Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation

Abstract

Background Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission –sexual or parenteral transmission for FSW and PWID, respectively- with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities. Methods In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes. Results IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI:2.4–18.9) and former injectors (AOR:4.5; 95%CI:1.7–11.6), compared to non-injectors. Some 6–8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI:1.2–6.4), client violence (AOR: 7.3, 95%CI:2.1–24.7), and police extortion (AOR: 3.0 95%CI:1.5–5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors. Conclusions FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.

Characterizing HIV risk and vulnerability among commercial sex workers in Zaporizhzhya, Ukraine

“…Excessive alcohol use "several times per week" was also reported by participants, which is reflective of previous findings at the national level [28]. Given that vulnerability to HIV infection is significantly increased for CSW who inject drugs [33], access to HIV-related services is known to be limited for PWID in Ukraine [34], and excessive alcohol consumption has been associated with increases in risky sexual behaviours among young people in Ukraine [35], it is critical that HIV prevention programmes in Zaporizhzhya simultaneously promote and support conventional safe sexual practices, routine HIV testing, and harm reduction strategies including needle exchange and methadone programmes.…”

Declining trends in HIV and other sexually transmitted infections among female sex workers in Iran could be attributable to reduced drug injection: a cross-sectional study

“…High prevalence of HIV was also reported among female PWID (ie, 9.9%) in Iran 18. Studies on FSWs who inject drugs19 20 reported client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections to increase the risk for HIV infection. FSWs who inject drugs are a highly vulnerable and marginalised subpopulation of FSWs, and may have many barriers to access and use of harm reduction services to mitigate the risk for both unsafe sex and unsafe injections.…”

“…FSWs who inject drugs are a highly vulnerable and marginalised subpopulation of FSWs, and may have many barriers to access and use of harm reduction services to mitigate the risk for both unsafe sex and unsafe injections. FSWs who have stopped the use of injection drugs are shown to have risk profiles closely similar to FSWs with no history of drug injection 20. Such harm reduction interventions targeting FSWs who inject drugs are a critical need in Iran and need to be prioritised.…”

Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa

“…Building on existing literature that explores substance use and HIV outcomes, our study emphasises the role of the work environment in shaping substance use for FSW. HIV-related risk practices, including non-use of condoms and condom compatible lubricants, increase among substance using FSW 22–25. Moreover, FSW living with HIV who are dependent on substances are less likely to be aware of their HIV status,26 use ART,27 and be virally suppressed27 compared with non-users.…”