Access and Utilization of HIV Treatment and Services Among Women Sex Workers in Vancouver's Downtown Eastside

Abstract

Many HIV-infected women are not realizing the benefits of highly active antiretroviral therapy (HAART) despite significant advancements in treatment. Women in Vancouver's Downtown Eastside (DTES) are highly marginalized and struggle with multiple morbidities, unstable housing, addiction, survival sex, and elevated risk of sexual and drug-related harms, including HIV infection. Although recent studies have identified the heightened risk of HIV infection among women engaged in sex work and injection drug use, the uptake of HIV care among this population has received little attention. The objectives of this study are to evaluate the needs of women engaged in survival sex work and to assess utilization and acceptance of HAART. During November 2003, a baseline needs assessment was conducted among 159 women through a low-threshold drop-in centre servicing street-level sex workers in Vancouver. Cross-sectional data were used to describe the sociodemographic characteristics, drug use patterns, HIV/hepatitis C virus (HCV) testing and status, and attitudes towards HAART. High rates of cocaine injection, heroin injection, and smokeable crack cocaine use reflect the vulnerable and chaotic nature of this population. Although preliminary findings suggest an overall high uptake of health and social services, there was limited attention to HIV care with only 9% of the women on HAART. Self-reported barriers to accessing treatment were largely attributed to misinformation and misconceptions about treatment. Given the acceptability of accessing HAART through community interventions and women specific services, this study highlights the potential to reach this highly marginalized group and provides valuable baseline information on a population that has remained largely outside consistent HIV care.

Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART

“…10 Nevertheless, the continued lack of women-centered services for HAART has been shown to be a major barrier to accessing treatment among vulnerable female populations. 37 The decreased adherence among women and intravenous drug users seen here may also reflect a similar lack of support for staying on treatment once HAART is accessed. Additional strategies targeting women and intravenous drug users are called for with results like those of our study, as are continuing education programs for service providers.…”

“…40 Reasons for women being less adherent may include genderbased barriers to help-seeking related to factors such as lack of adequate childcare or abuse/violence. 37,41 Another BC study found that close to half of intravenous drug users discontinue HAART within the first year of therapy due to factors such as recent incarceration, negative outcome expectations, efficacy expectations, and self-regulatory efficacy. 42 In addition, there is a high prevalence (>95%) of hepatitis C virus infection among intravenous drug users in BC, which has been shown to affect ability to adhere to HAART.…”

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

“…These characteristics have been persistently described as part of the environment in Vancouver's DTES from where the NAOMI participants were recruited. 9,[48][49][50] Conversely, the Montreal site recruited younger injection drug users who partook in more life-threatening and risk behaviors like overdoses and injection equipment sharing, even after adjusting for age and injected cocaine use. It has been previously reported that there is a higher proportion of injection equipment sharing and overdoses in Montreal compared to Vancouver.…”

Injection Drug Use Among Homeless Adults With Mental Illness: A Gender-based Analysis

“…The median age of first drunk and first drug use was the same for both women and men IDUs (age 12 and 13, respectively). The most common drugs used among the population were heroin, crack-cocaine and cocaine, as (Shannon, Bright, Duddy, & Tyndall, 2005).…”

“…It is documented that survival sex workers are less likely to access mainstream health services due to limited operating hours, the lack of gender-specific services, stigma and privacy and disclosure concerns (Shannon et al, 2007). However, among survival sex workers attending a drop-in centre that serves street-based sex workers in Vancouver"s DTES, researchers found participants engaged with numerous health care services, harm reduction initiatives, and contact with frontline workers (Shannon et al, 2005). These findings suggest that low-threshold, gender-specific services are providing a safe point of contact and essential care to this vulnerable and marginalised group.…”