Community-based HIV prevention research among substance-using women in survival sex work: The Maka Project Partnership

Abstract

Substance-using women who exchange sex for money, drugs or shelter as a means of basic subsistence (ie. survival sex) have remained largely at the periphery of HIV and harm reduction policies and services across Canadian cities. This is notwithstanding global evidence of the multiple harms faced by this population, including high rates of violence and poverty, and enhanced vulnerabilities to HIV transmission among women who smoke or inject drugs. In response, a participatory-action research project was developed in partnership with a local sex work agency to examine the HIV-related vulnerabilities, barriers to accessing care, and impact of current prevention and harm reduction strategies among women in survival sex work. This paper provides a brief background of the health and drug-related harms among substance-using women in survival sex work, and outlines the development and methodology of a community-based HIV prevention research project partnership. In doing so, we discuss some of the strengths and challenges of community-based HIV prevention research, as well as some key ethical considerations, in the context of street-level sex work in an urban setting.

Piloting a Peer-Driven Intervention Model to Increase Access and Adherence to Antiretroviral Therapy and HIV Care among Street-Entrenched HIV-Positive Women in Vancouver

“…18,19 Participants were recruited into the PDI through referral by an HIV specialist, family care physician, or other health provider, friend, or by self-referral. Recruitment happened on a rolling basis beginning in January through August 2007.…”

“…18 Other factors that may indirectly impact adherence, such as poor access to health and support resources, poverty, lifetime history of trauma, and high levels of drug use are also characteristic of this population. 18,19 In response to the suboptimal uptake and adherence to antiretroviral therapy in this community a peer support model, known as a PDI was developed and piloted. The objectives of this study are to examine trends describing the association between adherence and: (1) exposure to the intervention and (2) risk factors for lower retention (e.g., drug use patterns).…”

Negotiating the Local Food Environment: The Lived Experience of Food Access for Low-Income People Living With HIV/AIDS

“…Key tenets of CBR are (1) a focus on applied research that is of relevance to the community; (2) equal involvement of researchers and community members in exchanging and producing knowledge; (3) research is used to create change or social action; and (4) entrenched power dynamics are challenged. [25][26][27][28] CBR and related approaches have been used with PLWHA and other marginalized groups in order to address issues such as HIV prevention, treatment, and care 25,29,30 ; employment 31 ; housing stability 32 ; and homelessness. 33 Among the benefits of involving marginalized populations in research are personal empowerment, the creation of more appropriate services, and generating the potential for social change.…”

Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada

“…As part of a larger qualitative project examining the experiences of trans and two-spirit persons engaged in drug use and sex work, the first author conducted in-depth semistructured interviews with 34 [20][21][22][23] Eligibility included (1) identifying as a person whose gender identity/expression differed from assigned birth sex, (2) having engaged in sex work or illicit drug use, (3) ever accessing women-specific health or housing services, (4) residing in Greater Vancouver, and (5) being 14 years of age or older. All participants provided written consent and were paid CDN $20.…”

“…Two-spirit is a fluid concept that sits outside of Western concepts of gender and sexuality and is used to describe Indigenous persons who have feminine and masculine spirits. 7 Participants ranged in age from 23 …”