Social
Food and housing instability drive low sexual relationship power with heterosexual intimate partners among women sex workers in Vancouver, Canada: Findings from 12 years of longitudinal cohort data Kaylee Ramage* Kaylee Ramage Kate Shannon Andrea Krüsi Charlie Zhou Ran Hu Shira Goldenberg
Background: Unequal power dynamics within intimate partner relationships have been associated with intimate partner violence (IPV) and adverse impacts on physical and mental health; however, limited research has examined sexual power dynamics within sex workers’ intimate partner relationships. Using Pulerwitz’ Sexual Relationship Power Scale (SRPS), we examined the relationship between socio-economic factors and sexual relationship power scores among women sex workers (SWs) with heterosexual intimate partners in Metro Vancouver, Canada.
Methods: Using data from a prospective, community-based cohort study of SWs (2010–2022), we separately estimated the independent associations between socio-economic factors (i.e., food, housing, and income security) and SRPS scores. We conducted complete case bivariate and multivariable ordinal regression using generalized estimating equation modelling.
Results: Of 722 SWs who had ≥1 men-identified intimate partner during the study period and answered the SRPS, 60.25% reported high SRPS scores in their relationship(s). In bivariable and multivariable analyses, food insecurity (aOR: 0.66, 95%CI:0.51-0.85) and lack of stable housing (aOR: 0.62, 95%CI:0.48-0.80) were independently linked to lower SRPS scores, indicating lower power within their relationships. Compared to those who solicited sex work on the street or in public, SWs who primarily solicited indoors or online were significantly more likely to report high SRPS scores (aOR: 1.72).
Conclusion: Food and housing instability are directly linked to low sexual relationship power among SWs within heterosexual partnerships. Amidst growing food security and housing crises, these data suggest that lack of access to secure housing and food place criminalized and low-income women at risk of unintended pregnancies, sexual coercion and violence and STIs/HIV. Policy reform to ensure access to basic human rights remain critical to promote SWs’ agency and control in sexual relationships.
