Grant: Travel Awards - Institute Community Support

Background: Suicide is a critical public concern globally. Sex workers experience disproportionately elevated risks and rates of morbidity and mortality, yet empirical research on suicide risk among marginalized women is limited. This study therefore aimed to longitudinally investigate the burden and socio-structural correlates of suicidality among women sex workers in Vancouver, Canada. Methods: Data (2010-2017) were drawn from a community-based, prospective cohort of women sex workers known as AESHA (An Evaluation of Sex Workers Health Access). Participants completed biannual interviewer-administered questionnaires and correlates of suicidality (suicide attempts or ideation) in the last six months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Results: Of a total 867 participants at baseline, 16% (n=141) reported suicidality in the last six months, and 29% reported suicidality at some point during the study; 38% of women identified as Indigenous. In final multivariable analysis, the following factors were independently associated with suicidality: physical and/or sexual childhood abuse, mental health issues (depression/anxiety/post-traumatic stress disorder), intimate partner violence, physical and/or sexual violence by clients, and homelessness. Older age and higher social cohesion among women were significantly associated with reduced risk of suicide. Conclusions: These findings reveal key socio-structural correlates of suicidality among women sex workers, including past trauma, partner violence, and homelessness. Strengthening social cohesion among sex workers may have a protective effect on suicidality. Trauma-informed and community-led structural interventions tailored to women sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.