Shira Miriam Goldenberg

Simon Fraser University · Faculty of Health Sciences

Despite research on the health and safety of mobile and migrant populations in the formal and informal sectors globally, limited information is available regarding the working conditions, health, and safety of sex workers who engage in short-term mobility and migration. The objective of this study was to longitudinally examine work environment, hea...

Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for...

Given heterogeneous evidence regarding the impacts of migration on HIV/sexually transmitted infections (STIs) among female sex workers (FSWs), we explored factors associated with international migration among FSWs in Vancouver, Canada. We draw on baseline questionnaire and HIV/STI testing data from a community-based cohort, AESHA, from 2010-2012. L...

Women comprise an increasing proportion of migrants. Many migrate voluntarily for sex work or practise survival sex; others are trafficked for sexual exploitation. To investigate how the context of mobility shapes sex work entry and HIV risk, during 2010 to 2011 we conducted in‐depth interviews with formerly trafficked women currently engaged in se...

Mobility is a key determinant of HIV/sexually transmitted infection (STI) transmission dynamics in Asia and Africa. Scant data exist regarding its dynamic impacts on HIV/STI risk in Central America and Mexico. Our objective was to critically review the epidemiology and social and structural context of HIV/STI risk among mobile populations in Centra...

Background Sex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we know little about health insurance coverage, and in p...

Background: Due to structural marginalization, sex workers experience health inequities including a high prevalence of sexually transmitted and blood-borne infections, mental health disorders, trauma, and substance use, alongside a multitude of barriers to HIV and substance use services. Given limited evidence on sex workers’ broader primary health...

Background Women sex workers face substantial health inequities due to structural barriers including criminalisation and stigma. Stigma has been associated with HIV-related inequities among marginalised populations, however, we know less about the impacts of sex work-specific occupational stigma on HIV/sexually transmitted infection (STI) risk amon...

Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. PWI...

Introduction Globally, the COVID-19 pandemic upended healthcare services and created economic vulnerability for many. Criminalization of sex work meant sex workers were largely ineligible for Canada’s government-based financial pandemic relief, the Canadian Emergency Response Benefit. Sex workers’ loss of income and inability to access financial su...

Background Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in T...

Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings. Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions...

Background In light of the stark inequities in HIV and sexually transmitted infections (STIs) experienced by women sex workers, empirical evidence is needed to inform accessible and sex worker-friendly models of voluntary, confidential and non-coercive HIV and STI testing. We evaluated the prevalence and structural correlates of HIV/STI testing in...

The criminalization of sex work has been consistently shown to undermine workers' Occupational Health and Safety (OHS), including sexual health. Drawing on the 'Guide to OHS in the New Zealand Sex Industry' (the Guide), we assessed barriers to sexual health best practices among indoor sex workers in Metro Vancouver, Canada, in the context of ongoin...

Objectives Globally, criminalisation has shaped sex workers’ structural exclusion from occupational protections, and this exclusion has been exacerbated during the COVID-19 pandemic. While community organisations aim to bridge this gap through providing health and safety resources for sex workers, many were forced to scale back services when Canadi...

Objectives In 2014, Canada implemented end-demand sex work legislation that criminalises clients and third parties (eg, managers, security personnel, etc) involved in sex work. The focus of this analysis is to explore how the criminalisation of clients shapes the occupational health and safety of sex workers. Design As part of a longstanding commu...

Background/Objectives End-demand criminalization of sex work in Canada has been linked to increased risk of violence and lack of workplace protections and occupational health and safety standards for sex workers. In the context of end-demand criminalization, we drew on the Guide to Occupational Health and Safety in the New Zealand Sex Industry (the...

The COVID-19 pandemic has brought into stark focus the economic inequities faced by precarious, criminalized and racialized workers. Sex workers have been historically excluded from structural supports due to criminalization and occupational stigma. Given emerging concerns regarding sex workers’ inequitable access to COVID-19 income supports in Can...

The goal of this paper is to determine the association between traveling to engage in sex work in another country and recent access to HIV testing among substance-using female sex workers (FSWs) in the Mexico–Guatemala border region. From 2012 to 2015, through modified time-location sampling and peer referral, 255 FSWs were recruited at Mexico’s so...

Background Despite a high prevalence of substance use among women sex workers (SWs), rigorous social epidemiologic data on substance use treatment experiences among SWs remains limited. Given these gaps and the disproportionate burden of criminalization borne by Indigenous SWs, we evaluated (1) structural correlates of unsuccessful attempts to acce...

Background Research that accurately represents how characteristics of sex work clients relate to sex workers’ labour conditions is crucial for informing evidence-based legislation which upholds sex workers’ human rights. As little quantitative research has examined how seeing regulars (repeat clients) impacts sex workers’ occupational safety, parti...

Background Psychedelic-assisted therapies are receiving mounting attention for their therapeutic potential. However, little is known about interest among women who experience elevated risk of mental health and substance use disorders. This study examined interest in receiving psychedelic-assisted therapy and socio-structural factors associated with...

Objectives Examine the independent association between online solicitation and sex workers’ (SWs’) occupational health and safety (OHS), particularly violence and work stress. Methods Data were drawn from a cohort of women SWs (N=942, 2010–2019) in Vancouver, Canada. Analyses used descriptive statistics and bivariate and multivariable logistic and...

Background Sex work criminalization and occupational stigma pose barriers to sex workers’ access to support services, including community participation — engagement with sex work specific community organizing at both formalized and grassroots capacities. In light of gaps in evidence regarding impacts of community participation on sex workers’ occup...

In 2014, Canada implemented end-demand sex work legislation which leaves the sale of sex under some circumstances legal. However, immigration policies based on discourses positioning sex work as exploitation and migration as trafficking continue to criminalize many im/migrant sex workers. Despite community reports of punitive policing, limited rese...

Background Research that accurately represents how characteristics of sex work clients relate to sex workers’ labour conditions is crucial for informing evidence-based legislation which upholds sex workers’ human rights. However, little quantitative research has examined how seeing regulars (repeat clients) impacts sex workers’ occupational safety,...

Objective Given stark health inequities among precarious and criminalized workers, we aimed to apply a structural determinants framework to systematically review evidence on HIV/sexually transmitted infection (STI) prevalence, access to HIV/STI/SRH services, and condom use among im/migrant sex workers (ISWs) globally. Methods Systematic search of...

Substance use and depressive psychiatric symptoms have been associated with migration and mobility. The Mexico-Guatemala border is a key transit point for internal, regional, and international migration flows. However, there is limited knowledge of the role of substance use, migration, and mobility on mental health among migrants at this border. Ou...

Sex workers globally face high levels of violence. In Canada, im/migrant sex workers who work in indoor venues may be uniquely targeted by police due to immigration policies, racialized policing, and the conflation of trafficking and sex work. In 2014, Canada passed end-demand legislation that purportedly encourages sex workers to report violence t...

After Canada’s laws criminalising sex work were struck down by the Supreme Court for violating sex workers’ rights and new end-demand legislation was passed in 2014. These new laws however continue to criminalise sex work third parties (i.e. venue owners/managers) who gain material benefits, despite evidence that managed in-call venues can provide...

Background Following a global wave of end-demand criminalization of sex work, the Protection of Communities and Exploited Persons Act (PCEPA) was implemented in Canada, which has implications for the health and safety of sex workers. This study aimed to evaluate the impact of the PCEPA on sex workers’ access to health, violence, and sex worker-led...

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 bar...

Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers’ work/living environments in relation to gentrification exposure in Metro V...

In Canada, im/migrant sex workers face stigma, health access barriers, and overlapping marginalisation, with end-demand law reforms in 2014 postulated to exacerbate these inequities. Yet, little quantitative evidence on how immigration status shapes HIV/STI risk exists. Drawing on community-based longitudinal cohort data (AESHA, 2010–2018), we used...

Communication-based interventions have been linked to improved health and social outcomes among underserved populations. Migrant women in sex work face serious health and social inequities, including risks of HIV and other sexually transmitted infections (STIs) and violence. Given gaps in evidence about health communication among migrant sex worker...

Background: High rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing...

Given shifting sex work criminalization and enforcement in Canada, this study examined worrying about workplace inspections by authorities amongst indoor sex workers in Vancouver (2014–2017). Data were drawn from a community-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate fac...

Objectives: 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. M...

Objectives: Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. Methods: Questionnaire data were drawn...

Background Under new Canadian sex work laws (PCEPA) passed in 2014, sex workers with precarious legal status face exacerbated criminalization, yet little quantitative evidence exists on how legal immigration status shapes HIV/STI risk. This study aimed to model the effect of precarious status on client condom refusal; and the potential moderating e...

Mobility among sex workers has been linked not only to improved economic and social opportunities, but also to concerns regarding displacement, criminalization, and violence. In 2014, new “end-demand” legislation criminalized new aspects of sex work in Canada (e.g., third-party advertising, purchasing) while leaving the sale of sex legal. Utilizing...

Objective: To determine the impact of engagement with third parties (i.e., managers, receptionists, or owners of in-call venues; advertisers; security; spotters; and others) on sex workers' occupational health access. Methods: We drew longitudinal data from An Evaluation of Sex Workers' Health Access, a community-based cohort of more than 900 wo...

Background Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased struct...

Objectives Despite the precarious and unsafe working conditions frequently experienced by sex workers (SWs) and im/migrant workers, there remains a paucity of research on work-related stress and links to duration of im/migration residency among SWs. This study analyzes the relationship between duration of residency and two dimensions of work stress...

Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affect...

Background: Migrant women are over-represented in the sex industry, and migrant sex workers experience disproportionate health inequities, including those related to health access, HIV and sexually transmitted infections (STIs), and violence. Despite calls for occupational sex work interventions situated in labour rights frameworks, there remains...

Objective: To explore international migrant sex workers' experiences and narratives pertaining to the unmet need for and access to sexual and reproductive health (SRH) at the Mexico-Guatemala border. Methods: An inductive qualitative analysis was conducted based on ethnographic fieldwork (2012-2015) including participant observation and audio-re...

Background Migrant women engaged in precarious employment, such as sex work, frequently face pronounced social isolation alongside other barriers to health and human rights. Although peer support has been identified as a critical HIV and violence prevention intervention for sex workers, little is known about access to peer support or its role in sh...

Background Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. While much research has focused on HIV and sexually transmitted infections (STIs) among sex workers, there remains a gap in evidence regarding the broader health issues faced by this populatio...

Background While the conditions in emergency humanitarian and conflict-affected settings often result in significant sex work economies, there is limited information on the social and structural conditions of sex work in these settings, and the impacts on HIV/STI prevention and access to sexual and reproductive health (SRH) services for sex workers...

Public health regulations practices surrounding sex work and their enforcement can have unintended consequences for HIV and sexually transmitted infection (STI) prevention and care among sex workers. This analysis was based on qualitative in-depth (n = 33) and focus groups interviews (n = 20) conducted with migrant female sex workers in Tecún Umán...

Background: While sex work is often considered the world's oldest profession, there remains a dearth of research on work stress among sex workers (SWs) in occupational health epidemiological literature. A better understanding of the drivers of work stress among SWs is needed to inform sex work policy, workplace models and standards. Aims: To exa...

Background: Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in Sub-Saharan Africa. We explored interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. Methods: This analysis drew on data from a community-based cross-sect...

Background: Despite rapid increases in crystal methamphetamine (CM) use worldwide and established gendered patterns of use, empirical research on CM injection initiation among sex workers is limited. Given the wide range of harms associated with CM, alongside stimulant effects including sexual dis-inhibition and prolonged awake-ness, this study ai...

Despite universal health care in Canada, sex workers (SWs) and im/migrants experience suboptimal health care access. In this analysis, we examined the correlates of unmet health needs among SWs in Metro Vancouver over time. Data from a longitudinal cohort of women SWs (An Evaluation of Sex Workers Health Access [AESHA]) were used. Of 742 SWs, 25.5%...

This research aimed to determine the effect of food insecurity on sexual HIV risk with clients among youth sex workers (YSWs) <30 years in Metro Vancouver, Canada. Data were drawn from a prospective community cohort of sex workers (2010–2013). We examined the independent relationship between YSWs’ food insecurity and being pressured into sex withou...

Although human trafficking is recognized as a major human rights violation, there is limited evidence regarding the vulnerabilities that contribute to female adolescents’ risk of being forced or coerced into the sex trade. Vulnerabilities such as gender-based violence, economic and social inequalities have been shown to shape the risk of sexual exp...

Background: While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with life...

Background Globally, im/migrant women are overrepresented in the sex industry and experience disproportionate health inequities. Despite evidence that the health impacts of migration may vary according to the timing and stage of migration (e.g., early arrival vs. long-term migration), limited evidence exists regarding social and structural determin...

Despite the high HIV burden faced by sex workers, data on access and retention in antiretroviral therapy (ART) are limited. Using an innovative spatial epidemiological approach, we explored how the social geography of sex work criminalization and violence impacts HIV treatment interruptions among sex workers living with HIV in Vancouver over a 3.5-...

Background: Hepatitis C virus (HCV) represents a significant cause of morbidity and mortality globally. While sex workers (SWs) may face elevated HCV risks through both drug/sexual pathways, incidence data among SWs are severely lacking. We characterized HCV incidence and predictors of HCV seroconversion among women SWs in Vancouver, BC. Methods:...

Background Despite a large body of evidence globally demonstrating that the criminalization of sex workers increases HIV/STI risks, we know far less about the impact of criminalization and policing of managers and in-call establishments on HIV/STI prevention among sex workers, and even less so among migrant sex workers. Methods Analysis draws on et...

Objectives Surveillance data frequently indicate that young men and women experience high—yet considerably different—reported rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia. We examined how several sex-based (eg, biological) and gender-based (eg, sociocultural) factors may interact to influence STI...

Background Migrant sex workers are often highly marginalized and disproportionately experience health and social inequities, including high prevalence of HIV, sexually transmitted infections, and human rights violations. In recent years, research involving migrant sex workers has increased, yet many knowledge gaps remain regarding how best to prote...

Objective: Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver...

Objective: Sex workers in sub-Saharan Africa face a disproportionate HIV burden and growing concerns of severe human rights violations. Given the dearth of evidence on the burden and correlates of HIV among sex workers in sub-Saharan Africa, particularly within conflict-affected settings, we examined the relationship between structural determinant...

Despite reports of high levels of violence among women migrants in Central America, limited evidence exists regarding the health and safety of migrant sex workers in Central America. This study is based on 16 months of field research (November 2012–February 2014), including ethnographic fieldwork, in-depth interviews, and focus groups conducted wit...

Background: Sex workers (SWs) experience a disproportionately high burden of HIV, with evidence indicating that complex and dynamic factors within work environments play a critical role in mitigating or producing HIV risks in sex work. In light of sweeping policy efforts to further criminalize sex work globally, coupled with emerging calls for str...

Background: An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achi...

Background: Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Despite the disproportionate burden of HCV among sex workers, data regarding the HCV care continuum in this population remain negligible. Methods: Using baseline data from an ongoing cohort of women sex workers in Vancouver (An Evaluation of S...

This sampling of sex workers in Mexico investigated entry in the sex trade as an adolescent vs as an adult and risk for human immunodeficiency virus infection and sexual violence. Adolescents migrating from Central America and Mexico to the United States are at risk for being trafficked into the sex industry in Mexico’s northern border cities.¹ Re...

In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010-2012) and linked pharmacy records on...

Migrant women in sex work experience unique risks and protective factors related to their sexual health. Given the dearth of knowledge in high-income countries, we explored factors associated with inconsistent condom use by clients among migrant female sex workers over time in Vancouver, BC. Questionnaire and HIV/sexually transmitted infection test...

To describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda. The present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14years or older...