Sexual and Drug-related Vulnerabilities for HIV Infection Among Women Engaged in Survival Sex Work in Vancouver, Canada

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.

International Migration from Non-endemic Settings as a Protective Factor for HIV/STI Risk Among Female Sex Workers in Vancouver, Canada

“…Evidence from Canada[25-29,61,62] and elsewhere[6,50,63-66] suggests that criminalization of sex work can increase HIV/STI risk and violence, for example, through displacement of FSWs to higher-risk settings and fear of disclosing sex work involvement to providers. Qualitative research from Vancouver suggests that racialized populations, such as migrant and Indigenous sex workers, may be disproportionately impacted by criminalization and enforcement, through fear and distrust of police and other authorities, and lack of protections[28,67]. Given that almost one-fifth of migrant FSWs experienced heightened police surveillance, harassment and arrest, evidence suggests that the removal of criminal sanctions and law enforcement targeting sex workers can promote improved health and safety, including the ability to safely access police protections for violence and abuse, and workplace safety standards[68,69].…”

Global epidemiology of HIV among female sex workers: influence of structural determinants

“…112 The epidemic among street FSWs emerged alongside the epidemic among people who inject drugs, partly due to overlap between drug-using FSWs, clients, and non-paying partners. 113, 114 Because HIV incidence due to syringe sharing declined substantially, a temporal shift has occurred from illicit drug injection-acquired to sexually transmitted HIV infections in people who inject drugs and FSWs in the past 10 years. 115, 116 Alongside the HIV epidemic and decline of HIV within people who inject drugs, STI epidemics have continued to escalate, suggesting that sexual risks precipitate HIV transmission in key populations.…”

“…In Vancouver, estimates put HIV prevalence at 20% in FSWs working in informal indoor venues (eg, bars or hotels), 12% on the street, and 3% in formal sex work establishments (eg, in-call venues). 118 Because work environments represent a dynamic interplay of changing structural conditions (eg, legal changes and police crackdowns), historical exposure to street-based sex work 114 could remain important to understand the epidemic structure among FSWs in concentrated epidemics.…”

Generational sex work and HIV risk among Indigenous women in a street-based urban Canadian setting

“…One man has been charged with the murders of 22 women, and he is suspected to be responsible for the disappearance of many more (Carter 2005). Many of the missing women were engaged in sex work and it has been estimated that up to 70% of street sex workers on the Downtown Eastside are Aboriginal, in their early 20s and also mothers (Culhane 2003; Shannon, Bright, Gibson et al 2007). Aboriginal women on the Downtown Eastside continue to fight for visibility, justice and to have their voices heard.…”