Policing and nonfatal overdose in a community-based cohort of sex workers in Vancouver, Canada: influence of stigma and other intersecting systems of marginalization (2014-2024).

BACKGROUND

We evaluated the association between policing and recent (last 6 months) nonfatal overdose, and differences based on stigma and other intersecting systems of marginalization, among a cohort of sex workers in Canada.

METHODS

Data were drawn from a cohort of sex workers in Vancouver, Canada (9/2014-2/2024). We used generalized linear mixed models to examine the relationship between police-related factors (interactions, displacement, and barriers to safer sex work transactions and harm reduction) and recent nonfatal overdose. Stratified models evaluated potential heterogeneity in associations between policing and nonfatal overdose among women experiencing sex work occupational stigma, and marginalization based on race, sexual orientation and/or gender identities, homelessness, and criminalized injection drug use vs. their respective reference groups.

FINDINGS: Among 452 sex workers who use drugs, nonfatal overdose was associated with police harassment while working (adjusted odds ratio (AOR)=1.74, 95% confidence interval (95% CI): 1.05-2.89) and barriers to harm reduction due to police presence (AOR=1.96, 95% CI:1.40-2.75). Across stratified analyses, larger and significant effects were most frequently observed among women experiencing homelessness vs. housed women, as well as among people with minoritized sexual orientation and/or gender identities compared with cisgender and/or straight individuals. A larger and significant association was observed among women experiencing stigma compared to those who did not for police-related barriers to harm reduction and overdose, while other policing and overdose models showed similar but statistically null trends.

INTERPRETATION: Results suggest the need for interventions supporting harm reduction services for marginalized women and tailored services to mitigate impacts on those most affected, such as housings.