RISKY HEALTH ENVIRONMENTS:WOMEN SEX WORKERS’ STRUGGLES TO FIND SAFE, SECURE AND NON-EXPLOITATIVE HOUSING IN CANADA’S POOREST POSTAL CODE

Abstract

This study explored low-income and transitional housing environments of women sex workers and their role in shaping agency and power in negotiating safety and sexual risk reduction in Vancouver, Canada. A series of 12 focus group discussions were conducted with 73 women currently involved in street-based sex work. These women were purposively sampled for a range of experiences living in low-income housing environments, including homeless shelters, transitional housing, and co-ed and women-only single room occupancy (SRO) hotels. Drawing on the risk environment framework and theoretical constructs of gender, agency and power, analyses demonstrate that women continue to be vulnerable to violence and sexual and economic exploitation and have reduced ability to negotiate risk reduction resulting from the physical, structural and social environments of current dominant male-centred housing models. Within the physical environment, women described inhabitable housing conditions in SROs with infestations of bedbugs and rats, leading women to even more transitional housing options such as shelters and couch-surfing. In many cases, this resulted in their economic exploitation and increased sexual risk. Within the structural environment, enforcement of curfews and guest policies forced women to accept risky clients to meet curfew, or work outdoors where their ability to negotiate safety and condom use were limited. Certain policies promoted women’s agency and mitigated their ability to reduce risks when selling sex. These included flexible curfews and being able to bring clients home. The social environments of co-ed single-room occupancy hotels resulted in repeated violence by male residents and discrimination by male building staff. Women-only shelters and SROs facilitated ‘enabling environments’ where women developed support systems with other working women that resulted in safer work practices. The narratives expressed in this study reveal the critical need for public health interventions and safer supportive housing to account for the daily lived experiences of women sex workers.

INTRODUCTION

Housing has been identified as an important social determinant of health by the World Health Organization (WHO, 1986), the Public Health Agency of Canada (PHAC, 2004), and the Commission on the Social Determinants of Health (CSDH, 2008). A lack of affordable housing leads to health and social problems that make housing an urgent public health priority (Krieger & Higgins, 2002). Homelessness and unstable housing have been associated with increased risk of HIV infection (Aidala & Sumartojo, 2007; Corneil et al., 2006; Shannon et al., 2006), as well as with decreases in personal safety, higher rates of morbidity and mortality (Riley, Gandhi et al., 2007) and increased barriers to accessing health care (Lewis et al., 2003). Furthermore, research has shown that marginal housing is not evenly distributed across populations (Aidala et al., 2005). It has been recognized that factors such as poverty and racism keep individuals, and in particular women, living in high-risk neighborhoods; resulting in an increased risk of HIV infection regardless of their own individual risk behaviors (Zierler & Krieger, 1997). However, identifying the role of public health in creating housing policy and programs to mitigate health risks has proven difficult (Krieger & Higgins, 2002).

The definition of homelessness has often been described as a continuum, and has been expanded to include individuals who live in substandard accommodations (Echenberg & Jensen, 2008). Single room occupancy hotels (SROs) are often the last resort for low-income individuals residing in urban centres across North America (Evans & Strathdee, 2006). While the development of SROs varies by city, the historical context and proliferation of SRO’s are similar (Hopper, 1998; Foley, 1998; Gurstein & Small, 2005). The basic shelter of SROs were developed in the 1960s and 1970s for largely male migrant labour workers and the unemployed who would travel to cities in search of work on a short term, temporary basis.

In Vancouver, there are over 16,000 marginally housed individuals residing in over 6,000 SROs, 80% of which are located in Vancouver’s Downtown Eastside neighborhood, known as Canada’s poorest postal code (Shannon et al., 2006; Eby, 2007; Evans & Strathdee, 2006). As in most cities across North America, these buildings are often centuries old, unkept and unsanitary, with shared bathroom facilities, no kitchen space and rooms averaging 100ft². As average rents continue to increase and wait lists for social housing remain as long as 5 to 7 years in Vancouver, SROs are often the only housing option left for low-income groups, alongside emergency shelters and transitional housing (Eby, 2007; Gustein & Small, 2005). Yet, popular discourse continues to portray homelessness as a social problem affecting a certain type of person, rather than an economic one related to housing affordability (Pascale, 2005). In most cases, hotel owners are paid the maximum shelter allowance of CAN $375 that welfare recipients are entitled directly by government offices (Shannon et al., 2006; Eby, 2007). The majority of SROs are privately run and unregulated, and offer no services or building maintenance (Eby, 2007; Gurstein & Small, 2005).

The number of homeless and marginally housed males far outnumbers the number of homeless and marginally housed females (Hwang, 2001). In Vancouver, over 70% of the homeless population is male (Eberle Planning and Research, 2010; Hwang, 2001), creating a dominantly male street culture. Among homeless and marginally housed adults, biological sex and gender are among the strongest predictors of poor health (Wenzel et al., 2004; Zierler & Krieger, 1997), with men and women experiencing gendered patterns of risk (Riley, Weiser et al., 2007). Women-only shelters were first opened in the 1970s to meet the needs of women fleeing situations of domestic violence (Sev’er, 2002). However, there continues to be a lack of women-specific services targeting homeless and marginally housed women (Bukowski & Buetow, 2011). The plight of homeless women continues to receive little attention in the research literature, with women often included in male-centred homeless research (Bukowski & Buetow, 2011; Huey & Berndt, 2008).

The socio-economic and cultural environment of homelessness and marginal housing must be contextualized to understand how gender and power relations structure risk behaviours (Bourgois et al., 1997; Maher & Curtis, 1992). Unstable housing has been found to be independently associated with exchanging sex for money as a means of basic survival (Corneil et al., 2006). Epidemiological evidence suggests risks may be amplified for women engaged in sex work in low-income and transitional housing environments (Shannon et al., 2009; Surratt & Inciardi, 2004; Duff et al., 2011). Cross-sectional studies in Miami, Florida found homelessness and marginal housing to increase sexual risks through higher levels of unprotected sex and a greater number of clients refusing to wear condoms (Surratt & Inciardi, 2004). Longitudinal research in Vancouver, Canada found homelessness to be independently associated with increased odds of both client violence (Shannon et al, 2009) and sexual violence by primary non-commercial partners (Duff et al, 2011). Yet the dangers produced by these housing environments faced by homeless and marginally housed women, and in particular sex workers, have largely been ignored (Huey & Berndt, 2008).

Moore (2004) has argued that what appear to be ‘chaotic’ practices of street-based sex workers and drug users are often responses to particular environments and that individual-level risk prevention strategies must be combined with approaches to addressing micro- and macro-level risks. With a shift towards a more neo-liberal governmentality in many settings, there has been an increased focus on health promotion and prevention, with the responsibility falling on the individual to stay healthy (Moore, 2004). However, this approach does not acknowledge potential constraints that individuals may face in making choices and negotiating risk (Bourgois, 1998; Moore, 2004). For example, Epele (2002) discusses how women’s subordinate position in street economies leads them to adopt, negotiate and resist unequal gender relations as a way to survive structural, symbolic and physical violence. However, women’s focus on coping with immediate risks may place concerns surrounding HIV as a secondary priority, while simultaneously increasing their vulnerability to infection (Epele, 2002). In order to understand why individuals continue to make ‘risky choices’, it is important to contextualize the ‘risk environment’, defined as the physical, structural and social spaces where a variety of factors interact to increase or decrease the chances of harm (Rhodes, 2002).

To date, most studies evaluating current models of service delivery focus on improving outcomes, decreasing barriers to accessing services and maintaining client retention, while ignoring existing power dynamics between clients and service providers (Moore, 2009). Given the dearth of qualitative data on the lived experience of marginalized women sex workers in transitional and low-income housing, we undertook this study to explore the role of housing environments in shaping women’s agency and power in negotiating safety and sexual risk reduction in Vancouver, Canada.

METHODS

This qualitative investigation was part of a larger community-based HIV prevention research project, in partnership with local sex work agencies, exploring the HIV risk environment of women in a street-based sex work market. The development, process and methodologies of this partnership have been described in detail elsewhere (Shannon et al., 2007). Between May and August, 2009, a series of 12 focus group discussions were conducted with 73 women (6-8 participants in each) engaged in sex work. Participants were purposively sampled to reflect a range of lived experiences in different low-income and transitional housing environments that included homeless shelters, transitional housing, co-ed and women-only single-room occupancy (SROs) hotels.

All participants were residents of North American’s poorest postal code, Vancouver Canada’s Downtown Eastside (DTES) neighbourhood, known for its high concentration of poverty, homelessness and drug use. In the overall sample, the median age of women was 38 years (interquartile range: 29-45 years). Overall, 24 (34.3%) self-reported their ethnicity as White, 36 (51.4%) as Aboriginal (including First Nations, Metis, Inuit) and 13 (14.3%) as another visible minority, namely Asian, Black or Hispanic. While women reported significant mobility in housing over the previous six months, at the time of interviews, 33 (56.9%), reported currently living in social housing (e.g. government-subsidized apartments), 23 (13.8%) reported living in single room occupancy (SRO) hotels, 8 (13.8%) reported living in a shelter or hostel, 6 (10.3%) reported living in an apartment or house, 2 (3.5%) reported living in another type of housing and 1 (1.7%) living in a recovery house. All participants identified as women, of whom 6 (8.2%) were transgendered (male-to-female). Our thematic analysis drew on all focus group discussions, with our results representing key emergent themes and narratives related to gendered risk environments.

As previously described elsewhere (Shannon et al., 2008), interview topic guides were developed through a collaborative process between sex workers and researchers. All focus groups were co-facilitated by a sex worker and community researcher. Discussion groups were audiotape recorded, transcribed verbatim and checked for accuracy. This research received ethical approval under the University of British Columbia/ Providence Health Research Ethics Review Board.

Transcripts were coded for key themes and emergent categories using ATLAS.ti 6 followed by thematic and content analyses, with a focus on the social, physical, and structural risk environments and their role in shaping, women’s safety and agency in negotiation of sexual risk reduction with partners and clients. To interpret our findings, we drew on Rhodes’ ‘risk environment’ framework, which is a heuristic developed to conceptualize the physical and social space in which factors external to the individual interact to produce and reproduce HIV risks among drug users (Rhodes, 2002) and has subsequently been adapted to conceptualizing the interplay within the risk environment of sex work (Shannon et al., 2008). Risk is a product of the interplay between factors operating across and within physical, social, economic and policy environments (Rhodes et al., 2005) at various levels: the micro-level (e.g., interpersonal dynamics, social norms); the meso-level of insitutional and organizational action (e.g., policies and regulations); and the macro-level of distal factors (e.g., laws, building standards, social inequalities).

We also drew on concepts of gender, agency and power in interpreting our results. Ethnographic field work with street-level drug users has demonstrated the importance of contextualizing how gender and power relations work to produce and structure negotiation of individual risks shaping HIV transmission (Bourgois et al., 1997; Shannon et al., 2008). Externally imposed power constraints have been shown to impact everyday practices resulting in different levels of risk among populations. Bourgois and colleagues (2004) define power as refering to the ‘distribution of resources, the exercise of agency, and the institutional and social control in the production of social suffering’.

RESULTS

Analyses of the narratives demonstrate that women continue to be vulnerable to violence, exploitation and increased safety risks resulting from the physical, structural and social environments inherent in dominant ‘male-centred’ housing models. Poor physical housing conditions, strict enforcement of curfews, and existing guest policies failed to take into account the realities of women’s daily lives. Gendered experiences of violence, exploitation and discrimination all negatively impacted women’s abilities to negotiate safety and risk reduction. Certain housing policies, however, mitigated women’s ability to negotiate risks when selling sex, such as flexible curfews and being able to bring dates home. Living in co-ed buildings facilitated the development of support systems with other working women that resulted in safer sex work practices.

Micro-physical environments

‘Uninhabitable Living Conditions’

All of the women in the study had current or previous experiences of living in housing that suffered from poor physical upkeep. Women described deplorable physical environments, including common infestations, and that they were forced to live with bedbugs, mice, rats and cockroaches.

I don’t know how these other places are doing it, but I mean the more they sprayed the more, the more the bedbugs and his friends came. I’m serious. I caught two mice within two weeks under my door, the bedbugs kept multiplying, I swear to god, whatever they were spraying was making them multiply. It’s just disgusting and I can’t live like that. I mean nobody should have to and the mouse, the mouse droppings and stuff is a cause for illness (Participant residing in a women-only shelter referring to a women-only SRO where she previously lived).

Women described how their poor health status due to many years on the street was further compromised by high rates of infestations and unsanitary living conditions present in SRO buildings.

Um, I’ve always had a place until I lived in *name of SRO hotel+. There were rats, the place was being renovated and they, anyways, big huge rats in my bathroom, and in my house and I was terrified. They *managers+ wouldn’t do anything about it (Participant residing in a women-only shelter referring to a co-ed SRO where she previously lived).

I said, “You got rats in your house? Fuck you. So you don’t have rats in your house?” He goes okay, pay rent then maybe I check the rats. I said “I’ll pay you my rent when you get rid of the rats. Fuck you, I’m outta here”. So I was staying in a hotel for two months in another person’s room that didn’t have rats (Participant residing in a women-only shelter referring to a co-ed SRO where she previously lived).

When building managers refused to address infestations, women were forced to leave their homes and cycle between homelessness and temporary accommodations. Most women initially ‘couch surfed’ to avoid homelessness, but shared common experiences of increased expenses and financial exploitation when staying with others, and eventually opted to return to the streets.

Participant: And when they drained you dry they want you out [friends/acquaintances]. I just don’t choose to do that anymore, stay at peoples’ places. Interviewer: So when you’re couch surfing or staying out, the cost of living goes up? Participant: Way up (Participant residing in a women-only shelter).

Structural environment: Restrictive policies

Along with the poor physical environments of most available housing options, women’s agency and power were largely impacted by the structural environments of the buildings and management policies. Management policies, such as strict curfews and guest policies, sought to regulate women’s social interactions with family, friends and clients.

‘Curfews’

Housing policies varied across emergency shelters, transition houses and SRO hotels, but most had some regulations surrounding curfews and guests. The enforcement of strict curfews upheld by many residences minimized the abilities of women who sell sex to decide when to work. This also increased women’s likelihood of accepting riskier dates in order to earn their target income before curfew, as well as servicing clients in outdoor areas, rather than in their homes, where their ability to negotiate safety and condom use were significantly reduced.

I think by them taking a, putting an eleven o’ clock curfew, they’re putting myself in jeopardy, so I can’t do dates in my place [SRO room] where it’s safe (Participant residing in a co-ed SRO).

In residences with strict curfews, women felt that their safety was placed at risk and the policies directly limited their ability to decide when and where to work, causing them to make decisions that negatively impacted upon their safety. Instead of enforced curfews, women favoured a model used by one of the shelters that required residents to check-in with support staff at least once during a 24-hour period. This type of flexible check-in provided the women staying there with increased agency in deciding when to work and which dates to accept.

You just have to make yourself known. If you’re gone for twenty-four hours, you can ring the buzzer and walk upstairs, grab a quick glass of juice and walk back out for another twenty-four hours (Participant residing in a women-only shelter).

But that’s the only thing that makes sense to me for women who are working in survival sex trade (Participant residing in a women-only shelter).

The shelters that aren’t (flexible), we don’t last in, in my opinion, and other women I know, we don’t last in those places (Participant residing in a women-only shelter).

‘Guest policies’

Along with the enforcement of curfews, management also enacted policies related to guests visiting the building. Many SROs did not allow any guests at all, while others had complex regulations about who could visit, when, and how often, with many of the rules unclear to the residents.

I’m only allowed to have guests on Thursdays to Sundays from twelve to twelve and two days ago we’re allowed to have overnights twice a month, two weeks after cheque day and two weeks after that and they don’t need ID (Participant residing in a co-ed SRO).

Limited guest privileges in one’s own home were seen by the women as a violation of their rights as tenants and worked to regulate their private lives. These restrictive guest policies alienated women from their support networks, including friends, family and partners, as well as impacted their work with clients, forcing all of their social interactions onto the street.

Yeah, I just, I absolutely hate it, they’ve got this rule that people can’t come in after eleven o’clock and this one little security guard, this was last week, my girlfriend wanted to come into my room, it’s my room, I pay the rent, right? She brought her fellow up there or whatever, they were being quiet, I just stepped out for a little bit, well the security guard, came up to my room, I didn’t know this, marched her out twenty minutes after she was there and then I came back and she was gone. He says, you can’t have anymore guests for the rest of the night. Who the f-, pardon me, who died and made you god? (Participant residing in a co-ed SRO).

I say, “What I’m gonna have to see my kids (referring to the participant’s children) on Hastings, outside the Bottle Depot at Columbia and Hastings [an intersection in Vancouver’s Downtown Eastside community+? While I’m having a visit with one of my kids upstairs and the other two are waiting to visit with me? I don’t fucking think so” (Participant residing in a co-ed SRO).

At times, enforcement of these policies explicitly violated women’s safety, right to privacy and personal space.

Just last weekend I had a friend over and I was in the shower right, it was quarter to twelve and I hear somebody knocking at my door and my friend didn’t get it and I kept hearing them bang on the door, and they’re like *name+ your guest is not signed out, I don’t give a shit I said, I’m having a shower, can you respect me and come back in ten minutes, right? And they’re just like no, you gotta get your guests outta here and they came into my place and escorted him out and then I was naked in my bathroom (Participant residing in a co-ed SRO).

More flexible guest policies, such as those that allowed women to bring dates home, improved women’s abilities to reduce sexual risks by providing them with more control in negotiating condom use. Bringing dates home also increased women’s sense of safety in the event of a ‘bad date’ (violent client) by knowing their neighbours could hear them call for help if needed.

I’ve never had one say no at my place, you can use a condom or you can get the fuck out, right, but I’ve never had anybody walk out (Participant residing in a co-ed SRO).

However, many managers/ building owners did not condone women openly bringing dates home and some went as far as refusing to house women known to be involved in sex work. This type of policy restriction is likely reflective of the quasi-criminalized nature of sex work in Canada, in which the buying and selling of sex are legal, but communicating in public spaces, working indoors in managed/supported environments, and living off the avails of prostitution are prohibited. While technically, servicing clients alone in your own apartment would not contravene these laws, the ambiguity leaves much up to the discretion of managers and building owners in more marginalized housing environments.

‘Evictions and limited housing options’

Some SROs -- often the only option for long-term low-income housing for many of these women-- were particularly known for refusing to house women involved in sex work.

I got two points to make. One is a lot of the SROs down here are like that, they don’t want working women. They may not say that right out front, but no women live in the building (Participant residing in a women-only shelter referring to other SROs).

I know, they had me fill out a form here at [name of shelter], they had me fill out an application for the *name of SRO hotel+ and I’m supposed to hand deliver it and I just remember they said they don’t want drugs, no drugs or sex trade workers living there so I’m going to have to go back to *name of shelter+ and tell them I’m not delivering that particular one because I’m not gonna hide the fact that I do this and have a home that I can’t … feel free to do what I want in (Participant residing in a women-only shelter referring to other SROs).

I, um, my landlord when he found out I was working he gave me an eviction notice. He said there’s no workers allowed living here. Back then, they really put their nose up at you. They just didn’t allow workers there, I had to go in a shelter (Participant residing in a women-only shelter referring to other SROs).

Women had difficulty in fighting unjust evictions because of their involvement in sex work. Due to the quasi-criminalized nature in which sex work occurs in Canada, under which sex work is largely unregulated and highly policed, many women feared losing their anonymity in a public battle and chose not to pursue legal action, instead returning to transient housing options.

Social environment

‘Co-ed housing: Violence and exploitation’

Many of the shelters and SRO hotels available to women were co-ed residences, also housing men. Even when men slept on different floors of the buildings, interactions between residents were common. Women sometimes relied on emergency shelters to escape from unhealthy relationships and felt vulnerable to falling back into these same patterns of abuse and exploitation when staying in co-ed buildings.

Two people lonely, loneliness for me is huge, we’re victims, we’re needy, we’re always looking for the same thing that has been hurting us time after time after time, again hoping the next time is gonna be the one, no matter what we always set ourselves up for it, as simple as that (Participant residing in a women-only shelter referring to co-ed SROs and shelters).

Women felt vulnerable to violence and sexual assault when staying in co-ed residences and described feeling unsafe around male residents. These narratives of violence and sexual exploitation were associated with co-ed SRO environments.

I’ve never had anybody be violent with me, when I was at the *name of women-only SRO] or now, but when I lived at the [name of co-ed SRO], shit yeah (Participant residing in a co-ed SRO).

Well when I lived at the [name of SRO hotel], that was the only co-ed building I can think of, I had problems with guys coming to my door, I had one guy try to rape me in my place like just never ending, y’know (Participant residing in a co-ed SRO).

Women also described experiences of discrimination by male building staff, some who differentially enforced policies for men and women, particularly when women were suspected of being sex workers. These dominant male-centred housing models shaped gendered risk environments by placing women in positions of powerlessness and further reinforcing gender inequities. Policies enforced in attempts to prevent women from doing sex work, such as asking guests of female residents to display IDs, reinforce the stigmatization of sex workers and increase their vulnerability to violence and exploitation.

So you feel disrespected all the time like when I have friends in … I just tell them if you guys don’t like it you should put your rules up more instead of disrespecting my friend. They push this, we need picture ID, it’s never been an issue before. Very ignorant and I don’t bother any more right, I just try to keep it together. Y’know like not even bother (Participant residing in a co-ed SRO).

‘Women-only spaces: Mitigating gendered risk environments’

Women-only shelters and SROs, largely operated by women-only management, facilitated women’s agency in negotiating sexual risk reduction and mitigated gendered risks of violence, sexual and economic exploitation described in the dominant male-centred housing models. The social contexts of these women-only spaces afforded the development of personal friendships and informal peer supportive networks with other working women. By living together in women-only spaces, women described getting to know each other on a more personal level than they were able to while working on the street. These peer support mechanisms also acted as informal safety strategies with women looking out for each other.

When we’re all out there working, we are all kind of like, we’re a little edgy about going up to the next one, it’s kind of like when we walk by, we say, “Hey, how’s it going” and we keep going. We don’t know these women, we don’t know where they’ve been, what they’re like, what their story is, y’know what is gonna set them off, so getting to know them running into them in the shelter you get to know them (Participant residing in a women-only shelter).

By developing peer support mechanisms in their living environment, women were then able to carry those relationships out to the streets when working. As women got to know and trust each other, they more freely exchanged information about bad dates and were more likely to work together in groups. While these peer support networks formed an important safety strategy, the majority of women were still forced to see clients on the street due to strict guest policies, and restrictions by management to bringing clients indoors.

I was just gonna say for me what I find is I’m going down to work with someone else. “Oh what time are you going to work? Oh, I’m going down” and you end up going to work together…

Yeah, and it’s safer that way, the buddy system (Participant residing in a women-only SRO).

While these women-only shelters and SROs provided largely temporary spaces that facilitated peer networks, women also described the critical need for removal of strict guest policies on bring dates indoors to support their agency and control in negotiating safety and risk reduction with clients in indoor environments. The lack of supportive guest policies and curfews in many of these buildings, coupled with the temporary nature, limited the ability of these housing environments to fully mitigate the gendered risk environments faced by women sex workers in their daily lives.

DISCUSSION

The women in this study shared ongoing experiences of marginalization, sexual and economic exploitation and increased safety risks produced and reproduced by the gendered risk environments of the dominant male-centred housing models. The physical, structural and social environments of low-income and transitional housing worked to significantly limit women’s abilities to secure safe and stable housing, exert agency and negotiate safety in terms of reducing sexual risks and violence. The narratives reveal the critical need for public health interventions and safer supportive housing to account for the daily ‘lived experiences’ of women sex workers.

At the macro level, there is an urgent need to ensure that available housing meets basic minimum standards. The United Nations has stipulated in the Universal Declaration of Human Rights that every person has the right to safe and secure housing, and that this housing must be habitable (United Nations, 2007). In recent years, epidemiological research has linked sub-standard housing to an increased risk of chronic illness, with dampness and pest infestations linked to asthma and other respiratory disease (Krieger & Higgins, 2002). Women in our study described a lack of options for habitable low-income housing in Vancouver and a lack of recourse for management to improve these deplorable housing conditions. The poor physical environments that shaped risks were further compounded by the gendered risk environment of largely male-dominant housing models, in which women were vulnerable to sexual exploitation and violence by male building staff and residents, and feared disclosure of sex work due to current quasi-criminalized nature of prostitution.

When leaving uninhabitable spaces, women returned to situations of homelessness or temporary housing, such as couch-surfing. Research has shown that this pattern of unstable housing is associated with chronic stress, where daily survival is prioritized over efforts to reduce HIV risks (Aidala et al., 2005; Riley, Gandhi et al., 2007; Epele, 2002). Substance-using women entrenched in poverty, including women in this study, typically avoid absolute homelessness by finding places to stay, increasing their powerlessness and vulnerability to sexual and economic exploitation (Maher et al., 1996). Women who stayed with friends or acquaintances felt financially exploited, findings which have been mirrored in other research where women reported feeling pressured to provide drugs or sexual favours in return for temporary accommodation (Dickson-Gomez et al., 2009). In other qualitative studies, women often described these friends as older men, further reinforcing gender-power inequities (Shannon et al., 2008; Bourgois et al., 2004; Maher et al., 1996). These results highlight the human rights and public health imperative of ensuring access to safe and secure housing. Our study suggests the critical need for government policies that hold management and owners accountable to basic minimum housing standards and legal mechanisms to protect women’s rights against sexual exploitation from male staff and residents.

At the meso-level, strict management and building policies on guests and curfews limited women’s ability to assert agency and negotiate safety and sexual risk reduction, reflecting the failure of the culture of male-centred housing models to account for women sex workers’ ‘lived experiences’ (Moore, 2004). Coupled with current criminal sanctions on prostitution in Canada on working in more formal or cooperative indoor spaces (for example, indoor sex work establishments and brothels), the enforcement of strict curfews and guest policies within sex workers’ own housing environments produced a gendered risk environment, placing women in positions of increased vulnerability to physical, sexual and emotional violence and limiting their ability to assert agency and negotiate HIV risk reduction with clients and partners. The narratives of the male-centred housing models describe a symbolic violence (Bourdieu, 2001) where female subordination to existing policies combined with pervasive messaging about individual-level harm reduction strategies work to reproduce risk and normalize violence (Bourgois et al., 2004). Women describe how these policies within their own homes force them to rush sexual transactions to meet curfew and service clients in outdoor public spaces, previously associated with elevated violence (Shannon et al., 2009) and reduced control over condom negotiation with clients (Shannon et al., 2008).

Strict curfews and guest policies represent an infringement of the individual freedom promised by a neo-liberal governmentality, instead excessively regulating women’s private lives. This provides a clear example of how the ‘liberalization’ of neo-liberalism (see Moore, 2004) is selectively applied, and the promise of increased freedoms just as selectively delivered. Whereas a neo-liberal governmentality advocates for less government involvement, individuals living in poverty who seek government interventions, such as welfare and housing, actually face increased regulations (Pollack, 2010). Although it can be argued that building owners and managers refusal to allow women to bring dates home is due to a fear of prosecution under Canada’s prostitution laws that prohibit operating a common bawdy house (e.g. managed indoor sex work establishment) (Pivot, 2004), higher income women continue to see clients at their homes (”in-call”) without legal prosecution or restrictions by apartment owners throughout the rest of the city. Instead, the current ambiguity of the laws in Canada leave the door open to discretionary and exploitative policies adopted by managers and business owners and differentially applied to the most marginalized. Furthermore, many of the women in our study described how guest restrictions are broadly applied to include restrictions on bringing home other guests, such as boyfriends, family members and friends, or charging guest fees per visit, further exploiting women’s rights to negotiating safety and alienating them from their support networks. These restrictions and bureaucratic arbitrations on women’s movement, work and social networks would be unthinkable in other socioeconomic contexts. The curfews and guest policies together with the threats of eviction and sexual exploitation point to how women’s housing experiences are heavily mediated by gender and class.

Within dominant male-centred housing models, women in our study describe experiencing violence and sexual exploitation, as well as being more vulnerable to developing highly gendered relationships with other male residents. Normalized violence in street-based cultures often leads women to enter into relationships with older men for protection, as a rational, economic and safety strategy in the face of gendered and structural constraints (Shannon et al., 2008). These relationships can be physically abusive and economically exploitative, with romantic discourses surrounding love overshadowing gender-power imbalances (Bourgois et al., 2004). In dominant male-centred street ideology, women may be placed into subordinate positions (Epele, 2002), The choice becomes one of tolerating physical violence from a boyfriend or facing repeated sexual harassment and exploitation from other male acquaintances (Bourgois et al., 2004). Paradoxically, the protection sought from a partner may result in higher levels of physical violence, whereas single women often avoid the pervasiveness of domestic abuse while simultaneously facing greater risks from others by being alone (Epele, 2002). Qualitative interviews with homeless women have found that what women desire is both autonomy and protection from further victimization (Padget et al., 2006). The social environment of housing and access to a safe and secure sense of ‘place’ should be emphasized as critical to supporting women’s agency in negotiating health and safety.

The lived experiences of women-only spaces offer a critical opportunity to develop models that counter the gendered risk environment of the dominant male-centred housing models. Elsewhere, a secure sense of home has been found to lead to increased agency and resistance to risky behaviours (Aidala & Sumartojo, 2007; Dickson-Gomez et al., 2009). The narratives of the women’s-only shelters and transitional housing describe a safety from the exploitation and violence from male residents and staff in co-ed SROs. Instead, the environment of women-only spaces fostered the development of peer relationships and informal support networks among sex workers. At the same time, the temporary nature of many of these shelters and continued policy restrictions and curfews regulating women’s work and private lives meant that many of the gendered risk environments persisted, including rushing sexual transactions to meet curfews and seeing dates in isolated public spaces. Collectively, these results support the critical need for social and structural interventions informed by women’s lived experiences. The development of women’s-only housing models must counter the gendered risk environments both at macro and micro levels in shaping women’s agency and ability to negotiate safety and risk reduction.

Limitations

There are several limitations to this study that should be taken into consideration. Although a purposive sample was used to ensure a representation of different ages and low-income and transitional housing models, the experiences represented in our sample may not be representative of all street-based sex workers in low-income, transitional housing. Recruitment for this study took place in Vancouver’s most impoverished, inner city community, the Downtown Eastside, and may not represent the experiences of women in other low-income housing in other parts of Vancouver or elsewhere. This research was an initial exploratory study based on focus group discussions, co-facilitated by a researcher and sex worker. Further research that draws on other quantitative and qualitative methods, including in-depth interviews and ethnographic participant observation, would be beneficial to inform future housing policy and programs for women.

Conclusion

The results of this study point to the urgent need for collaboration between public health professionals, policy makers and urban planners in developing long-term, non-exploitative housing options for impoverished women. Furthermore, women’s lived experiences and active inclusion of women sex workers’ voices must be included in this process in order to mitigate the gendered risk environments of male-centred housing models and promote women’s agency and ability to negotiate health, safety and risks of HIV infection. It must be widely acknowledged by all stakeholders that the experiences of sexual exploitation and violence faced by women in these housing environments are absolutely intolerable. Eliminating these dynamics within existing housing models is imperative in order to effect immediate changes to gendered risk environments. These goals should be strongly considered when developing long-term housing strategies, in order to counter the dominant male-centered model that is currently prevalent in many of the affordable housing options available to women sex workers.

Research highlights.

• Explores transitional housing environments of street-based sex workers and role in shaping agency and power in negotiation of sexual risk

• Analyses draws on women’s narratives in elucidating the physical, structural and social environments of housing in shaping risk negotiation

• Results reveal violence, sexual, and economic exploitation produced by the gender risk environments of dominant male-centred housing models

• The study supports critical need for safer supportive housing models that account for the daily lived experiences of sex workers