Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada.

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=1.8, 95% CI: 1.3-2.2), Aboriginal ethnicity (aOR=2.1, 95% CI: 1.4-3.8), daily cocaine injection (aOR=2.2, 95% CI: 1.3-3.5), intensive, daily crack smoking (aOR=2.7, 95% CI: 2.1-3.9), and unprotected sex with an intimate partner (aOR=2.8, 95% CI: 1.9-3.6).

INTERPRETATION: Innovative and evidence-based strategies are urgently needed that address the sexual and drug-related vulnerabilities to HIV infection among survival sex workers and in particular, interventions targeting the precursors to early initiation into sex work.