The protective association of social cohesion on sex workers' experiences of violence and access to community support: Impacts of resource sharing, trust and connection among a community-based cohort in Metro Vancouver, Canada (2010-2022)

To measure recent social cohesion (resource sharing, trust and support) and its association with (1) sexual/physical violence, and (2) engagement with sex work-specific services among women sex workers in Metro Vancouver, Canada. Prospective data (January 2010-August 2022) were drawn from an open cohort of 900+ women sex workers. We developed multivariable logistic regression confounder models with generalized estimating equations (GEE) to examine associations between social cohesion and recent (1) physical/sexual violence and (2) engagement with sex work-specific services. Of 918 participants, 36.8% were Indigenous and 32.1% were Black/Women of Colour. At baseline, the median social cohesion score was 19 (IQR 16-22), out of 36, with higher levels among participants who work with other sex workers. In separate multivariable confounder models with GEE, social cohesion was associated with lower odds of recent physical/sexual violence (Adjusted Odds Ratio 0.98 per point on scale, 95% Confidence Interval 0.97, 0.99) and recent use of sex work-specific services, although only statistically significant for physical/sexual violence. Findings support the need to eliminate policing of work environments that promote sex workers' social cohesion and physical safety through full decriminalization.