Canadian Journal of Public Health

, Volume 110, Issue 5, pp 575–583 | Cite as

Sex workers’ experiences and occupational conditions post-implementation of end-demand criminalization in Metro Vancouver, Canada

  • Sylvia Machat
  • Kate Shannon
  • Melissa Braschel
  • Sarah Moreheart
  • Shira M. GoldenbergEmail author
Quantitative Research



In 2014, Canada introduced end-demand criminalization (the Protection of Communities and Exploited Persons Act (PCEPA)), criminalizing purchase of sexual services while leaving the sale of sex legal. We assessed factors correlated with self-reported changes in working conditions post-PCEPA among sex workers (SWs) in Metro Vancouver.


Post-PCEPA data for one year were drawn from a community-based cohort of SWs. We analyzed self-reported changes in working conditions among 299 participants who worked prior to PCEPA and were asked about working conditions post-PCEPA. Multivariate GEE analysis evaluated factors correlated with negative changes post-PCEPA, including reduced capacity to screen clients and reduced access to workspaces/clients.


Most (72.2%) experienced no change in working conditions, and 26.4% reported negative changes (e.g., reduced ability to screen clients or reduced access to workspaces/clients). Reporting negative changes was correlated with being an im/migrant to Canada (adjusted odds ratio (AOR) 2.79, 95% CI 1.59–4.92) and recent physical workplace violence (AOR 4.01, 95% CI 1.12–14.40). In sub-analysis, physical/sexual workplace violence (AOR 3.77, 95% CI 1.17–12.16) and living in the suburbs of Richmond/Burnaby (AOR 2.81, 95% CI 1.15–6.84) correlated with reduced screening capacity; incarceration (AOR 2.98, 95% CI 1.04–8.57) and being an im/migrant (AOR 2.39, 95% CI 1.14–4.99) correlated with reduced access to workspaces/clients.


Most SWs reported no change in working conditions and one quarter reported negative changes, suggesting that PCEPA may be failing to advance sex workers’ safety. Im/migrants, women experiencing workplace violence, and those facing criminalization were most likely to report negative impacts. Decriminalization of all aspects of sex work is needed to support well-being, health, and safety.


PCEPA Sex work Immigration Nordic model Criminalization Occupational health 



Depuis 2014 (avec la Loi sur la protection des collectivités et des personnes victimes d’exploitation, LPCPVE), le Canada criminalise la « demande finale » de services sexuels en sanctionnant l’achat de tels services tout en dépénalisant la vente de relations sexuelles. Nous avons évalué les facteurs corrélés aux changements autodéclarés des conditions de travail post-LPCPVE des travailleuses du sexe (TS) du District régional du Grand Vancouver.


Une année de données post-LPCPVE proviennent d’une cohorte communautaire de TS. Nous avons analysé les changements autodéclarés dans les conditions de travail de 299 participantes ayant travaillé avant la LPCPVE, à qui nous avons posé des questions sur leurs conditions de travail après la LPCPVE. Au moyen d’une analyse multivariée avec des équations d’estimation généralisées (EEG), nous avons évalué les facteurs corrélés aux changements négatifs après la LPCPVE, dont la capacité réduite de sélectionner les clients et d’accéder aux espaces de travail ou aux clients.


La plupart des répondantes (72,2 %) n’ont connu aucun changement de leurs conditions de travail, et 26,4 % ont fait état de changements négatifs (p. ex. la capacité réduite de sélectionner les clients ou d’accéder aux espaces de travail ou aux clients). La déclaration de changements négatifs était corrélée au statut de migrante ou d’immigrante au Canada (rapport de cotes ajusté (RCa) 2,79, IC 95% 1,59-4,92) et à la violence physique récente au travail (RCa 4,01, IC 95% 1,12-14,40). Dans nos sous-analyses, la violence physique ou sexuelle au travail (RCa 3,77, IC 95% 1,17-12,16) et le fait d’habiter en banlieue, à Richmond ou Burnaby (RCa 2,81, IC 95% 1,15-6,84), étaient corrélés avec une capacité de sélection réduite; l’incarcération (RCa 2,98, IC 95% 1,04-8,57) et le statut de migrante ou d’immigrante (RCa 2,39 IC 95% 1,14-4,99) étaient corrélés à l’accès réduit aux espaces de travail ou aux clients.


La plupart des TS n’ont déclaré aucun changement de leurs conditions de travail, mais le quart ont fait état de changements négatifs, ce qui indique que la LPCPVE pourrait ne pas améliorer la sécurité des travailleuses du sexe. Les femmes migrantes ou immigrantes, les femmes ayant subi de la violence au travail et celles confrontées à la criminalisation étaient les plus susceptibles de faire état d’effets nuisibles. Une décriminalisation de tous les aspects du travail du sexe est nécessaire pour favoriser le bien-être, la santé et la sécurité.


LPCPVE Prostitution Immigration Modèle nordique Criminalisation Santé au travail 



We thank all those who contributed their time and expertise to this project, particularly participants, AESHA community advisory board members and partner agencies, and the AESHA team, including Sarah Moreheart, Jennifer Morris, Brittney Udall, Jane Li, Minshu Mo, Rachel Nicoletti, Emily Leake, Anita Dhanoa, Alka Murphy, Jenn McDermid, Tave Cole, Jaime Adams, Chrissy Taylor, Tina Ok, Emily Groundwater, Heidi Safford, Emily Sollows, Ray Croy. We also thank Abby Rolston, Peter Vann, Erin Seatter, and Patricia McDonald for their research and administrative support.

Funding information

This research is supported by the US National Institutes of Health (R01DA028648), a Canadian Institutes of Health Research Foundation Grant, MacAIDS, and the Canadian Institutes of Health Research (201610PJT- 377304). SG is partially supported by NIH and a CIHR New Investigator Award. KS is partially supported by a Canada Research Chair in Global Sexual Health, NIH, and HIV/AIDS and Michael Smith Foundation for Health Research.

Compliance with ethical standards

The study holds ethical approval through Research Ethics Boards at Providence Health Care/University of British Columbia and Simon Fraser University.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

41997_2019_226_MOESM1_ESM.doc (37 kb)
ESM 1 (DOC 37 kb)


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Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  1. 1.Centre for Gender & Sexual Health EquitySt. Paul’s HospitalVancouverCanada
  2. 2.Faculty of Medicine, St. Paul’s HospitalUniversity of British ColumbiaVancouverCanada
  3. 3.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  4. 4.Division of Global Public Health, Department of MedicineUniversity of CaliforniaSan DiegoUSA

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