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Displacement, urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort.

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  1. Displacement, urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort Shira M. Goldenberg,1,2 Ofer Amram,3 Melissa Braschel,1 Sylvia Machat,1 Kate Shannon,1,4 on behalf of the AESHA Team 1. Gender and Sexual Health Initiative 2. Faculty of Health Sciences, Simon Fraser University 3. Elson S. Floyd College of Medicine, Washington State University 4. Faculty of Medicine, University of British Columbia 22nd International AIDS Conference, July 25, 2018 I have no conflicts of interest to declare

  2. Background • Objectives: • (1) Describe changes in social geography of work & living environments and service access among sex workers following gentrification, and • (2)model impacts of exposure to the gentrification period (2014) on service utilization • Mounting interest in better understanding the impact of social geography in HIV inequities • Prior research shows that policing, stigma, community harassment can displace sex workers to unsafe environments • Elevated HIV/STI risks, reduced health access • Marked increases in gentrification in Vancouver in recent years (2010-onwards) • Downtown Eastside (DTES) particularly impacted • Significant community concerns (housing, safety) • Little known about impacts on work/living environments or health access for sex workers Yolande Cole, Georgia Straight, 2011

  3. An Evaluation of Sex Workers’ Health Access Methods • Community-based cohort of >900 sex workers • Involves experiential staff + >15 community partners • Eligibility: Women (incl trans), age≥14, SW in last month • Time-location sampling and outreach • Street, indoor, and online venues across Metro Vancouver • Semi-annual questionnaire and voluntary HIV/STI/HCV testing, treatment, and referral • Before-and-after GEE analysis + GIS mapping • Data sources: AESHA cohort + publicly available land use data • Exposure: Gentrification (2014) vs. Pre- Gentrification (2010) • Outcomes: Use of HIV/STI testing, SRH and sex work services Funding: NIH R01DA028648, Mac AIDS, CIHR; PI: Kate Shannon, Co-PI: Shira Goldenberg

  4. Changes in Patterns of Land Use and Sex Workers’ Neighbourhood of Residence Between 2010 and 2014 Fig 1. Changes in Patterns of Land Use in Vancouver, 2010 and 2014 Fig 2. Neighbourhood In- and Out-Migration amongst SWs (2010-2014) Data source: DMTI Route Logistics Land Use, City of Vancouver, Jan 2010-Dec. 2014. Data source: AESHA questionnaire (n=136 sex workers) Variable: Changed primary place of residence between 2010 and 2014

  5. Changes in Uptake of HIV, STI, and Sexual Health Services Between 2010 and 2014 (n=203) Note: All comparisons statistically significant in bivariate GEE analysis at p<0.001

  6. Gentrification Period (2014) Linked to Declines in Utilization of HIV, STI, SRH and Sex Work Services Decreased uptake of services linked to period of unprecedented gentrification in Vancouver’s DTES Despite increased HIV test-and-treat efforts in Vancouver May be attributable to displacement from areas of service concentration Efforts to promote access to safer work/living environments and support sex worker-led and specific services urgently needed *In last 6 months 1n=200; 2n=198; 3n=202; 4n=202 Note: Separate multivariable confounder GEE logistic regression models were built for each outcome. Variables considered in all models: HIV status, homelessness, non-injection drug use, place of service.

  7. Acknowledgements We gratefully acknowledge the expertise and contributions of our participants. Research/Administrative staff: Sarah Moreheart, Jennifer Morris, Brittany Udall, Minshu Mo, Sherry Wu, Sylvia Machat, Alka Murphy, Jenn McDermid, Emily Leake, Anita Dhanoa, Maya Henriquez, Nina Brown, Carly Glanzberg, Abby Rolston, Peter Vann, Jill Chettiar, and Colette Ryan. Community Advisory Board: WISH, SWUAV, SWAN, PACE, HUSTLE/HiM, Options for Sexual Health, Vancouver Coastal Health, BCCDC Street Nurses, ATIRA, RainCity, Pivot Legal Society, Positive Women’s Network, YouthCO, Canadian HIV/AIDS Legal Network Funding: National Institutes of Health (R01DA028648), Canadian Institutes of Health Research Foundation and New Investigator Awards, MacAIDS, Open Society Foundations Contact: gshi-sg@cfenet.ubc.ca @GSHI_research

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