Canadian Sex Workers Convene for National Consultation on PrEP

North America and the Caribbean Regional Correspondent

In October 2016, Triple X and the Dalla Lana School of Public Health (DPLHS) collaborated to hold a convening in Toronto, Canada, bringing together 50 sex workers and health providers from all across the country to discuss concerns and share information regarding the use of Pre-Exposure Prophylaxis (PrEP) - a once daily pill that is prescribed to reduce the risk of HIV infection.

Documentation of the event led to a 160 page book entitled HIV Pre-Exposure Prophylaxis in Canada and Sex Work 2016, and a video #SWPrEP (above), both available on the Triple X website.

The book by Triple X highlights the relationship of sex workers to PrEP. Usage of PrEP has risen dramatically since its introduction in 2012. The motivation for this project was partially born out of the inclusion of ‘sex trade workers’ as a risk category in a draft of the Canadian PrEP prescription guidelines. Andrew Sorfleet, Triple X president said, I was appalled that there had been no community consultation whatsoever. At the very least Canadian sex workers deserve the right to have some input into that language.

In a reflection of the diversity of the sex work community, the report shares a wide scope of information. Included are several histories - including those of PrEP medical trials to date and HIV sex work activism, essays and interviews with stakeholders, and transcripts of panel conversations. The booklet is meant to act as a resource for attendees as an archive and a record of information shared. It also outlines how to plan sex worker consultations and gives budget information as a guideline for other organisations seeking to follow up on community-based forums.

While the goal of the meeting was not to come up with any one conclusion on what sex workers think about PrEP some themes emerged. Concerns about the possibility of state coercion and registration were voiced, as were frustrations around the cost and accessibility of the medication, the lack of information for cisgender women and transgender people and the likelihood of PrEP creating an environment where sex workers would be pushed by clients to not use condoms. These concerns were echoed in NSWP’s Briefing Paper on PrEP, which provides insights into what sex workers think about PrEP and the concerns they have about it globally.

Sorfleet said that the direct and indirect benefits of the consultation were many. People met each other. That was the best. Some people on the front line in their community had never heard of PrEP. We got to share stories. Feel the warmth of meeting in person that simply cannot be replaced by internet communications. We learned a lot together. We all have a very accurate picture now of the HIV prevention and risk landscape which we could not have gotten any other way. And people have a lot more perspective to take back to their communities and share,” he said.

Triple X and DPLHS will be utilising this consultation to inform a larger research study, funded through Canadian Institutes for Health Research. With information gathered through these meetings they will be constructing an innovative online survey exploring the relationship of HIV prevention and programming to sex workers to be released soon.