Successes and gaps in uptake of regular, voluntary HIV testing for hidden street- and off-street sex workers in Vancouver, Canada

Abstract

Despite evidence globally of the heavy HIV burden among sex workers (SWs), as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and associations with regular HIV testing among street- and off-street sex workers (SWs) in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as ‘An Evaluation of Sex Worker's Health Access’ (‘AESHA’) (January 2010-July 2012). This cohort included youth and adult sex workers (14 years+). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 sero-negative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients (AOR: 2.59, 95%CIs: 1.17-5.78), injecting drugs (AOR: 2.33, 95%CIs: 1.17-4.18) and contact with a mobile HIV prevention program (AOR: 1.76, 95%CIs: 1.09-2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95%CIs: 0.19-0.56) and having a language barrier to health care access (AOR: 0.26, 95%CIs: 0.09-0.73). Our results highlight successes of reaching SWs at high risk for HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support.

HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review

“…The lowest rate was reported in a study conducted in India (7.9%, N = 6648) [18]. Ten studies examined recent testing [25, 27–29, 35–40], which varied extensively from 76.1% in Canada (N = 435) [25] to 22% in China (N = 970) [38]. Six studies addressed willingness to test [18–20, 28, 41, 42], and this ranged from 88% (N = 17) in China [41] to 73.2% in India (N = 6648) [18].…”

“…In Uzbekistan, FSWs who started sex work before the age of 18 were less likely to test [32], and in Canada older age of sex work initiation was positively associated with recent testing [25]. FSWs who engaged in sex work for a longer time had a higher uptake of testing [18, 20, 33, 45] and willingness to test [19].…”

“…Sex work criminalization in Kenya, Zimbabwe, Uganda and South Africa, Canada, Uzbekistan and Russia [24, 25, 27, 32, 51, 52, 54] and fear of registration as a drug-user in Russia [24, 34] are seen to have hampered access to healthcare, including testing.…”

A systematic review of HIV testing among Canadian populations

“…Bauer, 2012 29 Deering, 2012 31 Ghai, 2008 38 Gray, 2008 32 Mairs, 2010 37 Peterman, 2008 36 Raffa, 2010 30 Schwandt, 2011 34 Vibert, 2010 33 Wagner Non-probability sampling (not specified) Non-probability sampling Non-probability (venue-based and snowball) Non-probability sampling Non-probability sampling Non-probability sampling (venue-based, word-of mouth) Non-probability sampling Non-probability sampling (venue-based) Non-probability sampling limitations and gaps were uncovered, including a lack of research on certain specific populations and a lack of information on testing frequency and recent testing. Most studies relied on self-reported health behaviour information which is subject to social desirability response bias.…”

“…The percentage of people ever tested from this category ranged from 10.4%-75.0%, with the lowest rate among young sexually active students (10.4%) and the highest rate among individuals from HIV-endemic countries (75.0%). [29][30][31][32][33][34][35][36][37][38] No information was provided on regular testing. Recent testing in the previous year was only reported in two studies.…”