@article {Goldenbergbmjsrh-2019-200408, author = {Shira Goldenberg and Ruchi Liyanage and Melissa Braschel and Kate Shannon}, title = {Structural barriers to condom access in a community-based cohort of sex workers in Vancouver, Canada: influence of policing, violence and end-demand criminalisation}, elocation-id = {bmjsrh-2019-200408}, year = {2020}, doi = {10.1136/bmjsrh-2019-200408}, publisher = {British Medical Journal Publishing Group}, abstract = {Objectives Sex workers (SWs) face a disproportionate burden of HIV/sexually transmitted infections (STIs), violence and other human rights violations. While recent HIV prevention research has largely focused on the HIV cascade, condoms remain a cornerstone of HIV prevention, requiring further research attention. Given serious concerns regarding barriers to condom use, including policing, violence and {\textquoteleft}end-demand{\textquoteright} sex work criminalisation, we evaluated structural correlates of difficulty accessing condoms among SWs in Vancouver over an 8-year period.Methods Baseline and prospective data were drawn from a community-based cohort of women SWs (2010{\textendash}2018). SWs completed semi-annual questionnaires administered by a team that included lived experience (SWs). Multivariable logistic regression using generalised estimating equations (GEE) modelled correlates of difficulty accessing condoms over time.Results Among 884 participants, 19.1\% reported difficulty accessing condoms during the study. In multivariable GEE analysis, exposure to end-demand legislation was not associated with improved condom access; identifying as a sexual/gender minority (adjusted odds ratio (aOR) 1.62, 95\% CI 1.16 to 2.27), servicing outdoors (aOR 1.52, 95\% CI 1.17 to 1.97), physical/sexual workplace violence (aOR 1.98, 95\% CI 1.44 to 2.72), community violence (aOR 1.79, 95\% CI 1.27 to 2.52) and police harassment (aOR 1.66, 95\% CI 1.24 to 2.24) were associated with enhanced difficulty accessing condoms.Conclusions One-fifth of SWs faced challenges accessing condoms, suggesting the need to scale-up SW-tailored HIV/STI prevention. Despite the purported goal of {\textquoteleft}protecting communities{\textquoteright}, end-demand criminalisation did not mitigate barriers to condom access, while sexual/gender minorities and those facing workplace violence, harassment or those who worked outdoors experienced poorest condom accessibility. Decriminalisation of sex work is needed to support SWs{\textquoteright} labour rights, including access to HIV/STI prevention supplies.}, issn = {2515-1991}, URL = {https://srh.bmj.com/content/early/2020/03/17/bmjsrh-2019-200408}, eprint = {https://srh.bmj.com/content/early/2020/03/17/bmjsrh-2019-200408.full.pdf}, journal = {BMJ Sexual \& Reproductive Health} }