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RESEARCH ARTICLE
The impact of end-demand legislation on sex
workers’ access to health and sex worker-led
services: A community-based prospective
cohort study in Canada
Elena Argento1,2☯, Shira Goldenberg1,3‡, Melissa Braschel1‡, Sylvia Machat1‡, Steffanie
A. Strathdee4‡, Kate ShannonID 1,2☯*
1 Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada, 2 Faculty of Medicine,
University of British Columbia, Vancouver, British Columbia, Canada, 3 Faculty of Health Sciences, Simon
Fraser University, Burnaby, British Columbia, Canada, 4 Department of Medicine, University of California
San Diego, La Jolla, California, United States of America
☯ These authors contributed equally to this work.
‡ These authors also contributed equally to this work.
Abstract
Background
Following a global wave of end-demand criminalization of sex work, the Protection of Com-
munities and Exploited Persons Act (PCEPA) was implemented in Canada, which has impli-
cations for the health and safety of sex workers. This study aimed to evaluate the impact of
the PCEPA on sex workers’ access to health, violence, and sex worker-led services.
Methods
Longitudinal data were drawn from a community-based cohort of ~900 cis and trans women
sex workers in Vancouver, Canada. Multivariable logistic regression examined the indepen-
dent effect of the post-PCEPA period (2015–2017) versus the pre-PCEPA period (2010–
2013) on time-updated measures of sex workers’ access to health, violence supports, and
sex worker/community-led services.
Results
The PCEPA was independently correlated with reduced odds of having access to health
services when needed (AOR 0.59; 95%CI: 0.45–0.78) and community-led services (AOR
0.77; 95%CI: 0.62–0.95). Among sex workers who experienced physical violence/sexual
violence or trauma, there was no significant difference in access to counseling supports
post-PCEPA (AOR 1.24; 95%CI: 0.93–1.64).
Conclusion
Sex workers experienced significantly reduced access to critical health and sex worker/com-
munity-led services following implementation of the new laws. Findings suggest end-
PLOS ONE | https://doi.org/10.1371/journal.pone.0225783 April 6, 2020 1 / 10
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OPEN ACCESS
Citation: Argento E, Goldenberg S, Braschel M,
Machat S, Strathdee SA, Shannon K (2020) The
impact of end-demand legislation on sex workers’
access to health and sex worker-led services: A
community-based prospective cohort study in
Canada. PLoS ONE 15(4): e0225783. https://doi.
org/10.1371/journal.pone.0225783
Editor: Marina Della Giusta, University of Reading,
UNITED KINGDOM
Received: May 31, 2019
Accepted: November 12, 2019
Published: April 6, 2020
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0225783
Copyright: © 2020 Argento et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: Due to the highly
criminalized and stigmatized nature of this
population, anonymized data may be made
demand laws may exacerbate and reproduce harms of previous criminalized approaches to
sex work in Canada. This study is one of the first globally to evaluate the impact of end-
demand approaches to sex work. There is a critical evidence-based need to move away
from criminalization of sex work worldwide to ensure full labor and human rights for sex
workers. Findings warn against adopting end-demand approaches in other cities or
jurisdictions.
Introduction
Global research and evidence demonstrate that criminal policies and punitive enforcement-
based approaches to sex work continue to undermine the health and human rights of sex
workers [1–3]. The legal environment has immense potential to shape the wellbeing of those
most marginalized in society. Substantial evidence demonstrates that the criminalization of
sex work perpetuates widespread forms of violence, stigma, and discrimination that prevent
sex workers from seeking or accessing critical health and support services [4–6]. In settings
where sex work is criminalized, sex workers are at significantly elevated risk of HIV and other
sexually transmitted infections (STIs) driven by social marginalization and increased exposure
to workplace violence and abuse [6,7]. The criminalized nature of sex work and related polic-
ing practices displace sex workers to more isolated and risker locations and reduce the ability
of sex workers to work together or more formally organize due to fear of arrest and police
harassment [4,6,8]. Where sex work is criminalized, the ability of sex workers to formally orga-
nize or work together is restricted. The hindering of collectivization among sex workers
through criminalization is of critical concern given the central importance of community
empowerment and enabling sex workers to negotiate safety in the workplace, as well as advo-
cate for human rights, including access to health and safety.
Numerous human rights and public health experts and international bodies, such as the
World Health Organization, UNAIDS, and Amnesty International, along with sex work com-
munities worldwide, have strongly endorsed full decriminalization of sex work based on well-
established evidence of the harmful impacts of criminalization and enforcement-based
approaches [3,9,10]. In 2013, the Supreme Court of Canada struck down three core anti-pros-
titution laws on the basis that they were a violation of sex workers’ constitutional rights [11];
however, Canada’s federal government implemented new legislation in 2014, known as the
“Protection of Communities and Exploited Persons Act” (PCEPA), which has serious implica-
tions for the health and safety of sex workers. Modeled after laws in Norway, Sweden and a
number of other European countries, the PCEPA is an end-demand approach that criminal-
izes new aspects of sex work including communicating for the purpose of selling sex and the
purchasing and advertising of sexual services, targeting clients and third parties while leaving
the sale of sex legal [12].
Research and legal experts and community have expressed serious concerns regarding end-
demand legislation, as it reproduces the same risks and harms of previous criminalization
models whereby targeting clients still leads to rushed transactions and improper screening,
increasing risk of violence and HIV/STIs [7,13]. The PCEPA also targets third party self-adver-
tising, which has the potential to detrimentally impact sex workers’ health and safety, and con-
flates sex workers with victims of violence and trafficking. Further, the PCEPA focuses on
cisgender women sex workers and makes no mention of sex workers who do not identify as cis
women (i.e., LGBTQ, men) [12], failing to acknowledge gender and sexual diversity of individ-
uals who sell sex and the unique vulnerabilities faced by gender and sexual minorities [14–16].
The impact of end-demand laws on sex workers’ access to health and sex worker-led services
PLOS ONE | https://doi.org/10.1371/journal.pone.0225783 April 6, 2020 2 / 10
available on request subject to the UBC/
Providence Health Ethical Review Board, and
consistent with our funding body guidelines (NIH
and CIHR). Requests should be directed to
Funding: This research is supported by the US
National Institutes of Health (NIH)
(R01DA028648), a Canadian Institutes of Health
Research (CIHR) Foundation Grant, and MacAIDS.
SG is partially supported by NIH and a CIHR New
Investigator Award. KS is partially supported by a
Canada Research Chair in Global Sexual Health and
HIV/AIDS, NIH, and Michael Smith Foundation for
Health Research. EA is supported by a CIHR
Doctoral Award. SAS is supported by a NIDA
MERIT Award (R37DA019829). The study funders
had no role in the study design, data collection,
analysis, interpretation, writing of the report, or
decision to submit the paper for publication.
Competing interests: The authors have declared
that no competing interests exist.
One of the explicit goals of end-demand approaches is to increase access to services and
supports for sex workers, yet scientific and legal evidence suggest that criminalization may
impede access to services [1,2,9,10]. There remains a paucity of empirical research and evi-
dence on the impacts of end-demand approaches globally. Therefore, this study aimed to lon-
gitudinally evaluate the impact of the PCEPA on sex workers’ access to health, violence, and
sex worker/community-led services and supports in Vancouver, Canada.
Methods
Longitudinal data (2010–2017) were drawn from a community-based, prospective open cohort
of over 900 women sex workers in Metro Vancouver known as AESHA (An Evaluation of Sex
Workers Health Access). Participants were recruited using time-location sampling [17], with
day and late-night outreach to outdoor sex work locations (i.e., streets, alleyways), indoor sex
work venues (i.e. massage parlors, micro-brothels, in-call locations), and online. Participatory
mapping strategies were conducted to identify work venues, and a weekly mobile van has
reached over 100 sex work venues across the city. AESHA includes a diverse experiential team
of both current and former sex workers represented across interviewer, outreach, nursing, and
coordinator staff since its inception in 2010. AESHA also has a Community Advisory Board of
over 15 women’s health, sex work and HIV agencies, as well as representatives from health
authorities and policy experts.
Eligibility criteria for participants include cis or trans women, 14 years of age or older, who
exchanged sex for money within the last 30 days. After providing written informed consent,
participants completed interviewer-administered questionnaires and voluntary HIV/STI/
HCV serology testing at enrollment and biannually. The questionnaires and clinical compo-
nents were completed at one of two study offices or at a safe location identified by participants.
The main interview questionnaire elicits responses related to socio-demographics (e.g., sexual
identity, ethnicity, housing), the work environment (e.g., access to services, safety, policing,
incarceration), client characteristics (e.g., types/fees of services, condom use), intimate part-
ners (e.g., cohabitation, financial support), experiences of violence (e.g., childhood abuse,
exposure to intimate partner and workplace violence), and drug use patterns. The clinical
questionnaire relates to overall physical, mental, and emotional health, and HIV testing and
treatment experiences to support education, referral, and linkages with care. The study holds
ethical approval through Providence Health Care/University of British Columbia Research
Ethics Board. As in previous studies, we have held ethical approval since 2004 to include self-
supporting youth aged 14–18 years who are not living with a parent or guardian under the
emancipated minor clause, given the critical importance of understanding the needs of vulner-
able youth. All participants received an honorarium of $40 CAD at each bi-annual visit for
their time, expertise and travel.
Measures
The main outcomes of interest were time-updated variables for having access to health care
when needed and sex worker/community-led services and supports in the last six months.
Having access to health services when needed was defined as>75% of the time (responding
‘Usually (over 75% of the time)’ or ‘Always (100% of the time)’ to the question ‘How often can
you get health care services when you need it?’). Utilization of sex worker/community-led ser-
vices was defined as responding ‘yes’ to using any sex worker/community-led health or sup-
port services, including outreach programs. Access to counseling support for violence/trauma
was also examined as an outcome variable among participants who had ever experienced any
physical and/or sexual violence and/or lifetime trauma, defined as responding ‘yes’ to
The impact of end-demand laws on sex workers’ access to health and sex worker-led services
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experiencing any barriers to counseling or therapy for sexual abuse or other trauma or
violence.
The primary exposure variable was the post-PCEPA time period (April 2015-August 2017
vs. 2010–2013). Given that the PCEPA was introduced in January 2014 and not officially
passed until the end of the year, the year 2014 was dropped from the analyses in order to
reduce any potential effects on the outcomes of interest due to variation in the ways in which
the laws may have been enforced during this phase. The first three months of 2015 were also
excluded to account for outcome measures referring to the preceding six months. Approxi-
mately half (53%, n = 452) of participants were interviewed in the pre-PCEPA time period
(2010–2013) only, and 14% (n = 117) were interviewed in the post-PCEPA time period (2015–
2017) only. One-third (33%, n = 285) of participants were interviewed in both pre- and post-
PCEPA time periods. Various other socio-demographic and structural-environmental vari-
ables were considered as potential confounders based on the literature and available data col-
lected for the AESHA cohort. Time-fixed variables included gender and/or sexual minority
(LGBTQ) and Indigenous ancestry (inclusive of First Nations, Metis, and Inuit). Participant
age was updated based on age at baseline and interview date. Primary place of soliciting clients
(e.g., street/public spaces, indoor venues/in-call, independent off-street/online), workplace
physical and/or sexual violence by clients, police harassment without arrest, any injection and
non-injection drug use, and being on any opioid substitution therapy (OST) were considered
time-varying and were updated to reflect their occurrence within the last six months.
Statistical analyses
Descriptive statistics at baseline were calculated for the primary independent variable, the
post-PCEPA period, and all potential confounders, stratified by the outcomes of interest. Cate-
gorical variables were assessed using Pearson’s chi-square test (or Fisher’s exact test for small
cell counts), and the Wilcoxon rank sum test was used for continuous variables. The relation-
ships between the post-PCEPA period and access to health care and sex worker/community-
led supports were examined using bivariate and multivariable logistic regression with general-
ized estimating equations (GEE) and an exchangeable correlation matrix. Separate multivari-
able confounder models were fitted to assess the independent relationship between the post-
PCEPA period and the outcomes of interest. All analyses were restricted to observations where
participants reported engaging in sex work in the last six months; the model for accessing vio-
lence supports was further restricted to those who had ever experienced physical and/or sexual
violence. A sub-analysis was conducted to examine whether physical and/or sexual workplace
violence was affected by the PCEPA; however, these results were not found to be significant.
Full models included all hypothesized confounders and were subjected to a manual stepwise
approach, whereby variables that altered the association of interest by<5% were systematically
removed [18]. Remaining variables were retained as confounders in the final multivariable
models. A complete case analysis was used such that observations with any missing data were
removed. Two-sided p-values and unadjusted and adjusted odds ratios (ORs and AORs) with
95% confidence intervals (95%CI) for the associations between the post-PCEPA period and
the outcomes of interest were generated. All statistical analyses were performed using SAS soft-
ware version 9.4 (SAS Institute, Cary, NC, USA).
Results
Of a total 854 participants who completed the baseline questionnaire, 14% (n = 118) reported
not having access to health services when needed at baseline and 29% (n = 247) reported not
having access at some point during the study. At baseline, 59% (n = 501) reported using a sex
The impact of end-demand laws on sex workers’ access to health and sex worker-led services
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worker/community-led health service (70%, n = 596 used these services at some point during
the study period). Of a total 683 participants who reported ever experiencing physical and/or
sexual violence and/or trauma, 11% (n = 77) reported experiencing barriers to accessing
counseling support for violence/trauma at baseline and 31% (n = 209) experienced barriers at
some point during the study period. Baseline characteristics among women who had access to
health care, sex worker/community-led services and supports, and violence supports are dis-
played in Tables 1, 2 and 3.
The median age at baseline was 35 years (interquartile range [IQR] = 28–42). At baseline,
36% (n = 310) identified as a gender or sexual minority and 39% (n = 332) as Indigenous,
highlighting the overrepresentation of gender and sexual minorities and Indigenous women
among sex workers in Vancouver. Among the restricted sample of participants who had ever
experienced violence or trauma, 44% (n = 299/683) identified as a gender or sexual minority
and 47% (n = 320/683) as Indigenous, and a significantly higher proportion of Indigenous
women reported experiencing barriers to counseling (p = 0.016).
Unadjusted and adjusted odds ratios for the associations between the post-PCEPA time
period and access to health care, sex worker/community-led services and supports, and counsel-
ing for violence/trauma are displayed in Table 4. In final separate multivariable confounder
models, the post-PCEPA period was independently associated with significantly reduced odds
of having access to health services when needed (AOR 0.59; 95%CI: 0.45–0.78) and sex worker/
community-led services and supports (AOR 0.77; 95%CI: 0.62–0.95). Among sex workers who
experienced violence or trauma, there was no significant difference in access to counseling sup-
ports following implementation of the new laws (AOR 1.24; 95%CI: 0.93–1.64; p = 0.140).
Discussion
Despite one of the explicit goals of end-demand criminalization approaches being to increase
access to services and supports for sex workers, this study found no statistically significant
Table 1. Baseline socio-structural characteristics of sex workers who had access to health services when needed in the last 6 months, compared to those who did not
(N = 852).
Characteristic Had access to health services when needed N = 734
(86%)
Did not have access to health services when needed N = 118
(14%)
p-value
Post-PCEPA 96 (13.1) 21 (17.8) 0.167
Age (median, IQR) 35 (28–42) 35 (28–43) 0.747
Gender/sexual minority 270 (36.8) 39 (33.1) 0.428
Indigenous 288 (39.2) 43 (36.4) 0.556
Used non-injection drugs† 501 (68.3) 66 (55.9) 0.007
Used injection drugs† 310 (42.2) 36 (30.5) 0.016
Workplace violence† 285 (38.8) 48 (40.7) 0.752
On opioid substitution therapy No 257 (35.0) 41 (34.8)
Yes 204 (27.8) 14 (11.9)
N/A (never used opioids) 268 (36.5) 59 (50.0) <0.001
Primary place to solicit clients†
Street/public space 384 (52.3) 48 (40.7)
Indoor/in-call venue 194 (26.4) 51 (43.2)
Independent/self-
advertising
148 (20.2) 19 (16.1) 0.001
† In the last 6 months.
https://doi.org/10.1371/journal.pone.0225783.t001
The impact of end-demand laws on sex workers’ access to health and sex worker-led services
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increase in access to health or sex worker/community-led support services following imple-
mentation of the PCEPA in Vancouver, Canada. Rather, findings suggest that after implemen-
tation of the new laws, sex workers had reduced access to health and sex worker/community-
led supports. To our knowledge, this study is the first to longitudinally evaluate the impact of
end-demand legislation on access to health services and supports for sex workers in Canada.
Table 2. Baseline socio-structural characteristics of sex workers who utilized sex worker/community-led health and support services in the last 6 months, compared
to those who did not (N = 854).
Characteristic Used community services N = 501 (59%) Did not use community services N = 353 (41%) p-value
Post-PCEPA 60 (12.0) 57 (16.2) 0.081
Age (median, IQR) 35 (28–42) 35 (28–42) 0.658
Gender/sexual minority 229 (45.7) 81 (23.0) <0.001
Indigenous ancestry 263 (52.5) 69 (19.6) <0.001
Used non-injection drugs† 443 (88.4) 125 (35.4) <0.001
Used injection drugs† 291 (58.1) 55 (15.6) <0.001
Workplace violence† 257 (51.3) 79 (22.4) <0.001
On opioid substitution therapy No 231 (46.1) 67 (19.0)
Yes 177 (35.3) 42 (11.9)
N/A (never used opioids) 86 (17.2) 242 (68.6) <0.001
Primary place to solicit clients†
Street/public space 357 (71.3) 76 (21.5)
Indoor/in-call venue 31 (6.2) 215 (60.9)
Independent/self-advertising 109 (21.8) 58 (16.4) <0.001
† In the last 6 months.
https://doi.org/10.1371/journal.pone.0225783.t002
Table 3. Baseline socio-structural characteristics of sex workers who experienced barriers to receiving counseling for trauma in the last 6 months, compared to
those who did not (N = 683)�.
Characteristic Experienced barriers to support N = 77 (11%) Did not experience barriers to support N = 606 (89%) p-value
Post-PCEPA 12 (15.6) 84 (13.9) 0.682
Age (median, IQR) 32 (28–40) 35 (28–42) 0.159
Gender/sexual minority 33 (42.9) 266 (43.9) 0.863
Indigenous ancestry 46 (59.7) 274 (45.2) 0.016
Used non-injection drugs† 68 (88.3) 486 (80.2) 0.054
Used injection drugs† 41 (53.3) 293 (48.4) 0.418
Workplace violence† 40 (52.0) 280 (46.2) 0.302
On opioid substitution therapy No 35 (45.5) 258 (42.6)
Yes 23 (29.9) 188 (31.0)
N/A (never used opioids) 17 (22.1) 153 (25.3) 0.808
Primary place to solicit clients†
Street/public space 50 (64.9) 372 (61.4)
Indoor/in-call venue 6 (7.8) 96 (15.8)
Independent/self-advertising 20 (26.0) 132 (21.8) 0.161
�Restricted to workers who reported sexual and/or physical violence or trauma in lifetime. † In the last 6 months.
https://doi.org/10.1371/journal.pone.0225783.t003
The impact of end-demand laws on sex workers’ access to health and sex worker-led services
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Findings from this study support global calls for full decriminalization of sex work as a criti-
cal and necessary structural intervention to improve health and human rights for sex workers
and reduce transmission of HIV and other STIs [2,3,7,10]. Existing data suggests that end-
demand criminalization that targets clients and third parties, but not sex workers, has been
shown to reproduce the risks and harms associated with previous laws criminalizing sex work.
For example, a recent study from France found that end-demand laws had detrimental effects
on sex workers’ safety, health and overall living conditions–worse than the previous laws
against soliciting [13]. Qualitative research in Vancouver elucidated the ways in which policing
practices that target clients recreate vulnerability to violence by hindering the ability of work-
ers to properly screen clients [7]. Further, the evidence is unequivocal that sex workers who
experience physical or sexual violence are less able to negotiate the terms of their transactions
and are more likely to experience client condom refusal, significantly increasing risk of HIV/
STI transmission [8,19–23]. Marginalized sex workers who experience violence face consider-
able barriers to accessing counselling for trauma support. The present analysis demonstrates
that there was no change in experiencing barriers to accessing counselling for violence or
trauma post-PCEPA. This lack of change suggests that end-demand criminalization has failed
to address such barriers and may potentially exacerbate the physical and psychological burden
among sex workers, especially given that one of the explicit goals of end-demand legislation is
to increase access to services and supports for sex workers. Future qualitative work would help
to shed more light on sex workers’ experiences of barriers to accessing these services pre- vs.
post-PCEPA.
Interventions aimed at promoting community empowerment and social cohesion among
sex workers can have powerful influences on women’s health and safety, as evidenced in lower
and middle-income countries [24–26]. However, criminalization, stigma, and a lack of fund-
ing to support sex worker-led programs continue to impede collectivization among sex work-
ers [1,24]. Akin to the US PEPFAR anti-prostitution pledge, the PCEPA reduces access to
community-led services and jeopardizes funding for and development of critical sex worker-
led supports, in addition to further conflating sex work with trafficking [6,10,27,28]. Legislative
reform to sex work laws in New Zealand and parts of Australia exemplify the benefits of
decriminalizing all aspects of sex work for enabling safer occupational conditions for sex work-
ers, with demonstrated impacts on increased access to health services and improved workplace
safety [29–31]. Structural and legal interventions should therefore be guided by the large and
growing body of evidence demonstrating that punitive approaches to sex work, including end-
demand criminalization such as the PCEPA recently implement in Canada, do not improve
health, safety, or access to services for sex workers.
Table 4. Unadjusted and adjusted odds ratios for the effect of the post-PCEPA period (2015–2017 vs. 2010–2013) on sex workers’ access to health and sex worker/
community-led services and supports in the last 6 months.
Health Access Outcomes Unadjusted Odds Ratio (95%
CI)
p-value Adjusted Odds Ratio (95%
CI)
p-value
Accessed health services when needed 0.60 (0.47–0.76) <0.001 0.59 (0.45–0.78)� <0.001
Utilized community-driven sex work health and support services 0.73 (0.63–0.85) <0.001 0.77 (0.62–0.95)�� 0.014
Experienced barriers to accessing counseling for sexual abuse, trauma or other
violence† 1.10 (0.86–1.40) 0.465 1.24 (0.93–1.64)��� 0.140
† Restricted to workers who reported sexual and/or physical violence or trauma in lifetime.
� Adjusted for workplace violence, non-injection drug use, and opioid substitution therapy.
�� Adjusted for age, Indigeneity, place of solicitation, workplace violence, injection and non-injection drug use, and opioid substitution therapy.
���Adjusted for age, Indigeneity, place of solicitation, workplace violence and non-injection drug use.
https://doi.org/10.1371/journal.pone.0225783.t004
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Strengths and limitations
A major strength of this study is prospective design and use of GEE analyses, which increased
statistical power. Sex workers’ access to health and support services is likely influenced by a
complex set of socio-structural variables, and not all potential confounders could be controlled
for in this study. Among the sample restricted to women who experienced violence/trauma,
experiencing barriers to counseling may have been underestimated due to the fact that baseline
questionnaires prior to September 2014 only asked about sexual violence and not physical vio-
lence or trauma. Data were self-reported, which introduces the potential for social desirability
and reporting biases, and events that occurred in the past may be subject to recall bias. Given
that interviews were conducted in safe and comfortable spaces, alongside the community-
based nature of the study represented by experiential interviewers (including current and for-
mer sex workers), the likelihood of some biases may have been reduced. Findings may not be
generalizable to other sex work populations and settings; however, the study included a wide
representation of sex workers from both street and off-street work environments. Women
who work more independently (e.g., escorts, online) may have been underrepresented. Com-
munity mapping and time-location sampling likely helped to minimize selection bias and
ensure a more representative sample of sex workers.
Conclusions
Findings demonstrate no increase in access to health, violence, and sex worker-led support ser-
vices post-PCEPA, and rather a reduction in odds of accessing sex worker/community-led
supports and health services when needed. End-demand approaches to criminalize sex work
may not only reproduce the harms of previous criminalized approaches to sex work in Canada,
but may further exacerbate barriers to accessing health and community-led services that have
been proven to be key contributors of better health outcomes. There is a critical evidence-
based need to move away from criminalized approaches to sex work to ensure full labor and
human rights for sex workers, including access to health, social, and legal support services.
Findings warn against adopting end-demand approaches in other cities or jurisdictions.
Acknowledgments
We thank all those who contributed their time and expertise to this project, particularly partic-
ipants, AESHA community advisory board members and partner agencies, and the AESHA
team, including: Jennifer Morris, Jane Li, Minshu Mo, Sherry Wu, Emily Leake, Anita Dhanoa,
Meaghan Thumath, Alka Murphy, Jenn McDermid, Tave Cole, Jaime Adams, Roisin Heather,
Anna Mathen, Bridget Simpson, Nadina Morin, Desire Tibashoboka, Carly Glanzberg and
Maya Henriquez. We also thank Abby Rolston, Peter Vann, Erin Seatter, Jill Chettiar, and
Megan Bobetsis for their research and administrative support.
Author Contributions
Conceptualization: Elena Argento, Shira Goldenberg, Steffanie A. Strathdee, Kate Shannon.
Formal analysis: Elena Argento, Shira Goldenberg, Melissa Braschel.
Funding acquisition: Kate Shannon.
Investigation: Elena Argento, Melissa Braschel, Sylvia Machat, Kate Shannon.
Methodology: Elena Argento, Melissa Braschel, Steffanie A. Strathdee, Kate Shannon.
Software: Melissa Braschel.
The impact of end-demand laws on sex workers’ access to health and sex worker-led services
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Supervision: Shira Goldenberg, Steffanie A. Strathdee, Kate Shannon.
Writing – original draft: Elena Argento.
Writing – review & editing: Elena Argento, Shira Goldenberg, Melissa Braschel, Sylvia
Machat, Steffanie A. Strathdee, Kate Shannon.
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