Abstract
Background
Women engaged in survival sex work face multiple sexual and drug-related harms that directly enhance their vulnerability to HIV infection. Although research on injection-drug-using women has explored predictors of sex work and HIV infection, little information currently exists on the complex vulnerabilities to HIV transmission faced by survival sex workers in this setting. This analysis aimed to determine HIV prevalence among women engaged in survival sex work, and explore sexual and drug-related vulnerabilities associated with baseline infection.
Methods
Descriptive and univariate analysis were used to explore associations with baseline HIV infection. Variables found to be associated with baseline infection at the univariate level (p<0.05) were entered into a fixed logistic regression model, adjusted for age.
Results
Of a total of 198 women, baseline HIV prevalence was 26%. In multivariate logistic regression, baseline HIV infection was associated with early age of sex work initiation (<18 years) (aOR=1.8, 95% CI: 1.3-2.2), Aboriginal ethnicity (aOR=2.1, 95% CI: 1.4-3.8), daily cocaine injection (aOR=2.2, 95% CI: 1.3-3.5), intensive, daily crack smoking (aOR=2.7, 95% CI: 2.1-3.9), and unprotected sex with an intimate partner (aOR=2.8, 95% CI: 1.9-3.6).
Interpretation
Innovative and evidence-based strategies are urgently needed that address the sexual and drug-related vulnerabilities to HIV infection among survival sex workers and in particular, interventions targeting the precursors to early initiation into sex work.
MeSH terms: Prostitution, HIV infections, harm reduction
Résumé
Contexte
Les femmes qui dépendent du commerce du sexe pour leur survie sont exposées à de nombreuses pratiques risquées, liées au sexe et à la drogue, qui augmentent directement leur vulnérabilité aux infections à VIH. Des études sur les utilisateurs de drogue injectable se sont penchées sur les variables prédictives du travail du sexe et de l’infection à VIH, mais on en sait encore très peu sur les risques complexes de transmission du VIH auxquels s’exposent les femmes qui dépendent du commerce du sexe pour leur survie. Dans le présent article, nous cherchons à déterminer la prévalence du VIH chez ces femmes et nous analysons les pratiques risquées, liées au sexe et à la drogue, associées à la primo-infection.
Méthode
L’association de diverses variables à la primo-infection à VIH a été étudiée au moyen d’analyses descriptives et univariées. Les variables jugées significatives selon les analyses univariées (p<0,05) ont été entrées dans un modèle de régression logistique fixe ajusté selon l’âge.
Résultats
Sur 198 femmes, 26 % étaient séropositives pour le VIH au départ. Selon l’analyse de régression logistique multivariée, la primo-infection à VIH était associée à l’initiation précoce (avant 18 ans) au travail du sexe (RCa=1,8; IC de 95 % = 1,3-2,2), à l’appartenance ethnique autochtone (RCa=2,1; IC de 95 % = 1,4-3,8), à l’injection quotidienne de cocaïne (RCa=2,2; IC de 95 % = 1,3-3,5), à l’habitude quotidienne et intensive de fumer du crack (RCa=2,7; IC de 95 % = 2,1-3,9) et aux relations sexuelles non protégées avec un partenaire intime (RCa=2,8; IC de 95 % = 1,9-3,6).
Interprétation
Il existe un urgent besoin d’instaurer des stratégies novatrices fondées sur les preuves pour combattre les pratiques risquées, liées au sexe et à la drogue, qui augmentent la vulnérabilité aux infections à VIH chez les femmes qui dépendent du commerce du sexe pour leur survie–et en particulier, des mesures d’intervention qui ciblent les précurseurs de l’initiation précoce au travail du sexe.
References
- 1.Irwin K, Edlin BR, Wong L, Faruque S, McCoy HV, Word C, et al. Urban rape survivors: Characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections. Multicentre Crack Cocaine and HIV Infection Study Team. Obstet Gynecol. 1995;85(3):330–36. doi: 10.1016/0029-7844(94)00425-D. [DOI] [PubMed] [Google Scholar]
- 2.El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: Substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care STDS. 2001;15(1):41–51. doi: 10.1089/108729101460092. [DOI] [PubMed] [Google Scholar]
- 3.Currie S, LaLiberte N, Bird S, Rosa N, Sprung S. Assessing the Violence Against Street-involved Women in the Downtown Eastside/ Strathcona Community. Vancouver, BC: DEYAS; 1996. [Google Scholar]
- 4.Farley M, Lynne J, Cotton AJ. Prostitution in Vancouver: Violence and the colonization of First Nations women. Transcultural Psychiatry. 2005;42(2):242–71. doi: 10.1177/1363461505052667. [DOI] [PubMed] [Google Scholar]
- 5.Ratner M, editor. Crack Pipe as Pimp: An Ethnographic Investigation of Sex-for-crack Exchanges. New York, NY: Lexington Books; 1993. [Google Scholar]
- 6.Booth R, Kwiatkowski CF, Chitwood DD. Drug Alcohol Dependence. 2000. Sex related HIV risk behaviours: Differential risks among injection drug users, crack smokers, and injection drug users who smoke crack; p. 58. [DOI] [PubMed] [Google Scholar]
- 7.Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, et al. Intersecting epidemics–Crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med. 1994;33121:1422–27. doi: 10.1056/NEJM199411243312106. [DOI] [PubMed] [Google Scholar]
- 8.Baseman J, Ross MW, Williams ML. Sale of sex for drugs and drugs for sex: An economic context of sexual risk behaviour for STDs. Sex Transm Dis. 1999;26:444–49. doi: 10.1097/00007435-199909000-00005. [DOI] [PubMed] [Google Scholar]
- 9.Astemborski J, Vlahov D, Warren D, Soloman L, Nelson KE. The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. Am J Public Health. 1994;84(3):382–87. doi: 10.2105/AJPH.84.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Braitstein P, Li K, Tyndall M, Spittal P, O’Shaughnessy MV, Schilder A, et al. Sexual violence among a cohort of injection drug users. Soc Sci Med. 2003;57(3):561–69. doi: 10.1016/S0277-9536(02)00403-3. [DOI] [PubMed] [Google Scholar]
- 11.Potterat J, Brewer DD, Muth SQ, Rothenberg RB, Woodhouse DE, Muth JB, et al. Mortality in a long-term open cohort of prostitute women. Am J Epidemiol. 2004;159:778–85. doi: 10.1093/aje/kwh110. [DOI] [PubMed] [Google Scholar]
- 12.Culhane D. Their spirits live within us: Aboriginal women in Downtown Eastside Vancouver emerging into visibility. Am Indian Q. 2003;273–4:593–601. doi: 10.1353/aiq.2004.0073. [DOI] [Google Scholar]
- 13.CBC Online News. The missing women of Vancouver. 2005. [Google Scholar]
- 14.Public Health Agency of Canada. HIV/AIDS Epi Update: HIV/AIDS Among Aboriginal Peoples in Canada: A Continuing Concern. Available online at: https://doi.org/www.phac-aspc.gc.ca/publicat/epiu-aepi/epi_update_may_04/9_e.html (Accessed June 8, 2005).
- 15.Currie S. Assessing the Violence Against Streetinvolved Women in the Downtown Eastside/Strathcona Community: A Needs Assessment. Cited in the Federal/Provincial Territorial Working Group on Prostitution (1998) Vancouver: Canadian Federal/Provincial Working Group on Prostitution; 1994. [Google Scholar]
- 16.Lowman J. Reconvening the federal committee on prostitution law reform. CMAJ. 2004;171(2):147. doi: 10.1503/cmaj.1040781. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.PIVOT. Voices for dignity: A call to end the harms caused by Canada’s sex trade laws. 1–37. Available online at: https://doi.org/www.pivotlegal.org/sextradereport/index.htm (Accessed May 10, 2005).
- 18.Spittal PM, Bruneau J, Craib KJ, Miller C, Lamothe F, Weber AE, et al. Surviving the sex trade: A comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs. AIDS Care. 2003;15(2):187–95. doi: 10.1080/0954012031000068335. [DOI] [PubMed] [Google Scholar]
- 19.Strathdee S, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003;80(Suppl34):iii7–14. doi: 10.1093/jurban/jtg078. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Craib KJ, Spittal PM, Wood E, LaLiberte N, Hogg RS, Li K, et al. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ. 2003;168(1):19–31. [PMC free article] [PubMed] [Google Scholar]
- 21.Shannon K, Bright V, Duddy J, Tyndall MW. Access and utilization of HIV treatment and services among women sex workers in Vancouver’s Downtown Eastside. J Urban Health. 2005;82(3):488–97. doi: 10.1093/jurban/jti076. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Weber A, Boivin J-F, Blais L, Haley N, Roy E. Predictors of initiation into prostitution among female street youths. J Urban Health. 2004;81(4):584–95. doi: 10.1093/jurban/jth142. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Greene J, Ennett ST, Ringwalt CL. Prevalence and correlates of survival sex among runaway and homeless youth. Am J Public Health. 1999;89:1406–9. doi: 10.2105/AJPH.89.9.1406. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Nadon S, Koverola C, Schludermann EH. Antecedents to prostitution: Childhood victimization. J Interpers Violence. 1998;13:206–21. doi: 10.1177/088626098013002003. [DOI] [Google Scholar]
- 25.Potterat J, Rothenburg RB, Muth SQ, Darrow WW, Phillips-Plummer L. Pathways to prostitution: The chronology of sexual and drug abuse milestones. J Sex Res. 1998;35:333–40. doi: 10.1080/00224499809551951. [DOI] [Google Scholar]
- 26.Seng M. Child sexual abuse and adolescent prostitution: A comparative analysis. Adolescence. 1998;24:664–75. [PubMed] [Google Scholar]
- 27.Miller CL, Spittal PM, LaLiberte N, Li K, Tyndall MW, O’Shaughnessy MV, Schechter MT. Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs. JAIDS. 2002;30(3):1–10. doi: 10.1097/00126334-200207010-00010. [DOI] [PubMed] [Google Scholar]
- 28.Statistics Canada. Population by Aboriginal Group. Available online at: https://doi.org/www40.statcan.ca/l01/cst01/demo26a.htm (Accessed June 8, 2005).
- 29.Public Health Agency of Canada. Situation analysis: A background paper on HIV/AIDS and Aboriginal people. Available online at: https://doi.org/www.phac-aspc.gc.ca/aids-sidaaids-sida/hiv_aids/pdf/situtionalanalysis-e.pdf (Accessed June 6, 2005).
- 30.BC Aboriginal HIV/AIDS Task Force. The Red Road: Pathways to wholeness. An Aboriginal Strategy for HIV/AIDS in, BC. Available online at: https://doi.org/www.red-road.org/download/PathwaysWholeness.pdf (Accessed June 9, 2005).
- 31.Simoni JM, Schgal S, Walters KL. Triangle of risk: Urban American Indian women’s sexual trauma, injection drug use, and HIV sexual risk behaviours. AIDS and Behavior. 2004;8(1):33–44. doi: 10.1023/B:AIBE.0000017524.40093.6b. [DOI] [PubMed] [Google Scholar]
- 32.Evans-Campbell T, Walters KL. Catching our breath: A decolonization framework for healing indigenous families. 2003. [Google Scholar]
- 33.Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV- 1 epidemic. AIDS. 2003;17(6):887–93. doi: 10.1097/00002030-200304110-00014. [DOI] [PubMed] [Google Scholar]
- 34.Logan T, Leukefeld C, Farabee D. Sexual and drug use behaviours among women crack users: Implications for prevention. AIDS Educ Prev. 1998;10(4):327–40. [PubMed] [Google Scholar]
- 35.Estebanez P, Russell NK, Aguilar MD, Beland F, Zunzunegui MV. Women, Drugs, and HIV/AIDS: Results of a multicentre European study. Int J Epidemiol. 2000;29(4):734–43. doi: 10.1093/ije/29.4.734. [DOI] [PubMed] [Google Scholar]
- 36.Spittal PM, Craib KJ, Wood E, Laliberte N, Li K, Tyndall MW, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166(7):894–99. [PMC free article] [PubMed] [Google Scholar]
- 37.De Irala J, Bigelow C, McCusker J, Hindin R, Zheng L. Reliability of self-reported human immunodeficiency virus risk behaviors in a residential drug treatment population. Am J Epidemiol. 1996;143(7):725–32. doi: 10.1093/oxfordjournals.aje.a008806. [DOI] [PubMed] [Google Scholar]