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In Canada, im/migrant sex workers face stigma, health access barriers, and overlapping marginalization, 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 multivariable confounder models with logistic regression to model 1) the independent effect of precarious immigration status (any status revocable under criminal charges: permanent residency/temporary residency/undocumented) on client condom refusal, and 2) the moderating effect of precarious status on the relationship between condom refusal and exposure to end-demand law reform (2015-present). Over this 8-year study involving 758 sex workers in Metro Vancouver 16.0% were im/migrants, of whom 57% had precarious immigration status at baseline. 16.5% of participants experienced client condom refusal. Precarious immigration was associated with increased odds of facing condom refusal (adjusted odds ratio [AOR] 2.53, 95% confidence interval [CI] 1.37–4.68), and these odds were heightened post-end-demand law reforms (AOR 4.35, 95%CI 1.21–15.66). Our findings suggest that lack of citizenship rights may enhance barriers to safer sex negotiation and increase HIV/STI risk among sex workers, highlighting the need for sex work and immigration policy reforms.

BACKGROUND: 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). METHODS: Community-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate factors associated with worry about inspections. RESULTS: 23.9% of participants experienced workplace inspections; 51.6% worried about inspections. In multivariable analyses, worrying about inspections was associated with recent im/migration (adjusted odds ratio[AOR] 3.13; 95% confidence interval[CI] 1.77–5.53), police harassment (AOR3.49; 95%CI 1.92–6.34), and workplace violence (AOR1.66, 95%CI 1.09–2.51). In a multivariable confounder model, worry was independently associated with barriers to health access (AOR1.45, 95%CI 1.06–1.98). DISCUSSION: Im/migrant indoor workers are disproportionately impacted by concerns about workplace inspections, which was independently linked to enhanced barriers to health access. Current criminalization measures may exacerbate health inequities among im/migrant sex workers.