Evaluating the impacts of migration and mobility on HIV, STIs and viral hepatitis among female sex workers in British Columbia

Mobility and migration are determinants of HIV, sexually transmitted infections (STIs), and related infections, such as viral hepatitis, in low and middle-income countries. This is particularly true for key populations such as female sex workers (FSWs), who are disproportionately impacted by HIV/STIs and often highly mobile. Mobility may also facilitate the diffusion of infectious diseases across geographic settings and populations. However, the linkages between migration, mobility and HIV among marginalized women remain poorly understood in higher-income countries such as Canada. Despite the advances of efforts to scale-up access to care for HIV and viral hepatitis, including a program initiated in 2010 in British Columbia (BC), migrant and mobile women remain disproportionately impacted by these infections. Whereas international migrants comprise >20% of Canada's population, migrants from HIV endemic countries represent >40% of heterosexually transmitted HIV cases, and most hepatitis B and 25% of hepatitis C infections also occur among migrants from endemic countries, where access to preventive vaccines has been historically lower. Internal mobility between cities and provinces within Canada is also common, and may also relate to elevated HIV/STI vulnerability and barriers to care, especially for Aboriginal women, among whom mobility is embedded in a legacy of dispossession and displacement. This study will evaluate patterns, predictors, and impacts of migration and mobility on HIV, STIs and viral hepatitis prevention and care among a new cohort of 200 migrant and mobile FSWs (100 internal, 100 international) in Vancouver, BC. It will be the first study in Canada to explore how migration and mobility impact HIV, STIs, and viral hepatitis among FSWs over time, and will provide a research platform to inform improved policy and public health practice related to HIV, STI and viral hepatitis prevention and care.