  3  1.2.1  Criminalization  of  sex  work  and  policing  ...................................................  3  1.2.2  Poverty,  residential  instability,  substance  use  ............................................  5  1.2.3  Sex  work  related  stigma  .................................................................................  9  1.2.4  Racism  and  colonialism  ................................................................................  10  1.3  Work  Environments  and  Sex  Work  Related  Violence  and  HIV  ....................  12  1.4  Study  Setting  .........................................................................................................  15  1.4.1  The  socio-­‐‑political  context  of  sex  work  in  Vancouver  .............................  15  1.4.2  The  changing  legal  landscape  of  sex  work  in  Canada  .............................  18  1.5  Study  Justification  ................................................................................................  20  1.6  Study  Objectives  ...................................................................................................  22  1.7  Conceptual  Framework  .......................................................................................  24  1.7.1  Sex  work  as  labour  ........................................................................................  24  1.7.2  Socio-­‐‑ecological  framework  .........................................................................  25  1.7.3  Intersectionality  .............................................................................................  28  1.8  Study  Population  ..................................................................................................  29  1.9  Study  Approach  ...................................................................................................  31  1.10  Outline  of  the  Dissertation  ................................................................................  34  Chapter  2:  CRIMINALIZATION  OF  CLIENTS:  REPRODUCING  VULNERABILITIES  FOR  VIOLENCE  AND  POOR  HEALTH  AMONG  STREET-­‐‑BASED  SEX  WORKERS  IN  CANADA  .......................................................................  36  2.1  Introduction  ..........................................................................................................  36  2.1.1  ‘Demand  criminalization’  ............................................................................  38  2.1.2  New  sex  work  enforcement  policy  in  Vancouver,  Canada  .....................  39  2.2  Methods  .................................................................................................................  40  2.3  Results  ....................................................................................................................  44  2.3.1  Sample  characteristics  ..................................................................................  44  	   viii	  2.3.2  Sex  workers’  experiences  with  new  sex  work  enforcement  guidelines  45  2.3.3  Continued  police  enforcement  of  sex  buyers  (clients)  .............................  46  2.3.4  Criminalization  of  clients:  limited  effect  on  deterrence  of  sex  work  .....  49  2.3.5  Criminalization  of  clients:  severely  limits  sex  workers’  safety  strategies  ...................................................................................................................................  51  2.4  Discussion  .............................................................................................................  57  Chapter  3:  ‘THEY  WON’T  CHANGE  IT  BACK  IN  THEIR  HEADS  THAT  WE’RE  TRASH’  THE  INTERSECTION  OF  SEX  WORK  RELATED  STIGMA  AND  EVOLVING  POLICING  STRATEGIES  .......................................................................  65  3.1  Introduction  ..........................................................................................................  65  3.2  Methods  .................................................................................................................  71  3.3  Results  ....................................................................................................................  75  3.3.1  The  everyday  violence  of  reporting  sex  work  related  violence  to  police  –  ‘you’re  not  a  beat  up  worker’  ............................................................................  78  3.3.2  Neighbourhood  stigma  ................................................................................  80  3.3.3  Neighbourhood  renewal  –  ‘god  forbid  there’s  a  hooker  on  the  condo  street’  ........................................................................................................................  84  3.4  Discussion  .............................................................................................................  86  Chapter  4:  NEGOTIATING  SAFETY  AND  SEXUAL  RISK  REDUCTION  WITH  CLIENTS  IN  UNSANCTIONED  SAFER  INDOOR  SEX  WORK  ENVIRONMENTS  .........................................................................................................  96  4.1  Introduction  ..........................................................................................................  96  4.2  Methods  ...............................................................................................................  100  4.3  Results  ..................................................................................................................  101  4.3.1  Environmental-­‐‑structural  safety  mechanisms  ........................................  102  4.3.2  Informal  safety  mechanisms  ......................................................................  107  4.3.3  Control  over  negotiating  risk  reduction  in  sex  work  transactions  ......  110  4.4  Discussion  ...........................................................................................................  113  Chapter  5:  CONCLUSION  ..........................................................................................  118  5.1  Summary  of  Findings  ........................................................................................  118  5.2  Unique  Contributions  ........................................................................................  121  5.2.1  Unique  contributions  to  social  science  research  on  sex  work  ..............  121  5.2.2  Unique  contributions  of  qualitative  research  to  policy  debates  on  sex  work  legislation  in  Canada  .................................................................................  125  5.3  Limitations  ..........................................................................................................  127  5.4  Recommendations  ..............................................................................................  129  5.5  Future  Research  ..................................................................................................  133  5.6  Conclusion  ...........................................................................................................  135  REFERENCES  ...............................................................................................................  136  	     	   ix	  LIST  OF  TABLES  Table  1:  Unsanctioned  Safer  Sex  Work  Environment  Model……………...………99  Table  2:  Environmental-­‐‑structural  Supports  of  Safer  Indoor  Sex  Work    Environment  Model  –  Sex  Worker  Voices……..………………………....106  Table  3:  Informal  Safety  Mechanisms  Safer  Indoor  Sex  Work  Environment  Model  –  Sex  Worker  Voices……………………………………………………..….109           	   x	  LIST  OF  FIGURES  Figure  1:  Prostitution-­‐‑Related  Criminal  Code  Offenses  Vancouver  2010-­‐‑2013….47       	   xi	  LIST  OF  ABBREVIATIONS  AESHA      An  Evaluation  of  Sex  Workers’  Health  Access  GSHI         Gender  and  Sexual  Health  Initiative  HIV         Human  immunodeficiency  virus  STI         Sexually  Transmitted  Infections  UNAIDS      Joint  United  Nations  Program  on  HIV/AIDS  UNFPA      United  Nations  Population  Fund  UNDP      United  Nations  Development  Program  VPD         Vancouver  Police  Department  WHO         World  Health  Organization       	   xii	  ACKNOWLEDGEMENTS  I   express   my   sincere   gratitude   to   my   co-­‐‑supervisors,   Dr.   Kate   Shannon  and   Dr.   Thomas   Kerr,   for   their   ongoing   generous   support,   guidance   and  encouragement.   Over   the   course   of   my   doctoral   training,   their   guidance   and  feedback  have  been  instrumental  in  my  academic  development.  This  dissertation  would   not   have   been   possible  without   their  mentorship   and   the   opportunities  they  have  afforded  to  me.  I  would  also  like  to  thank  my  supervisory  committee  members,  Dr.   Vicki   Smye   and  Dr.   Tim  Rhodes,   for   their   ongoing   support   and  involvement   in   my   doctoral   research.   I   feel   privileged   to   have   had   the  opportunity  to  work  with  such  distinguished  scholars.  None   of   this   work   would   have   been   possible   without   the   women   who  shared   their   stories   and   experiences.   I   thank   them   all   for   their   generosity.   I  extend   a   special   thanks   to   the  Gender   and   Sexual  Health   Initiative  Qualitative  and   Ethnographic   team,   frontline   and   support   staff.   Thank   you   so   much,   Jill  Chettiar,   Chrissy   Taylor,   Solanna   Anderson,   Sarah   Allan,   Elena   Argento,  Daniella  Barreto,   Julia  Homer,  Rhiannon  Hughes,  Emily  Leake,   Jane  Li,  Vivian  Liu,   Sylvia  Machat,  Meenakshi  Mannoe,   Jennifer  Morris,  Rachel  Nicoletti,   Tina  Ok,  Alex  Scott,  Saba  Tadesse-­‐‑Lee,  and  Brittney  Udall.  I  would  also  like  to  thank  Pivot  Legal  Society,  and  in  particular  Katrina  Pacey  and  Dr.  Darcie  Bennett,   for  	   xiii	  their  ongoing  collaborations  and  for  helping  to  keep  our  work  applied  and  policy  relevant.  I   have   been   truly   fortunate   to   work   with   an   exceptional   group   of  colleagues   and   fellow   graduate   students   at   the  University   of   British   Columbia  and   at   the   BC  Centre   for   Excellence   in  HIV/AIDS.   Thank   you   for   the   ongoing  support,   exchange   and   encouragement:   Dr.   Ryan  McNeil,   Dr.   Tara   Lyons,   Dr.  Putu   Duff,   Dr.   Danya   Fast,   Dr.   Kathleen   Deering,   Dr.   Shira   Goldenberg,   Dr.  Kanna  Hayashi,  Dr.  Will  Small,  Dr.  M-­‐‑J  Milloy,  Dr.  Lindsey  Richardson,  Dr.  Kora  DeBeck,  and  Dr.  Dan  Werb.  My   doctoral   training   and   research   was   generously   supported   by   a  Canadian   Institutes  of  Health  Research  Canada  Graduate  Scholarship  and  by  a  University   of   British   Columbia   Four   Year   Fellowship.   I   also   thank   the  Gender  and   Sexual   Health   Initiative   and   Urban   Health   Research   Initiative   of   the   BC  Centre  for  Excellence  in  HIV/AIDS  for  providing  salary  support  over  the  course  of  my  doctoral  research.    Finally,  I  express  my  heartfelt  gratitude  to  my  family  and  friends  for  their  unstinting  support  over  the  years.         	   xiv	  DEDICATION  	  	  	  	  	  	  	  	  	  To  the  women  who  so  generously  shared  their  time  and  experiences.  To  Scott  and  Frieda  who  support  me  in  all  things  that  matter.  And  to  my  parents  who  never  held  me  back.    	   1	  Chapter  1:  INTRODUCTION  1.1  Positioning  Violence  in  Sex  Work  The   links  between   sex  work  and  violence  have   long  been  established.  A  recent  review  estimated  the  lifetime  prevalence  of  sex  work  related  physical  and  sexual  violence  between  45%  and  75%  (Deering  et  al.,  2014).  Physical  and  sexual  violence  against  sex  workers  is  linked  to  the  transmission  of  sexually  transmitted  infections  (STIs)  and  HIV  through  coercive  unprotected  sex  and  reduced  capacity  to  negotiate  sexual  risk  reduction  with  clients  (Shannon  et  al.,  2009).  Debates  on  sex  work  are  critically  informed  by  their  engagements  with  the  issue  of  violence.  The  physical   and   symbolic  practices  of  violence   experienced  by  women   selling  sex   are   one   of   the  main  points   of   contention  between   advocates   for   the   labour  and  human  rights  of  sex  workers  and  prostitution  abolitionists  (Shah,  2004).  For  prostitution   abolitionists,   which   include   radical   feminists   as   well   as   political  Conservatives   and   some   religious   groups,   sex  work   is   intrinsically   violent   and  the  only  way  to  remedy  the  violence  that  may  ensue  in  the  context  of  sex  work  is  the   abolition   of   sex   work   through   prohibition   and   criminalization   (van   der  Meulen,  Dursin  &  Love,  2013).    However,   an   ever   growing   body   of   social   science   and   epidemiological  research   suggests   that   much   of   what   has   been   identified   as   harmful   in  	   2	  prostitution  is  a  product,  not  of  the  inherent  dangerous  or  violent  character  of  sex  work  per  se,  but  rather  of  the  social  and  structural  factors  that  shape  the  working  conditions  of  sex  workers,  such  as  prohibitive  sex  work  legislation  and  punitive  policing,  stigma,  work  environments,  poverty  and  gender  inequality  (Bruckert  &  Hannem,   2013;   Gruskin,   Williams   Pierce,   &   Ferguson,   2013;   Zatz,   1997).   The  concepts   of   structural   violence   or   vulnerability   and   everyday   violence   have  previously  been  useful   in   framing   the  violence  and  poor  health  experienced  by  street-­‐‑based  sex  workers   (Argento  et  al.,   2011;  Katsulis,  2008;  Shannon,  Kerr,  et  al.,   2008;   Simić   &   Rhodes,   2009).   This   more   expansive   definition   of   violence  includes   consideration   of   how   social   and   structural   forces   embedded   in   the  organization  of  society,  such  as  for  example,  laws,  policing,  welfare  policies  and  stigma,  render  particular  groups  of  people  such  as  sex  workers,  and  in  particular  those  living  in  poverty  and  working  on  the  street,  disproportionately  vulnerable  to  violence  and  harm  (Quesada,  Hart,  &  Bourgois,  2011).    Drawing  on  the  concept  of  structural  violence  and  structural  vulnerability,  this   dissertation   seeks   to   examine   how   social   and   structural   factors   such   as  stigma,   evolving   sex  work   legislation,   and  punitive  policing   strategies   intersect  to  shape  the  experiences  of  violence  and  HIV  risks  of  primarily  street-­‐‑based  sex  workers   in  Vancouver,  Canada.  To  date,   few   investigations  have  examined   the  nuanced   and   intersecting   influence   of   evolving   policy,   social   and   physical  	   3	  features  of   the  work  environment   in  shaping  violence  and  HIV  risk  among  sex  workers.  In  addressing  this  research  gap,  this  dissertation  aims  to  contribute  to  a  better   understanding   of   the   lived-­‐‑experiences   of   primarily   street-­‐‑based   sex  workers  in  the  context  of  evolving  sex  work  policies  and  policing  strategies.  The  objective  is  to  provide  critical  insights  into  what  types  of  sex  work  environments  can  contribute  to  the  wellbeing,  health  and  safety  of  this  group  of  women.  Below,  I  will  review  the  growing  body  of  social  science  and  epidemiological  research  on  the  social  and  structural  factors  that  have  been  found  to  shape  sex  workers’  risk  of  violence  and  HIV.        1.2  Literature  Review  of  Social   and  Structural  Determinants  of  Violence   and  HIV  among  Sex  Workers  1.2.1  Criminalization  of  sex  work  and  policing  Globally,   the   dominant   policy   approach   to   sex   work   has   been  criminalization   and   police   enforcement.   Enforcement-­‐‑based   approaches   and  policing   within   criminalized   frameworks   have   consistently   been   linked   to  elevated  risks  for  violence,  and  reduced  ability  to  negotiate  safer  sex  transactions,  including   prevention   of   HIV   and   other   sexually   transmitted   infections   (STIs)  (Decker,  et  al.,  2014;  Rhodes,  Simic,  Baros,  Platt,  &  Zikic,  2008;  Shannon  &  Csete,  2010;  Shannon  &  Montaner,  2012;  Simić  &  Rhodes,  2009;  WHO,  2011).  Previous  	   4	  work  in  this  setting,  as  well  as  internationally,  has  documented  that  interactions  between   sex   workers   and   police   are   frequent   and   can   be   violent   (Odinokova,  Rusakova,   Urada,   Silverman,   &   Raj,   2014;   Rekart,   2006;   Rhodes,   et   al.,   2008;  Sanders,  2004;  Shannon,  Kerr,  et  al.,  2008).  Prohibitive  sex  work   legislation  and  restrictive  policing   strategies   reduce   the  ability  of   sex  workers   to   screen   clients  and  displace  sex  workers  to  outlying  industrial  areas  where  there  is  little  chance  for  escape  or  help  in  case  of  violence  and  a  higher  likelihood  to  be  pressured  into  unprotected   sex   by   clients   (Krüsi   et   al.,   2014;   Shannon,   Strathdee,   et   al.,   2009).  Indeed,   it  has  been  estimated   that   the  decriminalization  of  sex  work   in  Canada  could   reduce   39%   of   new  HIV   infections   among   female   sex  workers   and   their  clients  over  the  next  decade  (Shannon  et  al.,  2014).    In   Vancouver,   experience   of   police   violence,   confiscation   of   drug  paraphernalia  by  police,  and  enforced  police  displacement  away  from  main  sex  work   areas   were   independently   associated   with   experiencing   client   violence  (Shannon,   et   al.,   2009).   Evidence   from   Britain   and   India   indicates   that   sex  workers   who   had   ever   been   arrested   or   imprisoned  were  more   likely   to   have  experienced   violence   (Deering   et   al.,   2013;   Platt   et   al.,   2011).   In   India,  multiple  measures  of  police  violence  and  coercion,  including  coercive  sexual  activity  with  police,  police  confiscating  condoms,  police  raiding  workplaces,  and  police  arrest,  were  associated  with  increased  physical  or  sexual  violence  by  clients  (Erausquin,  	   5	  Reed,   &   Blankenship,   2011).   Among   sex   workers   who   experienced   sexual  violence  in  the  past  year  in  India,  6.6%  reported  that  the  main  perpetrators  were  the   police   (Beattie   et   al.,   2010).   Similarly,   in   Russia,   a   study   documented   the  substantial   role   police   sexual   violence   plays   in   the   lives   of   sex   workers   and  highlighted   that   particularly   sex   workers   who   work   independently   and   those  with   a   history   of   substance   use   are   at   increased   risk   for   police   violence  (Odinokova   et   al.,   2014).   A   qualitative   study   from   Serbia   identified   that   sex  workers   perceived   police   violence   as   a   more   serious   threat   than   client  perpetrated   physical   violence,   as   they   felt   more   able   to   manage   their   clients’  behaviours  (Simić  &  Rhodes,  2009).  Sex  workers  of  ethnic  minorities  were  found  to  experience  the  most  brutal  and  relentless  police  violence  (Rhodes,  et  al.,  2008).  These   findings   highlight   that   policing   practices   can   reproduce   broader   societal  inequities,   including   regarding   gender,   race,   sexuality   and   drug   use   (Rhodes,  Wagner,  Strathdee,  Shannon,  Davidson,  Bourgois,  2012;  Simić  &  Rhodes,  2009).    1.2.2  Poverty,  residential  instability,  substance  use  The  negative   effects  of   criminalization  of   sex  work  are   amplified   for   sex  workers  who   live   in  poverty  and   for   those  who  use   illicit   substances   (Katsulis,  2008).  Sex  workers  who  live  in  poverty  are  more  visible,  as  they  are  more  likely  to  work  in  street-­‐‑based  settings  and  are,  therefore,  more  likely  to  be  subjected  to  	   6	  police   intervention   (Lazarus,   Chettiar,   Deering,   Nabess,   &   Shannon,   2011;    Sanders,   2004).   Poverty   is   an   important   catalyst   of   structural   violence,   and   the  link   between   poverty   and   poor   health   outcomes   and   HIV   is   well   established  (Marmot,  2005).  Poverty  is  rarely  considered  in  policy  discussions  as  a  factor  that  gives   sex   work   its   particular   public   character   and   shapes   important   health  consequences   (Culhane,   2003).   Previous   work   has   highlighted   the   connection  between  risky  sex  work  transactions  and  economic  necessity   (Shannon,  Kerr,  et  al.,   2008;   Simić   &   Rhodes,   2009).   For   example,   being   offered   more   money   by  clients  for  unprotected  sex  has  been  linked  to  inconsistent  condom  use  (Shannon,  Kerr,  et  al.,  2008).  Similarly,  the  risks  of  violence  and  degree  of  control  over  sex  work  transactions  differ  across  various  sex  work  locales  where  higher  track  sex  workers   (i.e.   escorts)   have   the   economic   resources   to   afford   security  measures,  such   as   drivers   and   security   cameras   etc.   (Sanders,   2004).   Internationally,   in  China   for   example,   increased   economic   pressure   on   migrant   sex   workers   was  linked  to  more  frequent  experiences  of  client  violence  (Choi,  2011).  In  India,  sex  workers  who  were  in  debt  were  found  to  experience  increased  levels  of  sex  work  related  violence  (Reed,  Gupta,  Biradavolu,  Devireddy,  &  Blankenship,  2010).    Marginal   housing   and   homelessness   have   been   identified   as   further  compounding  the  health  and  safety  risks  sex  workers  face  (Lazarus,  et  al.,  2011).  For  example,  homelessness  and  marginal  housing  are  known  to   increase  sexual  	   7	  risk  among  sex  workers   through  higher   levels  of  unprotected  sex  and  a  greater  number   of   clients   refusing   to   wear   condoms   (Surratt   &   Inciardi,   2010).  Additionally,   homelessness   is   associated  with   increased   risk   for   client   violence  (Shannon,  et  al.,  2009)  and  sexual  violence  by  primary  non-­‐‑commercial  partners  (Argento   et   al.,   2014).   Previous   qualitative   work   in   Vancouver   has   identified  privately   owned   single   room   occupancy   hotels   (the   main   housing   options  available   to   women   living   in   poverty   in   Vancouver)   as   predominantly   male-­‐‑centered  housing  options,  marked  by  fear  of  violence  and  sexual  abuse  (Lazarus,  et   al.,   2011).   Curfews   and   restrictive   guest   policies   were   found   to   negatively  impact   women’s   lives   by   alienating   women   from   their   support   networks   and  impeding   their   income   generation   activities   by   restricting   sex   workers   from  bringing   clients   into   their   rooms.   These   policies   force   sex   workers   to   service  clients   in   outdoor   public   spaces,   previously   associated   with   elevated   violence  (Shannon,  S.  Strathdee,  et  al.,  2009)  and  reduced  control  over  condom  negotiation  with  clients  (Shannon,  Kerr,  et  al.,  2008).    Many  of  the  women  working  in  the  lowest  paying  street  sex  work  tracks  have  a  history  of  illicit  substance  use  and  thus,  are  not  only  criminalized  due  to  their   income   generation   activities,   but   also   due   to   their   drug   use.   A   high  concentration   of   harms,   including   increased   risk   of   violence   and   HIV,   have  consistently  been  documented  in  settings  where  street-­‐‑based  sex  work  and  drug  	   8	  markets   coexist   (Cusick,   2006;   Deering   et   al.,   2011;   Harcourt,   Beek,   Heslop,  McMahon,  &  Donovan,  2001;  Harcourt  &  Donovan,  2005;  Lowman,  2000;  Rekart,  2006;   Shannon,   Kerr,   et   al.,   2008).   A   dependence   on   income   from   sex  work   to  support  illicit  substance  use  has  been  found  to  undermine  sex  worker’s  ability  to  negotiate   sex  work   transactions   (Aral   &   Lawrence,   2002;   Shannon   et   al.,   2007;  Shannon,  Kerr,  et  al.,  2008).  Specifically,  qualitative  and  ethnographic  work  has  linked   the   need   to   alleviate   withdrawal   symptoms,   intense   intoxication   and  exchanging   sex   for   drugs   to   reduced   control   over   sex   work   transactions  including  the  negotiation  of  type  of  service  provided  and  safer  sex  practices  (Aral  &   Lawrence,   2002;   Shannon,   Kerr,   et   al.,   2008).   Similarly,   recent   work   from  Russia  has  identified  binge  substance  use  as  increasing  the  risk  of  sexual  violence  by  clients  and  police  (Odinokova,  et  al.,  2014).    In   many   North   American   settings,   the   introduction   of   inexpensive   and  widely   available   crack   cocaine   has   been   linked   to   being   paid   less   per   sexual  transaction   in   the   lowest   paying   sex  work   tracks,   thereby   increasing   some   sex  workers’  economic  vulnerability  (Maher,  2010;  Shannon,  Kerr,  et  al.,  2008).  Also,  drug-­‐‑sharing   practices   in   the   context   of   sex   work   transactions   have   been  identified   to   increase   the   likelihood   of   clients   offering   and   workers   accepting  more  money   for   unprotected   sex,   thereby   increasing   sex  workers   risk   for  HIV  and  STIs  (Kate  Shannon,  Thomas  Kerr,  et  al.,  2008).  These  findings  highlight  the  	   9	  interconnectedness  between  poverty,   residential   instability,   illicit   substance  use  and  the  risk  of  violence  and  poor  health  associated  with  sex  work.    1.2.3  Sex  work  related  stigma    Sex   work   related   stigma   is   a   cross-­‐‑cutting   macro-­‐‑level   force   that   acts  dynamically  and  iteratively  and  is  invoked  in  sex  work  policy  and  enforcement  as  much  as   in  micro   level   interactions  and  sex  workers   subjectivities   (Bruckert,  2012;  Bruckert  &  Hannem,  2013;  Simić  &  Rhodes,  2009).  While  sex  work  related  stigma   is   imbued   in   sex   work   policy   and   enforcement   it   is   constructed   as   a  personal   attribute   of   sex  workers   and   extends   beyond   the   sphere   of  work   and  also  reaches  beyond  sex  workers  themselves  to  afflict  sex  workers’  families  and  intimate   partners   (Bruckert,   2012).   However,   how   sex   workers   experience,  negotiate  and  resist  stigma  is  highly  variable  and  influenced  by  material,  social,  and   interpersonal   factors.   For   example,   sex   workers   who   work   in   indoor  environments   are   better   able   to   conceal   their   labour   identity   compared   to  primarily   street   based   sex   workers   due   to   the   public   nature   of   their   work.  Additionally,  many  street  based  sex  workers  are  highly  marginalized  and  the  sex  work   related   stigma   intersects   with   multiple   layers   of   stigma   due   to   poverty,  race,  HIV  and  substance  use  (Bruckert,  2012).    	   10	  The  criminalization  of  sex  work  has  been  linked  to  sex  work  stigma,  which  in   turn   trickles  down  to   the  community-­‐‑organization   level  and  can  constitute  a  considerable  barrier  for  sex  workers  in  organizing  and  advocating  for  their  rights  (Blankenship,  Burroway,  &  Reed,  2010;  Kerrigan  et  al.,  2014;  Murray,  Lippman,  Donini,  &  Kerrigan,  2010).  As  well,  sex  work  stigma  has  been  linked  to  reduced  access  to  health  care  services  (Lazarus  et  al.,  2012;  Scambler  &  Paoli,  2008;  Scorgie  et   al.,   2013)   and  HIV   prevention,   including   access   to   condoms   (Scorgie,   et   al.,  2013;  Shannon  &  Montaner,  2012)  and  increased  experiences  of  physical  violence  (Blanchard  et  al.,  2005).    1.2.4  Racism  and  colonialism  It  has  been  suggested  that  the  overrepresentation  of  Aboriginal  women  in  street-­‐‑based   sex   work,   HIV   and   prison   statistics   should   be   understood   in   the  context   of   the   cumulative   effects   of   colonization,   including   displacement,  dispossession,  poverty  and  intergenerational  traumas  (Browne,  Smye,  &  Varcoe,  2005;   Varcoe   &   Dick,   2008).      Colonization   has   resulted   in   a   legacy   of  subordination   of   many   Aboriginal   people,   including   sex   workers,   who   face   a  multilayered  reality  of  racism  and  discrimination  (Bourassa,  McKay-­‐‑McNabb,  &  Hampton,  2004;  Culhane,  2003).    	   11	  In  Vancouver,  Canada,  more   than  60  women  have  disappeared  from  the  local   sex   work   and   drug   scene   since   the   1980’s,   approximately   33%   of   whom  were   of   Aboriginal   ancestry   (Amnesty   International,   2009).   Similar   dynamics  have   been   observed   elsewhere   in   Canada   (Strapagiel,   2012).   Very   few   studies  specifically   consider   the   synergistic   effects   of   colonialism   including  displacement,   dispossession,   poverty   and   intergenerational   traumas   and  Aboriginal   sex   workers’   risk   for   violence   and   HIV   (Bingham,   Leo,   Zhang,  Montaner,   &   Shannon,   2014).   Globally,   indigenous   populations   face   immense  economic,   social   and   health   disadvantages   (Gracey   &   King,   2009).   Aboriginal  women   in   Canada   experience   rates   of   violence   3.5   times   higher   than   non-­‐‑Aboriginal  women.  In  particular,  women  involved  in  sex  work  are  at  heightened  risk  of  violence  (Amnesty  International,  2009;    Shannon,  et  al.,  2009).    The   global   HIV   epidemic   disproportionately   impacts   marginalized  groups,   including   racial   and   ethnic   minorities.   Aboriginal   women   continue   to  bear  the  disproportionate  burden  of  ill  health  and  account  for  almost  three  times  more  AIDS  cases  than  their  non-­‐‑Aboriginal  counterparts  across  Canada  (Barlow,  2003).   Between   1998   and   2008,  Aboriginal  women   represented   49%   of   positive  HIV  tests  (Public  Health  Agency  of  Canada,  2010).  Also,  among  primarily  street-­‐‑based  sex  workers,  HIV  rates  are  elevated  among  women  of  Aboriginal  ancestry  (Shannon,  Bright,  Gibson,  &  Tyndall,  2007).    	   12	  Women   of   Aboriginal   ancestry   are   also   highly   criminalized.   While  Aboriginal  women  make  up   1   to   2%  of   the   general  Canadian  population,   they  represent   31.9%   of   all   incarcerated   women   in   Canada   (Public   Safety   Canada,  2011).   A   direct   link   has   been   drawn   between   the   challenges   that   Aboriginal  women   face   and   the   historical   impact   of   colonization   (Anderson   &   McCann,  2002;  Browne,  et  al.,  2005;  Bingham,  et  al.,  2014;  Duff  et  al.,  2014;  McCall,  Browne,  &  Reimer-­‐‑Kirkham,  2009;  Varcoe  &  Dick,  2008).    1.3  Work  Environments  and  Sex  Work  Related  Violence  and  HIV  Macro-­‐‑level  factors,  including  sex  work  legislation,  policing  and  economic  constraints,   both   shape   and   interact   with   the   social,   policy,   physical   and  economic   features   of   sex  workers’  work   environments.  The  work   environment  consists   of   intersecting   social,   policy,   physical   and   economic   features   of   places  where   sex   workers   service   clients,   such   as   the   street   and   public   places,  residences,  cars,  massage  parlours,  private  apartments,  etc.  There  are  a  growing  number  of  studies,  which  examine  the  impact  of  sex  work  venue-­‐‑type  on  sexual  health  and  violence  (Chen  et  al.,  2012;  Gaines  et  al.,  2013;  Jain  &  Saggurti,  2012;  Safika,  Johnson,  &  Levy,  2011).  However,  given  the  clandestine  nature  of  indoor  sex  work,  evidence  of  the  role  of  formal  and  informal  indoor  work  venues  on  risk  of  violence  and  HIV,  particularly  in  the  North  American  context,  remain  poorly  	   13	  understood   (Benoit,   Jansson,   Millar,   &   Phillips,   2005).   Local   estimates   suggest  differential   rates   of   HIV   infection   by   work   environment.   In   Vancouver,   HIV  prevalence  was  found  to  be  20%  among  women  sex  workers  in  informal  indoor  venues,  11%  among  street-­‐‑based  sex  workers,  and  4%  among  sex  workers  who  service   clients   in   formal   sex   work   establishments   (e.g.   massage   parlours)  (Shannon,  et  al.,  2014).  Sex  workers  who  serviced  clients  in  cars  or  public  places  compared   to   indoor   settings  were   found   to   be  more   likely   to   experience   client  violence   (Shannon,   et   al.,   2009).  Similarly,   in   the  United  Kingdom,   sex  workers  who  worked   outdoors   versus   indoors   had  more   than   six   times   higher   odds   of  experiencing   client   violence   (Church,   Henderson,   Barnard,   &   Hart,   2001).   In  Russia,  sex  workers  in  street-­‐‑based  settings  were  more  likely  to  experience  sexual  violence  by  police  (Odinokova,  et  al.,  2014).  In  India,  sex  workers  who  worked  in  their   homes,   rather   than   brothels,   lodges,   or   public   places,   were   less   likely   to  experience  sexual  violence  by  clients  (Blanchard,  et  al.,  2005).    A   number   of   studies   have   highlighted   how  macro-­‐‑level   factors,   such   as  sex  work   laws  and  policies  and   their   enforcement,   shape   sex  work  venues  and  intersect  with   interpersonal   and   individual-­‐‑level   factors   to   impact   sex  workers’  experiences   of   violence   (Anderson,   et   al.,   in   press)   and   access   to   health   care  services   (Shannon,   Rusch,   et   al.,   2008).   Evidence   from   massage   parlours   in  Vancouver   suggests   that   enforcement   of   restrictive   sex   work   laws   in   these  	   14	  venues  can  constrain  sex  workers’  ability  to  negotiate  their  health  and  safety.  For  example,  migrant  indoor  sex  workers  revealed  that  the  threat  of  police  raids  and  inspections   deter   condom   availability   onsite   due   to   fear   that   condoms  may   be  used   as   evidence   to   confirm   that   sex   work   takes   place   in   a   particular   venue  (Handlovsky,  Bungay,  &  Kolar,  2012).  The  physical  absence  of  condoms  onsite,  sex   workers’   immigration   status   (e.g.,   fear   of   arrest   or   deportation)   limited  English  proficiency,  gendered  power   imbalance,   and  poverty,  have  been   found  to   interact   to  reduce  women’s  ability   to  negotiate  and  use  condoms  in  massage  parlours  (Bungay,  Halpin,  Atchison,  &  Johnston,  2011;  Handlovsky  et  al.,  2012).  Conversely,  work  environments   that  allow  access   to   condoms  and  other  health  services   have   been   shown   to   reduce   HIV   risk   among   sex   workers   in   diverse  settings  globally  (Harcourt  et  al.,  2010;  Kerrigan  et  al.,  2003;  Mainkar  et  al.,  2011;  Munoz   et   al.,   2010;   Thilakavathi   et   al.,   2011).   Together,   these   studies   showcase  the   important   influence   of   workplace   environments   in   shaping   sex   workers’  working  conditions,  risk  of  violence  and  HIV.  However,  there  is  a  need  to  better  understand  the  interplay  of  various  features  of  the  work  environment  (i.e.,  social,  policy,   physical   and   economic)   on   experiences   of   violence   and   poor   health  among  sex  workers.        	   15	  1.4  Study  Setting  1.4.1  The  socio-­‐‑political  context  of  sex  work  in  Vancouver     Vancouver   has   a   long   history   of   repressive   sex   work   policies   and   of  displacing   sex   workers   around   different   areas   of   the   city   in   response   to  legislative   changes,   shifting   societal   perceptions   of   morality   and   urban  development  (Francis,  2006;  Oppal,  2012).  Some  of  the  first  accounts  of  sex  work  in  Vancouver  date  back   to   the   late  19th  century.   In   the  1870’s,  Vancouver  had  a  flourishing   brothel-­‐‑style   red   light   district   to   service   the  demands   of   local  men,  and   those  who   arrived   for   stretches   of   time   from   seasonal   logging   camps   and  mines,  as  well  as  from  ships  docked  in  the  harbor  (Ross,  2010).  While  sex  work  was   initially   tolerated   in   the   newly   founded   city   of   Vancouver,   later   the  approach   to   sex   work   fluctuated   between   controlled   toleration   and   occasional  police   crackdowns   (Francis,   2006;   Ross,   2010).   In   1975,   the   introduction   of   the  ‘bawdy   house’   laws,   which   criminalized   indoor   sex   work,   resulted   in   a  decentralized  outdoor  sex  work  market  and  dramatically  increased  the  presence  of   street-­‐‑based   sex   workers   on   the   streets   of   Vancouver.   The   tightened  enforcement  of   sex  work   laws  continued   into   the  1980’s  and  contributed   to   the  displacement   of   sex   workers   into   Vancouver’s   Downtown   Eastside.   The  Downtown  Eastside   is   a   low-­‐‑income   area   in   the  downtown   core   of  Vancouver  	   16	  that   borders   onto   an   industrial   port   area,   where,   to   this   day,   street-­‐‑based   sex  work  takes  place  and  sex  workers  are  continuously  pushed  towards  an  adjacent  industrial  area.  The  displacement  of  sex  workers  was  accompanied  by  a  wave  of  violence   against   sex   workers   (Francis,   2006).   As   noted   above,   over   60   women  from   the   Downtown   Eastside   have   disappeared   since   the   1980s.   Most   of   the  missing   women   had   been   engaged   in   sex   work   at   one   point   in   their   lives  (Amnesty   International,   2009;   Oppal,   2012).   One   man   (Robert   Pickton)   was  charged  with  the  murder  of  26  women.  In  December  of  2007  he  was  sentenced  to  life  in  prison.       In   response   to   significant   public   scrutiny   for   the   botched   police  investigation   into   the   disappearance   of   over   60   women   from   the   Downtown  Eastside,  a  public  inquiry  was  launched  by  the  British  Columbia  government  in  2010   to   inquire   into   the   investigation   and   events   leading   up   to   the   arrest   and  conviction   of   Robert   Pickton   and   to   examine   the   manner   in   which   cases  involving  missing  women  are  investigated  more  broadly  by  local  police  (Oppal,  2012).  While  fraught  with  controversy1  the  ‘missing  women  inquiry’  highlighted  the  shortcomings  of  police  in  handling  the  missing  women’s  cases  and  a  systemic  bias  in  the  police  response  to  the  women  who  went  missing  from  the  Downtown  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  1   The   missing   women   inquiry   has   been   subject   to   controversy.   Many   key   Aboriginal   and  Downtown   Eastside   advocacy   groups   boycotted   the  process   after   the   British   Columbia  government   announced   they   would   not   fund  legal   representation   for   advocacy   groups   at   the  inquiry,  while  the  police  was  represented  by  a  substantial  legal  team  (Cole,  2012).  	   17	  Eastside,   which   in   turn   contributed   to   a   failure   to   prioritize   and   effectively  investigate   the   cases   (Cole,   2012).   The   report   outlines   63   official  recommendations,   including   calls   for   the   provincial   government   to   fund  additional  full-­‐‑time  sex  trade  liaison  officers,  to  create  and  fund  two  community-­‐‑based  liaison  positions  for  individuals  who  have  experience  in  sex  work,  and  to  establish  a  position  of  aboriginal  liaison  officer  (Oppal,  2012).  In  part  in  response  to  the  missing  women’s  inquiry  report  and  as  a  result  of   strong   pressure   from   sex   work   and   other   community   organizations,   legal  experts,  and  academic  researchers  calling  for  reforms  to  local  policing  practices,  in  January  2013,  the  Vancouver  Police  Department  (VPD)  officially  adopted  new  sex   work   enforcement   guidelines.   The   VPD   acknowledged   that,   even   in   the  context  of  prohibitive  sex  work  legislation,  police  have  “considerable  discretion”  in  deciding  how  and  when  to  enforce  the  law  (VPD,  2013a).    The  new  sex  work  policing  guidelines  set  out  a  strategy  of  ‘open  communication’  with  sex  workers,  balance   the  needs  of   the  community  with   sex  workers’   safety  and   focus  on   the  prevention  of  violence  against  sex  workers  through  prioritizing  their  safety  over  enforcement  measures   such  as   arrest   (VPD,   2013a).  However,   the  new  policing  guidelines  did  not  address  changes  in  enforcement  of  clients.  The  result  is  that,  as  of   January   2013,   Vancouver   has   been   a   de   facto   ‘demand   criminalization’  environment.   The   interview  narratives  presented   in  Chapters   two   and   three   of  	   18	  this   dissertation  were   collected   after   the   implementation   of   the   new   sex  work  enforcement  guidelines,  while  the  interview  narratives  presented  in  Chapter  four  were   collected   prior   to   the   implementation   of   the   new   sex   work   enforcement  guidelines.    1.4.2  The  changing  legal  landscape  of  sex  work  in  Canada       Canada   is   at   a   critical   time   in   the   evolution   of   its   legal   response   to   sex  work.  During   the  period  of  data   collection   for   this  dissertation,   sex  workers   in  Vancouver  operated  within  a  context  of  prohibitive  sex  work   legislation.  While  the   buying   and   selling   of   sex   itself   is   legal,   the   Criminal   Code   of   Canada  prohibits  the  operation  of  a  ‘bawdy  house’,  ‘living  off  the  avails  of  prostitution’,  and   the   ‘communication’   for   the   purposes   of   selling   sex   (Goodyear   &   Cusick,  2007;  Shannon,  Strathdee,  et  al.,  2009).  In  December  2013,  Canada’s  highest  court,  the   Supreme   Court   of   Canada,   unanimously   struck   down   Canada’s   core  prostitution   laws,   deeming   them   unconstitutional   for   violating   sex   workers’  constitutional   rights,   including   the   ability   to   protect   themselves   from   violence,  abuse  and  HIV/STI  infection  (Canada  Attorney  General  v.  Bedford,  2013).  Similar  to  the  United  Kingdom  and  other  commonwealth  countries,  the  Canadian  Criminal  Code  has  never  criminalized  the  buying  or  selling  of  sex  per  se,  however;  the  laws  prohibit  virtually  every  other  aspect  of  sex  work,  making  it  effectively  impossible  	   19	  to   engage   in   sex   work   legally.   The   hypocrisy   of   the   criminalized   prostitution  laws  and  the  unintended  harms  on  sex  workers’  safety,  health,  and  human  rights  were  a  critical  reason  for  the  Supreme  Court  of  Canada  decision  (Canada  Attorney  General   v.   Bedford,   2013).   The  Court   suspended   the   decision   for   one   year   (until  December  2014)  to  provide  the  Canadian  government  time  to  respond;  by  either  removing  the  struck  down  laws  from  the  Criminal  Code  and  thus  decriminalize  sex  work;  or  bringing  the  laws  governing  prostitution  in  line  with  the  decision.  In  June  2014,  the  Canadian  government  tabled  new  legislation,  termed  the  ‘Protection  of  Communities  and  Exploited  Persons  Act’  (Bill  C-­‐‑36).  The  proposed  legislation   sets   out   to   criminalize   the   purchase   of   sexual   services,   along   with  benefiting   from   the   proceeds   of   sex   work   from   another   person   commercially  (Protection  of  Communities   and  Exploited  Persons  Act,   2014).  This   impairs   the  ability  of  sex  workers  to  effectively  work  in  indoor  settings  and  will  prevent  sex  workers   from  working  with  managers  or  drivers  who  can  provide  sex  workers  with   protection   from   violent   clients   (Scoular,   2004).   Finally,   the   proposed   new  legislation   also   sets   out   to   prohibit   communicating   for   the   purpose   of   selling  sexual  services  near  schools,  daycare  centers  and  playgrounds.    This  represents  a  slightly   narrower   version   of   the   previous   Criminal   Code   provision   that  prohibited  the  communication  for  the  purpose  of  prostitution  in  any  public  space  and  was  struck  down  by  the  Supreme  Court  of  Canada  as  violating  the  Charter  	   20	  rights  and  freedoms  of  sex  workers.  The  tabled  legislation  is  expected  to  recreate  the   harms   seen   in   the   previously   struck-­‐‑down   sex   work   laws,   and   will   likely  create  additional   challenges   for   sex  workers.  Currently,   the  proposed  sex  work  legislation   is   undergoing   Parliamentary   review;   therefore,   there   still   remains   a  window  of  opportunity  to  modify  the  proposed  legislation  to  better  protect  sex  workers’   working   conditions   and   citizenship   rights.   Despite   the   ongoing  Supreme  Court  of  Canada  challenge  during  the  study  period  the  Criminal  Code  Provisions   prohibiting   ‘communication   for   the   purposes   of   selling   sex’,   the  operation  of  a  ‘bawdy  house’,  and  ‘living  off  the  avails  of  prostitution’  remained  in  place  over  the  course  of  the  entire  study  period.  1.5  Study  Justification  Given  that  Canada  is  at  a  critical  time  in  the  evolution  of  its  legal  response  to   sex   work,   this   dissertation   aims   to   provide   critical   evidence   regarding   the  lived-­‐‑experiences   of   street-­‐‑based   sex   workers   in   the   context   of   evolving   legal,  policy  and  social  responses  to  sex  work.  There  is  a  critical  need  for  including  the  narratives   of   the   ‘lived-­‐‑experiences’   of   sex   workers   in   evidence-­‐‑based   policy  making   (Dewey   &   Kelly,   2011).      Decades   of   failures   of   prostitution   laws   in  Canada   stemmed   from   failure   of   consecutive   governments   to   take   seriously  strong   evidence   by   sex   workers,   academics   and   human   rights   advocates   that  	   21	  existing  laws  were  creating  and  exacerbating  devastating  harms  to  sex  workers’  safety,  health  and  human  rights,  including  violence  and  poor  health.      Given   the  VPD’s   sex  work   enforcement  guidelines,   that   resulted   in   a  de  facto   ‘demand  criminalization’  environment  and  the   implementation  of  unique,  low-­‐‑barrier  housing  programs   for  women   that   are   functioning  as  unsanctioned  quasi-­‐‑brothels   under   special   needs   housing   regulations,   Vancouver   provides   a  unique  window  into  the  possible  impacts  of  legislative  change  to  sex  work  laws.  This   dissertation   provides   critical   evidence   of   how   structural   change   and  interventions  can  shape  the  working  conditions  of  marginalized  street-­‐‑based  sex  workers.    Despite   a   growing   body   of   research   on   the   social   and   structural  determinants   of   violence,   safety   and   sexual   risk   among   sex  workers,  we   know  less  about  the  specific  features  of  these  environments  and  the  dynamic  interplay  that  shape  the  negotiation  of  safety  and  sexual  risk  in  sex  work  transactions.  To  date,   few  investigations,  have  examined  the  nuanced  and  intersecting   influence  of   evolving   policy,   social   and   physical   features   of   the   work   environment   in  shaping  violence  and  HIV  risk  among  sex  workers.      	   22	  1.6  Study  Objectives  Therefore,  the  overall  aim  of  this  dissertation  is  to  examine  how  social  and  structural   factors   such   as   stigma,   evolving   sex   work   legislation   and   policing  practices  intersect  to  shape  the  working  conditions  of  primarily  street-­‐‑based  sex  workers  in  Vancouver.  The  specific  objectives  of  this  dissertation  are:  1) To  examine  how  evolving  laws  and  policies  that  target  sex  buyers  rather  than   sex   workers   shape   sex   workers’   working   conditions   and   sexual  transactions,  including  risk  of  violence  and  HIV/STI  infections.  Chapter  two  explores  how  a  new  local  enforcement  strategy  that  targets  clients,  but  not   sex   workers,   shapes   sex   workers’   interactions   with   police   and  negotiation   of   their   working   conditions   and   sexual   transactions   with  clients,  with  a  particular  focus  on  protections  from  violence  and  HIV/STI  infections.  2) To   explore   how   intersecting   regimes   of   criminalization   and  stigmatization   shape   sex   workers’   civic   rights   and   experiences   of  violence   and   poor   health.  Chapter   three   explores   the   complex   ways   in  which   coexisting   stigmatizing   assumptions   of   sex   workers   as   ‘risky’   to  their   communities   and   themselves   and   ‘at   risk’   of   harm   intersect   with  evolving   sex  work  policing   strategies   to   shape   street-­‐‑based   sex  workers’  	   23	  citizenship   rights   and   structural   vulnerability.   Chapter   three   outlines  some  of  the  specific  ways  in  which  sex  work  related  stigma  influences  the  risk  of  violence  and  poor  health  by  normalizing  the  violence  experienced  by   sex   workers   and   continuously   displacing   them   from   the   neoliberal  urban   landscape,  not  merely  by  police   force,  but  also  by  neighbourhood  watch   groups,   private   security   and   other   mechanisms   of   urban  gentrification.    3) To   explore   how   unsanctioned   indoor   sex   work   environments   with  supportive  management   policies   shape   sex  work   transactions.  Chapter  four  examines  how  unique,  low-­‐‑barrier  housing  programs  for  women  that  are   functioning   as   unsanctioned   quasi-­‐‑brothels   under   special   needs  housing   regulations   influence   risk   negotiation   with   clients   in   sex   work  transactions.  Chapter  four  highlights  how  intersecting  physical,  social  and  policy   features   of   a   specific   sex  work   environment   interact   to   shape   the  negotiation  of  safety  and  sexual  risk  in  sex  work  transactions.  This  chapter  considers   the   potential   role   of   safer   indoor   sex   work   environments   as  venues  for  public  health  and  violence  prevention  interventions  and  points  to   the  critical   importance  of  removing  the  socio-­‐‑legal  barriers  preventing  the  formal  implementation  of  such  programs.       	   24	  1.7  Conceptual  Framework  1.7.1  Sex  work  as  labour  In  this  dissertation,  I  understand  sex  work  as  both  a  form  of  labour  and  an  income   generation   strategy   (van   der  Meulen,   Dursin   &   Love,   2013).   Although  ‘prostitution’  and  ‘sex  work’  both  refer  to  the  sale  or  trade  of  sexual  services,  the  term  ‘sex  work’  in  particular  represents  a  specific  position  on  the  ways  in  which  women  are  cast  in  the  analysis.  The  term  sex  worker  was  coined  in  the  1980’s  and  emphasizes  the  labour  aspect  of  paid  sex,  and  is  thus  linked  to  the  call  for  better  working  conditions  for  sex  workers.  The  use  of  the  term  ‘sex  work’  signifies  the  recasting   of   people   who   sell   sex   as   workers   organizing   for   the   rights   and  protections   afforded   to  workers   in   any   other   context,   including   the   right   to   be  free  from  violence  and  bodily  harm  in  the  workplace  (Shah,  2004).  This  language  is  also  used  by  sex  workers’  rights  organizations  and  is  now  commonly  used  in  research   and   theory   on   sex   workers   (Koken,   2010).   For   the   purpose   of   this  dissertation,   the   term   ‘sex  worker’  will   be   used   to   refer   specifically   to   persons  who   engage   in   direct   paid   sexual   contact  with   clients.   The   term   ‘prostitute’   or  ‘prostitution’  will   be   used   in   reference   to  writings   by   feminists  who   reject   the  phrase   sex  work,   and   also  when   referring   to   specific   sections   of   the   Canadian  Criminal  Code.    	   25	  1.7.2  Socio-­‐‑ecological  framework     Conceptualizing  sex  work  as  a  form  of  labour  creates  space  for  discussing  the  complex  and  varied  experiences  of  people  in  sex  work  and  allows  space  for  conceptualizing   how   sexual   labour   is   organized   within   a   broader   social   and  structural  context,   including  its  gendered,  class  and  racial  dimensions.   (van  der  Meulen,   Dursin   &   Love,   2013).   My   approach   to   the   health   and   safety   of   sex  workers   in   this  dissertation  has  been  primarily  shaped  by  critical   social   science  scholarship,   particularly   by   those   approaches   that   emphasize   the   impact   of  political   economy,   structural   violence   or   vulnerability,   social   geography,   and  gender   (Bourgois,   2009;   Collins,   2000;   Farmer,   2005;   Harvery,   1990;   Parker   &  Aggleton,   2003;      Rhodes,   Wagner,   Strathdee,   Shannon,   Davidson,   Bourgois,  2012).   ‘Critical’  here  refers   to   the  shared  position  within  all  critical  perspectives  that  relations  of  power  influence  the  processes  by  which  “...groups  of  people  are  differently  placed  in  specific  political,  social,  and  historic  contexts  characterized  by  injustice”  (Collins,  2000).    Socio-­‐‑ecological   frameworks   for   conceptualizing   health   and   wellbeing  emphasize   that  health   is  an  outcome  of  social  and  structural  conditions  and,   in  particular,   sociocultural,   economic   and   political   inequalities,   including   the  exercise   of   power   (Farmer,   1999).      These   approaches   highlight   the  	   26	  interconnectedness   of   the   biological   with   social,   political,   legal   and   economic  forces,   to   move   beyond   individually   focused   and   behavioural   approaches   to  understanding  health  and  wellbeing   that  has  dominated  much  of  public  health  research  on  sex  work.  I  draw  on  concepts  of  ‘structural’  and  ‘everyday’  violence  to  further  situate  the  sex  work  related  violence  and  risks  to  health  in  relation  to  theoretical  debates  on  social  suffering  (Bourgois,  Prince,  &  Moss,  2004;    Shannon,  Kerr,   et   al.,   2008;   Simić   &   Rhodes,   2009).   Structural   violence   is   distinct   from  personal   or  direct   violence,  which  has   been   the   focus   of  much   research   on   sex  work,   in   that   it   is   embedded   in   social   structures   and   draws   attention   to   how  “unequal  power”  shapes  “unequal  life  chances”  (Galtung,  1990).    Structural   violence   has   been   conceptualized   as   the   product   of   social  arrangements   embedded   in   the   organization   of   society   that   inflict   injury   upon  vulnerable   populations   (Farmer,   2005).   These   social   arrangements   are  determined  by  large-­‐‑scale  forces  (e.g.,  criminalization  of  sex  work,  poverty)  that  are  rooted  in  historical  and  economic  processes  (e.g.,  colonialism,  globalization).  Importantly,   the   institutionalization   and   everyday   internalization   of   structural  violence  through,  for  example,  policing  practices  and  stigmatization  can  render  it  invisible   (Bourgois,   et   al.,   2004;   Scheper-­‐‑Hughes,   2004),   a   process   Scheper-­‐‑  Hughes  (2004)  refers  to  as  ‘everyday  violence.  More  recent  iterations  of  structural  violence  have  adopted  the  term  ‘structural  vulnerability’  to  conceptualize  social  	   27	  suffering   and   emphasize   the   role   of   ‘positionality’   (Quesada,   et   al.,   2011).  Structural  positionings   frame  choices,   influence  decision-­‐‑making  and  may   limit  opportunities.   Vulnerability   is   produced   as   the   outcome   of   position   in   a  hierarchical   social   order   and   a   network   of   power   relationships   that   constrain  agency  (Quesada,  et  al.,  2011).    This   dissertation   is   also   informed   by   recent   work   on   structural   stigma  (Biradavolu,   Blankenship,   Jena,   &   Dhungana,   2012;   Hansen,   Bourgois,   &  Drucker,   2014;   Hatzenbuehler   &   Link,   2014).   The   concept   of   structural   stigma  brings   into   focus  how  broader  macro-­‐‑level   forms  of   stigma,   including   societal-­‐‑level   conditions,   cultural   norms,   and   institutional   policies   constrain   the  opportunities,   resources,   and   wellbeing   of   individuals   and   groups   who   are  stigmatized  (Biradavolu,  et  al.,  2012;  Hansen,  et  al.,  2014;  Hatzenbuehler  &  Link,  2014).  As  suggested  by  Parker  and  Aggleton  (2003),  I  will  conceptualize  sex  work  related   stigma   in   relation   to   broader   notions   of   power   and   domination.   Stigma,  then,  is  not  simply  an  expression  of  individual  attitudes  or  of  cultural  values  but  is   central   to   the   constitution   of   the   social   order   (Parker   &   Aggleton,   2003).   In  relation   to   sex  work,   structural   stigma   is   evident   in   the  way   sex  work   specific  laws  govern  the  buying  and  selling  of  sex  (Bruckert  &  Hannem,  2013)  and  in  the  spatial   practices   that  mark   out  who   can   legitimately   and   safely   use   the   urban  landscape.   Stigmatized   groups,   such   as   sex   workers,   who   are   outside   the  	   28	  mainstream   are   continually   pushed   to   the   sidelines,   through   policing   but   also  through   mechanisms   of   urban   renewal,   gentrification   and   neighbourhood  protesters  (Hubbard  &  Sanders,  2003;  Sanders,  2004).  1.7.3  Intersectionality     The  intersectionality  paradigm  is  also  a  significant  underlying  framework  for  this  dissertation.  Intersectionality  has  roots  in  feminist  thought  and  refers  to  the  perspective  that  systems  of  race,  class,  gender,  and  sexuality  form  mutually  constructing   features   of   social   organization   (Collins,   2000).   The   theory   of  intersectionality   works   to   highlight   the   multiple,   dynamic   and   interconnected  ways   in  which   subordination   affects   lived-­‐‑experiences   and   ability   to   negotiate  risks   (Hankivsky   et   al.,   2010;  Katsulis,   2008).   In   a  move   away   from  hegemonic  feminism  that  essentializes  women’s  experiences  of  gendered  subordination,  the  intersectionality   paradigm   brings   into   focus   the   complex   interrelationships  between   multiple   social   positionings   such   as   gendered   subordination,   racial  discrimination   and   economic   deprivation   (van   der   Meulen,   Dursin   &   Love,  2013).   Thus,   intersectionality   draws   attention   to   the   multidimensional   and  relational   nature   of   social   locations   and   places   lived   experiences,   social   forces,  and   overlapping   systems   of   discrimination   and   subordination   at   the   center   of  analysis  (Hankivsky,  et  al.,  2010).    	   29	  An   intersectional   understanding   of  multiple   forms   of   subordination   sets  the   foundation   for   understanding   the   dynamic,   multidimensional   factors   that  shape  sex  workers  differential  exposure  to  occupational  risk,  and  the  capacity  to  successfully  mange   those   risks.   For   example,   indigenous   scholars   have   drawn  attention  to  the  centrality  of  race  in  the  organization  of  labour  in  the  sex  industry,  with  non-­‐‑racialized  workers  often  occupying  better  paying  jobs  in  safer  working  conditions,   and   indigenous   and   racialized   sex   workers   more   vulnerable   to  violence  by  police  and  clients  (van  der  Meulen,  Dursin  &  Love,  2013).  1.8  Study  Population     Questions  of  generalizability  and  sample  representativeness  of   the   larger  population  of  sex  workers  pose  a  challenge  for  all  research  on  sex  work  (Weitzer,  2005).   Sex   workers   globally   represent   a   highly   diverse   group,   including  cisgender   women   and  men,   transgender   individuals,   those   who   assume   other  positions  on  the  gender  and  sexuality  continuums,  those  who  solicit  and  service  clients  in  a  variety  of  settings,  including  through  the  internet,  at  escort  agencies,  in   brothels,   bars,   massage   parlours,   or   on   the   street.   This   dissertation   aims   to  examine   the   experiences   of   poor,   street-­‐‑involved   sex   workers   (cis-­‐‑   and  transgender  women)  who  have  a  history  of  soliciting  and/or  servicing  clients  on  the   street,   given   substantial   data   that   stigma,   criminalization   and   enforcement  	   30	  disproportionately  target  this  segment  of  the  sex  industry  due  to  increased  public  visibility   and   reduced   cultural,   social   and   economic   capital   (Bruckert,   2012;  Lowman,  2000;  Sanders  &  Campbell,  2007;  Shannon,  Kerr,  et  al.,  2008).    At  the  core  of  much  debate  about  sex  work  and  sex  work  legislation  is  the  question   of   whether   or   not   sex   work   can   ever   be   a   rational   choice   of   income  generation,  or  whether  it  is  an  inherent  form  of  domination  and  violence  against  women,   especially   for   street-­‐‑involved  women   living   in  poverty.   In   essence,   the  debate   centers   on   the   question   of   whether   sex   work   constitutes   a   form   of  voluntary  income  generation  or  involuntary  sexual  objectification  (Scoular,  2004).  Conceptualizing  sex  work  as  a   form  of   labour  allows   for  conceptualizing  “how  sexual   labour   is   organized   within   the   broader   capitalist   context,   including   its  class   and   racial   dimensions.”   (van   der   Meulen,   Dursin   &   Love,   2013,   p.17).  Therefore,   in   line   with   socio-­‐‑ecological   frameworks,   in   this   dissertation   poor  women’s   involvement   in   sex  work   is   understood   in   the   context   of   the   broader  social,   structural  and  economic  context,  where  human  agency   is  defined   in   line  with  Bourdieu  &  Wacquant  (1992),  who  use  the  term  ‘human  agency’  to  describe  an  individuals’  power  to  make  choices  regarding  his  or  her  actions  in  the  context  of  a  given  set  of  circumstances   (Bourdie  &  Wacquant,  1992).  From  this  vantage  point,   street-­‐‑involved   sex   workers’   participation   in   the   sex   industry   is  conceptualized   in   the   context   of   the   very   limited   income   generation   options  	   31	  available   to   women   in   the   lowest   sectors   of   the   economic   ladder.   Deciding  between  exclusive  dependence  on  welfare  payments,  informal  income  generation  opportunities,   such   as   domestic   labour,   and   higher-­‐‑paying   sex   work   may  constitute  a  rational  choice,  but  it  is  one  that  is  clearly  a  constraint  (Koken,  2010).  However,   even   sex   work   in   the   lowest   paying   tracks   involves   skilled   sexual  labour,  as  well  as  emotional  labour,  where  friendships  between  sex  worker  and  clients   can  develop  and  where   sex  workers  not  only  attend   to   serve   the   sexual  desires   of   clients,   but   also   connect   on   an   emotional   level   and   may   provide  companionship  and  social  support  (van  der  Meulen,  Dursin  &  Love,  2013).  1.9  Study  Approach  The   individual   empirical   studies   that   comprise   this   dissertation   were  undertaken  within  the  context  of  the  Gender  and  Sexual  Health  Initiative  (GSHI)  of   the  British  Columbia  Centre   for  Excellence   in  HIV/AIDS.  Ethnographic  data  collection  was   linked  with   a   cohort   of   over   800   on   and   off   street   sex  workers,  known  as  AESHA   (An  Evaluation  of   Sex  Workers  Health  Access)   (Shannon,   et  al.,  2007).  The  AESHA  cohort  is  a  community-­‐‑based  longitudinal  study  with  bi-­‐‑annual   follow-­‐‑up,   focused   on   evaluating   the   physical,   social   and   policy  environments   shaping   sexual   health,   violence,  HIV   vulnerability   and   access   to  care  among  sex  workers  (Shannon,  et  al.,  2007).  The  research  builds  on  ongoing  	   32	  community   partnerships   developed   since   2004   with   a   Community   Advisory  Board  comprised  of  sex  worker,  community  and  health  support  agencies.    The   studies   included   in   this  dissertation  employed  diverse   ethnographic  methods,   including   participant-­‐‑observation,   in-­‐‑depth   interviews   and   focus  groups,  to  examine  how  social  and  structural  factors,  such  as  stigma,  punitive  sex  work   legislation   and   policing,   intersect   to   shape   the   working   conditions   of  primarily  street-­‐‑based  sex  workers  in  Vancouver.  The  research  methods  of  each  individual  study  are  outlined  in  detail  in  the  individual  chapters  that  follow.  In  brief:    Chapters   2   &   3:   Chapters   two   and   three   draw   on   31   semi-­‐‑structured  qualitative   interviews   with   street-­‐‑involved   sex   workers   about   their   working  conditions,   interactions  with  police,   and  negotiations   of   health   and   safety  with  clients,  in  the  City  of  Vancouver,  Canada.  These  interviews  were  conducted  over  11  months   (January-­‐‑November   2013)   following   the   implementation   of   the   new  safety  focused  sex  work  enforcement  policy  by  the  Vancouver  Police  Department  (VPD)   in   January   2013   (Krüsi,   et   al.,   2014);   and   following   the   release   of   the  Missing   Women’s   Commission   Inquiry   report   regarding   the   botched   police  investigation   into   the   disappearance   and   murder   of   over   60   street-­‐‑based   sex  workers  in  Vancouver  since  the  1980’s  (Oppal,  2012).      	   33	  In   addition   to   31   semi-­‐‑structured   interviews   with   street-­‐‑involved   sex  workers   about   their   working   conditions,   interactions   with   police,   and  negotiations   of   health   and   safety   with   clients,   Chapter   two   draws   on   over   40  hours   of   ethnographic   field   work   of   street   sex   work   scenes   in   the   City   of  Vancouver  that  focused  on  assessing  levels  of  police  presence;  shifts  in  sex  work  areas;   and   police,   sex   worker   and   client   interactions.   Qualitative   and  ethnographic  data  were   triangulated  with  sex  work-­‐‑related  violence  prevalence  data   from  the  AESHA  cohort  pre  and  post  policy   implementation  and  publicly  available   police   statistics   that   report   on   prostitution   related   criminal   code  offences  in  the  City  of  Vancouver  (VPD,  2013b).  These  data  were  used  to  explore  how  criminalization  and  policing  of  sex  buyers,  rather  than  sex  workers,  shapes  sex  workers’  working   conditions   and   sexual   transactions,   including   the   risk   of  violence  and  poor  health.    Chapter   4:  Chapter   four   draws   from   39   in-­‐‑depth   qualitative   interviews  and  6  focus  groups  conducted  with  women  who  live  in  low-­‐‑barrier,  supportive  housing   for  marginalized  sex  workers  and   focused  on  participants’  experiences  of   living   and  working   in   these  housing  programs.  Chapter   four   examines  how  unique,   low-­‐‑barrier   housing   programs   for   women   that   are   functioning   as  unsanctioned   indoor   sex   work   environments   under   special   needs   housing  	   34	  regulations   shape   safety   and   sexual   risk   negotiation   among   marginalized   sex  workers.  1.10  Outline  of  the  Dissertation  In   summary,   this   dissertation   consists   of   five   chapters.  Chapter   one,   the  introduction,   situates   the   concept   of   ‘violence’   in   debates   about   sex  work   and  summarizes   the   current   evidence   regarding   the   social   and   structural  determinants  of  violence  and  HIV  among  sex  workers  and  points  out  potential  shortcomings   of   the   existing   evidence   base.   Chapter   one   then   summarizes   the  socio-­‐‑legal  context  of  sex  work  in  Vancouver  and  the  research  objectives  of  this  dissertation.   Chapter   one   also   provides   a   detailed   outline   of   the   conceptual  framework   and   study   approach   that   inform   all   aspects   of   this   dissertation.  Chapter   two   examines  how   the   implementation   of   a   novel   policing   strategy   in  Vancouver,   that   targets   clients   rather   than   sex   workers,   shapes   sex   work  transactions.  Chapter   three,  drawing  on   the  concepts  of   structural  violence  and  stigma,  explores   the  complex  ways   in  which  sex  work  related  stigma   intersects  with   evolving   sex   work   policing   strategies   to   shape   street-­‐‑based   sex   workers’  civic  rights  and  experiences  of  violence  and  poor  health.  Chapter  four  examines  how  unique,   low-­‐‑barrier  housing  programs   for  women,   that   are   functioning  as  unsanctioned   quasi-­‐‑brothels   under   special   needs   housing   regulations,   shape  	   35	  safety   and   sexual   risk   negotiation   among   marginalized   sex   workers.   Finally,  Chapter  five  reviews  the  key  findings  of  the  empirical  chapters  that  comprise  this  dissertation  and  elaborates  on  the  implications  of  the  current  research  for  policy  and  programming  debates,  and  outlines  areas  for  further  investigation.    	   36	  Chapter  2:  CRIMINALIZATION  OF  CLIENTS:  REPRODUCING  VULNERABILITIES  FOR  VIOLENCE  AND  POOR  HEALTH  AMONG  STREET-­‐‑BASED  SEX  WORKERS  IN  CANADA    2.1  Introduction  Harassing   the   clients   is   exactly   the   same   as   harassing  the   women.   You   harass   the   clients   and   you   are   in  exactly   the   same   spot  you  were  before.   I’m   staying  on  the   streets.   I’m   in   jeopardy   of   getting   raped,   hurt.   -­‐‑  Jasmine,  Cisgender  Woman  As  outlined  in  the  previous  Chapter,  there  is  now  a  well-­‐‑established  body  of  epidemiological  and  social  science  research  globally  pointing  to  the  negative  impact  of   legislation   and   policies   that   criminalize   sex  work   on   violence   and   other   health  risks  including  HIV/STI  infection  among  sex  workers  (Gruskin,  et  al.,  2013;    Platt  et  al.,   2013;   Platt   et   al.,   2007;   Rhodes,   et   al.,   2008;   Shannon   &   Csete,   2010;   Simić   &  Rhodes,  2009;  WHO,  2011).  However,   the  criminalization  of   some  or  all  aspects  of  prostitution   remains   the   dominant   legal   approach   globally   (Gruskin,   et   al.,   2013;  WHO,  2011),  despite  growing  empirical  evidence  and  clear  international  guidelines  by   the  World  Health  Organization,  UNAIDS,  UNDP,   and  UNFPA   calling   for   full  decriminalization   of   sex   work   as   necessary   to   promoting   the   health   and   human  rights  of  sex  workers.    Enforcement-­‐‑based  approaches  and  policing  within  criminalized  frameworks  have  consistently  been   linked  to  elevated  risks   for  violence,  and  reduced  ability   to  negotiate   safer   sex   transactions,   including   prevention   of   HIV   and   other   sexually  	   37	  transmitted  infections  (STIs)  (Rhodes,  et  al.,  2008;  Shannon  &  Csete,  2010;  Shannon  &  Montaner,  2012;  Simić  &  Rhodes,  2009;  WHO,  2011).  Previous  research  indicates  that   in   criminalized   settings,   policing   strategies   can   range   from   surveillance   and  crackdowns  to  arrests  or  threats  of  arrest,  intimidation  by  police,  and  police  violence  can   be   frequent   and   go   largely   unreported   (Okal   et   al.,   2011;   Rekart,   2006;   Tim  Rhodes,   et   al.,   2008;   Sanders,   2004;   Shannon,   Kerr,   et   al.,   2008).   These   risks   are  amplified  for  the  most  marginalized  and  visible  sex  workers,  those  living  in  poverty  and  working   on   the   street   (Lowman,   2000;   Sanders  &   Campbell,   2007;      Shannon,  Kerr,  et  al.,  2008).   In  an  effort   to  avoid  police,   sex  workers  often  move   to  outlying  secluded   areas   to  meet   and   service   clients   where   there   are   few   to   no   protections  from  violence  and  abuse,  and  reduced  ability  to  refuse  unwanted  clients  or  services,  including  client  demands  for  sex  without  a  condom  (Krüsi  et  al.,  2012;  Maher  et  al.,  2011;  Okal,  et  al.,  2011;  Shannon,  Kerr,  et  al.,  2008;  Shannon,  Strathdee,  et  al.,  2009).  Criminalization   and   policing   force   sex   workers   to   rush   or   forgo   screening  prospective  clients  or  negotiating  the  terms  of  sexual  transactions  before  entering  a  vehicle,  placing  sex  workers  at  increased  risk  of  physical  violence,  rape  and  HIV/STI  infection  (Deering  et  al.,  2013;  Okal,  et  al.,  2011;  Shannon,  et  al.,  2009).    The  criminalization  of  sex  work  has  been  found  to  prevent  sex  workers  from  reporting   violent   perpetrators   and   seeking   legal   recourse   after   physical   or   sexual  assault   (Okal,  et  al.,  2011;  Richter  et  al.,  2010).  There   is  also  growing  evidence   that  	   38	  legislation  criminalizing  sex  work  constitutes  a  significant  barrier  to  accessing  health  care   services,   including   primary   care,   HIV   treatment   and   prevention,   and   sexual  health   services   (Boynton  &  Cusick,   2006;  Lazarus,   et   al.,   2012;  Maher,   et   al.,   2011).  Additionally,   stigma   and   discrimination   against   sex   workers   are   significantly  amplified   in   settings   where   sex   work   is   criminalized,   and   further   reduce   sex  workers   ability   to   access   police   protections   or   health   and   social   support   services  (Lazarus,  et  al.,  2012;  Scorgie,  et  al.,  2013).  2.1.1  ‘Demand  criminalization’  Over  the  past  decade  there  has  been  increased  interest  by  a  number  of  higher  income   countries   to   attempt   to   eradicate   prostitution   through   ‘demand  criminalization’,   which   criminalizes   the   purchase,   but   not   the   selling,   of   sexual  services.   Sweden,  Norway,   Iceland,   and  most   recently   France,   opted   for   ‘demand  criminalization’,   despite   the   lack   of   evidence   supporting   this   legal   framework.  Similarly,   the   European  Union   has   also   recently   voted   in   favour   of   implementing  this  approach  (Oppenheim,  2014).  ‘Demand  criminalization’  was  first  implemented  in  Sweden  in  1999.  The  primary  objective  of  the  law  is  to  eradicate  prostitution  by  eliminating   demand.  However,   evidence   from   Sweden,   indicates   that   the   law   has  been  unsuccessful   in  meeting  this  objective  (Goodyear  &  Weitzer,  2011).   Instead,  a  number  of  unintended  consequences  have  been  reported  –  namely,  that  it  drives  sex  	   39	  workers   and   clients   underground   to   more   clandestine   locales,   and   is   difficult   to  enforce   due   to   the   unwillingness   of   sex   workers   to   testify   against   their   clients  (Global  Commision  on  HIV  &  the  Law,  2012;  Scoular,  2004).      As  outlined  in  detail  in  Chapter  one,  following  the  December  2013  Supreme  Court   of   Canada   decision,   which   deemed   Canada’s   core   prostitution   laws  unconstitutional,   the   Conservative   government   has   moved   swiftly   towards   the  criminalization  of  the  purchase  of  sex  (Crawford,  2014).  In  June  2014,  the  Canadian  government   tabled   new   legislation,   termed   the   ‘Protection   of   Communities   and  Exploited   Persons   Act’   (Bill   C-­‐‑36).   A   key   feature   of   the   new   legislation,   which   is  currently  under  parliamentary  review,  sets  out  to  criminalize  the  purchase  of  sexual  services.  The  government  proposed   the  new   legislation,  despite  a   lack  of  evidence  that   this  change  would  address   the  harms  associated  with  criminalized  and  quasi-­‐‑criminalized  approaches  of  regulating  prostitution.      2.1.2  New  sex  work  enforcement  policy  in  Vancouver,  Canada    In  this  context  of  shifting  sex  work  legislation,  Vancouver,  provides  a  unique  opportunity   to   evaluate   the   potential   impact   of   laws   and  policies   that   criminalize  sex  buyers   (clients).  As  described   in  Chapter   one,   in   January   2013,   the  Vancouver  Police  Department   (VPD)  officially  adopted  new  sex  work  enforcement  guidelines  that  shifted  the  focus  in  policing  sex  work  away  from  arresting  or  pressing  charges  	   40	  against   sex  workers.     The   sex  work  policing  guidelines   set   out   a   strategy   to   ‘open  communication’  with  sex  workers  and  prevent  violence  against  sex  workers  through  prioritizing   their   safety   over   enforcement   measures   such   as   arrest   (VPD,   2013a).  However,  the  policing  guidelines  did  not  address  changes  in  enforcement  of  clients.  In  fact,  on  their  website  the  VPD  confirms  that  they  continue  to  “target  both  pimps  and   customers,   in   locations   where   the   impact   of   the   sex   trade   has   become  unacceptable”   (VPD,   2013c).   The   result   is   that   as   of   January   2013,   Vancouver   has  been  a  de  facto  ‘demand  criminalization’  environment.  Therefore,   the   objectives   of   this   study   are   to   evaluate   how   a   new   local  enforcement  strategy   that   targets  clients,  but  not  sex  workers,   shapes  sex  workers’  interactions   with   police   and   negotiation   of   their   working   conditions   and   sexual  transactions  with   clients,  with  a  particular   focus  on  protections   from  violence  and  HIV/STI  infections.    2.2  Methods  This   study   is   situated   within   a   larger   NIH-­‐‑funded   longitudinal   qualitative  and   ethnographic   research  project   investigating   the   structural   and  physical,   social  and   policy   features   of   work   environments   shaping   sex   workers’   sexual   health,  violence,   and   access   to   care   in   Vancouver,   Canada.   The   research   builds   on  longstanding   partnerships   and   a   community   advisory   board   with   sex   worker,  	   41	  community,  policy  and  health  stakeholders  since  2004,  and  runs  alongside  a  sister  project   known   as   AESHA   (An   Evaluation   of   Sex   Workers’   Health   Access).   The  AESHA   cohort   is   a   community-­‐‑based   longitudinal   study   of   over   800   sex  workers  with   bi-­‐‑annual   follow-­‐‑up,   focused   on   evaluating   the   physical,   social   and   policy  environments  shaping  sexual  health,  violence,  HIV  vulnerability  and  access  to  care  among  sex  workers.(Shannon,  et  al.,  2007)  The  research  and  outreach  team  include  both  experiential  and  non-­‐‑experiential  staff.    This  study  draws  on  ethnographic  field  work  of  street-­‐‑based  sex  work  scenes  and  qualitative   semi-­‐‑structured   interviews  with   street-­‐‑involved   sex  workers   about  their  working   conditions,   interactions  with   police,   and   negotiations   of   health   and  safety   with   clients,   in   the   City   of   Vancouver,   Canada   over   11   months   (January-­‐‑November   2013),   following   the   implementation   of   the   new   sex  work   enforcement  guidelines  by  the  Vancouver  Police  Department  (VPD)  in  January  2013.  Qualitative  and  ethnographic  data  were  triangulated  with  sex  work-­‐‑related  violence  prevalence  data   from   the   AESHA   cohort   pre   and   post   policy   implementation   and   publicly  available  police  statistics  that  report  on  prostitution  related  criminal  code  offences  in  the  City  of  Vancouver  (VPD,  2013b).    The   lead   author   (AK)   and   co-­‐‑author   (JC)   conducted  more   than   40   hours   of  ethnographic  observation  within  known  street-­‐‑based  sex  work  strolls  in  the  City  of  	   42	  Vancouver  to  assess  level  of  police  presence;  shifts  in  working  areas;  and  police,  sex  worker   and   client   interactions.   All   ethnographic   observations   were   conducted  within   the   context   of   regular   weekly   AESHA   outreach   shifts,   which   included  provision   of   harm   reduction   supplies,   food   and   referrals   to   social   and   health  supports.  Observation  sessions  lasted  three  to  five  hours  and  took  place  during  peak  hours   of   sex   work   activity   between   10pm   and   3am.      AK   and   JC   recorded   brief  fieldnotes  in  a  research  log  during  the  observation  sessions  and  elaborated  on  them  after  each  observation  outing.    Interview  participants  were  recruited   through  purposive  sampling   from  the  longitudinal  cohort  (AESHA),  and  aimed  to  reflect  variation  in  demographics  (e.g.,  age,   ethnicity,   gender)   and  work   environments   (e.g.,   geographic   neighbourhoods;  variation   in   street   and   off-­‐‑street   solicitation   and   transaction   spaces).   Eligibility  criteria   for   the   in-­‐‑depth   interviews   included:   1)   current   sex   work   defined   as  exchanged  sex  for  money  in  the  last  30  days  in  City  of  Vancouver;  2)  identifying  as  cis-­‐‑   or   transgender   woman   and   3)   aged   18   years   or   older.      While   the   larger  qualitative  and  ethnographic   research  and  AESHA  projects   focus  on  a  diversity  of  street  and  off-­‐‑street  (e.g.,  indoor,  online)  sex  work  environments,  this  specific  study  aimed   to   examine   the   experiences   of   street-­‐‑involved   sex   workers   (i.e.,   those  soliciting  and/or  servicing  on  the  street)  given  substantial  data  that  criminalization  and   enforcement   disproportionately   target   this   segment   of   the   sex   industry  	   43	  (Lowman,  2000;  Sanders  &  Campbell,  2007;  Shannon,  Kerr,  et  al.,  2008).    It  should  be  noted   that   even  within   this   context,  many   street-­‐‑involved   sex  workers  worked   in  both  street  and  off-­‐‑street  venues,   including  online  and  indoor  informal  and  formal  venues  (see  results).        The   31   semi-­‐‑structured   interviews   were   facilitated   by   an   interview   guide  encouraging   broad   discussions   of   working   conditions,   police   presence   and  interactions,  and  negotiation  of  health  and  safety  in  transactions  with  clients,  post-­‐‑VPD   policy   implementation   (January   2013).   The   interview   guide   was   developed  based  on  existing  knowledge  of  the  research  team  and  in  collaboration  with  our  sex  worker,  community  and  policy  partners.  We  conducted  all  interviews  at  one  of  two  field  offices  in  the  City  of  Vancouver.  Interviews  lasted  between  45  and  90  minutes,  were   audio-­‐‑recorded,   transcribed   verbatim   and   checked   for   accuracy.   All  participants   provided   informed   consent   and   were   remunerated   with   a   CAD   $30  honorarium  for  their  time,  expertise  and  travel.  The  study  holds  ethical  approval  by  the  Providence  Healthcare/University  of  British  of  Colombia  Research  Ethics  Board.          Interview   transcripts   and   ethnographic   data   were   analyzed   using   thematic  analyses   to   examine   sex  worker’s   interactions  with  police   and  negotiation  of   their  working  conditions  and  sexual  transactions  with  clients,  including  protections  from  violence,   abuse,   and   HIV/STI   infections,   post-­‐‑policy   implementation.      All   textual  	   44	  data   were   analyzed   using   an   inductive   and   iterative   process   facilitated   by   the  qualitative  analysis  software  ATLAS.TI  V7.  The  initial  coding  framework  was  based  on   key   themes   reflected   in   the   interview   guide,   participants’   accounts   and  fieldnotes.  More   conceptually-­‐‑driven   substantive   codes   (e.g.,   trust,   stigma,   control  over   sex   work   transactions)   were   then   applied.   Verbatim   narratives   are   reported  using   pseudonyms   assumed   by   sex   workers   to   ensure   anonymity.   Longitudinal  quantitative  data  on  prevalence  of  workplace  physical   and   sexual  violence  among  sex  workers   from   the  AESHA   cohort  were   analyzed   by   two   8month   time-­‐‑periods  (pre-­‐‑policy,  May  1-­‐‑  December  31,  2012;  vs.  post-­‐‑policy   implementation,   January  1-­‐‑August  31,  2013).    Analysis  was  conducted  using  SAS  statistical  software  version  9.2  and  restricted  to  sex  workers  in  AESHA  who  solicited  and/or  serviced  clients  on  the  street.   Descriptive   frequencies   and   bivariate   analyses   were   analyzed   to   test   for  statistical   significance  by   time  period  of  VPD  policy   implementation   (pre  vs.  post)  and  reported  using  odds  ratios  (OR),  95%  confidence  intervals  (CIs)  and  p-­‐‑values.    2.3  Results  2.3.1  Sample  characteristics  The   sample   for   semi-­‐‑structured   interviews   is   representative   of   the   broader  community  of  street-­‐‑based  sex  workers  in  Vancouver  and  included  26  cisgender  and  5  transgender  women  sex  workers  (total  n=31).  The  mean  age  of  participants  was  38  	   45	  years   (range:   24-­‐‑53).   Overall,   21   identified   as   Caucasian,   8   were   of   Aboriginal  ancestry   and   2   participants   were   of   other   visible   minorities.   All   participants   had  experience   with   street   solicitation.   The   majority   (77%,   n=   24)   reported   street  solicitation  as  their  primary  way  of  connecting  with  clients,  while  others  (23%,  n=  7)  primarily  used  phone/text  solicitation   to  connect  with  clients.      Just  over  half   (55%,  n=  17)  primarily  serviced  clients  in  vehicles  or  outdoor  public  spaces,  while  45%  (n=  14)  primary  serviced  clients  in  informal  indoor  venues  (e.g.,  hotels,  client’s  place,  or  their  home).  2.3.2  Sex  workers’  experiences  with  new  sex  work  enforcement  guidelines  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.   Most   sex   workers  experienced   a   gradual   change   in   policing   over   a   number   of   years   rather   than   an  abrupt  change  in  policing  with  the  publication  of  new  sex  work  enforcement  policy  in  January  2013.  Some  women  felt  that  they  were  interacting  less  with  police  as  long  as   they  solicit  clients   in   two  separate  areas  of   the  city   that   function  as  de  facto  sex  work  tolerance  zones.      	   46	  There’s  more   [police]   presence.   There’s   not   very  many  more  interactions.  Before  the  interactions  were  always  there.  They’d  come   and   pull   you   right   outta   car   and,   like   push   you   over.  They’d  get  away  with  it  back  then.  You  know.  But  now  it’s  like  they  don’t,  interact.  -­‐‑  Anna,  Transgender  woman    The  vast  majority  of  participants,  regardless  of  gender,  ethnicity  and  primary  place  of  solicitation,  reported  that  their  interactions  with  police  when  soliciting  sex  work  clients  are  more  positive  and  generally  focus  on  their  safety.      Every   time   they   pull   you   over   it’s   strictly   to   ask   you   how  you’re   doing,   how   things   are.      If   there’s   any   bad   dates   you  want  to  report.  Fiona,  Cisgender  woman  While  participants  in  this  study  viewed  this  change  as  positive,  the  continued  police  enforcement  of  clients  severely   limited  any  positive   impact  of   this  change  on   their  overall  working   conditions,   risks   for   violence,   abuse,   or   negotiation   of   sexual   risk  reduction  with  clients.  2.3.3  Continued  police  enforcement  of  sex  buyers  (clients)    Sex  workers’  narratives  indicated  that  while  police  tolerated  sex  work  related  activities  in  two  separate  de  facto  sex  work  zones,  clients  continued  to  be  at  risk  of  police   scrutiny.   Indeed,   according   to   official   police   statistics   sex   work-­‐‑related  Criminal  Code  offences   rose   from  an  all   time   low  of   47   in   2012   to   71   in   2013   (see  Figure1)  (VPD,  2013b).  This  represents  a  51  percent   increase  in  prostitution-­‐‑related  offences   since   the   announcement   of   the  VPD   sex  work   enforcement   guidelines   in  	   47	  January  2013.    Figure  1:  Prostitution-­‐‑Related  Criminal  Code  Offenses  Vancouver  2010-­‐‑2013  (VPD,  2013b)	      Unfortunately,   no   statistics   are   available   regarding   the   proportion   of   sex  workers  versus  clients  who  were  charged.  However,  participants’  accounts  indicate  that  the  51  percent  rise  in  prostitution  related  offences  likely  reflects  an  increase  of  enforcement   efforts   targeting   clients,   as   the  majority   of   sex  workers   felt   that   their  clients  were  currently  the  main  targets  of  police  (consistent  with  messaging  on  the  VPD  website)  (VPD,  2013c).  I  think  the  Johns  or  clients  that  I  have  probably  worry  the  most  about  police.  -­‐‑  Melissa,  Cisgender  woman      	   48	  [Clients]  do  get  stopped.    A  couple  of  my  regulars  they’ve  been  chased   off   the   street,   they’re   not   allowed   to   come   downtown  anymore.  Down  here  they’re  bad  for  that.  I  guess,  it’s  more  so  not  the  girls  they  go  after  -­‐‑  it’s  the  guys.  -­‐‑  Maria,  Cisgender  woman    Most  sex  workers  reported  that  clients  are  at  risk  of  being  pulled  over  by  police  even  before  actually  negotiating  a   sex  work   transaction  by  circling  around  known  sex  work  areas.  However,  sex  workers’  narratives  indicated  that  the  riskiest  time  for  attracting  police   attention  was   the  moment  when  women   entered   the   vehicle   of   a  prospective  client.   In  some  cases,  police  used  non-­‐‑prostitution  related  charges  (e.g.  traffic   violations)   as   a   means   to   pull   over   the   vehicle   and   target   clients.   Women  expressed   that   while   they   used   to   be   the   main   target   of   police,   the   more   recent  experiences   generally   ended  with   the   police   allowing   sex  workers   to   leave,   often  without  checking  for  outstanding  warrants.  Clients  were  being  detained  by  police,  and  issued  either  a  warning  or  a  fine.    Right  now  when  they  [police]  pull  you  over  they  let  you,  the  girl  go,  keep  the  guy.  Before  they  would  separate  you  and  then  make  a  big  investigation.    Try  to  catch  you  in  lies  or  intimidate  you   and  make   you   nervous   and   try   to   say   you   can   get  more  charges.  –  Ruth,  Transgender  woman         	   49	    One   of   my   regulars,   they   gave   him   a   five-­‐‑hundred   dollar  disturbing   the   peace   ticket.   And   they   didn’t   run   my   name  through.  They  just  come  out  of  nowhere,  right?  [Yeah,  was  it  just  for  you  getting  in  the  car?]  Yeah,  I  guess  that  was  just  the  punishment,  you  know  what  I  mean?    So,  I  saw  the  guy  a  few  times  afterwards  and  he  was  saying  he  was  going  to  fight  and  wanted  me   to   be   a   witness   and   then   I   guess   he   thought  afterwards,  geez  no.  He  told  me  he  paid  it  online,  I  guess  he  has  a  family  and  that  and  he  just  wanted  it  to  go  away.  -­‐‑   Jessica,  Cisgender  woman    2.3.4  Criminalization  of  clients:  limited  effect  on  deterrence  of  sex  work  Sex  workers   reported   that  when   police   target   clients,   some   clients   are  deterred  from  purchasing  sex  on  the  street.  No  one  will  pull  over  if  there’s  a  car,  a  police  car  near  you.    It’s,  like,   if   they   see   the   lights   they’ll   disappear.      You   can   see   the  difference  in  traffic.    They’re  just  gone.  –  Selina,  Transgender  woman    Some  sex  workers,  however,  felt  that  rather  than  preventing  clients  from  purchasing  sex,   police   presence   resulted   in   potential   clients   seeking   out   sex   workers   in   a  different  area  of  the  city.  Once   the   guy   that’s   looking   for   a   woman   sees   a   cop,   in   the  neighbourhood,   he’s   scared.   So   he’ll   go   to   another  neighbourhood   and   find   another   woman   somewhere.   –Rebecca,  Cisgender  woman  For   participants   in   this   study,   the   reality   of   living   in   poverty,   and  marginalization   often   combined   with   illicit   substance   use,   meant   that   even  	   50	  when  police   target   clients,   sex  workers   report   that   they  continue   to  work   for  the   obvious   reason   of   earning   an   income.   Ethnographic   observation   and   sex  worker  narratives  indicated  that  police  enforcement  of  clients  had  no  effect  on  deterring  women   from   engaging   in   street-­‐‑based   sex  work.   Indeed,   for  many  participants   the  enforcement  of  clients   forced   them  to  spend   longer  hours  on  the   street   to   earn   an   income.  Thus   contrary   to   the  objectives   of   criminalising  clients,   impeding  sex  workers  ability   to  engage  with  potential   clients  did  not  result  in  less  street-­‐‑based  sex  work  for  these  women.  Instead,  having  access  to  fewer  clients  meant  it  was  harder  to  earn  an  income  and  forced  sex  workers  to  accept   clients   or   services   (e.g.   sex   without   a   condom)   that   they   would  otherwise  reject  due  to  safety  concerns,  this  directly  increased  risks  for  physical  and  sexual  violence  and  poor  health,  including  HIV/STI  infection.    While   they’re   going   around   chasing   johns   away   from  pulling  up  beside  you,  I  have  to  stay  out  for  longer  […]  Whereas  if  we  weren’t   harassed   we   would   be   able   to   be   more   choosy   as   to  where  we  get  in,  who  we  get  in  with  you  know  what  I  mean?  Because   of   being   so   cold   and   being   harassed   I   got   into   a   car  where   I   normally   wouldn’t   have.   The   guy   didn’t   look   at   my  face   right   away.   And   I   just   hopped   in   cause   I   was   cold   and  tired  of  standing  out  there.  And  you  know,  he  put  something  to  my   throat.  And   I  had   to  do   it   for  nothing.  Whereas   I  woulda  made  sure  he  looked  at  me,  if  I  hadn’t  been  waiting  out  there  so  long.  –  Violet,  Cisgender  woman         	   51	    It  pisses  me  off  that  they  [the  police]  are  there  because  basically  what  it  comes  down  to  is  the  shortest  time  that  I’m  out  there,  the  shorter  I’m  on  the  street  and  the  better  I’m  paid.    But  you  [police]  stand  out  there  and  you  fuck  up  my  business  and  scare  away  my  dates.    The  longer  I’m  out  there  my  chances  of  getting  sick,   raped,   robbed,   beat   up   whatever   are   greater   so.   -­‐‑   Lisa,  Cisgender  woman    	   Of   course,   ‘cause   no   one’s   [clients]   going   to   stop   with   them  there.  I’m  not  going  to  go  home.    So  they’re  [police]  not  really  doing   anything,   they’re   just   keeping   me   out   there   longer.    Really,  if  they  would  just  leave  me  alone,  I’d  get  a  date  and  go  home  and  they  wouldn’t  see  me.    But  that  way  I  end  up  staying  out  there  for  hours  ‘cause  I’m  not  going  home  empty-­‐‑handed  so  I   don’t   know   what   they   think   they’re   really   achieving.  Charlene,  Cisgender  woman    2.3.5  Criminalization  of  clients:  severely  limits  sex  workers’  safety  strategies  Our   findings   indicate   that  criminalization  and  policing  strategies   that   target  clients   reproduce   the   harms,   created   by   the   broader   criminalization   of   sex   work.  Analyses   of   prevalence   of   workplace   physical   and   sexual   violence   against   street-­‐‑based   sex   workers   in   Vancouver   indicated   no   statistically   significant   change   in  violence  rates  following  policy  implementation  (OR=1.05,  95%CI:0.70-­‐‑1.58;  p=0.804).  Specifically,  in  the  8-­‐‑month  period  post-­‐‑policy  implementation,  24.6%  (58/236)  of  sex  workers   experienced   work-­‐‑related   physical   and   sexual   violence   (as   compared   to  23.7%   (65/275)   interviewed   in   the   8months   pre-­‐‑policy   in   2012),   of   whom   22.0%  	   52	  reported   physical   abuse   and   14.0%   had   been   raped   post-­‐‑policy   implementation  (compared  with  19.3%  and  15.6%  pre-­‐‑policy,  respectively).    Qualitative   analysis   of   the   sex   workers’   narratives,   reveal   three   key  mechanisms   by  which   criminalization   and  police   targeting   of   clients   continued   to  severely   impacts   sex   workers’   ability   to   negotiate   their   working   conditions   and  transactions   with   clients,   including   protections   from   violence   and   HIV/STI  infections.    A)  Inability  to  Screen  Clients  and  Negotiate  Terms  of  Sexual  Transactions  Sex   workers’   narratives   emphasized   that,   in   the   context   where   clients  continue  to  be  police  targets,  it  remains  in  both  the  clients’  and  sex  workers’  interest  not   to   get   pulled   over   by   police.   Therefore,   sex  workers   continue   to   be   forced   to  severely  limit  or  forego  screening  of  prospective  clients  or  negotiating  the  terms  of  sex  work   transactions   (e.g.   fee,   sexual   services,   condom  use)   before   getting   into   a  vehicle.  Well,  usually  I  try  to  hop  in  the  car  right  away,  right?  ‘Cause  I  don’t  want  to  get  seen  talking,  in  case  a  cop  drives  by  or  something.  […]  I’ll  hop  in  and  then  we  can  like  negotiate  and  talk,  you  know?    First  I  like  to  make  sure  that  nobody’s  around  or  following  or  anything.  –  Maria,  Cisgender  woman      In  addition  to  entering  a  prospective  client’s  car  swiftly,  participants  reported  that  in  order  to  reduce  the  risk  of  attracting  police  attention,  potential  clients  point  them  	   53	  to   an   alleyway   away   from   the  main   street  with   limited   lighting   to   allow   them   to  enter  the  vehicle  undetected  by  police.  To  avoid  police  they  [clients]  drive  by  couple  times  and  they  point.  They  point  at  like  a  place  where  nobody’s  driving  by.  So  they  point  and  that  means  to  go  follow  them  with  the  vehicle  and  then  they’ll  stop  […]  They  go  somewhere  different  in  an  alley  or  something.  They  just  leave  like  the  window  open  and  then  you  just,  get  in.  [But  would  you  talk  to  them  first?]  Um  no  well  when  they’re  trying  to  avoid  police  like  that  you  just  get  into  the  vehicle,  right.  –  Jane,  Transgender  woman  Sometimes  the  guy  will  drive  up  and  just  sort  of  wave  or  point  to  go  down  the  alley  or  something  like  that  somewhere  else  were  he  can  pick  me  up.  [How  does  that  affect  your  safety?]  You  never  know  who  it  is  right?    And  you  can’t  really  see  his  face,  can’t  really  see  anything  they  could  have  a  gun  in  their  hand  or.  You  know  what  I  mean  they  could  be  a  little  bit  drunk  or  something  if  you  can’t  really  see  them  very  clearly,  you  know?    And  you  don’t  you  can’t  say  hi  or  whatever  before  you  get  in.    You  have  to  just  hurry  up  before  the  cops  come.  –  Laura,  Cisgender  woman      Policing  of  clients  thus  directly  undermines  sex  workers  ability  to  screen  potential  clients  including,  checking  “bad  date”  sheets  for  past  violent  perpetrators,  detecting  possible   weapons,   or   intoxication;   and   negotiating   the   terms   of   the   sexual  transactions,   including  where   the  date  will   take  place,   the   fee  and   types  of  sexual  services,  and  use  of  condoms,  before  entering  a  vehicle.  These  practices  of  screening  and  negotiating  the  terms  of  transactions  have  both  been  well  documented  as  critical  to  sex  workers’  ability  to  control  their  health  and  safety,  including  protections  from  violence,  abuse  and  HIV/STI  infection.  (Krüsi,  et  al.,  2012;  Shannon  et  al.,  2009).  	   54	  Prior  to  the  VPD  policy,  police  frequently  engaged  in  undercover  operations  in  order   to   target   sex  workers   and   their   clients.   This   practice   continues   to   shape   sex  work   transactions   and,   in   the   context   of   sustained   criminalization   of   clients,  undercover   operations   negatively   affect   the   ability   of   sex   workers   to   screen   their  clients  or  negotiate  the  terms  of  sexual  transactions.    Participants’  accounts  indicated  that,   rather   than   trying   to   assess   the   safety   of   entering   a   vehicle   of   a   prospective  client  and  negotiating  the  terms  of  the  transaction,  the  initial  interaction  with  a  client  is  dictated  by  determining  whether   the  sex  worker   is  an  undercover  police  officer.  This  usually  involves  both  the  client  and  sex  worker  touching  each  other,  due  to  the  belief   that   undercover   police   officers   are   not   allowed   to   engage   in   bodily   contact  without  identifying  themselves  as  police.      Normally  when  you  get  picked  up,  you  go:  Are  you  a  cop?    No,  are  you?     Nope.     Prove   it.  And  you,   touch   each   other   just   to  make  sure,  right?    ‘Cause  cops  can’t  do  that.  So  that’s  the  rule,  if   you’re   undercover   you   can’t   touch   someone.   Normally,   a  guy’ll   touch  my  boob,   I’ll   touch  his  crotch.  Or  he’ll   touch  my  crotch,  I’ll  touch  his,  right?    That’s  just  to  verify  okay,  you’re  not  a  cop,  right?  Martha,  Cisgender  woman    B)  Displacement  to  Isolated  Areas  Sex  workers’  accounts  further  indicated  that,  in  the  context  of  continued  criminalization   of   clients,   many   clients   demand   on   engaging   in   sex   work  transactions   away   from   known   sex   work   areas   where   there   is   heightened  	   55	  police   presence.   Participants   reported   that   being   alone   with   clients   in   often  unknown,  secluded,   industrial  areas  where  there  is   little  chance  for  help  puts  women   at   increased   risk   of   violence   and   rape   and   reduces   their   ability   to  negotiate  the  transaction  on  their  terms,  elevating  their  risks  for  client  condom  refusal  and  thus  HIV/STI  infection.    Clients   worry   [about   police].   Like   for   me   I   don’t   like   going  outside  the  neighborhood,  right.  Cause,  you  know  what  about  if  the  guy  turns  out  to  be  an  asshole.  […]  That’s  how  I  do  loose  dates  by  not  going  where  I’m  supposed  to  cause  they’re  afraid  of   cops.   [So   do   you   turn   dates   down   sometimes?]   Yeah  sometimes   but   not   all   the   time   cause  when   I’m   I’m   really   in  need  of  money  I  will  maybe  try  and  go.  But  then  I  just  try  and  get  a  good  feel  of  them  first.  -­‐‑  Jane,  Transgender  woman    Clients   are  worried   about   police.   To   avoid   police   they  wanna  move   to   a   different   area.   I   don’t   want   to   go   out   of   my   zone  right.  […]  Once  you  get  out  there,  like  you  know  their  turf  so  it’s   harder   for  me   cause   it’s   their   comfort   zone   or,   so   hey   act  differently,  you  know  what  I  mean.  Yeah  it  never  ends  up  good.  -­‐‑  Sandra,  Cisgender  woman    We   try   to   get   away   from   the   area   as   quick   as   possible.   You  know.  So   that  we’re  not   in   the   area.  Right.  The   farther   away  you   get   from   [name   of   sex   work   stroll],   the   better   it   is.  You’re   not   gonna   get   pulled   over   right?      I’m   just   a   little  nervous   as   it’s   so   quiet   down   there   by   [industrial   area].   –  Violet,  Cisgender  woman    C)  Inability  to  Access  Police  Protections  The   main   objective   of   the   police   enforcement   guidelines   is   to   foster   more  trusting   relationships   between   sex  workers   and  police   and  prioritize   the   safety   of  sex   workers   in   any   police   interactions.   A   striking   feature   of   many   sex   workers’  	   56	  accounts  was  that  police  inquiring  about  their  safety  was  perceived  as  a  nuisance  at  best,  and  a  form  of  police  harassment,  at  worst.  In  a  context  were  clients  continue  to  be   police   enforcement   targets,   sex   workers’   narratives   indicated   it   is   difficult   for  police  to  fulfill  their  stated  objective  of  prioritizing  the  safety  of  sex  workers.    Even  conversations  between  sex  workers  and  police  can  have  a  destabilizing  effect,  as  any  police  interactions  may  scare  away  clients  and  have  the  potential  to  raise  suspicion  that  a  sex  worker  might  be  an  undercover  police  officer.  It’s  a  drag,  you  know?  I’m  out  there  to  make  money,  not  waste  twenty  minutes  talking  to  them  [police].    And  then  I’m  talking  to   them   and   half   the   dates   that   see   me   talking   to   them   now  think   maybe   I’m   a   cop,   so   they   don’t   wanna   stop,   now   they  know   the   cops   are   around,   they   don’t   wanna   stop,   or   they  wonder  what  I’ve  done  to  attract  the  cops  so  they  don’t  wanna  stop,  like,  it’s  just  a  hassle,  you  know?  –  Charlene,  Cisgender  woman    If   the   clients   see   you   talking   to   the   cops   then   they   don’t   pick  you   up.   [When   police   talk   to   me]   they’re   respectful   but   they  know  that   they’re  wasting  my  time  so.  They  can  do  whatever  they   want.   They’re   fucking   up   everything.   –   Selina,  Transgender  woman    Similarly,   an   important   aspect   of   sex   workers’   safety   is   the   ability   to   report  theft,  violence  and  sexual  harassment  to  police.  Currently  however,  the  majority  of  sex  workers  voiced  reservations  about  reporting  such  incidents  to  police.  Many  sex  workers,   drawing  on  historic  discrimination   and  maltreatment   by  police,   doubted  that   police   would   take   their   complaints   seriously   and   voiced   that   the   continued  	   57	  criminalization   of   clients   constituted   a   significant   barrier   to   reporting   violence   to  police   as   any   information   about   where   they   work   could   be   used   to   refine  enforcement  strategies  targeting  clients.    No  I  would  never  go  to  the  cops  [to  report  violence].  Because  it  makes  it  look  like,  we  shouldn’t  be  out  there  like  we  can’t  take  care  of  ourselves.  I  feel  like  if  I  went  and  reported  some  of  these  things   that   it  might   do  more   harm   to   the  working   profession  than  do  good.  So  I  don’t  do  that.  Basically  we  have  to  fend  for  ourselves.   They   don’t   really   like   us   to   begin   with.   –   Rose,  Cisgender  woman      I’ve   needed   the   police’s   help  with   bad   dates   and   they’ve   done  absolutely  nothing.     The   fact   that   it’s  not   legalized  you  kinda  can’t  do  it,  you  know.  –  Charlene,  Cisgender  woman    2.4  Discussion    These  findings  suggest  that  criminalization  and  policing  strategies  that  target  clients   reproduce   the   harms,   created   by   the   criminalization   of   sex   workers,   in  particular,  risks  for  violence  and  abuse.  Contrary  to  the  goal  of  criminalizing  clients,  our  findings  suggest  that  this  approach  has  limited  to  no  effect  on  preventing  street-­‐‑based  sex  work  and  did  not  reduce  the  prevalence  of  sex  work  related  violence.  Our  analysis  provides  strong  empirical  evidence  of   the   lived  experience  of  sex  workers  indicating  that  the  continued  criminalization  and  policing  of  clients,  even  when  sex  workers   are   no   longer   police   targets,   profoundly   impacted   sex  workers   ability   to  negotiate  their  working  conditions  and  health  and  safety.  Collectively,  this  research  	   58	  suggests   that   displacement   to   isolated   areas   and   inability   to   screen   clients   or  negotiate   the   terms   of   sexual   transactions   directly   reduced   sex  workers’   ability   to  refuse  unwanted  clients  or  services  (e.g.  sex  without  a  condom),  thereby  increasing  risks   for   physical   and   sexual   violence   and  HIV/STI   infection.   In   addition,   despite  improved   relations  between   sex  workers   and  police,   continued  police   targeting  of  clients  created  mistrust  of  police  and  severely   limited  sex  workers  ability  to  access  police  protections.    In   a   legal   environment  where   clients   remain   the   target   of   enforcement,   our  findings  indicate  a  shared  interest  of  sex  workers  and  clients  to  remain  undetected  by   police,   forcing   sex   workers   to   rush   or   completely   forgo   client   screening,   and  pushing  sex  workers  to  work  in  secluded  areas  away  from  street  lighting  and  other  passers  by.    These  findings  reflect  earlier  epidemiological  and  social  science  research  that   have   consistently   demonstrated   a   direct   correlation   between   criminalization  and  policing  of   street-­‐‑based   sex  work   and   elevated  odds  of  physical   violence   and  rape,   as  well   as  HIV/STI   infection   through   client   condom   refusal   (Deering,   et   al.,  2013;  Platt,  et  al.,  2013;  Rekart,  2006;  Shannon  &  Csete,  2010;  Shannon,  Kerr,  et  al.,  2008;   Shannon,   Strathdee,   et   al.,   2009).   This   work   has   identified   screening   of  prospective   clients   as   essential   to  allowing   sex  workers   to   take   safety  precautions,  including  agreement  on  where   the   transaction  will   take  place,   checking   ‘bad  date’  reports   describing   the   personal   characteristics   and/or   vehicle   of   known   violent  	   59	  perpetrators,  and  checking   for   the  presence  of  weapons  and   intoxication   (Sanders,  2004).  In   addition   to   screening,   negotiating   the   terms   of   sexual   transactions   with  clients   before   entering   the  vehicle,   including   the   fee,   and   types   of   sexual   services,  remains  critical  for  sex  workers  to  negotiate  the  terms  of  their  work,  and  avoid  risky  sexual  encounters   (e.g.  unprotected  sex).  Without   the  opportunity   to  screen  clients  or  safely  negotiate  the  terms  of  sexual  services,  research  has  shown  that  sex  workers  face   increased   risks   of   violence,   abuse   and  HIV/STI   infection   (Decker,   et   al.,   2010;  Decker,  et  al.,  2012;  Deering,  et  al.,  2013;  Krüsi  et  al.,  2012;  Shannon,    Strathdee,  et  al.,  2009).  Our  findings  resonate  with  evaluations  from  Sweden  that  reported,  since  the  implementation   of   the   law   that   criminalizes   clients,   there   had  been   an   increase   in  violence   experienced   by   sex   workers,   which   was   linked   to   greater   risk   taking   in  client   selection   due   to   the   necessity   of   rushed   negotiation   with   potential   clients  (Global  Commision  on  HIV  &  the  Law,  2012;  Scoular,  2004)      Police   undercover   operations   further   reduce   the   safety   of   sex   workers   as  initial   interactions   with   clients   focus   on   determining   that   sex   workers   are   not  undercover  police  officers,  rather  then  allowing  time  to  negotiate  the  details  of  the  transaction,  including  condom  use,  type  of  service  and  price.  The  negative  impact  of  undercover  police  operations  on  the  safety  and  health  of  sex  workers  is  of  note  as  it  is   one   of   the   main   enforcement   strategies   available   to   police   in   a   context   where  	   60	  clients   are   criminalized.      Sex  workers   also   described   how   police   used   other   non-­‐‑prostitution   related   offenses   (e.g.   administrative   laws   such   as   traffic   violations,  public  nuisance)  to  target  sex  workers  and  clients.      The  results  of  this  study  further  highlight  that  in  a  context  where  sex  buyers  are   criminalized,   sex   workers   continue   to   be   displaced,   as   many   clients   insist   on  engaging   in   sex  work   transactions   away   from   police   scrutiny.   Being   displaced   to  unknown,   secluded,   industrial   areas  where   there   is   little   chance   of   receiving   help  when   needed   is   linked   to   increased   risk   of   violence   and   rape   and   reduces   sex  workers’   ability   to  negotiate   the   transaction  on   their   terms,   including   condom  use  (Decker,  et  al.,  2010;  Decker,  et  al.,  2012;  Krüsi,  et  al.,  2012;  Shannon,  Strathdee,  et  al.,  2009).      Evidence   both   in   Canada   and   globally   has   consistently   shown   that  criminalization   of   sex   workers   prevents   sex   workers   from   accessing   police  protection,   whereby   police   become   adversaries   as   opposed   to   safety   mechanisms  (Global  Commision  on  HIV  &  the  Law,  2012;  Okal,  et  al.,  2011;  Richter,  et  al.,  2010;  Shannon  &  Csete,  2010;  Shannon,  Kerr,  et  al.,  2008).  A  clear  example   is   the  case  of  the   detrimentally   flawed   police   investigation   of   the   serial   murder   of   the  Missing  Women   in  Vancouver,  Canada;  where   criminalization,   and  historic   discrimination  by   police   were   found   to   be   key   factors   in   putting   police   in   an   adversarial  relationship  with   sex  workers   (Oppal,   2012).   In   addition   to   the   deeply   engrained  	   61	  stigma   of   sex   work   and   the   historic   police   discrimination   of   sex   workers,   our  findings   indicate   that  when   sex  work   clients  are  police   enforcement   targets,  many  sex  workers   remain   reluctant   to   seek   police   protection.   Sex  workers  worry   about  disclosing  details  of  how  they  operate  and  where  they  work  for  fear  police  may  use  this  information  to  refine  their  enforcement  strategies  that  target  sex  work  clients.    This  study  also  identified  that  in  a  context  of  continued  police  enforcement  of  sex   work   clients,   even   conversations   with   police   about   safety   can   have   a  destabilizing   effect,   as   any   police   interactions   scare   away   clients   and   have   the  potential   to  rise  suspicion  a  sex  worker  might  be  an  undercover  police  officer  or  a  police   informant.  This  policing  practice  deters  women  from  interacting  with  police  and   undermines   the   main   objective   of   the   VPD   policing   guidelines,   which   is   to  prioritize  the  safety  of  sex  workers.  In  addition  to  scaring  away  potential  clients,  and  thus  potentially   reducing   the   income  women   rely  upon,  being   labelled  as  a  police  informant  can  place  a  woman  at  the  bottom  of  street  hierarchy  and  may  place  her  at  severe  risk  for  violence.      While  rhetorically  powerful  and  politically  appealing,  there  is  a  fundamental  conceptual  inconsistency  in  policies  that  criminalize  clients  and  purport  to  prioritize  the   safety   of   sex   workers.   In   its   original   incarnation,   the   model   of   criminalizing  clients   in   Sweden  was  not  designed   to   increase   the   safety   of  women   in   sex  work;  rather  its  goal  was  to  eradicate  prostitution  and  increase  the  safety  of  women  who  	   62	  exit  sex  work.  Indeed,  in  Sweden,  the  government  explicitly  condoned  the  increased  risks   that  marginalized   sex  workers  were   exposed   to  by  arguing   that   any  adverse  effects  on  women  who  remain  in  sex  work  were  outweighed  by  the  message  of  the  law   that   prostitution   is   not   tolerated   (Scoular,   2004).   Our   findings   indicate   that  policies  that  criminalize  clients  are,  in  practice,  not  reconciled  with  policies  that  aim  to   prioritize   the   safety   of   sex   workers,   such   as   outlined   in   VPD   sex   work  enforcement   guidelines.   Indeed,   the   findings   of   our   study   indicate   that   despite  police   efforts   to   prioritize   the   safety   of   sex   workers,   when   clients   remain  enforcement   targets,   sex  workers   continue   to  be  at   increased   risk   for  physical   and  sexual   violence   and  perceive  police   concern   for   their   safety   as   a   form  of   nuisance  and  harassment.  Street-­‐‑involved  sex  workers,  those  living  in  poverty,  Aboriginal  sex  workers  and   transgender   sex   workers   have   historically   been   exposed  most   directly   to   the  negative   effects   of   restrictive  policing   and   criminalized   sex  work   laws   (Sanders  &  Campbell,   2007;   Scoular,   2004;   Shannon,   Strathdee,   et   al.,   2009).   Evidence   from  Sweden   indicates   that   criminalizing   clients   negatively   affected   the   working  conditions   and   safety   of   all   segments   of   sex   workers   by   further   pushing   them  underground.  However,  marginalized  sex  workers  who  solicit  and/or  service  on  the  street  were  most  negatively  impacted  by  the  criminalization  of  clients,  as  they  may  not   have   the   resources   to   reduce   police   scrutiny   by   advertising   online,   or   be  	   63	  contacted   by   phone   (Scoular,   2004).   Due   to   a   less   developed   welfare   system   in  Canada,  and  the  larger  population  of  street-­‐‑based  sex  workers  compared  to  Sweden,  the  negative  impact  of  demand  criminalization  on  sex  workers  health  and  safety  will  likely  be  even  more  pronounced  in  the  Canadian  context.      This  study  has  limitations.  The  lived  experiences  of  participants  represented  in   this   study   reflect   street-­‐‑involved   sex  workers   living   in  poverty  and  may  not  be  representative  of  the  experiences  of  sex  workers  in  other  segments  of  the  industry.  However,   given   that   evidence   has   consistently   shown   that   criminalization   and  policing  disproportionately  target  street-­‐‑based  sex  workers,  we  feel  these  narratives  provide  critical  evidence  of  the  health  and  safety  harms  of  such  a  policy.    In   summary,   this   study   suggests   that   enforcement   strategies   that   target   sex  work   clients   reproduce   the   harms   related   to   criminalized   and   quasi-­‐‑criminalized  approaches   to   the   regulation   of   sex   work.   This   empirical   research   clearly  demonstrates   that   continued   criminalization   and   policing   of   clients,   even   in   a  context  where   sex  workers   no   longer   represent   police   targets,   did   not   reduce   the  prevalence   of   sex   work   related   violence   and   profoundly   impacted   sex   workers’  ability   to   negotiate   their   working   conditions,   health   and   safety,   including  protections  from  violence,  abuse  and  HIV/STI  infection.  Sex  workers  were  displaced  to  isolated  areas  with  few  protections  from  violence  and  abuse;  were  forced  to  rush  or  forgo  screening  clients  and  negotiating  the  terms  of  transactions  (e.g.  fee,  condom  	   64	  use)  and  agree  to  clients  or  sexual  services  they  would  otherwise  refuse;  and  were  unable  to  access  police  protections.  In  sum,  this  study  raises  serious  questions  about  legislative   approaches,   such   as   the   proposed   ‘Protections   of   Communities   and  Exploited   Persons   Act’   that   criminalize   clients   and   suggests   that   ‘demand  criminalization’   risks   reproducing   the   devastating   harms   to   health   safety   and  human  rights  created  by  the  criminalization  of  sex  workers.  	   65	  Chapter  3:  ‘THEY  WON’T  CHANGE  IT  BACK  IN  THEIR  HEADS  THAT  WE’RE  TRASH’  THE  INTERSECTION  OF  SEX  WORK  RELATED  STIGMA  AND  EVOLVING  POLICING  STRATEGIES    3.1  Introduction  The   criminalization   of   sex   work   is   rooted   in,   and   expressive   of,   a   broader  social   and   structural   context  were   sex  workers   are  highly   stigmatized   (Bruckert  &  Hannem,   2013;   Hallgrimsdottir,   Phillips,   Benoit,   &  Walby,   2008;   Simić   &   Rhodes,  2009).   Goffman   (1963)   conceptualized   stigmas   as   ‘discrediting’   and   ‘undesirable’  social   labels   that   profoundly   impact   the   social   status   of   an   individual.   Goffman’s  work  on  stigma,  as  well  as  much  of  the  subsequent  work  in  the  area,  was  primarily  focused  on  the  individual  level  effects  of  stigmatization  on  those  characterized  with  undesirable   social   labels   (Goffman,   1963).  More   recent  work   has   focused   on   how  broader   macro-­‐‑level   forms   of   stigma,   including   societal-­‐‑level   conditions,   cultural  norms,   and   institutional   policies   constrain   the   opportunities,   resources,   and  wellbeing  of   individuals  and  groups  who  are  stigmatized   (Biradavolu,  et  al.,  2012;  Hansen,  et  al.,  2014;  Hatzenbuehler  &  Link,  2014).  Structural  stigma  is  also  enacted  in   spatial   practices   that   mark   out   who   can   legitimately   and   safely   use   the   urban  landscape,   stigmatized   groups,   such   as   sex   workers,   who   are   outside   the  mainstream   are   continually   pushed   to   the   sidelines,   through   policing   but   also  through  mechanisms  of  urban  renewal,  gentrification  and  neighbourhood  protesters  (Hubbard  &  Sanders,  2003;  Sanders,  2004).  	   66	  Parker   and  Aggleton   (2003),   drawing   on   Foucault   and  Bourdieu’s  writings,  conceptualize   stigmatization   and   discrimination   in   relation   to   broader   notions   of  power   and   domination.   Stigma   then   is   not   simply   an   expression   of   individual  attitudes  or  of  cultural  values  but  is  central  to  the  constitution  of  the  social  order  and  takes  shape  in  specific  historical  contexts  of  culture  and  power  (Parker  &  Aggleton,  2003).   Structural   stigmas   are   produced   and   reproduced   in   reciprocal   relationships  between   individuals   and   their   environments   where   stigmatized   individuals   are  often   complicit   in   reproducing   stigmatizing   social   categories   (Bourdieu,   1977).   As  well,  stigmatizing  assumptions  are  often  institutionalized  and  due  to  their  everyday  occurrence   normalized   and   rendered   invisible   (Scheper-­‐‑Hughes,   2004).   Therefore,  responding  to  stigma  is  not  merely  about  individuals’  coping  or  resisting  structural  stigma  but  also  about  shifting  social  relationships  through  structural  change  such  as  legislative  change  and  change  to  societal  norms.  Historically,  the  stigma  related  to  sex  work  is  rooted  in  women  transgressing  the   norms   of   acceptable   femininity   which   includes   immoral   sexual   behaviours,  charging   a   fee   for   sex,   being   viewed   as   vectors   of   diseases,   and   as   a   source   of  transmission  of  sexually  transmitted  infections  into  mainstream  society  (Pheterson,  1993;  Scambler,  2007).  Sex  workers  are  believed  to  be  a  risk  to  society  by  threatening  family   values   and   are   viewed   as   a   disruptive   and   dangerous   presence   in   urban  landscapes   (Hubbard   &   Sanders,   2003;   Sanders,   2004).   As   a   result   spatial  	   67	  displacement   through   law   enforcement   or   community   protesters   from   the   urban  landscape  has  been   the  most   typical   ‘geopolitical’   strategy   in   the   repression  of   sex  work   (Hubbard,   1998).      Sex  work   related   stigma   has   also   been   linked   to   reduced  access  to  health  care  services  (Lazarus,  et  al.,  2012;  Scambler  &  Paoli,  2008;  Scorgie,  et  al.,  2013)  and  HIV  prevention,  including  access  to  condoms  (Scorgie,  et  al.,  2013;  Shannon   &   Montaner,   2012)   and   increased   experiences   of   physical   violence  (Blanchard,  et  al.,  2005;  Rhodes,  et  al.,  2008).  How  sex  workers  experience,  negotiate  and   resist   stigma   is   highly   variable   and   influenced   by   material,   social,   and  interpersonal   factors.  For  example,  sex  workers  who  work   in   indoor  environments  maybe   better   able   to   conceal   their   labour   identity   compared   to   primarily   street  based  sex  workers  due  to  the  public  nature  of  their  work  (Bruckert,  2012).  Increasingly,   stereotypes   also   position   sex   workers   as   victims   at   perpetual  risk   of   violence   by   their   clients,   pimps   and   by   traffickers   and   in   need   of   rescue  (Bruckert  &  Hannem,  2013;  Cook,  2014;  Sanders,  2009a).  This  stance  is  influenced  by  radical   feminist   conceptualizations   of   prostitution   as   an   inherent   form  of   violence  against  women,  and  links  are  often  made  between  human  trafficking  and  sex  work  by   such   groups   (e.g.   (Farley,   2004).   Ever   more,   in   discourses   of   sex   work,   a  distinction  is  made  between  forced  and  chosen  prostitution.  Women  who  are  forced  into   prostitution   are   seen   as   victims   in   need   for   protection,   while   those   who   are  unwilling  or,  due  to  various  structural  impediments,  unable  to  exit  prostitution  are  	   68	  denied   their   social   and   civic   rights   (Bruckert  &  Hannem,   2013;  Koken,   2010).   The  construction  of  sex  workers  universally  as  victims,  undermines  sex  workers’  sexual  and  economic  agency,  precludes  understanding  sexual  labour  as  a  rational  choice  of  income  generation  (albeit  in  the  case  of  many  street-­‐‑based  sex  workers  a  constraint  one),   precludes   the   institution   of   a   labour   rights   approach   to   sex   work   and  importantly   conceals   examination   of   how   sexual   labour   is   organized   within   a  broader   social   and   structural   context,   including   its   gendered,   class   and   racial  dimensions.   (van   der   Meulen,   Dursin   &   Love,   2013).   The   deeply   embedded  stigmatizing  assumptions  of   sex  workers  as   ‘risky’  and   ‘at   risk’,  at  once  victimizer  and   victim,   exist   in   tension   and   are   reproduced   widely,   including   in   sex   work  legislation,   law  enforcement  strategies,  by  municipal  governments,  neighbourhood  associations  and  in  media  discourses  (Bruckert  &  Hannem,  2013).  Regulatory   approaches   to   sex   work   based   on   coexisting   stigmatizing  assumptions   of   sex   workers   as   ‘risky’   and   ‘at   risk’   have   proven   politically   and  rhetorically  appealing  in  a  growing  number  of  settings.  For  example,  recent  changes  to  the  UK  law  (most  noticeably  in  the  Policing  and  Crime  Act  2009)  have  included  forced  court-­‐‑appointed  classes  to  plan  exiting  from  prostitution  among  sex  workers  who  have  been  charged  with  solicitation  (Sanders,  2012).  The  emphasis,  in  line  with  the  contradictory  discourse  of  sex  workers  as  victims  and  deviants,  is  on  the  forced  savior  of  sex  workers  from  themselves  (Cook,  2014;  Sanders,  2009a).  As  such,  what  	   69	  are  hailed  to  be  protective  and  inclusionary  mechanisms  for  vulnerable  women  have  been   identified   as   punitive   and   controlling   mechanisms   that   provide   little  opportunity   for   support,   change,   or   individual   choice   or   determination   (Sanders,  2009a).   Similarly,   in   line   with   conceptualizing   sex   workers   as   victims   in   need   of  saving   from   themselves   and   others,   evolving   regulatory   responses   to   sex  work   in  the   global   West   have   shifted   to   the   rapid   adoption   of   ‘demand   criminalization'ʹ  approaches,  which  criminalize   the  purchase  of   sexual   services  and  conceive  of   sex  workers  as  victims  of  sexual  violence.    As  outlined  in  Chapter  two,  to  date,  Sweden,  Norway,  and  Iceland,  opted  for  ‘demand  criminalization’.  More  recently,  the  European  Union  has  voted  in  favour  of  implementing   this   approach   and   the   Canadian   government   in   June   2014   has   also  proposed   legislative   change   toward   the   criminalization   of   sex   buyers.   Canada’s  proposed   prostitution   bill,   is   tellingly   termed   ‘Protection   of   Communities   and  Exploited   Persons   Act’   –   this   name   neatly   summarizes   the   government’s  conceptualization   of   sex   workers   as   ‘risky’   to   their   communities   and   themselves  and,   at   the   same   time,   as   ‘at   risk’   of   exploitation.   In   line  with   conceptualizing   sex  workers   as   ‘at   risk’,   the   proposed   new   legislation   sets   out   to   criminalize   the  purchase   of   sexual   services,   along  with   benefiting   from   the   proceeds   of   sex  work  from  another  person  commercially.  To  counteract  the  risks  sex  workers’  are  believed  to  pose  to  the  community  and,  in  particular,  to  children  the  proposed  legislation  also  	   70	  sets  out  to  criminalize  communicating  for  the  purpose  of  selling  sexual  services  near  schools,  daycare  centers  and  playgrounds.  As  discussed  in  Chapters  one  and  two,  in  Vancouver,  over  the  last  number  of  years,   there   has   been   a   continuous   shift   in   the   policing   of   sex   work   away   from  arresting  and  charging  sex  workers  that,  in  January  2013,  led  to  the  implementation  of   a   policing   strategy,   which   explicitly   prioritized   the   safety   of   sex   workers   and  focused   enforcement   efforts   on   sex   buyers   (VPD,   2013a;   Krüsi,   et   al.,   2014).   The  novel   sex   work   policing   strategy   explicitly   addresses   the   tensions   between  prioritizing   the   safety  of   sex  workers  and  concerns  by   residents  and  businesses   in  locales  where  street-­‐‑based  sex  work  takes  place.  The  Vancouver  Police  Department  (VPD)  sex  work  enforcement  policy  states  “…  we  will  focus  on  balancing  the  needs  of   the   community   and   the   safety   of   the   sex   workers.   The   VPD   does   not   seek   to  increase  the  inherent  dangers  faced  by  sex  workers,  especially  survival  sex  workers.  Therefore,   where   there   are   nuisance   complaints   against   survival   sex   workers,  alternative  measures  and  assistance  must  be  considered  with  enforcement  as  the  last  resort.”  (VPD,  2013a,  p.3).    Drawing  on  the  concepts  of  structural  vulnerability  and  structural  stigma,  we  undertook   the   present   study   to   explore   the   complex   ways   in   which   coexisting  stigmatizing   assumptions   of   sex   workers   as   ‘risky’   and   ‘at   risk’   intersect   with  	   71	  evolving  sex  work  policing  strategies  to  shape  street-­‐‑based  sex  workers’  civic  rights  and   experiences   of   violence   and  poor  health.  We  will   outline   some  of   the   specific  ways   in   which   sex   work   related   stigma   influences   the   risk   of   violence   and   poor  health   by   normalizing   the   violence   experienced   by   sex  workers   and   continuously  displacing  them  from  the  neoliberal  urban  landscape,  not  merely  by  police  force,  but  also   by   neighbourhood   watch   groups,   private   security   and   other   mechanisms   of  urban  gentrification.    3.2  Methods  This   study   is   situated   within   a   larger   NIH-­‐‑funded   longitudinal   qualitative  and  ethnographic  study  investigating  the  features  of  the  physical,  social  and  policy  environments   shaping   working   conditions,   sexual   health,   violence,   HIV/STI   risks  and  access  to  care  for  sex  workers  in  Vancouver,  Canada  and  runs  alongside  a  sister  epidemiological   cohort   of   over   800   street   and   off-­‐‑street   sex   workers,   known   as  AESHA  (An  Evaluation  of  Sex  Workers  Health  Access)  (Shannon,  et  al.,  2007).    This   study   draws   on   qualitative   semi-­‐‑structured   interviews   with   street-­‐‑involved  sex  workers  about  their  working  conditions,   interactions  with  police,  and  negotiations   of   health   and   safety   with   clients,   in   the   City   of   Vancouver,   Canada.  These   interviews   were   conducted   over   11   months   (January-­‐‑November   2013),  following   the   implementation   of   the   new   safety   focused   sex   work   enforcement  	   72	  policy   by   the   Vancouver   Police   Department   (VPD)   in   January   2013   (Krüsi,   et   al.,  2014);  and  following  the  release  of  the  Missing  Women’s  Commission  Inquiry  report  regarding   the   botched   police   investigation   into   the   disappearance   and  murder   of  over   60   street-­‐‑based   sex  workers   in  Vancouver   in   the   late   1990’s   and   early   2000’s  (Oppal,  2012).  While  we  have  previously  examined  the  impact  of  the  new  policing  efforts  on   sex  workers’  negotiation  of  health   and   safety   (Krüsi   et   al.   2014),   for   the  current  analyses  we  draw  on  concepts  of  structural  vulnerability  and  stigma  to  gain  a  better  understanding  of  how  evolving  policing   strategies   and  policy   approaches  intersect  with  stigmatizing  assumptions  about  sex  workers  as  at  once  ‘risky’  and  ‘at  risk’.      The   concepts   of   structural   vulnerability   and   everyday   violence   have  previously  been  used  to  frame  the  violence  and  poor  health  experienced  by  street-­‐‑based   sex  workers   (Shannon,   Kerr,   et   al.,   2008;   Simić  &   Rhodes,   2009).   Structural  vulnerability   refers   to   how   social   arrangements   embedded   in   the   organization   of  society,  such  as  laws,  institutional  and  regulatory  practices  and  social  norms,  render  particular  groups  of  people  disproportionately  vulnerable  to  harm  (Quesada,  et  al.,  2011).   The   concept   of   everyday   violence   refers   to   the   normalization   of  institutionalized   brutalities   that   are   rendered   invisible   (Scheper-­‐‑Hughes,   2004).  Together,  these  concepts  give  focus  to  how  various  social  and  structural  forces,  such  	   73	  as   the   criminalization  of   sex  work  and  sex  work   related   stigma,   intersect   to   shape  experiences  of  violence  and  poor  health  among  sex  workers.    Interview  participants  were  recruited   through  purposive  sampling   from  the  longitudinal  cohort  (AESHA),  and  aimed  to  reflect  variation  in  demographics  (e.g.,  age,   ethnicity,   gender)   and   work   environments   (e.g.,   geographic   neighbourhoods  and   transaction   locales).  Eligibility  criteria   for   the   in-­‐‑depth   interviews   included:  1)  current  sex  work  defined  as  exchanged  sex  for  money  in  the  previous  month  in  the  City   of  Vancouver;   2)   identifying   as   a   cis-­‐‑   or   transgender  woman   and   3)   aged   18  years  or  older.    While  the  larger  qualitative  and  ethnographic  research  and  AESHA  projects   focus  on  a  diversity  of   street   and  off-­‐‑street   (e.g.,   indoor,   online)   sex  work  environments,   this   specific   study   aimed   to   examine   the   experiences   of   street-­‐‑involved   sex   workers   (i.e.,   those   soliciting   and/or   servicing   on   the   street)   given  substantial   evidence   that   stigma,   criminalization   and   enforcement  disproportionately  affect  this  segment  of  the  sex  industry  (Lowman,  2000;    Sanders  &  Campbell,  2007;  Shannon,  Kerr,  et  al.,  2008).    It  should  be  noted  that  even  within  this  context,  many  street-­‐‑involved  sex  workers  worked  in  both  street  and  off-­‐‑street  venues,  including  online  and  indoor  informal  and  formal  venues.  Our   sample   of   participants   is   representative   of   the   broader   community   of  street-­‐‑based  sex  workers  in  Vancouver.  Interview  participants  included  26  cisgender  	   74	  and   5   transgender  women   sex  workers   (total   n=31).   The  mean   age   of   participants  was  38  years  (range:  24-­‐‑53).  Overall,  21  identified  as  Caucasian,  8  were  of  Aboriginal  ancestry   and   2   participants   were   of   other   visible   minorities.   All   participants   had  experience   with   street   solicitation.   The   majority   (77%,   n=   24)   reported   street  solicitation  as  their  primary  way  of  connecting  with  clients,  while  others  (23%,  n=  7)  primarily  used  phone/text  solicitation   to  connect  with  clients.      Just  over  half   (55%,  n=  17)  primarily  serviced  clients  in  vehicles  or  outdoor  public  spaces,  while  45%  (n=  14)  primary  serviced  clients  in  informal  indoor  venues  (e.g.,  hotels,  client’s  place,  or  their  home).  The   31   semi-­‐‑structured   interviews   were   facilitated   by   an   interview   guide  encouraging   broad   discussions   of   working   conditions,   police   presence   and  interactions,  and  negotiation  of  sex  work  transactions  with  clients,  post-­‐‑VPD  policy  implementation   (January   2013).   The   interview   guide   was   developed   based   on  existing  knowledge  of  the  research  team  and  in  collaboration  with  our  community  partners.   We   conducted   all   interviews   at   one   of   two   field   offices   in   the   City   of  Vancouver.   Interviews   lasted   between   45   and   90   minutes,   were   audio-­‐‑recorded,  transcribed  verbatim  and  checked  for  accuracy.  All  participants  provided  informed  consent  and  were  remunerated  with  a  CAD  $30  honorarium.  The  study  holds  ethical  approval  by  the  Providence  Healthcare/University  of  British  of  Colombia  Research  Ethics  Boards.          	   75	  Data   collection   and   analysis   occurred   concurrently.   All   textual   data   were  analyzed   using   an   inductive   and   iterative   process   facilitated   by   the   qualitative  analysis   software   ATLAS.TI   V7.   The   research   team   discussed   the   content   of  interviews,  emerging  themes  and  coding  framework  throughout  the  data  collection  and   analytic   processes.   The   initial   coding   framework   was   based   on   key   themes  reflected   in   the   interview  guide,  participants’   accounts  and   fieldnotes.  To  advance  beyond   thematic   description,   we   drew   on   concepts   of   structural   vulnerability,  structural  stigma  and  everyday  violence  to  interpret  the  emerging  themes  and  give  focus  to  how  the  criminalization  of  sex  work  and  sex  work  related  stigma,  intersect  to  render  sex  workers’  disproportionately  vulnerable   to  harm.  Verbatim  narratives  are  reported  using  pseudonyms  assumed  by  sex  workers  to  ensure  anonymity.  3.3  Results  Our  results  indicated  that  stigmatizing  assumptions  of  sex  workers  as  ‘at  risk’  and   ‘risky’,   both   victims   and   victimizers,   coexisted   and   profoundly   shaped   sex  workers’  experiences  of  evolving  policing  and  policy  efforts.  Regardless  of  gender,  ethnicity   and   primary   place   of   solicitation,   participants   reported   that   their  interactions  with  police  when  soliciting  sex  work  clients  have  become  more  positive  over   the   years   and   generally   focus   on   their   safety.      Women   who   had   been  supporting   themselves   through   sex   work   for   many   years   cited   the   detrimentally  	   76	  flawed  police  investigations  into  the  disappearance  of  60  women  in  street  level  sex  work   in  Vancouver   and   the,   at   the   time   of   data   collection,   ongoing   constitutional  challenge   on   sex   work   laws   in   Canada   as   important   drivers   for   change   in   the  policing  of  sex  work  over  the  years.    Women’s   narratives   articulated   a   clear   shift   in   police   interactions   over   the  years   that   is   in   line  with  an   increased  conceptualization  of   sex  workers  as  victims  rather   than  deviants.  While  police  used   to   threaten   sex  workers  with  arrest,   order  them  off  the  street  and  follow  them,  current  police  interactions  focused  on  inquiring  about  violent  costumers  and  reminding  women  to  stay  safe.      I’ve  seen  a  huge  change  [in  policing].    Like  before  they  would  come  up  and  they’d  say  if  we  see  you  on  the  street  again  we’re  gonna  arrest  you.  Straight  up.  You  go  home  cause  if  we  see  you  again  on  the  street  we’re  gonna  arrest  you.  That’s  what  it  used  to  be.    Now  it’s  like  just  be  safe.    Make  sure  that  you  report  any  bad  dates.  -­‐‑  Charlotte,  Cisgender  woman,  Caucasian  I  see  a  big  change.  Some  cops  are  different  from  others  but  a  lot  of  them  I  noticed  just  come  and  see  how  you’re  doing  and  how  your  night  is,  they’re  not  rude  to  you  anymore,  you  know?    I  found   that   they   used   to   be   really   rude   and   ignorant   to   you.  They  would  run  your  name  and  or  just  uh,  you  know,  just  stop  you   for   nothing   like   if   you’re,   even   if   you’re   walking,   just  walking,  you  know?    Um,  just  run  your  name  or  park,  on  the  same  block,  watching  me  so  I  had  to  move.  -­‐‑  Maria,  Cisgender  woman,  Aboriginal  However,   while   sex  workers  welcomed   the  more   positive   police   interactions   and  that  police  no  longer  threaten  them  with  arrest,  some  participants  were  critical  of  the  	   77	  newfound   concern   for   their   safety   and   expressed   that   underlying   stigmatizing  assumptions  of  sex  workers  as  deviants  and  ‘whores’  continued  to  coexist  with  the  more  recent  police  focus  on  sex  workers’  safety.  It  comes  out  in  their  [police]  expressions  that  they  don’t  really  like  you.  […]  But  generally  they  haven’t  really  been  harassing  as   much   lately,   but   that   attitude   is   still   there.   I   don’t   think  they’ll  change  it  back  in  their  heads  that  we’re  trash.  -­‐‑  Violet,  Transgender  woman,  Caucasian    Similarly,  some  participants   like  Moira  questioned  police’  motive  for  the   increased  concern   on   sex   worker’   safety   by   drawing   on   historic   discrimination   and  maltreatment  of  sex  workers  by  police   in   the   local  context.   In  Moira’s  view,  police  focus  on  sex  workers’  safety  is  rooted  less  in  a  genuine  concern  for  their  safety  but  is  rather  a  way  of  increased  surveillance  of  sex  workers  -­‐‑  albeit  in  the  name  of  safety.         	   78	  After   the   Pickton   [local   serial  murderer]   thing   there  was   a  bunch   of   cops   came   out,   every   time   every   night   and   were  talking   to   every   girl,   pretending   like   they   wanted   to   be   our  friends.   Now,   it’s   like   come   on.  What   the   fuck   is   this?   Now  you’re   trying  to   fucking  do  a  180  because  you’re  now  all  of  a  sudden  you’re  under  scrutiny?  Because  you  fucked  up  and  you  didn’t   take   our   -­‐‑  When  we   told   you  what  was   going   on,   you  wouldn’t  listen  to  us?  Cause  we’re  a  bunch  drug  addict  ho’s?  You  know  that’s  what  -­‐‑  That’s  the  way  they  see  us.  You  know.  And  uh,  now  they  care.  They  care  about  us  working  girls  now.  They  have  to  keep  a  count  of  us.  They  wanna  make  -­‐‑  You  know  they   gotta   know  who  we   are,   uh   have   you   seen   so   and   so  we  haven’t  seen  her  for  a  while.  Have  you  seen  her?  Do  you  know  if  she’s  still  around?  Blah  blah  blah.  Or  we’re  looking  for  this  girl   or   do   you   know   if   she’s   okay   and   blah   blah   blah,   right.   -­‐‑  Moira,  Cisgender  woman,    Aboriginal    3.3.1   The   everyday   violence   of   reporting   sex   work   related   violence   to   police   –  ‘you’re  not  a  beat  up  worker’  Despite   more   positive   police   interactions   and   increased   concern   for   sex  workers’  safety  the  vast  majority  of  participants  expressed  that  they  continued  to  be  reluctant   to   report   theft,   fraud   or   violence   that  might   occur   in   the   context   of   sex  work  to  police.  “There  is  not  a  chance  in  hell  I’m  gonna  call  911”,  “No  I  wouldn’t  call  the  cops  again.  For  anything.”  “I  just  don’t  call  the  cops.  I  don’t  trust  them”.  While  there  was  a  uniform  reluctance  among  participants  to  seek  police  protection  when  they  needed  it,  particularly  participants  of  Aboriginal  ancestry  recounted  negative  experiences  in  the   context   of   reporting   sex   work   related   violence   to   police.      As   highlighted   by  excerpts   from   Sonia   and   Erica,   both   Aboriginal   participants,   many   sex   workers  	   79	  experienced   seeking   police   protection   as   a   form   of   everyday   violence,   in   that   the  police   response   normalized   their   experiences   of   violence   as   an   inherent   part   of  selling   sex.   Participants   were   denied   their   citizenship   rights   for   police   protection  and  legal  recourse  by  virtue  of  their  ‘risky’  occupation,  and  were  effectively  blamed  for  the  violence  they  experienced.  My   views   on   the   police,   especially   the   VPD   changed  dramatically  when  I  had  a  cop,  sergeant  with  the  VPD  tell  me  that  I  cannot  charge  my  date  [client]  for  sexual  assault  because  I   was   a   hooker.   […]   I   was   supposed   to   write   a   complaint  against  it,  which  I  still  haven’t  done.    Um,  I  want  to  but  I  fear  repercussion  […]  I  won’t  go  to  cops  [in  case  of  violence],  not  after  that  sergeant.    There’s  just  no  point,  not  if  I’m  gonna  get  shot   down   and   belittled.   I’m   not   going   to  waste  my   precious  breath   on   somebody   who   doesn’t   give   a   rat’s   ass.   -­‐‑   Sonia,  Cisgender  woman,  Aboriginal  Police  say  oh  if  you’re  in  the  trade  you  take  risks  and  you  know  what’s  gonna  happen.  You’re  gonna  get  hurt.  There’s  nothing  we   can  do   about   it.   […]  Where  does   it   say   if   you’re   a   hooker  you’re   gonna   get   hurt?   You   don’t   get   paid   to   get   beat   up.  You’re  not  a  beat  up  worker,  you  know?  -­‐‑  Erica,  Transgender  woman,  Aboriginal  Participants’   narratives   bring   to   bare   how   in   a   context   where   sex   work   is  conceptualized   as   inherently   dangerous   and   sex   workers   are   increasingly  understood   as   victims   in   need   for   saving,   blame   for   sex   work   related   violence  continues  to  be  shifted  to  sex  workers’   themselves  for  continuing  to  engage  in  this  dangerous   practice.   Thus,   the   deeply   embedded   stigmatizing   assumptions   of   sex  work   as   inherently   dangerous   can   function   to   alleviate   some   of   the   police’  	   80	  responsibility  in  protecting  the  social  and  civic  rights  of  sex  workers.  This  increases  sex  workers’   structural   vulnerability   to   violence   because   if   they   do   engage   in   sex  work  they  have  to  operate  outside  the  societal  protections  other  citizens  can  take  for  granted.      3.3.2  Neighbourhood  stigma  Neighbourhood   nuisance   concerns   and   neighbourhood   renewal   also  profoundly   shaped   sex  workers’  working   conditions   and   are   closely   linked   to   sex  work   related   stigma   and   policing.   Our   results   indicated   that   stigmatizing  assumptions   of   sex   workers   as   ‘at   risk’   and   ‘risky’,   both   victims   and   victimizers  coexisted  after   the   implementation  of   the  safety   focused  VPD  sex  work  policy  and  profoundly  shaped  the  geography  of  where  women  can  engage   in  sex  work.  Most  participants   recounted   interactions   with   residents,   neighbourhood   watch   groups  and   security   guards.      Women’s   narratives   indicated   that   these   interactions   were  shaped   by   a   discourse   of   sex   workers   as   a   risky   presence   in   neighbourhoods  threatening   the   social   and   moral   order,   rather   than   by   conceptualizations   of   sex  workers   as   victims   in   need   for   safety   as   delineated   in   the   sex   work   enforcement  policy.   Harassment   by   residents   and   community   groups   often   took   the   form   of  verbal   degradation,   pursuing   sex   workers   on   foot   until   they   leave   the  neighbourhood  and  noting  down  license  plates  of  clients  presumably  to  pass  on  to  	   81	  police.    Residents  will  drive  by,  stop  and  tell  us  where  to  go  in  not  such  nice   words.   I   had   a   guy   come   after   me   and   two   of   my  girlfriends   with   a   rake.   He   literally   chased   us   off   the   corner  with   a   rake.      He   came   at   us.   I’ll   never   forget   it.   -­‐‑   Julia,  Cisgender  woman,    Caucasian  Neighbourhood   watch   they   suck.   They   are   annoying.   They’ll  follow  you  from  the  ends  of  the  world,  holy  cow!  Yeah  they’re  terrible.   It’s   basically   almost   like   they’re   stalking   you.   You  can’t  work.  It  is  like  they’re  harassing  you.  I  swear  one  night  I  walked   a   mile   and   a   half   and   they   were   still   behind   me  following   me.   That’s   total   harassment   you   can’t   do   that   to  someone.  -­‐‑  Joy,  Cisgender  woman,    Caucasian  In  addition  to  neighbourhood  watch  groups  and  residents  -­‐‑  private  security  guards  also  profoundly   shaped   sex  workers  working   conditions.  Participants   experienced  these   interactions   as   more   overtly   disruptive   than   current   policing   practices,   as  security  guards  are  not  bound  by   the   safety   focused   sex  work  enforcement  policy  and   draw   on   discourses   of   sex  workers   as   deviants  who   need   to   be   evicted   from  their  area  of  surveillance.         	   82	  [Security   guards]   they’re   horrible,   they’re   worse   than   the  cops.  Like  they’ll  get  out  and  they’ll  fight.    Like  not  physical  yet  as  far  as  I  know,  but  they  just  say  ‘you  fucking  whore’.  They’re  not  professional  from  what  I  can  tell  right.  They’ll  go  and  park  so   you   have   to   keep  moving   and   then   if   they   decide   to   get   a  hard   on   for   you   they’ll   follow   you   around   everywhere.      So  wherever  you  try  to  work  they’ll  be  in  an  area  where  the  dates  will  see,  you  know  it’s,  like  they’re  worse  than  the  cops.  […]  It  fucks   it   up   obviously   cause   then   the   dates   [clients]   can’t   tell  the   difference   right   or   they   just   think   if   anybody’s   watching  then   they’re   nervous   right.   -­‐‑   Gloria,   Transgender  woman,  Caucasian  The  safety  focused  sex  work  enforcement  policy  explicitly  outlines  that,  in  the  case   of   sex  work   related   nuisance   complaints,   police   are   to   respect   the   rights   and  safety   of   sex   workers.   However,   participants’   described   that,   in   the   case   of  community   complaints,   police  without   exception  ordered   sex  workers   to   leave.   In  effect,  sex  workers  continued  to  be  displaced;  however  in  contrast  to  the  past,  police  prefaced   their   order  with   a   reference   to   neighbourhood   complaints.   This   practice  highlights  how  discourses  of   sex  workers  as  deviants  who   threaten   the  moral  and  social   order   co-­‐‑existed   and   intersected   with   police   enforcement   that   purports   to  prioritize  the  safety  of  sex  workers  and  profoundly  shaped  the  working  condition  of  street-­‐‑based  sex  workers.  Given  the  criminalized  status  of  sex  work  and  the  power  imbalance   between   police   and   sex   workers,   participants   had   limited   options   in  managing  community  complaints.    	   83	  If   they   [police]  get  complaints   than  they’ll   tell  us   to  move  so  yeah.  It’s  just  like  in  certain  areas.    You  know  like  the  residents  will   call   and,   you   know.  So   they   [police]  will   be   like  OK  we  got   complaints.      You   gotta   walk.   -­‐‑   Amber,   Cisgender  woman,  Aboriginal  It  might   go   for   a   couple  weeks  where,   they   [police]  will   just  keep   driving   by   but   if   neighbours   are   phoning   in   then   that’s  when   they   come   for   the   complaints.  They   say,   the  neighbours  called   in   that’s   why   we’re   here.   They   are   polite,   they’re   not  rude  or  mean.    They’re  nice  to  me,  right?  They  don’t  search  me,  they  don’t  really  say  move,  you  can’t  stand  on  the  corner,  but  they  say,  we   just  have  complaints   from  neighbors,  so  can  you  find  it  in  your  courtesy  to  kinda  like,  not  be  around  for  a  long  time,  they  just  put  it  like  that,  right?  [Okay,  so  not  like,  get  out   of   here?]   No,   they   don’t   say   it   in   those   words,   but  basically  that’s  what  they  mean.  -­‐‑  Ruby,  Cisgender  woman,  Caucasian  R     When   community  watch  groups   call,   then   the   cops   come   and  they   say   you   have   to   move,   carry   on   and   move.      Go   home  basically  for  the  night.  But  I  mean  if  I’m  not  in  your  yard  and  if  I’m  not  soliciting  and  doing  something  to  your  family,  your  property,   your   housing   -­‐‑   mind   your   own   business.   I’m   not  around   schools,   I’m  not   around,  you  know  your  back  yard   so  beat  it.    What  is  it  any  of  your  business  what  I’m  doing?  You  know   what   I   mean?      I’m   not   harming   anybody,   I’m   not  stealing  off  you  people.  So.  I   Would  you   ever   feel   comfortable   calling   the   cops   on   them,   on  the  community  watch  people?  R   Yeah   I  would   feel   comfortable   sure,   but   I  mean   I   don’t   think  they   would   do   anything   about   it   because   it’s   community  watch,   you   know.   I   would   look   like   the   idiot   right   so.   -­‐‑   Joy,  Cisgender  woman,  Caucasian  These   narratives   of   police   readily   assisting   residents   in   known   sex  work   areas   by  removing  sex  workers  stands  in  stark  contrast  to  sex  workers’  narratives  about  the  	   84	  everyday   violence   they   experience   in   seeking   police   protection.   In   contrast   to   the  inaction  of  police  regarding  sex  work  related  violence,  participants  witnessed  police  taking   swift   action   to   address   neighbourhood   nuisance   complaints.      It   is   in   these  discrepancies   in   policing   where   the   power   imbalance   between   sex   workers   and  neighbourhood   residents  materialize   to   shape   the  working   conditions   and   curtail  the   civic   rights   of   street-­‐‑based   sex  workers   through   displacement   from   the   urban  landscape  and  the  denial  of  police  protection  and  legal  recourse  in  case  of  violence.    3.3.3  Neighbourhood  renewal  –  ‘god  forbid  there’s  a  hooker  on  the  condo  street’  Neighbourhood   renewal   and   gentrification   also   profoundly   shape   the   work  environment  of  sex  workers  and  are  intimately  connected  to  the  stigma  and  policing  of  sex  work.  Participants’  narratives  outline  how  neighbourhood  renewal  is  directly  linked   to   increased   presence   of   security   guards   and   police.      The   continued  criminalization   of   clients   exacerbates   the   effects   of   gentrification   as   it   gives   police  the  power  to  continue  to  govern  where  sex  work  can  take  place  and  thus  allows  for  removing   sex   workers   from   areas   of   urban   renewal.   As   outlined   by   Parker   and  Aggleton   (2003)   stigma   and   discrimination   are   central   to   the   constitution   of   the  social   order   and   deployed   by   concrete   and   identifiable   social   actors   seeking   to  legitimize   their   own  dominant   status  within   existing   structures   of   social   inequity.    Participants’  narratives  here  outline  how  policing  strategies  intersect  with  sex  work  	   85	  related   stigma   in   an   attempt   to   increase   the   value   of   newly   gentrified   inner-­‐‑city  neighbourhoods.    The  minute   that   they’re   bringing   the   new   condos   next   thing  you   know   there’s   security   cars,   there’s   cop   cars,   god   forbid  there’s  a  hooker  on  the  condo  street.  The  minute  someone  buys  the  building,  puts   in  a   condo,   it’s   a  whole  new  set   of   fucking  rules.   It’s   totally   changed,   I   don’t   even   recognize   it,   and   you  don’t   see   any   girls   up   there,  where   I   used   to  work  up   on   the  corner   of   X   and   Y   street.   See   the   cops   shift   girls   to   certain  areas,   and   if   they   deny   it,   they’re   lying.   -­‐‑   Ruby,   Cisgender  woman,  Caucasian  Like   I   said,  when   the   condos   started  popping  up  on  uh,   on  X  street,   they  did  have  security,  you  know,  to  watch   for   thieves,  which   I   can   understand,   but,   you   know,   what’s   he   doing  parked   right   by   me,   going   around   the   corner.   So   yeah,   they  were   told   to   mess   with   the   working   girls.   -­‐‑   Claudia,  Cisgender  woman,  Caucasian  References  to  urban  renewal  and  displacement  of  sex  work  strolls  were  particularly  prominent   in   transgender   participants’   accounts,   who   were   displaced   not   just  because   of   their   status   of   sex   workers   but   also   based   on   their   marginal   gender  identity.  Transgender   sex  workers   in   the   local   context   tend   to  work   in   rather  well  defined   geographical   areas,   where   regular   and   new   clients   can   find   them   with  relative  ease.  Transgender  participants   in   this  study  recounted  several   instances  of  displacement  due  to  urban  renewal  in  recent  years.        	   86	  I  used  to  work  at  the  corner  of  Street  A  and  B,  well  there  is  no  corner  of  Street  A  and  B  anymore,   it’s  a  park.  They  turned   it  into   a   park   where   the   transsexuals   worked.      But   there’s   still  high   track   where   the   girls   worked   but   there’s   no   transsexual  stroll.   They   closed   it   down.   -­‐‑   Violet,   Transgender  woman,  Caucasian  Because   the   people   who   live   in   condo’s   there   don’t   want   us  down  there  anymore.  Yeah  cause  the  transsexuals  used  to  work  down  there,  remember?  They  just  wanted  us  outta  there  yeah.    If  I  go  to  try  to  work  there  the  uh  the  cops  pulled  my  name  up  I’d  be  red  zoned  and  then  they  can  arrest  me  yeah.  Yeah,  even  the  boy’s  [male  sex  workers]  are  gone  from  there  yeah.    They  made   it   completely   illegal   to   work   on   that   street.   And   now  we’re   going   to   be   pushed   out   of   this   street   right   away   too.    Yeah  cause  there’s  condo’s  going  up  there  too.  On  X  street  and  whatcha  ma   callit.   They’re   tearing   down   those   buildings   and  building   condo’s   there.   -­‐‑   Liz,   Transgender   woman,  Caucasian  3.4  Discussion    This  study  sheds  light  on  how  the  intersecting  regimes  of  criminalization  and  stigmatization   serve   to   marginalize   sex   workers   and   increase   their   structural  vulnerability   to   violence   and   poor   health.   Our   findings   demonstrate   how  mechanisms  of  responsibilization  are  applied  to  sex  workers  through  contradictory  discourses  of  sex  workers  as   ‘at  risk’  and   ‘risky’   to   themselves  and  others   through  the  everyday  violence  of  normalizing  sex  work   related  violence.  Sex  workers  who  cannot   or   will   not   choose   the   prescribed   responsible   route   out   of   sex   work   are  denied  citizenship  rights  including  legal  protections,  labour  rights  and  safe  working  conditions.   Despite   police   rhetoric   of   prioritizing   sex   workers’   safety,   our   results  	   87	  indicated   that   sex   workers’   interactions   with   neighbourhood   residents   were  predominantly   shaped   by   a   discourse   of   sex  workers   as   a   ‘risky’   presence   in   the  urban  landscape  and  police  took  swift  action  in  removing  sex  workers  in  instances  when  complaints  were  made.  This  stands  in  stark  contrast  to  the  police  inaction  in  response   to   sex   work   related   violence   and   brings   to   bear   the   power   imbalance  between   sex  workers   and  neighbourhood   residents,  which  profoundly   shaped   sex  workers’  civic  rights.    Evidence   both   in   Canada   and   globally   has   consistently   highlighted   the  barriers  sex  workers  face  in  accessing  police  protection  (Global  Commision  on  HIV  &   the   Law,   2012;   Okal,   et   al.,   2011;   Richter,   et   al.,   2010;   Shannon   &   Csete,   2010;    Shannon,  Kerr,  et  al.,  2008).  Our  findings  illustrate  that  sex  workers  continued  to  be  highly   reluctant   to   report   sex  work   related   violence   to   police,   despite   the   official  police   focus   on   safety.   Particularly,   women   of   Aboriginal   ancestry   recounted  negative   experiences   of   reporting   sex   work   related   violence   to   police   and   were  highly  reluctant  to  seek  police  protection  in  case  of  violence.  In  Canada,  Aboriginal  women   are   not   only   over   represented   in   street-­‐‑based   sex   work   (Bingham,   et   al.,  2014;   Culhane,   2003;   Shannon,   et   al.,   2007)   they   also   represent   31.9%   of   all  incarcerated  women  despite  the  fact  that  Aboriginal  women  only  make  up  1  to  2%  of   the   general   Canadian   population   (Public   Safety   Canada,   2011).   These   numbers  highlight   the   disproportionate   criminalization  women   of   Aboriginal   ancestry   face  	   88	  and  draw  attention  to  the  historical  trauma  and  their  multilayered  reality  of  stigma  and  racism  (Bingham,  et  al.,  2014;  Bourassa,  et  al.,  2004;  Culhane,  2003).    Sex   workers   experienced   seeking   police   protection   as   a   form   of   everyday  violence,  in  that  the  police  response  normalized  their  experiences  of  violence  as  an  inherent  part  of  selling  sex,   thus   justifying  their   inaction.  Participants  were  denied  their   citizenship   rights   for   police   protection   and   legal   recourse   by   virtue   of   their  ‘risky’  occupation.  Our   findings  bring   to  bear   that,   in  a  context  where  sex  work   is  viewed   as   inherently   dangerous   and   sex   workers   are   increasingly   understood   as  victims   in   need   for   saving,   blame   for   sex   work   related   violence   continues   to   be  shifted  to  sex  workers’  themselves  for  their  ongoing  engagement  in  this  dangerous  practice.   At   the   same   time,   by   invoking   the   inherent   dangers   of   sex  work,   police  absolved   themselves   from   the   duty   of   safeguarding   the   legal   protections   of   sex  workers  who  continue  to  engage  in  sex  work.    As  such,  mechanisms  of  responsibilization  are  applied  to  sex  workers  through  contradictory   discourses   of   sex  workers   as   ‘at   risk’   and   ‘risky’   to   themselves   and  others.   Responsibilization,   Scoular   and   O’Neill   (2007)   argue,   is   presented   as  protecting   vulnerable   victims   from   risk   and   thus   allows   for   dividing   between  responsible   sex   workers   who   exit   and   those   ‘risky’   subjects   who   continue   to   put  themselves  at  risk  by  selling  sex  (Scoular  &  O'ʹNeill,  2007).  Those  sex  workers  who  	   89	  cannot   or   will   not   choose   the   prescribed   responsible   route   out   of   sex   work   are  stigmatized  and  denied  citizenship  rights  including  safe  working  conditions,  labour  rights   and   legal   protections.  Neoliberal   ideology   is   implicated   in   rewarding   those  women  who  exit  prostitution  and  take  on  a  victim  subjectivity  and  denying  the  most  basic  citizenship  rights  to  those  who  do  not.  Conceptualizing   sex   workers   universally   as   victims   in   need   for   safety   thus  precludes  conferring  citizenship  rights  including  legal  recourse  and  labour  rights  to  those   sex   workers   who   continue   to   sell   sex.   Rather   than   providing   structural  supports   such  as   ‘living’  welfare   rates   and   real   alternatives   for   those  women  who  want   to  exit  sex  work,   the  focus  remains  on   individual  women’s  risky  behaviours.  This  increases  sex  workers’  structural  vulnerability  as  they  have  to  operate  outside  the   societal   protections   other   citizens   can   take   for   granted,   such   as   labour   rights,  police  protection  in  case  of  violence  and  the  opportunity  for  legal  recourse.  As  such,  our   findings   highlight   that   the   police   rhetoric   of   safety   for   sex   workers   does   not  include  the  bestowing  of  citizenship  rights  to  sex  workers;  rather  sex  workers’  safety  is  more  narrowly  defined  as   individual   focused  safety  strategies  with   the  ultimate  state  of  safety  being  attained  when  exiting  sex  work.    In   line   with   previous   work,   neighbourhood   nuisance   concerns   and  neighbourhood   renewal   also   profoundly   shaped   sex  workers’  working   conditions  	   90	  and  were   closely   linked   to   sex  work   related   stigma   and   policing   (Hubbard,   1998;  Teela  Sanders,  2004).  Our  results  indicate  that  interactions  between  sex  workers  and  neighbourhood   residents   and   security   guards   were   predominantly   shaped   by   a  discourse   of   sex   workers   as   a   risky   presence   in   neighbourhoods   threatening   the  social  and  moral  order,  as  well  as  property  values,  rather  than  by  conceptualizations  of   sex   workers   as   victims   in   need   for   safety   as   delineated   in   the   police’   safety  focused  sex  work  enforcement  policy.       The  safety  focused  sex  work  enforcement  policy  explicitly  outlines  that,  in  the  case  of  neighbourhood  complaints,  police  are  to  respect  the  rights  and  safety  of  sex  workers.  However,  our   findings   indicated   that,   in  cases  of  community  complaints,  police  ordered  sex  workers  to  leave  the  area.  In  effect,  sex  workers  continued  to  be  displaced  to  industrial  areas  where  there  is  little  chance  for  escape  or  support  in  case  a  client  oversteps  a  service  agreement  or  uses  violence.  However,  in  contrast  to  the  past,  police  prefaced  their  order  with  a  reference  to  neighbourhood  complaints.  As  such,  the  ongoing  neighbourhood  stigma  of  sex  workers  as  polluting  the  moral  and  social  order  coupled  with  the  continued  criminalization  of  sex  buyers  resulted  in  the  displacement  of  sex  workers  to  isolated  areas,  despite  police  rhetoric  of  prioritizing  sex  workers’  safety.    	   91	  The  current   results  build  on  previous  work   that  has   identified   that   the  way  police   and   community   protesters   control   the   sites   of   street   prostitution   has  significant   implications   for   the   safety   of   sex   workers   workers   (Hubbard,   1998;  Hubbard   &   Sanders,   2003;   Sanders,   2004),   and   highlight   the   role   of   stigma   in  governing  sex  work.  The  negative  effects  of  displacement  to  isolated  industrial  areas  on  the  health  and  safety  of  sex  workers  have  been  well  documented.  Displacement  to  unknown,  secluded,  industrial  areas,  where  there  is  little  chance  of  receiving  help  when   needed,   is   linked   to   increased   risk   of   violence   and   rape   and   reduces   sex  workers’   ability   to  negotiate   the   transaction  on   their   terms,   including   condom  use  (Decker  et  al.,  2010;  Decker,  et  al.,  2012;  Krüsi,  et  al.,  2012;    Shannon,  Strathdee,  et  al.,  2009).    Our   findings   indicate   that   references   to   displacement   and   urban   renewal  were  particularly  prominent   among   transgender  participants,  who  were  displaced  not   just   because   of   their   status   as   sex   workers   but   also   based   on   their   marginal  gender  identity.  Transgender  sex  workers,  in  the  local  context,  tend  to  work  in  quite  well  defined  geographical  areas,  where   regular  and  new  clients   can  seek  out   their  services  with  relative  ease.  The  geographical  displacement  of  the  transgender  stroll  may  increase  the  risk  of  violence  for  transgender  sex  workers  as  disclosure  of  their  gender  identity  in  the  broader  context  of  trans-­‐‑  and  homophobia  can  place  them  at  	   92	  increased   risk   for  potential  violence   (Infante,  Sosa-­‐‑Rubi,  &  Cuadra,  2009;  Poteat   et  al.,  2014).        Hubbard   (1998)   describes   the   policing   of   prostitution   a   spatial   process   that  perpetuates  the  marginal  status  of  those  involved.  In  the  urban  landscape,  territory  is  marked  out  for  those  who  can  legitimately  and  safely  use  it,  while  groups  who  are  outside   the  mainstream  are  continuously  pushed  to   the  margins,  away  from  view.    Social   boundaries   are   constructed   and  maintained   through  geographical   ones   that  signify   distinct  ways   of   life   (Pratt   &  Hanson,   1994).   Thus,   the   geographies   of   sex  work   are   the   outcome   of   a   complex   continuous   struggle   between   different   social  actors,   including   sex   workers,   neighbours   and   businesses,   private   security   and  police   (Hubbard   &   Sanders,   2003;   Sanders,   2004).   Our   findings   indicate   that   this  struggle   is   marked   by   a   significant   power   imbalance   where   neighbourhood  complaints,  rooted  in  stigmatizing  assumptions  about  sex  workers  as  a  threat  to  the  moral  order,  in  practice,  outweigh  the  need  for  protecting  the  working  conditions  of  street-­‐‑based  sex  workers.    For  Parker   and  Aggleton   (2003),   stigmatizing   assumptions   are  not   simply   an  expression  of  individual  attitudes  or  of  cultural  values.  Rather  they  function  at  the  point   of   intersection   between   culture,   power   and   difference,   and   are   central   to   the  constitution  of  the  social  and  moral  order.  Stigmatizing  assumptions  of  sex  workers  	   93	  coupled   with   the   power   imbalance   between   sex   workers   and   other   community  residents   allowed   for   the   displacement   of   sex  workers   from   urban   space,   despite  police  rhetoric  of  increasing  sex  workers’  safety.  Echoing  previous  work  (Hubbard,  1998),  our  findings  further  indicate  that  neighbourhood  renewal  was  directly  linked  to   increased  presence  of   security  guards  and  police.     The   intersection  between  sex  work  related  stigma  and  the  criminalization  of  clients,  despite  police  rhetoric  about  prioritizing   the   safety   of   sex   workers,   allowed   for   the   continued   governance   of  where  sex  work  can  take  place.  Our  findings  highlight  that  despite  the  different  tone  of  the  novel  sex  work  enforcement  policy,   the  power  to  displace  sex  workers  from  the   urban   landscape   remained   ultimately   with   police.   This   allowed   for   the  continued  policing  of   the   social   and  moral  order   in  neighbourhoods  where   street-­‐‑based  sex  work  took  place  and  the  protection  of  property  values  in  newly  gentrified  urban   areas.   In   effect,   the   status   quo,   which   renders   sex   workers   susceptible   to  displacement   from   the   urban   landscape   towards   secluded,   industrial   areas,   was  maintained,   thus  perpetuating  sex  workers  structural  vulnerability  to  violence  and  HIV/STI  infection  (Deering,  et  al.,  2013;  Okal,  et  al.,  2011;  Shannon,  et  al.,  2009).  In   a   policy   framework   that   does   not   allow   for   full   citizenship   entitlement  among   sex  workers,   police   and   neighbourhood   interactions   reify   the   stigmatizing  and   othering   discourses   of   sex   workers   and   continue   to   contribute   to   unsafe  working   conditions.   Building   on   Bruckert   &  Hannem’s  work   (2013),   our   findings  	   94	  indicate   that   coexisting   stigmatizing  assumptions  of   sex  workers   as   ‘risky’   and   ‘at  risk’   are   not   only   an   impediment   to   sex   workers’   civic   rights;   they   are   the   very  foundation  of   regulatory  approaches   that  criminalize  sex  buyers  and  allow  for   the  continued   marginalization   of   sex   workers.   The   very   existence   of   specific   laws   to  regulate   sex   work   speaks   to   the   stigma   associated   with   sex   work   and   the   link  between  sex  work  legislation  and  morality  (Bruckert  &  Hannem,  2013).  In  Canada,  as   in  most   settings   globally,   there   are   already   laws   in   place   for   targeting   various  forms  of  exploitation  and  nuisance  that  may  arise  in  the  context  of  sex  work,  such  as  public  disturbance,  indecent  exhibition,  coercion,  sexual  assault,  trafficking  persons,  extortion,  and  kidnapping.  As  such,  given   the  negative   impact  of   criminalized  sex  work  laws  and  enforcement  practices,  our  findings  lend  further  support  to  calls  for  the   full   decriminalization   of   sex   work   in   Canada,   consistent   with   international  guidelines   by   global   policy   bodies   (Global   Commision   on   HIV   &   the   Law,   2012;  WHO,  2011).    Given   the   intersection   between   regulatory   approaches   and   sex   work   related  stigma,   there   is   an   urgent   need   for   sustained   efforts   to   broaden   the   public  representations   of   sex   workers   to   work   towards   unmasking   and   redressing   the  stigmatizing  assumptions  of  sex  workers  as  victims  and  deviants.    This   study   has   limitations.   The   experiences   of   stigma   and   criminalization  experienced  by  participants  of  this  study  may  not  be  restricted  to  sex  work  and  may,  	   95	  therefore,   be   influenced   by   the   wider   stigmatization   of   women   who   are  marginalized  by  other   forms  of  social  and  structural   inequity  such  as  poverty  and  racism.  The  lived  experiences  of  participants  represented  in  this  study  reflect  street-­‐‑involved   sex   workers   and   may   not   be   representative   of   the   experiences   of   sex  workers  in  other  segments  of  the  industry.    In   sum,   intersecting   regimes   of   criminalization   and   stigmatization   serve   to  increase   the   structural   vulnerability   of   street-­‐‑based   sex   workers,   including   the  ability   to   access   police   protection   in   case   of   violence   and   continued   displacement  from   the   urban   landscape.   Our   findings   highlight   that   the   criminalization   of   sex  work  and   the   co-­‐‑existing   stigmatizing  assumptions  of   sex  workers   as   ‘at   risk’   and  ‘risky’,  both  victims  and  victimizers,  deny  sex  workers  the  opportunity  to  engage  as  citizens,   facilitate   the   removal   of   sex   workers   from   public   space   and   perpetuate  labour   conditions   that   render   sex  workers   at   increased   risk   for   violence   and  poor  health.    	   96	  Chapter  4:  NEGOTIATING  SAFETY  AND  SEXUAL  RISK  REDUCTION  WITH  CLIENTS  IN  UNSANCTIONED  SAFER  INDOOR  SEX  WORK  ENVIRONMENTS    4.1  Introduction  Macro-­‐‑level  factors,  including  sex  work  legislation,  policing  and  economic  constraints,  both  shape  and  interact  with  the  social,  policy,  and  physical  features  of  particular  sex  work  environments.  Increasing  research  calls  for  environmental-­‐‑structural  interventions  to  promote  HIV  and  STI  reduction  and  prevent  violence  against  sex  workers  (Blankenship,  Friedman,  Dworkin,  &  Mantell,  2006;    Parker,  Easton,   &  Klein,   2000).   Environmental-­‐‑structural   interventions  move   beyond   a  sole   focus   on   individual-­‐‑level   risks   associated  with   sex  work   to  understanding  risk  as  embedded  in  contextual  factors,  gendered  power  dynamics  and  access  to  resources   (Blankenship,  et  al.,  2006;  Farmer,  Connors,  Simmons,  2005;  Parker  et  al.,   2000;   Zierler   &   Krieger,   1997).   Therefore,   environmental-­‐‑structural  interventions   seek   to   create   ‘enabling   environments’   that   are   conducive   to  reducing   violence   and   sexual   risks   in   the   context   of   sex  work   (Kerrigan   et   al.,  2003;  Moore  &  Dietze,  2005;  T.  Rhodes,  2002,  2009).    Previous   work   in   the   Dominican   Republic   indicated   that   brothels   with  environmental-­‐‑structural   support,   including   supportive   management   policies,  security  measures  and  access   to  HIV/STI  prevention   resources,  were  associated  	   97	  with   sexual   risk   reduction,   including   consistent   condom   use   (Kerrigan   et   al.,  2003;   Kerrigan,   et   al.,   2006).   Similarly,   legalized   brothels   in   the   US   state   of  Nevada   were   found   to   reduce   the   risk   of   physical   and   sexual   violence  experienced  by  sex  workers  (Brents  &  Hausbeck,  2005).    However,   to   date,   the   adaptation   of   environmental-­‐‑structural   HIV   and  violence  prevention   interventions   for   street-­‐‑involved   sex  workers   to  developed  country  settings  have  been  scarce  and  their  formal  implementation  continues  to  be  hampered  by  prohibitive  sex  work   laws   in  many  settings.  While   the  buying  and  selling  of  sex  itself  is  legal  in  Canada,  the  Criminal  Code  of  Canada  prohibits  ‘communication   for   the   purposes   of   selling   sex’,   the   operation   of   a   ‘bawdy  house’,   and   ‘living   off   the   avails   of   prostitution’   (Goodyear   &   Cusick,   2007;    Shannon,  Strathdee,  et  al.,  2009).  This  makes  it  effectively  impossible  to  engage  in  sex  work  legally2.       Despite  a  prohibitive  legal  environment,  various  unsanctioned  indoor  sex  work   environments   have   long   existed   across   Canadian   cities   in   the   form   of  licensed  body  rub  or  massage  parlours  (Anderson,  et  al.,  in  press,  Handlovskey,  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  2  Data   for   this   study   was   collected   in   the   context   of   an   ongoing   Constitutional   challenge   of  Canada’s   sex   work   laws   but   prior   to   the   official   implementation   of   the   VPD   sex   work  enforcement  policy  that  was  described  in  detail  in  the  previous  Chapters.  However,  Canada’s  sex  work  laws  remained  in  place  unchanged  during  the  course  of  this  study.   	  	   98	  et  al.,   2012).  More   recently,   an   innovative   indoor   sex  work  environment  model  has  emerged  within  the  context  of  low-­‐‑barrier,  supportive  housing  programs  for  women  in  the  Province  of  British  Columbia  (see  Table  1  for  a  description  of  the  programs).  Herein,  we   report   on   the   findings   of   a   qualitative   interview   study,  examining   the   experiences   of   sex   workers   living   and   working   in   these  unsanctioned   indoor   sex   work   environments.   We   focus   on   how   these  unsanctioned   indoor   sex   work   environments   influence   safety   and   risk  negotiation  with  clients  during  sex  work  transactions.  	   99	  Table  1:  Unsanctioned  Safer  Sex  Work  Environment  Model  The  housing  programs  offer  a  minimal  barrier,  high  tolerance  environment  and  follow  a  women-­‐‑centered  empowerment  and  harm  reduction/health  promotion  philosophy.  Residents  represent  the  most  marginalized,  chronically  homeless  women  in  the  community  who  live  with  trauma,  substance  use  issues  and  support  themselves  through  sex  work.    Resident  guest  policies  reflect  the  needs  of  women  who  are  working  in  the  street  level  sex  trade  and  thus  allow  women  to  bring  clients  to  their  rooms  for  transactional  sex  encounters.  Environmental-­‐‑structural  policy  supports  include:    1.Building/  management  policies:    o Women  only  buildings  (including  residents,  staff  and  management)  o Women  are  allowed  to  bring  clients  (sex  buyers)  into  their  rooms  during  the  facilities  guest  hours  (which  are  depending  on  the  program  between  8am-­‐‑2am  or  10am  to  11pm)    o Clients  are  required  to  register  at  the  front  desk  (one  program  requires  photo  ID)  o Women  are  not  allowed  to  have  more  than  one  guest  at  a  time  2.  Environmental  Cues/  Security  measures    o ‘Bad  date’  reports  (descriptions  of  recent  client  violence)  are  posted  at  the  building  entrance  o A  camera  system  is  in  place  throughout  the  hallways  of  the  buildings  to  allow  staff/residents  to  detect  incidents  of  violence  o In  case  of  altercations  residents  or  staff  will  ask  visitors  to  leave  or  call  police  to  remove  violent  clients    3.  Access  to  Health,  Prevention  and  Harm  Reduction  Resources  o Condoms,  syringes  and  other  harm  reduction  paraphernalia  are  available  onsite  o Medication  dispension  onsite  (including  methadone  and  antiretroviral  therapy)    o GPs,  nurses,  and  mental  health  workers  regularly  visit  the  buildings  	   100	  4.2  Methods    We  drew  upon  data   from  39   in-­‐‑depth  qualitative   interviews  and  6   focus  groups   conducted   with   residents   of   the   two   housing   programs   (described   in  Table   1)   from   July   2009   to  March   2010.  All   residents   of   the  housing  programs,  who   were   willing   to   participate   and   met   the   minimum   criterion   of   having  engaged   in   sex  work   in   the  previous  month,  were   interviewed.   Interviews  and  focus  groups  were  conducted  by  two  experienced  interviewers  at  the  study  office  and  all  focus  group  discussions  were  co-­‐‑facilitated  by  a  sex  worker  trained  in  co-­‐‑facilitating  peer  focus  groups.  The  number  of  participants  in  the  6  focus  groups  ranged   from  3   to  6  participants.  The   focus  groups  were   conducted  prior   to   the  interview  phase  of   the  project   to  gain  a  preliminary  understanding  of  women’s  experiences   with   the   housing   programs.   Focus   groups   and   interviews   were  facilitated  using  a  topic  guide  encouraging  broad  discussion  related  to  women'ʹs  experiences   of   living   and   working   in   these   low-­‐‑barrier,   supportive   housing  programs  and  included  areas  such  as  rules  &  regulations,  police  &  staff  relations,  and  safety  &  negotiation.  The  interviews  and  focus  groups  lasted  between  20  and  60  minutes,  were  tape-­‐‑recorded,  transcribed  verbatim,  and  checked  for  accuracy.  All  participants  provided  informed  consent,  and  the  study  was  undertaken  with  ethical   approval   granted   by   the   Providence   Healthcare/University   of   British  Columbia  Research  Ethics  Board.  Participants  were  remunerated  with  a  twenty-­‐‑	   101	  five  Canadian  dollar  stipend.     The   textual   data  was   coded   in   two   stages   guided   by   a   content   analysis  approach.   Initial   codes   were   based   on   key   themes   reflected   in   the   interview  guide   and   in  participants’   accounts   (e.g.   safety   strategies   in  different   sex  work  locales).  More  conceptually  driven  substantive  codes  (e.g.  control,  social  cohesion  and  solidarity)  were  then  applied  to  the  initial  categories/themes.  Three  members  of  the  research  team  discussed  the  content  of  the  interviews  throughout  the  data  collection   and   analysis   processes,   thus   informing   the   focus   and   direction   of  subsequent  interviews  (e.g.,  through  the  addition  of  new  questions  and  probes),  as  well   as  developing  and   refining   the   coding   scheme.  Verbatim  narratives  are  reported  using  pseudonyms  assumed  by  sex  workers  to  ensure  anonymity.  4.3  Results  Our  sample  of  participants  is  representative  of  the  broader  community  of  sex  workers  who  live  in  the  two  supportive  housing  programs  and  consisted  of  38  cisgender  and  one  transgender  women.  The  mean  age  of  participants  was  35,  ranging   from  22   to   58   years.   The  mean  number   of   years   involved   in   sex  work  was  19,   ranging   from  6   to  45  years.  All  participants   reported  a  history  of   illicit  substance  use.  Ninety  percent  of  the  women  reported  current  crack-­‐‑cocaine  use  and   39%   reported   current   heroin   injection.      Thirty   participants   were   of  	   102	  Aboriginal   ancestry,   7   participants  were   Caucasian,   1   participant  was  African-­‐‑Canadian,  and  1  participant  was  of  another  visible  minority.     All   participants   reported   the   risk   of   violence   and   rape   as   a   ubiquitous  feature   of   the   street-­‐‑level   sex   work   environment.   Safety   from   violence   and  increased   control   over   negotiating   sexual   risk   reduction   with   clients   were   the  most  prominent  themes  in  participants’  accounts  of  living  and  working  in  these  unsanctioned  indoor  sex  work  environments.    4.3.1  Environmental-­‐‑structural  safety  mechanisms     Women’s   accounts   of   safety   emphasized   the   role   of   environmental-­‐‑structural  supports  these  low-­‐‑barrier  supportive  housing  programs  offer,  such  as  ‘bad  date’  reports  (descriptions  of  recent  violent  incidents  with  clients  including  descriptions   of   the   offender,   their   car   etc.   published   by   a   local   non-­‐‑profit  organization),   access   to   condoms   and   other   harm   reduction   supplies,  surveillance  cameras  and  support  from  staff  or  police  in  removing  violent  clients  (see  Table  2).  Many  sex  workers  contrasted  the  level  of  safety  in  their  rooms  with  their   limited   options   of   self-­‐‑defense   in   other   sex   work   environments,   such   as  cars,  back  alleys  and  clients’  houses.  The  residents  cited  the  availability  of  up-­‐‑to-­‐‑date  information  regarding  violent  clients  in  the  form  of  bad  date  reports,  which  are   distributed   to   residents   and   posted   by   the   entrance   of   the   buildings   as  	   103	  contributing   to   an   increased   sense  of   safety.  This   information  was   said   to  help  sex  workers   screen   their   clients   and  was   reported   to   have   led   to   a   number   of  arrests   of  wanted   offenders  who  were   recognized   by   staff   upon   entry   into   the  buildings.  While  bad  date  reports  are  also  integrated  with  other  harm  reduction  services,  a  majority  of  women  noted  that  staff  support  in  recognizing  and  calling  police  on  wanted  offenders  enhanced  their  sense  of  safety.       A   striking   feature  of  many  sex  workers’   accounts  of   the   safety  provided  by   these   unsanctioned   indoor   sex   work   environments   was   a   concern   with  eliminating  some  of   the  anonymity   that  marks  street-­‐‑level   sex   transactions.  Sex  workers  viewed  the  surveillance  cameras  that  are  installed  at  the  entrance  and  in  the   hallways   of   the   buildings   as   important   environmental   safety   mechanisms  that   facilitated   the   identification   and   removal   of   violent   clients.   One   of   the  buildings  also  required  picture  ID  from  all  visitors  entering  the  building.  While  many   residents  welcomed   this   practice,   a  minority   of  women  pointed   out   that  overly  stringent  rules  can  become  a  barrier  to  bringing  clients  to  their  rooms  as  clients  may  not  hold  picture  ID  or  may  be  unwilling  to  disclose  their  identity  to  building  staff  for  fear  of  being  identified  to  police  or  found  out  by  their  partners  and  families.    	   104	     Most   residents   referred   to   being   able   to   count   on   staff   and   police   for  support  in  removing  violent  clients  as  an  important  structural  safety  feature  that  is  not  available  in  other  street-­‐‑level  sex  work  environments,  such  as  in  cars  and  back  alleys.  Although  a   few  exceptions  were   reported,  most  women  welcomed  the  support  of  police  in  removing  violent  clients.  Generally,  participants  reported  that   they  had   the   impression   that  neighbourhood  police  welcomed   them  being  able  to  conduct  ‘dates’  indoors  under  safer  working  conditions:    I  think  that  they  [police]  are  kind  of  happy  that  the  place  is  there   because   it   keeps   a   lot   of   the   girls   off   the   streets.   –  Densie,  Caucasian  I’m  sure  they  [police]  know  about  it.  But  I  think  that  they  like  it  because  it  keeps  the  girls  safer  and  they  don’t  have  to  come   over   so   much.   I   think   they   think   it’s   a   good   thing  ‘cause  a  lot  of  girls  are  a  lot  safer  than  they  would’ve  been.  –  Kitty,  Caucasian  Accordingly,   a   large   proportion   of   residents   reported   improved   relations  with  neighbourhood  police,  and  noted   that  police   tended  to  show  increased  concern  with  their  safety.  Police  just  stop  me  and  then  sometimes  they  ask  if  I’m  okay  or  if  I’ve  had  dates  with  assholes  or  jerks  lately.  They  used  to   hassle   us   a   long   time   ago;   it’s   changed.   –   Penny,  Aboriginal  On  the  corner,  doing  it  in  the  car,  I  used  to  be  scared  all  the  time,  paranoid  about  cops,   scared  about  getting  charged…  It’s  a   lot   easier  now.   I   can  come  and  go  and  cops  actually  say  hi  to  me,  it’s  different.  –  Kristen,  Caucasian    	   105	  Now,  they  just  check  me  out  and  help  me  be  safe.  –  Tonia,  Aboriginal  However,   more   traditional   policing   practices,   such   as   patrolling   and   parking  close   to   well   known   street-­‐‑level   sex   work   areas,   were   said   to   continue   to   be  prevalent  and  negatively  affected  many  women  by  displacing  them  to  outlying  industrial  areas,  where  there  is  little  chance  for  help  or  escape  in  case  of  violence.  These  practices   impacted  women  particularly   negatively  during   the   hours   that  they  were  not  allowed  to  bring  guests  into  their  place  of  residence.  Just  last  night,  police  were  driving  by  every  3-­‐‑5  minutes.  I  kept  on  walking  from  corner  to  corner.  I  was  trying  to  find  a   good   place   for   the   dates   to   pull   over   -­‐‑   they   are   already  freaked   out   as   it   is.   I’m   not   comfortable   working   on   the  corners,   where   police   presence   was   worst.      I   just   like   to  work  on  the  main  drag;  I  don’t  like  to  be  anywhere  secluded  and  dark  either,  it’s  too  scary.  –  Marla,  Aboriginal      I   don’t   know   what’s   going   on   in   their   head   [police],   but  when   I   do   see   them   and   when   they   do   park   somewhere,  where  I  am  trying  to  work,  it  makes  me  uncomfortable  and  annoyed.   Guys   won’t   approach   me   with   the   cops   just  parked   not   too   far.   It   makes   it   harder.   –   Veronica,  Aboriginal       	   106	  Table  2:  Environmental-­‐‑structural  Supports  of  Safer  Indoor  Sex  Work    Environment  Model  –  Sex  Worker  Voices  Bad-­‐‑date  reports  “They  [staff]  really  pay  attention  we  get  all  the  lists  of  all  the  offenders  and  stuff  and   they’re  put  up   [by   the  door]  and  staff   study   them.  One  of   the   staff   caught  one  [a  violent  client].  He  was  a  visitor  in  the  house  and  he  came  in  as  a  date  and  they  called  the  police  and  he  got  arrested.”  –  Kitty,  Caucasian  Camera  Surveillance  “I   prefer   the   date   in   my   place   for   safety   reasons,   you   know.   ‘Cause   there’s  cameras  on  each  floor,  they’re  not  allowed  in  unless  they  have  ID,  their  name  is  written  down,  and,  people  have  seen  you  with  the  guy,  so  he  knows  that  he  can’t  go  and  try  to  do  something  to  me  and  get  away  with  it.”  –  Veronica,  Aboriginal  “In  the  back  alley  or  out  in  the  industrial  area,  the  guy  could  slice  my  throat  open  or  something  and  just  leave  me  there  for  dead.  Nobody  would  ever  know,  but  at  [my  place  of  residence]  they  have  surveillance  cameras,  right?  So  if  anything  ever  did  happen  to  me  that  bad,  god  forbid,  then  they  could  look  on  the  camera  and  say,  “Hey,   that’s   the  guy   that  murdered  S.,  or   the  guy   that  beat   the   shit  out  of  her”  and  then  they  could  print  it  out  and  warn  other  girls  too,  right?”  –  Nancy,  Aboriginal  Call  staff  or  police  “It’s  safer.  I  can  just  yell  for  help  and  you  know,  in  the  alley  you  can’t  really  yell,  you  know?  It’s  hard  to  run  away,  and…  you  don’t  know  whether  they’re  going  to  get  violent  or  something.  There’s  a  lot  more  chance  of  that  outside  than  at  my  place.  [If  it  happened  in  my  room]  I’d  run  for  the  door.  It’s  happened  before,  and  the  staff  have  come  and  they’ve  told  him  to  leave  or  they  even  got  the  police  to  get   him   to   leave.  They  do   that   right   away.   It   took   four   cops   to   get   this   guy   to  leave.  Then  they  barred  him  [from  the  place]”  –  Jane,  Aboriginal  “So  I  told  the  staff  that  he’s  yelling  and  cursing  and  I  haven’t  got  the  money  yet  and  he’s  kind  of  a  bastard.    And,  I  didn’t  know  what  to  do.  They  told  him  that  he  has   to  go  and  he  wouldn’t  go  until   the  police  got   there.     Oh  my  god,  he  could  have  beat  me  up  and  everything…  So  when  police   came   they  asked  him  some  questions  and  it  turned  out  that  he  had  a  warrant  out  for  his  arrest.  So  I’m  like,  ‘oh  my  god’.”  –  Faith,  Aboriginal  	   107	  4.3.2  Informal  safety  mechanisms     Women’s   accounts   indicated   that   the   above   outlined   environmental-­‐‑structural   supports   facilitated   the   institution   of   informal   safety   strategies,  including  sharing  of  information  about  violent  clients,  calling  for  help  from  other  residents,   and   enhanced   opportunity   for   self-­‐‑defence   in   case   of   violence   or  refused   payment   by   clients   (see   Table   3).   The   majority   of   residents’   accounts  indicated   that   a   supportive   indoor   environment,   where   women   can   conduct  ‘dates’,  can  create  a  space  more  conducive  of  sex  workers  standing  together  and  looking   out   for   each   other’s   safety.      Although  most  women   reported   frequent  conflicts,   predominantly   revolving   around   everyday  matters   of   living   in   close  proximity   to   each   other,   the   vast  majority   of  women   emphasized   that  when   it  comes  to  protecting  fellow  residents  from  clients  who  are  violent  or  unwilling  to  pay   for   their   services,   the   residents   will   look   out   for   each   other.   Many   sex  workers  described  how  their  attempts  to  institute  informal  safety  strategies  when  working  on   the   street  had  been   thwarted  due   to   the  pressures  of   the   street   sex  and  drug  scenes.    In   the   back   alley   nobody   cares,   really.  We   just   mind   our  own  business  then  right?  –  Edna,  Aboriginal    It’s   more   about   the   drugs   and   stuff   down   here   [on   the  streets],  like,  nobody  really  helps  anybody  down  here  unless  you  have  dope,  right?  –  Rhonda,  Aboriginal    	   108	  It’s  not  cultivated,  they  don’t  look  out,  some  of  them  won’t  trust  each  other.  It’s  because  a  lot  of  things  can  happen  out  there,  you  know.  A  lot  of  things  can  influence  you  out  there  so  you  got  to  be  really  cautious.  –  Tasha,  Aboriginal       	   109	  Table  3:  Informal  Safety  Mechanisms  Safer  Indoor  Sex  Work  Environment  Model  –  Sex  Worker  Voices  Sharing  information  about  violent  clients  “We  share  advice  on  not  to  let  every  guy  in  the  room.  If  someone  already  had  them  there,  then  they  let  the  other  girls  know  that  it’s  not  safe  for  that  guy  to  be  in  that  room.”  –  Kim,  Aboriginal  “I  tell  all  the  girls  don’t  go  with  that  idiot  in  that  Civic  right  there.  That  idiot  took  advantage  of  me,  tried  to  kill  me,  murder  me…”  Tanisha,  Caucasian  Calling  for  help  from  other  residents  “All  I  have  to  do  is  yell  and  every  girl  in  my  building  will  be  there,  right?  The  guy  gets  scared  and  leaves.  Sixteen  girls  show  up  at  your  door,  banging  on  your  door.    He’s  gonna  go,  right?    People  are  remembered  there  too,  right?”  –  Edna,  Aboriginal  “I   could   scream  and  yell   for  help,   and   I’d  have  help   there  within   seconds.  My  neighbours,  you  know?  It  makes  a  big  difference!  Oh  yeah,  all  I  have  to  do  is  like,  “HELP!”  Boy  oh  boy,  there’d  be  help  right  there.  In  a  second!  Oh  yeah,  when  it  comes   to   that,   it   doesn’t   even   matter   if   you’re   arguing,   or   whatever,   when   it  comes  to  getting  help…doesn’t  matter.  It’s  right  there.  “  –  May,  Caucasian  Self-­‐‑defence  strategies  “I’ve  taken  a  crowbar  after  somebody  already.  He  wasn’t  giving  me  fuck  all  for  cash.    He  started  getting  rough  with  me.    And  I  said,  ‘this  is  my  fucking  house,  man.  I  pay  the  rent  here.    You’re  not  gonna  do  this  to  me.’  So  I  went  around  my  side  of  my  bed  and  I’m  pulling  out  the  crowbar.    And  I  said,  ‘now  you  put  some  money  on  that  fucking  table,  if  you  don’t  have  the  kind  of  cash  then  get  the  fuck  out,  but  you’re  gonna  leave  with  a  fucking  beating.’  You  know,  we  have  to  have  a  safe  environment.    Now  I  do.”    Tasha,  Aboriginal  “I  just  tell  them  to  leave,  ‘cause  I’m  a  big  girl.  I  pull  the  old  psychotic  act,  and  then  they  get  scared  and  run  out  my  door.  I  pull  the  old  knife  out  and  they’re  like,  ‘holy  shit  she’s  got  a  knife  out’.    I’d  never  use  it  on  them,  it’s  just  you  know,  I  like  having  it  there.”  –  Ashlee,  Aboriginal    	   110	  4.3.3  Control  over  negotiating  risk  reduction  in  sex  work  transactions       Women’s   accounts   indicated   that   both   the   structural-­‐‑environmental,   as  well   as   the   informal   safety   mechanisms   facilitated   by   the   indoor   sex   work  environment,  greatly  increase  women’s  control  over  negotiating  risk  in  sex  work  transactions  (see  Table  4).  Women’s  narratives  suggested  that   these  models  can  promote  increased  control  among  sex  workers  over  negotiating  transactions  with  clients  on  their  own  terms,  including  types  of  services  provided,  amount  charged  and  overall  health   and   safety.  Many  described  how   the   control   afforded  by  an  enhanced   sense   of   safety   allowed   them   to   refuse   unwanted   risky   services   that  they  would  have  to  give   in   to   in  other  environments  where  support   from  staff,  other  sex  workers  or  police,  is  not  easily  available  in  case  clients  used  violence  to  force  unwanted  services  such  as,  for  example,  unprotected  sex.    I  like  to  do  it  [a  sex  work  transaction]  on  my  territory.  You  know  that  you’ve  got  people  around  you  that  you  can  count  on.      You   can   stop  when   you  want   to…  Out   there   you’re  like  a  hostage  almost.  You  feel  almost  that  bad  if  you  were  out   there.   You’re   going   to   settle   or   you’re   going   to   put  yourself   in   a   bad   position   maybe.   If   it’s   not   going   good  you’re  stuck  and  that’s  not  a  good  feeling.    You  don’t  want  to  be  isolated  then  you  might  be  willing  to  hurt  yourself  in  order   to   maybe   get   home.   You   maybe   have   to   do   extra  things  just  so  that  you  can  get  home  and  that’s  not  cool.  –  Ashlee,  Aboriginal         	   111	  It  doesn’t  usually  happen  [that  I  go  to  a  guy’s  place]  cause  I’m  at  his  disposal.  I’m  in  his  domain.  Once  the  door  closes  it’s  just  that.    He’s  got  me  cornered.    That’s  it.    When  I  am  in  my  room,  it’s  my  house.    I  ask  him  how  much.    He  tells  you  or  you  tell  him.    I  usually  tell  him,  right.  And  then  we  go  to  our  house.    Do  the  date.    He  pays.    Kick  him  out.    [In  the]   back   alley?     Same   thing.     Do   the  date.      Sometimes   it  doesn’t  always  work  out  though.    Like  I  said,  ‘cause  you’re  vulnerable  right?  It  can  become  very  dangerous  very,  very  quickly.  –  Edna,  Aboriginal  Once  you  get   into  a  guy’s  house  they  can  just...  That’s   it,  you  know.     You  don’t   know  where  you’re  gonna  go.  At   a  guy’s  place  it’s  more  or  less  like,  what  he  says  you  have  to  do,   you   know.   Um.   I   guess   you   just   go   with   uh,   risk.   –  Tamara,  Caucasian    Having  a  safer  indoor  place  to  live  and  work  also  contributed  to  women  feeling  more  dignified.  Many  women  felt  that  being  able  to  bring  clients  to  their  own   place   facilitated   negotiating   the   terms   of   their   sex   work   transactions,  including   condom   negotiation,   as   they   felt   clients   viewed   them   with   more  respect.    Having   a   self-­‐‑respect   looking   place,   a   respectful  environment,  gives  you  a  chance  at  having  a  better  chance  at  him,  treating  you  better  or  maybe  wear  a  condom  ‘cause  he  thinks  you  respect  yourself.  –  Melinda,  Aboriginal       Control  over  sex  work   transactions  was  also   linked   to   the  prices  women  can   charge   for   sexual   services.   A   common   concern   among   participants   was  clients  who  were  unwilling  to  pay  for  the  services  they  received.    	   112	  Some   of   them   don’t   pay.   They’re   like,   ‘I’ll   pay   you   after.’  And  then  they  just  fuck  me  over.  They  just  leave  you  with  nothing   after   they’ve   wasted   your   time   and   do   shit   that  makes  you  feel  little  about  yourself.  –  Keri,  Aboriginal    They   gave  me   two   hundred   and   they   took   it   back.   That’s  just  rape  done  up  fancy.  –  Melinda,  Aboriginal      Having  control  over  price  negotiations  was  facilitated  in  the  indoor  environment  as   women   could   count   on   the   support   of   other   residents   in   case   clients   are  unwilling  to  pay.  If  a  guy  is  unwilling  to  pay,  girls  will  be  opening  the  door  and  coming  to  check  it  out,  and  then  that  date’s  cornered  in  that   room  until   he   pays.      The   girls   take   that   very   serious  that  they  get  paid  for  their  work.  –  Tracy,  Aboriginal     However,   a   few  residents’  narratives  also   revealed  how  a   lack  of   formal  sex   industry   regulations   (e.g.   the   ability   of   sex   workers   to   self-­‐‑organize   in  unions)  can  result  in  undercutting  and  competition  for  dates.    A  working   girl   couldn’t   ask   for   a   better   place   to   be,   you  know.  And  it’s  safe,  except  for  a  lot  of  the  girls  there  charge  so   little  money.  A   lot   of   the  girls   are   charging   ten  dollars  and  I’m  starting-­‐‑I’m  trying  to  keep  my  hundred  dollars  and  up  going,  you  know,  and  it’s  hard  when  the  other  girls  are  undercutting   you   so   badly.   It   becomes   very   frustrating.   –  Denise,  Caucasian       	   113	  4.4  Discussion  Within  a  criminalized  sex  work  environment,  residents’  accounts  describe  how  low-­‐‑barrier  supportive  housing  programs  for  women  can  provide  a  unique  opportunity   to   conduct   sex  work   in   safer,   informally  managed,   indoor   spaces.  This   chapter   demonstrates   that,   despite   the   lack   of   formal   legal   support   for  brothels   in   Canada,   the   environmental-­‐‑structural   supports   afforded   by   these  unsanctioned   indoor   sex   work   environments,   including   surveillance   cameras,  direct  access  to   ‘bad  date’  reports  and  support   from  staff  or  police   in  removing  violent   clients,   were   linked   to   improved   police   relations,   facilitated   the  institution   of   informal   peer-­‐‑safety   mechanisms   and   ultimately,   increased   sex  workers’   control   over   sex  work   transactions.   Thus   the   findings   of   this   chapter  highlight   how   intersecting  physical,   social   and  policy   features   of   a   specific   sex  work  environment   interact   to  shape  the  negotiation  of  safety  and  sexual  risk   in  sex  work  transactions.  The   structural-­‐‑environmental   and   informal   safety   mechanisms   afforded  by   the   indoor   sex   work   spaces   were   linked   to   increased   control   among   sex  workers  over  negotiating  the  types  of  services  provided,  negotiating  condom  use  and   avoiding   violent   perpetrators.   Many   sex   workers   stated   that   the   control  facilitated   by   the   enhanced   safety   allowed   them   to   refuse   unwanted   extra  	   114	  services.   The   significance   of   control   over   transactional   sex   encounters   is  consistent  with   previous  work   that   identified   control   over   client   encounters   as  critical   for  sex  workers   to  achieve  compliance  by  clients,   including  condom  use  (Barnard,  1993;  Sanders,  2004).    Our   findings   are   consistent   with   international   reports   pointing   to   the  benefits   of   safer   sex   work   environment   interventions   (Kerrigan,   et   al.,   2003;  Kerrigan,  et  al.,  2006;  Lippman,  et  al.,  2010;  Lippman,  et  al.,  2012  )  including  the  Songachi   Project   in   India   (Jana,   Basu,   Rotheram-­‐‑Borus,   &  Newman,   2004)   and  managed  sex  work  zones  in  Germany  and  the  Netherlands  (Sanders  &  Campbell,  2007;  Van  Doorninck,  2006).  Our  study  documents  that  being  able  to  conduct  sex  work   transactions   in   safer   indoor   environments   bolstered   solidarity   and   social  cohesion   among   sex   workers   and   allowed   for   informal   peer   support  mechanisms.   Previous   work   in   developing   setting   has   found   a   strong   link  between   social   cohesion   among   sex  workers  with   consistent   condom   use   thus  linking   increased  solidarity  and  social   cohesion  among  sex  workers   to   reduced  risk  for  HIV/STIs  (Kerrigan,  Telles,  Torres,  Overs,  &  Castle,  2008;  Lippman  et  al.,  2010).    Social   cohesion   and   solidarity   among   sex   workers   are   more   difficult   to  advance   in   heavily   policed   and   stigmatized   street-­‐‑level   sex   and   drug  markets  	   115	  (Jana,   et   al.,   2004;   Wojcicki   &   Malala,   2001),   therefore,   safer   indoor   sex   work  environments   have   the   potential   to   empower   women   to   stand   together   and  enforce  safer  working  conditions  for  themselves  and  their  colleagues  (Kerrigan  et  al.,  2014).  Building  on  this  strength  would  include  the  implementation  of  formal  sex   industry   regulations,   developed   in   collaboration   with   sex   workers,   to  counteract   undercutting   and   competition.   (Jana,   et   al.,   2004).   The   striking  overrepresentation   of   women   of   Aboriginal   ancestry   among   those   engaged   in  street-­‐‑level   sex   work   in   Canada   highlights   the   need   for   involvement   of  Aboriginal  women   in   the  development   of   sex  work   regulations   and   ‘culturally  safe’  programs  and  services  for  sex  workers  of  Aboriginal  ancestry  (Anderson  et  al.,  2003;  Culhane,  2003).  Previous  work  in  this  setting,  as  well  as  internationally,  has  documented  that  interactions  between  sex  workers  and  police  are  frequent  and  can  be  violent  (Odinokova,   et   al.,   2014;   Rekart,   2006;   Rhodes,   et   al.,   2008;   Sanders,   2004;    Shannon,  Kerr,  et  al.,  2008).     Police  contact  can  displace  sex  workers  to   isolated  industrial  areas,  where  their  ability  to  escape  violence  and  HIV  risk  was  severely  compromised  (Shannon,  Kerr,  et  al.,  2008;  Shannon,  Kerr,  et  al.,  2009;  Shannon,  Rusch,   et   al.,   2008).  Our   findings   suggest   that  police   relations   and   trust   can  be  improved   through   the   establishment   of   supportive   indoor   sex   work  environments,   where   there   is   a   potential   for   sex   workers   to   see   police   as   a  	   116	  genuine   ally   in   protecting   their   safety,   rather   than   as   a   repressive   and   violent  force   that   targets   both   clients   and   sex   workers   and   hampers   the   income  generation  activities  of  sex  workers.    This   study   has   limitations.   There   is   a   possibility   that   the   views  represented   in   our   sample   are   not   entirely   representative   of   all   residents.   This  study  focused  exclusively  on  the  experiences  of  residents  who  have  been  active  sex  workers   in   the   past  month.   Therefore,   the   views   of   residents  who   are   not  currently   supporting   themselves  with   sex  work   are   not   represented.   Likewise,  some  residents  with  deviating  views  may  have  chosen  not  to  participate.  Finally,  the   influence   of   substance   use   with   clients   during   sex   work   transactions   on  sexual   risk   behaviors   was   not   assessed.   Future   research   is   needed   to   further  explore   the  potential  of   regulated   indoor   sex  work  environments   in   re-­‐‑shaping  client  social  norms  and  attitudes.    In   conclusion,   this   study   highlights   the   urgent   need   to   further   evaluate  safer   indoor   sex   work   environments   as   public   health   and   violence   prevention  intervention,   and   points   to   the   critical   importance   of   removing   the   socio-­‐‑legal  barriers   preventing   the   formal   implementation   of   such   programs,   such   as   the  ability   to   develop   occupational   health   and   safety   standards.   Our   findings  support   the   urgent   need   for   scaling   up   structural   and   environmental  	   117	  interventions   that   facilitate   sex   workers’   capacity   to   negotiate   safety   and   risk  reduction  with  clients  in  sex  work  transactions  within  safer  sex  work  settings.    	   118	  Chapter  5:  CONCLUSION  5.1  Summary  of  Findings     This   dissertation   examined   the   intersecting   influence   of   evolving   policy,  social  and  physical  features  of  the  work  environment  in  shaping  violence  and  HIV  risk  among  street-­‐‑based  sex  workers  in  Vancouver,  Canada.    Chapter  one  presents  a  review  of   the  epidemiological  and  social   science   literature  on  social  and  structural  determinants   of   violence   and   HIV   among   sex   workers   and   lays   out   the   socio-­‐‑ecological,   labour   rights   focused,   conceptual   framework   guiding   this   dissertation,  and   identifies   key   gaps   in   the   existing   literature   that   are   addressed   within   this  dissertation.    Chapter   two   explored   how   a   new   local   enforcement   strategy   that   targets  clients,   but   not   sex   workers,   shaped   sex   workers’   interactions   with   police,  negotiation  of   their  working  conditions  and  sexual   transactions  with  clients.  These  findings   suggest   that   criminalization   and   policing   strategies   that   target   clients  reproduce   the   harms   created   by   the   criminalization   of   sex  workers,   in   particular,  risks   for   violence   and   abuse.   Contrary   to   the   goal   of   criminalizing   clients,   the  findings  of  Chapter  two,  suggest  that  the  criminalization  of  sex  buyers  had  limited  to  no  effect  on  preventing  street-­‐‑based  sex  work  and  did  not  reduce  the  prevalence  of   sex  work  related  violence.  This  chapter  highlights   that,   in  a  policy  environment  	   119	  where  clients  remain  a  target  of  enforcement,  it  continues  to  be  in  the  shared  interest  of   sex  workers   and   clients   to   remain  undetected  by  police,   forcing   sex  workers   to  rush   or   completely   forgo   client   screening,   and   pushing   sex   workers   to   work   in  secluded   areas,   which   directly   reduced   sex   workers’   ability   to   refuse   unwanted  clients  or  services  (e.g.  sex  without  a  condom),  and  thereby  increased  their  risks  for  violence  and  HIV/STI  infection.     Drawing   on   the   concepts   of   structural   vulnerability   and   structural   stigma,  Chapter   three   explored   the   complex   ways   in   which   coexisting   stigmatizing  assumptions  of  sex  workers  as  both  ‘risky’  and  ‘at  risk’   intersect  with  evolving  sex  work   policing   strategies   to   shape   street-­‐‑based   sex  workers’   citizenship   rights   and  experiences   of   violence   and   poor   health.   The   findings   presented   in   Chapter   three  indicated   that,  despite  police   rhetoric  of  prioritizing   the   safety  of   sex  workers,   sex  workers  were  denied   their   citizenship   right   for  police  protection  by  virtue  of   their  ‘risky’  occupation.  The   findings   in  Chapter   three   further  suggest   that   sex  workers’  interactions   with   neighbourhood   residents   were   predominantly   shaped   by   a  discourse  of  sex  workers  as  a  ‘risky’  presence  in  the  urban  landscape  and  police  took  swift  action  in  removing  sex  workers  in  case  of  complaints.  These  findings  brought  to   bear   the   power   imbalance   between   sex   workers,   police   and   neighbourhood  residents   that   profoundly   shaped   sex   workers’   citizenship   rights,   despite   police  rhetoric  of  prioritizing  the  safety  of  sex  workers.    	   120	  Chapter   four   examined   the   influence   of   an   unsanctioned   environmental  intervention   in   the   context  of   low-­‐‑barrier  housing   for  marginalized  women  on  sex  work   transactions.   Specifically,  Chapter   four   investigated  how  unique,   low-­‐‑barrier  housing  programs   for  women,   that  are   functioning  as  unsanctioned  quasi-­‐‑brothels  under   special   needs  housing   regulations,   influence   risk  negotiation  with   clients   in  sex   work   transactions.   Chapter   four   highlighted   how   intersecting   physical,   social  and   policy   features   of   a   specific   sex   work   environment   interact   to   shape   the  negotiation   of   safety   and   sexual   risk   in   sex   work   transactions.   This   chapter  demonstrates  that,  despite  the  lack  of  formal  legal  and  policy  support  for  brothels  in  Canada,   the   environmental-­‐‑structural   supports   afforded   by   these   unsanctioned,  quasi-­‐‑brothels,   including   surveillance   cameras   and   support   from   staff   or   police   in  removing  violent  clients,  were  linked  to  improved  police  relations  and  facilitated  the  institution  of  informal  peer-­‐‑safety  mechanisms.    Collectively,   the   findings  of   this  dissertation  highlight   the   complex  ways   in  which   social   and   structural   factors   such   as   stigma,   evolving   sex  work   legislation,  policing   practices,   and   sex   work   environments   intersect   to   profoundly   shape   the  working   conditions   of   street-­‐‑based   sex   workers,   including   citizenship   and   labour  rights,  violence  and  ill  health.    	   121	  5.2  Unique  Contributions    5.2.1  Unique  contributions  to  social  science  research  on  sex  work     The  studies  that  comprise  this  dissertation  make  several  unique  contributions  to   the   growing   body   of   research   on   how   features   of   the   social   and   structural   sex  work  environment  condition  the  health  and  safety  of  sex  workers.  Collectively,  the  empirical   research   presented   in   this   dissertation   highlights   the   dynamic   and  interconnected   influence   of   societal   perceptions   of   sex  work,   sex  work   legislation,  and  policing  strategies  on  street-­‐‑based  sex  workers’  working  conditions  and  brings  into  focus  how  multiple  interacting  social  and  structural  factors  can  create  a  context  of   vulnerability   to   violence   and  HIV/STI   risks   among   street-­‐‑based   sex  workers.  A  socio-­‐‑ecological   conceptualization   of   violence   and   ill   health   among   sex   workers  moves   beyond   solely   individually   focused   and   behavioural   approaches   that   have  dominated   much   of   public   health   research   on   sex   work   and   facilitates   a   better  understanding  of  the  interconnectedness  of  the  biological  with  social,  political,  legal  and  economic  forces.  This  dissertation  underscores  that,  even  among  street-­‐‑based  sex  workers,  there  is  heterogeneity  in  how  structural  factors  shape  the  working  conditions  for  differently  positioned  groups  of  sex  workers.  For  example,  Aboriginal  sex  workers,  due  to  their  racialized  status  and  history  of  colonization  (Bingham,  et  al.,  2014;  Bourassa,  et  al.,  	   122	  2004;   Culhane,   2003)   experienced   increased   barriers   to   reporting   sex  work   related  violence   to   police,  while   transgender   sex  workers   based   on   their  marginal   gender  identity  (Infante,  et  al.,  2009;  Poteat,  et  al.,  2014),  were  disproportionately  displaced  from   the  urban   landscape   through   forces  of  urban   renewal,  gentrification  and   law  enforcement.  These  findings  underscore  the  value  of  intersectional  approaches  to  sex  work   research   that   consider   the   multiple,   dynamic   and   interconnected   ways   in  which  subordination  affects  sex  workers’   lived-­‐‑experiences  and  ability   to  negotiate  risks   (Hankivsky,   et   al.,   2010;  Katsulis,   2008).   In  designing   structural   interventions  and   reforming   sex   work   laws,   it   is   essential   that   the   impacts   of   interventions   on  specific  subgroups  of  sex  workers  are  carefully  considered.  While  there  is  a  substantial  body  of  social  science  and  epidemiological  research  globally  pointing  to   the  negative   impact  of   legislation  and  policies   that  criminalize  sex  work  on  experience  of  violence  and  poor  health  among  sex  workers  (Decker  et  al.,  2014;  Gruskin,  et  al.,  2013;  Platt,  et  al.,  2013;  Platt,  et  al.,  2007;  Rhodes,  et  al.,  2008;  Shannon  &  Csete,  2010;  Simić  &  Rhodes,  2009;  WHO,  2011),  the  findings  presented  in   Chapter   two   extend   this   literature   by   documenting   how   criminalization   and  policing  of   sex  buyers   shapes   sex  workers’   risks   for  violence   and  poor  health   and  reproduces  the    same  harms  of  policies  that  criminalize  sex  workers.  This  is  the  first  empirical   study   of   how   criminalization   and   policing   of   sex   buyers   shapes   sex  workers’   risks   for  violence  and  poor  health,  outside  of  a  small  body  of   research   in  	   123	  Scandinavia   (Levy,   2011;   Scoular,   2004).   Chapter   two   brings   to   bear   how   policies  that   criminalize   clients   are,   in   practice,   not   reconciled   with   policies   that   aim   to  prioritize   the   safety  of   sex  workers.   Indeed,  Chapter   two  underscored   that  despite  police   efforts   to   prioritize   the   safety   of   sex   workers,   when   clients   remain  enforcement   targets,   sex  workers   continue   to  be   at   increased   risk   for  physical   and  sexual   violence   and  perceive   police   concern   for   their   safety   as   a   form  of   nuisance  and  harassment.    Chapter   three   extends   the   current   social   science   literature   on   sex   work   by  underscoring  the  pivotal  role  of  structural  stigma  in  shaping  sex  workers  structural  vulnerability  to  violence  and  poor  health.  Chapter  three  illustrated  how  mechanisms  of  responsibilization  are  applied  to  sex  workers  through  stigmatizing  discourses  of  sex  workers  as  ‘at  risk’  and  ‘risky’  to  themselves  and  others  through  the  ‘everyday  violence’   of   normalizing   sex   work   related   violence.   The   results   of   Chapter   three,  build  on  Parker  and  Aggleton  (2004)  and  Bruckert  and  Hanem  (2013)  to  outline  how  sex   work   related   stigma   is   not   simply   an   expression   of   individual   attitudes   or  cultural  values  but   is   imbued   in   legal,  policy  and  neighbourhood  responses   to   sex  work  and  takes  shape  in  specific  historical  contexts  of  power  and  social  control.  This  work,  highlights  that  in  a  policy  framework,  that  purports  to  prioritize  the  safety  of  sex  workers  but  does  not  allow  for  full  citizenship  entitlement  among  sex  workers,  	   124	  police   and   neighbourhood   interactions   reify   the   stigmatizing   and   othering  discourses  of  sex  workers  and  continue  to  contribute  to  unsafe  working  conditions.     Previous   work   in   developing   settings   indicated   that   safer   sex   work  environment  interventions  were  linked  to  consistent  condom  use  (Jana,  et  al.,  2004;  Kerrigan,   et   al.,   2003;  Kerrigan,   et   al.,   2006;  Lippman,   et   al.,   2010;  Lippman,   et   al.,  2012   ).   However,   the   adaptation   of   environmental-­‐‑structural   HIV   and   violence  prevention   interventions   for   street-­‐‑involved   sex   workers   to   developed   country  settings   have   been   scarce   and   their   formal   implementation   continues   to   be  hampered   by   restrictive   sex   work   laws.   The   findings   presented   in   Chapter   four  highlight   that   access   to   indoor   sex   work   spaces   with   supportive   management  policies  can  create  safer  working  conditions  for  street-­‐‑based  sex  workers  in  Canada  by   increasing   their   control   over   sex   work   transactions   through   the   institution   of  safety  mechanisms  such  as  security  cameras,  and  staff  support   in  removing  clients  who   do   not   adhere   to   the   terms   of   transaction.   Building   on   previous   work   from  developing  settings  (Kerrigan,  Telles,  Torres,  Overs,  &  Castle,  2008;  Kerrigan,  et  al.,  2014;  Lippman  et  al.,  2010),  the  findings  of  Chapter  four  also  underscores  the  role  of  social  cohesion  in  HIV/STI  prevention  among  sex  workers  in  Canada.  Chapter  four  highlights   that   safer   indoor  workspaces   facilitated   the   institution  of   informal  peer-­‐‑safety  mechanisms,   including   sharing   of   information   about   violent   clients,   calling  	   125	  for  help  from  other  residents,  and  enhanced  opportunity  for  self-­‐‑defence  in  case  of  violence  or  refused  payment  by  clients.    5.2.2   Unique   contributions   of   qualitative   research   to   policy   debates   on   sex   work  legislation  in  Canada  This  dissertation  also  underscored  the  relevance  and  merit  of  policy  focused,  community   engaged,   applied   qualitative   research,   documenting   the   lived-­‐‑experiences   of   street-­‐‑based   sex   workers   and   draws   attention   to   the   value   of  evaluating   ‘natural   experiments’,   such   as   the   implementation   of   a   novel   policing  strategy   or   unsanctioned   safer   sex   work   environments   (Beyrer,   et   al.,   2014).  Qualitative  and  ethnographic  research’s  greatest  potential  contribution  to  sex  work  policy   lies   in   its   representation   of   the   everyday   realities   of   sex  workers,   which   is  often   ignored   in   sex   work   policy   discussions   (Dewey   &   Kelly,   2011).   Indeed,  Chapters   two   and   three   (Krüsi,   et   al.,   2012;  Krüsi,   et   al.,   2014)   of   this   dissertation  have  garnered  significant  attention  from  policy  makers  and  local  and  national  media  outlets  (including  the  Canadian  Broadcasting  Corporation,  The  Globe  and  Mail,  The  National  Post,  CTV).  To  disseminate  the  findings  of  Chapter  two  (Krüsi,  et  al.,  2014)  the  Gender  and  Sexual  Health   Initiative   (GSHI)  held  a  press  conference  on   June  3,  2014,   together  with  our   community  partners  Sex  Workers  United  against  Violence  (SWUAV)  and  Pivot  Legal  Society.  Additionally,  the  findings  of  Chapter  two  (Krüsi,  	   126	  et  al.,  2014),  together  with  a  constitutional  analysis  provided  by  Pivot  Legal  Society  and  SWUAV  (Sex  Workers  United  Against  Violence,  2014),  were  sent  to  all  Senators  and  Members  of  the  Canadian  Parliament  to  inform  them  about  the  potential  impact  of  policy  approaches  that  target  sex  workers’  clients.  The  findings  of  this  study  were  referred   to   repeatedly   in   the   hearings   of   the   Parliamentary   Justice   and   the   Senate  committees   regarding   the  proposed   reform  of   the  Canadian  Prostitution   laws   (Bill  C-­‐‑36)   that   took  place   in   the  summer  of  2014.  Opposition  MPs,  Senators  and  expert  witnesses  referred  to  the  findings  of  this  work  to  call  into  question  the  impact  of  the  proposed  new  legislation.           Similarly,  the  results  presented  in  Chapter  four  have  been  featured  in  a  high  impact,   first-­‐‑authored   American   Journal   of   Public   Health   publication   (Krüsi,   et   al.,  2012).  This  work   led   to   separate  policy  briefs   to   the  BC  Ministers   of  Housing   and  Health,  the  Chief  of  the  Vancouver  Police,  and  the  Mayor  of  the  City  of  Vancouver.  This   publication   has   been   submitted   to   the   Supreme   Court   of   Canada   as   expert  evidence,   and   was   cited   several   times   during   the   June   2013   Supreme   Court   of  Canada  hearing  regarding  the  constitutionality  of  Canada’s  sex  work  laws.  Finally,  this  work  was  also  referred  to  numerous  times  in  the  hearings  of  the  Parliamentary  Justice   committee  and   the  Senate   committee   regarding   the  proposed   reform  of   the  Canadian   Prostitution   laws   (Bill   C-­‐‑36).   The   research   presented   in   this   dissertation  clearly   demonstrates   the   policy   relevance   of   qualitative   research   and   underscores  	   127	  the  value  of  qualitative  research  in  contributing  to  strategic  litigation  that  documents  human  rights  violations  by  the  judiciary  (Centre  for  Strategic  Litigations,  2014).      5.3  Limitations  Although   the   limitations   of   the   studies   that   comprise   this  dissertation  were  described   in   detail   in   each   of   the   empirical   chapters,   several   limitations   spanning  these   studies   should   be   highlighted.   The   lived   experiences   of   participants  represented   in   this   study   reflect   street-­‐‑involved   sex  workers   living   in  poverty  and  are   not   representative   of   the   experiences   of   sex  workers   in   other   segments   of   the  industry.  However,  given  that  evidence  has  consistently  shown  that  stigmatization,  criminalization  and  policing  disproportionately  harm  street-­‐‑based  sex  workers,   the  narratives   presented   in   this   dissertation   provide   critical   evidence   regarding   the  intersecting   influence   of   evolving   policy,   social   and   physical   features   of   the  work  environment   in   shaping  violence  and  HIV   risk  among   street-­‐‑based   sex  workers   in  Vancouver,  Canada.  Also,   the  findings  presented  in  this  dissertation  represent   the  experiences  of  cis-­‐‑  and  transgender  women  sex  workers.  Further  work  is  needed  to  examine  how  evolving   sex  work  policies   and   societal  perceptions   shape   the   experiences  of  male  identified  sex  workers  and  of   those   sex  workers  who  occupy  marginalized  gender  identities  and  sexualities  including  lesbian  and  gay  sex  workers.        	   128	  This  dissertation   reflects   the   contextual   forces   operating  within   this   specific  socio-­‐‑political   sex  work   context,  described   in  detail   in   the   introductory  Chapter  of  this   thesis,  and  might  not  be   fully   transferable   to  other   settings.     Although  similar  social,   structural   and   environmental   factors   may   operate   in   some   settings,   the  interactions  among   these  historical   and  contextual   forces  unquestionably  vary  and  pose  unique  opportunities  and  challenges  for  structural  and  legislative  change.    Moreover,   the   influence   of   different   types   of   client   relationships   e.g.   with  regular   clients   versus   one   time   clients   on   experiences   of   violence   were   not  considered.  Also,  this  dissertation  focuses  on  experiences  of  violence  in  the  context  of  sex  work  transactions  and  did  not   take   into  consideration  how  gendered  power  imbalances  in  intimate  relationships  shape  sex  workers  experiences  of  violence  and  poor  health.    Finally,  experiences  of  stigma  and  criminalization  experienced  by  participants  of   the  studies  presented   in   this  dissertation  may  not  be   restricted   to  sex  work  and  may,   therefore,   be   influenced   by   the   wider   stigmatization   and   criminalization   of  women  who  live  in  poverty.  Also,  despite  careful  attention  to  temporality   in  semi-­‐‑structured  interviews,  some  participants,  especially  those  who  had  been  involved  in  street-­‐‑based   sex   work   for   many   years,   might   have   temporally   conflated   some  experiences  of  stigma  and  policing.    	   129	  5.4  Recommendations     The   chapters   that   comprise   this   dissertation   offer   a   number   of   concrete  suggestions   and   recommendations   to   policy   makers   regarding   how   public   policy  governing  sex  work  can  improve  the  working  conditions,  health  and  safety  of  street-­‐‑based   sex   workers.   While   specific   recommendations   have   been   outlined   in   each  chapter,  there  are  several  important  recommendations  worth  highlighting.  First,  the  studies   presented   in   this   dissertation   raise   serious   questions   regarding   the  implementation  of   legislative  approaches   that  criminalize  sex  workers’  clients.  The  findings   of   this   dissertation   indicate   that   the   criminalization   of   sex   buyers   risks  reproducing  the  devastating  harms  to  health,  safety  and  human  rights  created  by  the  criminalization   of   sex  workers.   Therefore,   the   findings   of   this   dissertation   caution  against   the   implementation   of   laws   that   criminalize   clients   as   suggested   by   the  proposed  ‘Protection  of  Communities  and  Exploited  Persons  Act’  (Bill  C-­‐‑36)  that  has  been  put  forward  by  the  Conservative  Canadian  Government  in  June  2014.    Second,  this  dissertation  demonstrates  that  there  is  an  urgent  need  to  expand  access   to   safer   indoor   sex   work   environments   for   marginalized,   predominantly  street-­‐‑based,   sex   workers.   The   work   presented   in   this   dissertation   points   to   the  critical   importance   of   removing   the   socio-­‐‑legal   barriers   preventing   the   formal  implementation  of  environmental  interventions,  such  as  the  implementation  of  safer  	   130	  indoor  sex  work  environments  with  structural  supports,   to  ameliorate  the  working  conditions   of   street-­‐‑based   sex   workers.   Regretfully,   the   proposed   sex   work  legislation   in   its   current   form   is   expected   to   limit   sex   workers’   ability   to   work  effectively   in   safer   indoor   spaces   by   preventing   sex   workers   from   working   with  others,   such   as   receptionists   and   security   guards.   This   is   due   to   the   proposed  Criminal   Code   provision   that   criminalizes   commercially   benefiting   from   the  proceeds  of  prostitution  by  a  third  party.  Additionally,  the  proposed  criminalization  of   clients   further   precludes   the   implementation   of   safer   indoor   sex   work  environments  due  to  a  predictable  reluctance  of  potential  clients  to  frequent  locales  where  sex  work  is  known  to  take  place  and  where  police  could  easily  intercept  them.  This  is  likely  to  drive  sex  workers  underground  (Goodyear  &  Weitzer,  2011)  which,  as  highlighted   in   the   findings  of   this  dissertation,  perpetuates  violence  against   sex  workers  and  profoundly  limits  their  ability  to  negotiate  their  health  and  safety.    Third,   the   work   presented   in   this   dissertation   also   highlights   the   need   for  enduring   change   in   how   sexual   labour   is   conceptualized   in   public   discourse.   The  findings  of  this  dissertation  highlight  how  stigmatizing  assumptions  of  sex  workers  are  at  the  core  of  legislative  approaches  that  criminalize  sex  work  and  contribute  to  rights   violations   of   sex   workers   and   unsafe   working   conditions,   including   being  unable   to  access  police  protections  and  being  displaced   from  the  urban   landscape,  by  police,  community  protesters  and  other  forces  of  urban  gentrification.  Therefore,  	   131	  there   is   a  need   for   sustained   efforts   to   redressing   the   stigmatizing   assumptions  of  sex  workers   towards  an  understanding  of   sex  work   in  a   labour   context  where   sex  work   is   a   legitimate   form   of   income   generation   and   not   a   mark   of   stigma.   This  includes  a  move  away  from  conceptualizing  sex  workers  as  victims  and  deviants,  as  is  evident  in  Canada’s  proposed  prostitution  act,  that  is  tellingly  termed  ‘Protection  of  Communities  and  Exploited  Persons  Act’   –  a  name,   that  neatly   summarizes   the  government’s  conceptualization  of  sex  workers  as   ‘risky’   to   their  communities  and  themselves   and,   at   the   same   time,   as   ‘at   risk’   of   exploitation.  The   emphasis   of   the  proposed   legislation   is   on   the   forced   savior   of   sex  workers   from   themselves.   The  findings  of   this  dissertation  caution  against   such  an  approach  and   further  validate  the  need  to  confer  full  citizenship  rights  to  sex  workers,  including  labour  rights  and  protections,   and   unconditional   access   to   police   protections   and   legal   recourse   in  order  to  facilitate  the  health  and  safety  of  sex  workers.  In   New   Zealand   where   sex   work   has   been   decriminalized   since   2003,  workplace  health   and   safety   standards  have  been   established   in   consultation  with  sex   workers,   and   sex   workers   can   bring   employment   complaints   to   governing  bodies  (Goodyear  &  Weitzer,  2011).  The  New  Zealand  Prostitution  Reform  Act  treats  sex  workers  as  full  citizens  with  rights  and  responsibilities.  Sex  work  is  regulated  in  the   same   manner   as   any   other   business,   by   regulating   its   commercial   practice  through   standard   employment   Health   and   Safety   regulations;   regulating   the  	   132	  location  of   commercial   sex  establishments   through  zoning  by-­‐‑laws;  and  specifying  the  health  and  safety  obligations  of  managers  and  workers.  Regulating  sex  work  as  any   other   business   in   the   service   industry   has   significantly   reduced   the   structural  stigma   of   sex   work   in   New   Zealand   (Bruckert   &   Hannem,   2013).   Although  decriminalization  of  sex  work  is  by  no  means  a  panacea,  there  is  significant  evidence  to   suggest   that,   in   New   Zealand,   where   sex   work   has   been   decriminalized   since  2003,  it  has  created  improved  working  conditions  for  sex  workers  of  all  segments  of  the   industry,   including   increased   ability   to   report   violence   to   police   (Abel,  Fitzgerald,  &  Brunton,  2009).    Consistent   with   international   guidelines   by   global   policy   bodies   (Global  Commision  on  HIV  &  the  Law,  2012;  WHO,  2011)  and  recommendations  by  public  health  experts  and  human  rights  advocates  (Beyrer  et  al.,  2014),  the  collective  work  presented   in   this  dissertation  points   to   the  need  to   fully  decriminalize  sex  work   in  Canada.  This  approach  has  the  potential  to  counteract  structural  stigma  and  reduce  the  structural  vulnerability  of  sex  workers   in  Canada  by  conferring  full  citizenship  rights  and  responsibilities  to  sex  workers,  including  access  to  police  protection,  legal  recourse  and  labour  rights.        	   133	  5.5  Future  Research  Given   that   Canada   is   currently   at   the   precipice   of   change   regarding   its  legislative  approach  to  sex  work,  there  is  a  critical  need  for  ongoing  qualitative  and  quantitative   documentation   of   the   impact   of   legislative   change   on   sex   workers  working   conditions,   health,   safety   and   wellbeing.   This   research   can   provide   the  basis   for   evidence-­‐‑based   sex   work   policy   or   inform   strategic   litigation   should  another  constitutional  challenge  of   the  reformed  sex  work   legislation  be  necessary.  The   previous   constitutional   challenge   on   sex   work   laws   has   demonstrated   the  pivotal   role   of   scientific   research   in   strategic   litigation.   The   presentation   of  epidemiological  and  social  scientific  research  documenting  the  negative   impacts  of  the   previous   sex   work   legislation,   on   the   health   and   safety   of   sex   workers   has  significantly   contributed   to   the   Supreme  Court   of  Canada  decision   to   strike  down  the  laws  and  deem  them  unconstitutional  (Canada  Attorney  General  v.  Bedford,  2013).  This   dissertation   has   focused   exclusively   on   the   experiences   of   cis-­‐‑   and  transgender  women.  There  is  an  urgent  need  to  better  understand  the  experiences  of  male  sex  workers,  as  well  as  those  who  occupy  other  gender  positions  (Poteat,  et  al.,  2014;  Beyrer,  et  al.,  2014)  .  Future  research  should  focus  on  how  legislative  changes  to   sex  work   laws   shape  male   sex  workers  working   conditions,   health   and   safety.  Currently,   the  male   and   transgender   sex  workers  have  been   conspicuously   absent  	   134	  from  public  deliberations  of  the  novel  sex  work  legislation  that  has  been  strategically  centered   on   debates   around   how   sex   work   cannot   be   tolerated   in   a   society   that  values  gender  equality.    Additionally,   there   is   a  need   to   further   evaluate   the   impact   of   evolving   sex  work   policies   on   other   sectors   of   the   sex   industry,   including   women   working  independently  from  their  homes,  in  massage  parlours,  and  through  escort  agencies.  This   research   will   aid   a   broader   understanding   of   the   impact   of   stigma   and  prohibitive   sex   work   policies   on   sex   workers   and   contribute   to   a   more   nuanced  understanding  of  the  heterogeneous  group  of  people  who  engage  in  sexual  labour.  Finally,   future   research   should   include   the   voices   of   sex   buyers,   who   have  also   been   largely   absent   from  public   debate   regarding   the   regulation   of   sex  work  and,   aside   from   a   few   notable   exceptions,   have   been   absent   from   the   research  agenda   on   sex   work   (Cook,   2014;   Lowman   &   Atchison,   2006;   Sanders,   2009b).   A  research   focus   on   sex   workers’   clients   will   provide   important   insights   on   how  stigma  and  evolving  sex  work  policies  shape  sex  buyers  experiences  and  risks  in  the  sex   industry   and   will   provide   important   insights   into   the   social   and   relational  dimension  of  negotiating  sex  work  transactions,  including  condom  use.        	   135	  5.6  Conclusion  Collectively,   the   findings  of   this  dissertation  highlight   the   complex  ways   in  which   social   and   structural   factors   such   as   stigma,   evolving   sex  work   legislation,  policing   practices,   and   sex   work   environments,   intersect   to   shape   the   citizenship  rights   and   working   conditions   of   street-­‐‑based   sex   workers,   including   workplace  violence,  health 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