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Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
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Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
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3
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Høj SB, Minoyan N, Zang G, Larney S, Bruneau J. Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19. Drug Alcohol Depend 2023; 251:110956. [PMID: 37716286 DOI: 10.1016/j.drugalcdep.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada. METHODS Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models. RESULTS 803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada.
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal H3N 1X9, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada
| | - Sarah Larney
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada.
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Argento E, Shannon K, Fairbairn N, Moreheart S, Braschel M, Goldenberg S. Increasing trends and incidence of nonfatal overdose among women sex workers who use drugs in British Columbia: The role of criminalization-related barriers to harm reduction. Drug Alcohol Depend 2023; 244:109789. [PMID: 36753803 PMCID: PMC10773461 DOI: 10.1016/j.drugalcdep.2023.109789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Structurally marginalized women who use drugs experience disproportionately elevated health and social inequities that require specialized responses to mitigate risk of overdose. This study aimed to longitudinally investigate incidence and predictors of first nonfatal overdose among women sex workers who use drugs. METHODS Data (2010-2019) were drawn from AESHA (An Evaluation of Sex Workers Health Access), a community-based, prospective, open cohort of > 900 women sex workers in Metro Vancouver, Canada. Incidence was examined and Cox regression modelled time-updated predictors of first nonfatal overdose. Time series analysis examined annual trends. RESULTS Among 273 eligible participants, 23% (n = 63) reported a first nonfatal overdose over follow-up with an incidence density of 5.87/100 person-years. In multivariable analysis, independent predictors of time to nonfatal overdose were police-related barriers to harm reduction (Adjusted Hazard Ratio [AHR]=2.62; 95% confidence interval [CI] 1.51-4.54), binge alcohol use (AHR=2.28; 95%CI 1.16-4.45), opioid use (AHR=2.23; 95%CI 1.15-4.33), and crystal methamphetamine use (AHR=2.07; 95%CI 1.27-3.39). Time series analysis demonstrated a significantly increasing trend in first nonfatal overdose, with annual proportions increasing 0.59% (95%CI 0.39-0.78%) every year, on average. CONCLUSIONS This study provides strong longitudinal evidence from the longest-standing cohort of sex workers in North America. Nonfatal overdose in this setting is a critical public health concern. Criminalization-related barriers to harm reduction strongly predicted nonfatal overdose. Structural changes to legal and policing practices alongside gender-sensitive addiction services are urgently needed.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; BC Centre on Substance Use, 1045 Howe St., Vancouver, BC V6Z 1Y6, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; BC Centre on Substance Use, 1045 Howe St., Vancouver, BC V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada; Centre for Gender & Sexual Health Equity, 1190 Hornby St, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, USA.
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5
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Harris MT, Goldenberg S, Cui Z, Fairbairn N, Milloy MJS, Hayashi K, Samet JH, Walley AY, Nolan S. Association of sex work and social-structural factors with non-fatal overdose among women who use drugs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103950. [PMID: 36640591 PMCID: PMC9974922 DOI: 10.1016/j.drugpo.2022.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/24/2022] [Accepted: 12/24/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Women who use drugs (WWUD) and engage in sex work experience disproportionate sex- and drug-related harms, such as HIV, however comparatively little is known about their overdose risk. Therefore, we examined the association between sex work and overdose and secondarily explored the association of social-structural factors, such as policing and gendered violence, with overdose. METHODS Data were derived from two community cohort studies based in Vancouver, Canada between 2005 to 2018. We used logistic regression with GEE to examine the associations between a) sex work and nonfatal overdose and b) social-structural and individual variables with overdose among WWUD who engaged in sex work during the study. Sex work, overdose, and other variables were time-updated, captured every six months. RESULTS Among 857 WWUD included, 56% engaged in sex work during the study. Forty-three percent of WWUD engaged in sex work had at least one overdose compared to 26% of WWUD who did not. Sex work was not significantly associated with an increased odds of overdose (AOR = 1.14, 95% CI: 0.93-1.40). In the exploratory analysis amongst 476 WWUD engaged in sex work, social-structural variables associated with overdose in the multivariable model included exposure to: punitive policing (OR = 1.97, 95% CI: 1.30-2.96) and physical or sexual violence (OR = 2.55, 95% CI: 1.88-3.46). CONCLUSIONS WWUD engaged in sex work had an increased overdose burden that may be driven by social-structural factors rather than sex work itself. Interventions that address policing and gendered violence represent potential targets for effective overdose prevention.
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Affiliation(s)
- Miriam Th Harris
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA.
| | - Shira Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA; Centre for Gender and Sexual Health Equity, St Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada
| | - Zishan Cui
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J S Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Jeffrey H Samet
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
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Giang HT, Duc NQ, Khue PM, Quillet C, Oanh KTH, Thanh NTT, Vallo R, Feelemyer J, Vinh VH, Rapoud D, Michel L, Laureillard D, Moles JP, Jarlais DD, Nagot N, Huong DT. Gender Differences in HIV, HCV risk and Prevention Needs Among People who Inject drug in Vietnam. AIDS Behav 2022; 27:1989-1997. [PMID: 36441408 PMCID: PMC10149475 DOI: 10.1007/s10461-022-03932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
We examined gender differences among people who inject drug (PWID) in Hai Phong, Vietnam in term of blood-borne infections, risk behaviors, and access to care. Using respondent-driven-sampling surveys, we recruited 3146 PWID from 2016 to 2018. Inclusion criteria included a positive urine test for heroin and recent injection marks. There were 155 female PWID (4,9%), including 82 at RDS-2016, 32 at RDS-2017 and 38 at RDS-2018. The age mean was 36.3 ± 7.2 years. The majority of female PWID had less than high school education (90.9%) and were unemployed (51.3%). There was no difference in the proportion of HIV and HCV positive by gender. However, women had several significant differences in risk behaviors than men in multivariable logistic regression. Being a woman was independently associated with being unemployed, being a sex worker, having unstable housing, having uses drugs for less than 5 years, more use of methamphetamine, having a partner who ever injected drugs, and less access to methadone treatment. Interventions targeting female PWID are needed, possibly through community organizations and peer educators.
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Affiliation(s)
- Hoang Thi Giang
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam.
| | - Nguyen Quang Duc
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Pham Minh Khue
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Catherine Quillet
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | | | - Roselyne Vallo
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Vu Hai Vinh
- Dept of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Delphine Rapoud
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Center, CESP/Inserm 1018, French Red Cross, Paris, France
| | - Didier Laureillard
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Jean Pierre Moles
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Nicolas Nagot
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
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Knight L, Xin Y, Mengo C. A Scoping Review of Resilience in Survivors of Human Trafficking. TRAUMA, VIOLENCE & ABUSE 2022; 23:1048-1062. [PMID: 33468034 DOI: 10.1177/1524838020985561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Resilience is critical among survivors of trafficking as they are mostly vulnerable populations who face multiple adversities before, during, and after trafficking. However, resilience in survivors of trafficking is understudied. This scoping review aims to clarify the current state of knowledge, focusing on definitions of resilience, how resilience has been studied, and factors associated with resilience among survivors. Five databases were searched using key words related to trafficking and resilience. Studies were included if they were published in English between 2000 and 2019 and focused on resilience with the study design including at least one of these four features: (a) use of standardized measures of resilience, (b) qualitative descriptions of resilience, (c) participants were survivors or professionals serving survivors, and (d) data sources such as case files or program manuals directly pertained to survivors. Eighteen studies were identified. Findings indicated that resilience was primarily described as emergent from interactions between the survivor and the environment. Resilience in trafficking appeared largely similar to resilience in other kinds of victimization. Nonetheless, trafficking survivors also may display resilience in alternative ways such as refusing treatment. Positive interpersonal relationships were the most commonly mentioned resilience factor. In addition, current research lacks studies featuring longitudinal designs, interventions, participatory methods, types of trafficking other than sexual trafficking, and demographic characteristics such as age, gender, and national origin. Future research needs to establish definitions and measures of resilience that are culturally and contextually relevant to survivors and build knowledge necessary for designing and evaluating resilience-enhancing interventions.
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Affiliation(s)
- Logan Knight
- College of Social Work, 2647The Ohio State University, Columbus, OH, USA
| | - Yitong Xin
- College of Social Work, 2647The Ohio State University, Columbus, OH, USA
| | - Cecilia Mengo
- College of Social Work, 2647The Ohio State University, Columbus, OH, USA
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Goldenberg SM, Perry C, Watt S, Bingham B, Braschel M, Shannon K. Violence, policing, and systemic racism as structural barriers to substance use treatment amongst women sex workers who use drugs: Findings of a community-based cohort in Vancouver, Canada (2010-2019). Drug Alcohol Depend 2022; 237:109506. [PMID: 35753282 PMCID: PMC9381028 DOI: 10.1016/j.drugalcdep.2022.109506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a high prevalence of substance use among women sex workers (SWs), rigorous social epidemiologic data on substance use treatment experiences among SWs remains limited. Given these gaps and the disproportionate burden of criminalization borne by Indigenous SWs, we evaluated (1) structural correlates of unsuccessful attempts to access substance use treatment; and (2) the interaction between policing and Indigenous ancestry on unsuccessful attempts to access treatment among SWs who use drugs. METHODS Prospective data were from an open community-based cohort of women SWs (2010-2019) in Vancouver, Canada. Bivariate and multivariable logistic regression with generalized estimating equations(GEE) assessed correlates of unsuccessful attempts to access treatment. A multivariable GEE confounder model examined the interaction between Indigenous ancestry and policing on unsuccessful attempts to access treatment. RESULTS Amongst 645 SWs who used drugs, 32.1 % reported unsuccessful attempts to access substance use treatment during the 9.5-year study. In multivariable GEE analysis, unsuccessful substance use treatment access was associated with identifying as a sexual/gender minority (AOR: 1.90, 95 %CI:1.37-2.63), opioid use (AOR: 1.43, 95 %CI: 1.07-1.91), and exposure to homelessness (AOR: 1.72; 95 %CI:1.33-2.21), police harassment (AOR: 1.48, 95 %CI:1.03-2.13), workplace violence (AOR: 1.80, 95 %CI: 1.31-2.49) and intimate partner violence (AOR: 2.11, 95 %CI:1.50-2.97). In interaction analysis, Indigenous SWs who experienced police harassment faced the highest odds of unsuccessful attempts to access substance use treatment (AOR: 2.59, 95 %CI:1.65-4.05). CONCLUSION Findings suggest a need to scale-up culturally-safe, trauma-informed addictions, gender-based violence, and sex worker services, alongside dismantling of systemic racism across and beyond health and addictions services.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, USA,Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Chelsey Perry
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Brittany Bingham
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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9
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Jawa R, Stein MD, Anderson B, Liebschutz JM, Stewart C, Phillips KT, Barocas JA. Behavioral Risk Factors for HIV Infection in Hospitalized Persons Who Co-use Stimulants and Opioids. AIDS Behav 2022; 26:1047-1055. [PMID: 34510289 PMCID: PMC8435119 DOI: 10.1007/s10461-021-03460-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/03/2023]
Abstract
We investigated the association of 90-day opioid and stimulant co-use and HIV risk behaviors in a cross-sectional analysis of hospitalized HIV-negative people who inject drugs (PWID). We compared those injecting opioids alone to two sub-groups who co-used opioids with (1) cocaine, (2) amphetamine-type stimulants (ATS), on sex and injection drug risk behaviors assessed via the Risk Assessment Battery (RAB), where a higher score indicates a higher risk. Of 197 participants who injected opioids, 53% co-used cocaine only, 5% co-used ATS only, 18% co-used both cocaine and ATS, 24% co-used neither stimulant. PWID who injected opioids alone had a mean RAB drug risk score of 5.98 points and sex risk score of 2.16 points. Compared to PWID who injected opioids alone, PWID who co-used stimulants had higher mean drug risk RAB scores: cocaine, b = 2.84 points [95% confidence interval (CI) 1.01; 4.67]; ATS, b = 3.43 points (95% CI 1.29; 5.57). Compared to PWID who injected opioids alone, cocaine co-use was associated with higher sex RAB scores b = 1.06 points (95% CI 0.32; 1.79). Overall, we found a significant association between stimulant co-use and higher HIV sex and drug risk scores.
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Affiliation(s)
- Raagini Jawa
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Michael D Stein
- Boston University School of Public Health, Boston, MA, USA
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Bradley Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Honolulu, Honolulu, HI, USA
| | - Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
- Boston University School of Medicine, Boston, MA, USA
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10
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Brooks O, Bach P, Dong H, Milloy MJ, Fairbairn N, Kerr T, Hayashi K. Crystal methamphetamine use subgroups and associated addiction care access and overdose risk in a Canadian urban setting. Drug Alcohol Depend 2022; 232:109274. [PMID: 35033951 PMCID: PMC8890780 DOI: 10.1016/j.drugalcdep.2022.109274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Methamphetamine use is rising globally and we have limited treatments for this. Subgroups within the diverse methamphetamine-using population may have distinct treatment needs. Among a community-recruited sample of people who use crystal methamphetamine, we aimed to identify subgroups and characterize their overdose risk and access to addiction care. METHODS Data from prospective cohorts of people who use drugs in Vancouver, Canada from 2014 to 2018 were used to conduct a repeated measures latent class analysis among participants who used crystal methamphetamine. Multivariable generalized estimating equations models were fit to determine the associated factors. RESULTS Among 824 eligible participants, a five-class model was identified as the best fit: (1) primary stimulant use (15.7%); (2) women engaged in sex work and opioid use (21.4%); (3) street income generation and opioid use (31.6%); (4) opioid agonist therapy (OAT) patients (22.3%); and (5) men who have sex with men (9.0%). In multivariable analyses, compared to the primary stimulant use group, non-fatal overdose was positively associated with street income generation (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI]=1.30-1.71), sex work (AOR = 1.38, 95% CI=1.20-1.59) and OAT (AOR = 1.22, 95% CI=1.06-1.41) subgroups; engagement in non-OAT addiction care was negatively associated with street income generation (AOR = 0.81, 95% CI=0.68-0.97) and sex work (AOR = 0.78, 95% CI=0.63-0.98) subgroups. DISCUSSION Socioeconomically marginalized subgroups with opioid and crystal methamphetamine co-use were at highest risk of non-fatal overdose and had poorer access to addiction care, highlighting the need for tailored interventions.
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Affiliation(s)
- Olivia Brooks
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Rm 10203, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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11
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Benner BE. HIV Vulnerability Among Survival Sex Workers Through Sexual Violence and Drug Taking in a Qualitative Study From Victoria, Canada, With Additional Implications for Pre-exposure Prophylaxis for Sex Workers. FRONTIERS IN SOCIOLOGY 2022; 6:714208. [PMID: 35047587 PMCID: PMC8762116 DOI: 10.3389/fsoc.2021.714208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
Objective: This qualitative study investigates how social and structural forces mediate vulnerability to HIV infection and transmission among survival sex workers, their clients, and their non-commercial, intimate partners-with especial focus on sexual violence and drug taking. Method: I employed an adapted grounded theory approach to conducting and analyzing (n = 9) open-ended, in-depth interviews with a convenience sample of currently working (and recently exited) survival sex workers from a community setting in Victoria, Canada. Findings: Participants revealed important contexts and conditions under which they were vulnerable to HIV infection. At the behavioural level, participants were aware of how HIV could be transmitted (condomless sex and sharing drug equipment), yet participants voiced strongly how structural and systemic features (for instance, client violence, the need for drugs, and "bad date" referrals) could squeeze and constrain their agency to take up safer practices, mediating their optimal HIV health and safety. Some participants reported strained relationships with police because of previous drug involvement. Conclusion: Survival sex workers constitute a health population vulnerable to HIV infection, and ensuring there could be a supportive (outreach) community replete with HIV resources is paramount. The availability of safer sex and drug equipment play important roles in HIV behavioural prevention efforts. However, uptake of pre-exposure prophylaxis (PrEP) at no cost in the Canadian province of British Columbia could be an important and beneficial structural intervention for non-injection drug taking cis-female sex workers in this study who are presently ineligible for no cost PrEP.
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Affiliation(s)
- Bryan Eric Benner
- Department of Sociology, University of Victoria, Victoria, BC, Canada
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12
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Income generation and the patterning of substance use: A gender-based analysis. Drug Alcohol Depend 2021; 226:108862. [PMID: 34198138 PMCID: PMC8356895 DOI: 10.1016/j.drugalcdep.2021.108862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has demonstrated how income-generating activities among marginalized people who use drugs (PWUD)-including employment, income assistance, street-based activities, sex work, and illegal activities-can provide both benefit (e.g., additional income) and harm (e.g., violence, criminalization). However, little is known about gender differences in factors such as drug use patterns that are associated with income-generating activities among PWUD. METHODS Using data from prospective cohorts of HIV-positive and HIV-negative PWUD in Vancouver, Canada, we conducted exploratory gender-stratified analyses of associations between substance use patterns and income-generating activities, using generalized linear mixed-models. RESULTS Participants reported income sources as employment (23.4 %), income assistance (88.1 %), street-based activities (24.9 %), sex work (15.2 %), drug dealing (31.5 %), or other illegal activities (13.9 %). GLMM results showed gendered patterns of engagement in specific income-generating activities and some diverging patterns of substance use. For instance, men receiving income assistance were less likely to use opioids (Adjusted odds ratio(AOR) = 0.64; 95 % confidence interval(CI) = 0.50-0.82) and women engaged in sex work were more likely to use crack-cocaine (AOR = 2.74, 95 % CI = 2.22-3.37). However, results reflected primarily converging patterns of substance use between women and men across income-generating activities, particularly for drug dealing and other illegal activities. CONCLUSIONS Our results suggest that substance use patterns may be more closely associated with income generation context than gender. Given potential harms associated with some income generation activities, results highlight the need for further investigation of the social and structural context of income generation, its intersections with gender and substance use, and the expansion of low-threshold work opportunities.
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Tales of gender-based oppression and violence: Risks and vulnerabilities of women who inject drugs (WWID) in Dhaka, Bangladesh. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103144. [PMID: 33549468 DOI: 10.1016/j.drugpo.2021.103144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/03/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women who inject drugs (WWID) experience various complexities, risks and vulnerabilities attributed to unequal gendered power differentials. This article has aimed to explore the unequal gendered power dynamics that influence HIV risks and vulnerabilities among WWID in Dhaka, Bangladesh. METHODS This paper is based on an ethnographic study conducted from April 2018 to December 2019 in Dhaka, Bangladesh. This component of the study constituted 2500 h of extensive field observations, 15 in-depth interviews and five focus groups exclusively with WWID. We also interviewed 15 key-informants including programme managers, an academician and harm reduction service providers. Data were thematically analysed in relation to the four bases of gendered power theorised by gender scholars Pratto and Walker which include force, resource control, asymmetrical obligations and consensual ideologies. RESULTS The first base, "force", highlighted situations where WWID were compelled into risky injecting and sexual behaviours to avoid violent ramifications or losing their safety nets with intimate partners. The second base, "resource control", depicted unequal access to commodities where men exercised their dominance over money and drugs. The third base, "social obligations", depicted the propensity of WWID to obey their partners and clients, thus precipitating their risky behaviours. The fourth base, consensual ideologies, were linked to weakened negotiation powers of WWID, thus increasing their propensity to risky injecting and sexual behaviours alongside poly-drug use. Despite several instances of gender-based violence and oppression, WWID have fallen victim to gender-blind interventions, as demonstrated by study observations and anecdotes. CONCLUSION Gender-based violence and oppression were depicted as prominent driving forces exacerbating WWID's HIV risks and vulnerabilities. If these issues are overlooked, the HIV burden will continue permeating among WWID. Thus, stakeholders need to look beyond the lens of conventional harm reduction modalities and synergize evidence-based gendered dynamics to formulate a gender-responsive comprehensive service package for WWID.
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Sharma R, Pooyak S, Jongbloed K, Zamar D, Pearce ME, Mazzuca A, Schechter MT, Spittal PM. The Cedar Project: Historical, structural and interpersonal determinants of involvement in survival sex work over time among Indigenous women who have used drugs in two Canadian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:103012. [PMID: 33166826 DOI: 10.1016/j.drugpo.2020.103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. METHODS The Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016 . Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. RESULTS Among 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50-2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36-2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22-2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18-2.28), used crack daily (ARR: 2.85; 95% CI: 2.36-3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98-3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15-2.05) were more likely to be involved in sex work. CONCLUSION Indigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.
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Affiliation(s)
- Richa Sharma
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Sherri Pooyak
- AHA Centre/ Canadian Aboriginal AIDS Network, 6520 Salish Dr, Vancouver, BC, V6N 2C7
| | - Kate Jongbloed
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - David Zamar
- BC Children's Hospital Research Institute, 950 W28th Ave, Vancouver, BC, V5Z 4H4
| | - Margo E Pearce
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4
| | - April Mazzuca
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Martin T Schechter
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Patricia M Spittal
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3.
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15
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West BS, Becerra Ramirez M, Bristow CC, Abramovitz DA, Vera A, Staines H, Gudelia Rangel M, Patterson TL, Strathdee SA. Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities. Int J STD AIDS 2020; 31:866-875. [PMID: 32623979 DOI: 10.1177/0956462420929463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Milagros Becerra Ramirez
- Department of Family Medicine, University of California Los Angeles International Medical Graduate Program, Los Angeles, CA, USA
| | - Claire C Bristow
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela A Abramovitz
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
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16
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Shokoohi M, Karamouzian M, Dolan K, Sharifi H, Mirzazadeh A. Social and structural determinants of health associated with drug use patterns among female sex workers in Iran: A latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 91:102798. [PMID: 32505433 DOI: 10.1016/j.drugpo.2020.102798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Female sex workers (FSWs) experience adversities regarding social determinants of health (SDH) and behavioural factors including illicit drug use. This study aimed to assess the clustered impact of SDH on illicit drug use among FSWs in Iran. METHODS We surveyed 1,347 FSWs in 13 major cities in 2015. Latent class analysis was conducted to identify distinct classes of five measured SDH including low education, unemployment, unstable housing, last-year incarceration and sexual violence. We examined the association of these classes with five illicit drug use patterns using multivariable generalized linear model with Poisson family and log link, and reported adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI). RESULTS We identified five SDH classes: Class 1: no SDH adversities; Class 2: mainly unemployment; Class 3: low education and unemployment; Class 4: sexual violence and unemployment; and Class 5: multiple SDH adversities. The prevalence of last-month drug use ranged from 7.0% in Class 1 to 53.3% in Class 5. Compared to FSWs in Class 1, those in Class 2 (aPR: 2.47, 95% CI: 1.15, 5.27), Class 3 (aPR: 3.69, 95% CI: 1.62, 8.36), Class 4 (aPR: 4.49, 95% CI: 1.71, 11.78) and Class 5 (aPR: 6.35, 95% CI: 2.42, 16.69) were more likely to report last-month drug use. The same patterns were observed for specific drugs of opium use, crystal methamphetamine use, and heroin-crack use, as well as poly-drug use. CONCLUSION Socio-structural determinants are clustered together and elevate the likelihood of illicit drug use among FSWs. Our findings highlighted the significance of assessing and addressing such key determinants of health in drug use harm reduction programs targeting FSWs.
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Affiliation(s)
- Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Biostatistics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, California, United States.
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Fleming T, Barker A, Ivsins A, Vakharia S, McNeil R. Stimulant safe supply: a potential opportunity to respond to the overdose epidemic. Harm Reduct J 2020; 17:6. [PMID: 31924209 PMCID: PMC6954588 DOI: 10.1186/s12954-019-0351-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022] Open
Abstract
Background Occurring against the backdrop of an overdose crisis, stimulant use and stimulant-involved deaths in North America are increasing at an alarming rate. Many of these deaths are being attributed to fentanyl and related analogs, which have been increasingly found within street-level stimulant supplies. Within this, people experiencing socio-economic marginalization are at the greatest risk of overdose and other harms from adulterated stimulants. Current treatments for stimulant use disorder have limited effectiveness, and even less applicability to the lived realities of marginalized stimulant users. Emerging technologies, such as drug checking, are being implemented to support safer stimulant use, but the accessibility and utility of these technologies to stimulant users are framed by experiences of vulnerability that render them largely ineffective. Stimulant safe supply Solutions that provide a legal and safe supply of non-adulterated stimulants of known quality, and within a health care framework, are needed to directly address the risk of an increasingly adulterated stimulant supply. Similar innovative opioid-focused interventions are being piloted with medications that have a similar pharmacological effect as their illicit counterparts. While there are currently no approved pharmacotherapies for stimulant use, research has demonstrated a number of stimulant medications that are promising substitutes for cocaine and methamphetamine use. Much like with opioid-focused pharmacotherapies, having a consistent and safe supply of stimulants can lead to improved health outcomes and will drastically reduce overdose risk. However, for a stimulant safe supply intervention to be a success, it must provide the high and performance-enhancing effects that people seek from the illicit market, which requires doses and user agency that trials to date have not provided. Conclusion Efforts are needed to investigate the feasibility of pharmacological stimulant-based interventions that address safe supply needs. The promise of similar opioid-focused approaches in addressing both overdose-related risks and experiences related to vulnerability underscores the need to advance safe supply approaches targeted towards people who use stimulants. Given the current overdose crisis and rising stimulant use across North America, the implementation and evaluation of such novel stimulant-focused interventions should be a public health priority.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Allison Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sheila Vakharia
- Drug Policy Alliance, 131 West 33rd Street, 15th Floor, New York, NY, 10001, USA
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT, 10001, USA. .,Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT, 10001, USA.
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Liu L, Chai X. Pleasure and Risk: A Qualitative Study of Sexual Behaviors Among Chinese Methamphetamine Users. JOURNAL OF SEX RESEARCH 2020; 57:119-128. [PMID: 30004801 DOI: 10.1080/00224499.2018.1493083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In China, the number of methamphetamine (meth) users has increased dramatically in recent years. This issue has caused researchers to consider the association of meth use with public health concerns, such as the spread of sexually transmitted infections (STIs). Despite the potential outcomes of meth use, qualitative research has not as yet explored Chinese meth users' sexual experiences and feelings associated with meth use. To contribute to the literature, this study employed semistructured interviews to collect data from 19 female and 16 male Chinese meth users (mean age = 31) who were predominantly heterosexual and were recruited from seven compulsory drug treatment institutions in Eastern China. Most participants had completed nine or fewer years of education. Gender similarities and differences were observed in the participants' pursuits of sexual pleasure while using meth. Meth use can enhance the likelihood of high-risk sexual behaviors in both genders and therefore increases the number of public health issues. Men largely dominated the discussion of unprotected sex, while women reported transactional sex in their interviews. Based on research findings, we suggest policymakers strengthen safer-sex educational programs. Policymakers should also enhance prevention methods targeting meth use among women who may engage in transactional sex.
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Affiliation(s)
- Liu Liu
- School of Social and Behavioral Sciences, Nanjing University
| | - Xiangnan Chai
- Department of Sociology, Social Science Centre, University of Western Ontario
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19
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Goldenberg S, Watt S, Braschel M, Hayashi K, Moreheart S, Shannon K. Police-related barriers to harm reduction linked to non-fatal overdose amongst sex workers who use drugs: Results of a community-based cohort in Metro Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102618. [PMID: 31838244 DOI: 10.1016/j.drugpo.2019.102618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND High rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing impacts overdose risk amongst sex workers who use drugs. Given this, we aimed to explore the independent effects of experiencing police-related barriers to harm reduction on non-fatal overdose amongst women sex workers who use drugs in Metro Vancouver, Canada over a 7.5-year period. METHODS Data were drawn from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women sex workers in Metro Vancouver, from 2010 to 2017. Using multivariate logistic regression with generalized estimating equations (GEE), we used a confounder modeling approach to identify the independent effect of experiencing police-related barriers to harm reduction strategies on non-fatal overdose amongst sex workers using drugs within the last six months at each study visit. RESULTS Amongst 624 participants, 7.7% overdosed within the last six months at baseline and 27.6% overdosed during the study period, contributing 287 non-fatal overdose events over the 7.5-year period. 68.6% reported police-related barriers to harm reduction strategies during the study. In a multivariate confounder model, exposure to police-related barriers to harm reduction strategies [AOR: 2.15, CI: 1.60-2.90] was independently associated with higher odds of non-fatal overdose after adjustment for key confounders. CONCLUSIONS Our findings suggest that in the context of the current overdose crisis, adversarial policing practices may undermine access to lifesaving overdose prevention services and exacerbate overdose risks for marginalized women. Findings underscore the urgent need to scale-up access and remove barriers to progressive harm reduction strategies for women sex workers.
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Affiliation(s)
- Shira Goldenberg
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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20
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Drug use patterns and associated factors among female sex workers in Iran. Addict Behav 2019; 90:40-47. [PMID: 30355536 DOI: 10.1016/j.addbeh.2018.09.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/20/2018] [Accepted: 09/29/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study examines the prevalence of drug and poly-drug use and their associated factors among female sex workers (FSW) in Iran. METHODS We analyzed data from a bio-behavioral surveillance survey of 1347 FSW across 13 major cities in Iran in 2015. Two outcome measures were defined: i) past-month "any drug use", a binary variable defined as none or any; and ii) a three-category past-month "poly-drug use" variable defined as none, only one drug, and more than one drug. Correlates of these two study outcomes were assessed using multivariable logistic regression and multinomial logistic regression, respectively. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. RESULTS We found that 24.9% (95% CI: 16.1, 36.4) and 13.5% (95% CI: 8.1, 21.5) of FSW reported past-month any drug use and poly-drug use, respectively. Longer sex work career (AOR 2.44 [95% CI: 1.28, 4.63]), unstable housing (AOR 2.56 [1.17, 5.64]), past-year experience of sexual violence (AOR 1.61 [1.15, 2.27]), and incarceration (AOR 2.02 [1.23, 3.32]) were positively associated with any drug use. Similarly, FSW who were unstably housed (AOR 3.4 [1.06, 10.95]), reported past-year experience of sexual violence (AOR 2.06 [95% CI: 1.24, 3.41]) and incarceration (AOR 2.82 [1.60, 4.97]) were positively associated with past-month poly-drug use. CONCLUSION Drug use is frequent among Iranian FSW, particularly among those who experienced sexual violence, unstable housing or incarceration. Programs to reduce harms associated with drug and poly-drug use should target FSW as a priority population.
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21
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Stoicescu C, Cluver LD, Spreckelsen T, Casale M, Sudewo AG. Intimate Partner Violence and HIV Sexual Risk Behaviour Among Women Who Inject Drugs in Indonesia: A Respondent-Driven Sampling Study. AIDS Behav 2018; 22:3307-3323. [PMID: 29948336 PMCID: PMC6154010 DOI: 10.1007/s10461-018-2186-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Women who inject drugs are disproportionately affected by HIV and intimate partner violence (IPV); however, the link between IPV and HIV remains under-researched among substance-using women in low- and middle-income countries. This study examined associations and additive effects of different forms of IPV victimization (psychological, physical and/or injurious, and sexual) on HIV sexual risk behavior among women who inject drugs in Indonesia. Respondent-driven sampling (RDS) was used to recruit 731 women from Greater Jakarta and Bandung, West Java. RDS-II weighted prevalence of any past-year IPV was 68.9% (95% CI 65.0, 72.6) in Jakarta and 55.9% (95% CI 48.0, 63.5) in Bandung. In separate logistic regressions controlling for socio-demographic covariates, all three forms of IPV showed statistically significant associations with sexual risk behavior. After adjusting for all IPV types, psychological (OR 1.87; 95% CI 1.17, 2.99; p = 0.009) and sexual (OR 1.98; 95% CI 1.22, 3.21; p = 0.006) IPV independently predicted women’s sexual risk behavior. Marginal effects models suggested that co-occurrence of multiple forms of IPV had greater adverse consequences: sexual risk behavior was reported by 64.1% of women who did not experience any IPV, but increased to 89.9% among women exposed to all three types. Comprehensive harm reduction services that integrate IPV monitoring and prevention are urgently needed to reduce both HIV and IPV.
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Affiliation(s)
- Claudia Stoicescu
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK.
| | - Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Thees Spreckelsen
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK
| | - Marisa Casale
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anindita Gabriella Sudewo
- HIV and AIDS Research Centre, Atma Jaya Catholic University, Jakarta, Indonesia
- Kirby Institute, University of New South Wales, Sydney, Australia
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22
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Urada LA, Smith LR, Yore J, Triplett DP, Hucks-Ortiz C, Raj A. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav 2018; 22:2553-2563. [PMID: 29748844 PMCID: PMC6443569 DOI: 10.1007/s10461-018-2131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.
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Affiliation(s)
- Lianne A Urada
- School of Social Work, San Diego State University, Hepner Hall #119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.
| | - Laramie R Smith
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Daniel P Triplett
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | | | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
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23
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Conners EE, Gaines TL, Strathdee SA, Magis-Rodriguez C, Brouwer KC. Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico. Drug Alcohol Rev 2018; 37 Suppl 1:S294-S302. [PMID: 29218799 PMCID: PMC5940512 DOI: 10.1111/dar.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Smoking methamphetamine is associated with increased risk of HIV among female sex workers (FSW). The structural context of substance use is an important shaper of individual behaviour; however, structural determinants of methamphetamine use among FSWs are largely unknown. We identified individual, structural and neighbourhood factors associated with smoking methamphetamine among FSWs in the border city of Tijuana, Baja California, Mexico. DESIGN AND METHODS A prospective cohort of 301 FSWs sampled from indoor and outdoor sex work venues throughout Tijuana participated in quantitative surveys on behaviours and mapping of home and work neighbourhoods across three visits. Multinomial logistic regression using generalised estimating equations identified individual, structural and neighbourhood variables associated with smoking methamphetamine. RESULTS Methamphetamine use, particularly smoking, was highly prevalent among FSWs. Over half (61%) of FSWs had ever used methamphetamine in their lifetime and at baseline, 38% currently smoked methamphetamine. Smoking methamphetamine daily was associated with living in the red light district [adjusted odds ratio (AOR) = 2.72, 95% confidence interval (CI) = 1.23-6.02] and with perceived homelessness, but only among women in a good financial situation (AOR = 4.08, 95% CI = 1.58-10.50). Smoking methamphetamine less than daily was associated with older age (AOR = 1.06, 95% CI = 1.02-1.10). DISCUSSION AND CONCLUSIONS Our findings point to the important dynamic between the residential environment and more severe methamphetamine use. FSWs may prioritise the purchase of methamphetamine over stable housing if they have the financial means. Given the high prevalence of smoking methamphetamine among FSWs in Tijuana, drug treatment options, especially for women living in the red light district, are needed.
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Affiliation(s)
- Erin E. Conners
- Department of Medicine, University of California, San Diego, USA
- San Diego State University, San Diego, USA
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, USA
| | | | - Carlos Magis-Rodriguez
- National Center for the Prevention and Control of HIV and AIDS, Col Anzures, Distrito Federal, Mexico
| | - Kimberly C. Brouwer
- Department of Family Medicine & Public Health, University of California, San Diego, USA
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24
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Shokoohi M, Karamouzian M, Sharifi H, Rahimi-Movaghar A, Carrico AW, Hosseini Hooshyar S, Mirzazadeh A. Crystal methamphetamine use and its correlates in women engaged in sex work in a developing country setting. Drug Alcohol Depend 2018; 185:260-265. [PMID: 29477085 DOI: 10.1016/j.drugalcdep.2017.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/22/2017] [Accepted: 12/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Worldwide, crystal methamphetamine (CM) use and associated high-risk sexual behaviors are a concern, but they are less studied among female sex workers (FSW) in developing countries. This study aimed to characterize the prevalence and individual, interpersonal, and structural correlates of self-reported past-month CM use among FSW in Iran. METHODS FSW aged ≥ 18 years who reported penetrative sex with more than one client in the last year were recruited (analytic sample: 1295). Data were collected in one-on-one interviews using a standardized behavioral questionnaire. Poisson regression model was used to assess the correlated of past-month self-reported CM use by crude and adjusted prevalence ratio (APR) and 95% confidence intervals (CI). RESULTS Non-injecting and injecting CM use was reported by 15.0% (95% CI: 8.7, 24.7) and 0.9% (95% CI: 0.4, 2.1) of participants. CM use was positively associated with concurrent use of opioids (APR from 2.08 to 3.84, P-value < 0.01), higher number of sexual partners (APR: 2.05, P-value: 0.018), housing instability (APR: 3.54, P-value: 0.001), and history of forced sex (APR: 1.47, P-value: 0.050). CONCLUSIONS A considerable number of FSWs use CM along with opioids, have a higher number of sexual partners, forced sex, and housing instability. Both prevention strategies as well as strategies to reduce harm associated with CM need to be added to current programs that predominantly focus on opioid dependency and male drug injectors.
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Affiliation(s)
- Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1151 Richmond St., London, ON, Canada.
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada.
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th St., Miami, FL, USA.
| | - Samira Hosseini Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California San Francisco, 550 16th St., San Francisco, CA, USA.
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25
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Jamshidimanesh M, Khoie EM, Mousavi SA, Keramat A, Emamian MH. Perceptions of Iranian Female Drug Users Toward HIV Testing: A Qualitative Content Analysis. J Int Assoc Provid AIDS Care 2017; 16:555-561. [PMID: 28814121 DOI: 10.1177/2325957417724202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug-dependent women are the vulnerable population deprived of access to health services and also have particular relevance to public health perspective because they are important bridge population for driving HIV/AIDS epidemic. This qualitative study aimed to explore the perception of drug-dependent women regarding HIV testing. METHODS In this qualitative study, we approached 23 women with substance use disorders in 2 of the selected drop-in centers in the south Tehran. Focus group discussion, face-to-face semistructured interviews, and field notes were used to collect the data. Qualitative content analysis was used to extract the explanatory model of women's perceptions about HIV testing. RESULTS Four main themes emerged from the data: forgotten health during use, having misconception, and sharing of sexual partner in secrecy and concerns. Seven subthemes were extracted, including not being sex worker, point of ruin, voluntary selection and concerns about fear of abandonment and fear of loss and death, double concern, and future of children. CONCLUSION Beliefs and values of drug-dependent women can be positive points leading them to do an HIV test, and misconceptions of these women would be corrected by using safe behavioral skills training.
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Affiliation(s)
- Mansoureh Jamshidimanesh
- 1 Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran.,2 Department of Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Effat Merghati Khoie
- 3 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Mousavi
- 4 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- 4 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hassan Emamian
- 4 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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26
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Argento E, Strathdee SA, Goldenberg S, Braschel M, Montaner J, Shannon K. Violence, trauma and living with HIV: Longitudinal predictors of initiating crystal methamphetamine injection among sex workers. Drug Alcohol Depend 2017; 175:198-204. [PMID: 28448903 PMCID: PMC5496650 DOI: 10.1016/j.drugalcdep.2017.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/04/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite rapid increases in crystal methamphetamine (CM) use worldwide and established gendered patterns of use, empirical research on CM injection initiation among sex workers is limited. Given the wide range of harms associated with CM, alongside stimulant effects including sexual dis-inhibition and prolonged awake-ness, this study aimed to longitudinally investigate socio-structural predictors of initiating CM injection among sex workers in Vancouver, Canada. METHODS Data (2010-2014) were drawn from a community-based cohort of women sex workers: AESHA (An Evaluation of Sex Workers Health Access). Participants completed bi-annual interviewer-administered questionnaires and HIV/STI testing. Kaplan Meier methods and Cox proportional hazards regression were used to model predictors of CM injection initiation among CM injection-naïve participants. RESULTS Of 455 participants eligible at baseline, 14.3% (n=65) injected CM for the first time over follow-up, with an incidence density of 6.79 per 100 person-years (95% Confidence Interval [CI] 5.30-8.69). In multivariable analysis, injection heroin use (Adjusted Hazard Ratio [AHR] 6.11; 95%CI 3.24-11.52), having an intimate partner who injects drugs (AHR 2.93; 95%CI 1.57-5.46), workplace violence (AHR 2.85; 95%CI 1.74-4.67), HIV seropositivity (AHR 2.69; 95%CI 1.45-5.00), and childhood abuse (AHR 1.86; 95%CI 0.99-3.49) were independently associated with initiating CM injection. CONCLUSIONS Findings underscore the gendered and social risk environment of CM injection initiation among sex workers. The strong influences of historical/workplace violence, coupled with heroin injection (known to be self-medicating for post-traumatic stress) as a primary risk pathway, emphasize the urgency of increasing access to integrated, trauma-informed addiction treatment and HIV care for marginalized women.
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Affiliation(s)
- Elena Argento
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, Canada V6T 1Z4
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, USA 92093-0507
| | - Shira Goldenberg
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Melissa Braschel
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Julio Montaner
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6,Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada.
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Zhao Q, Mao Y, Li X, Zhou Y, Shen Z. Social support and amphetamine-type stimulant use among female sex workers in China. AIDS Care 2017; 29:1324-1330. [PMID: 28514866 DOI: 10.1080/09540121.2017.1328101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Existing research has suggested a positive role of social support in reducing drug use among female sex workers (FSWs). However, there is limited research on the role of social support in amphetamine-type stimulant (ATS) use among FSWs in China. This study explored the present situation of ATS use among FSWs in Guangxi, China and examined the associations of different types of social support from different sources with ATS use. METHOD A sample of 1022 FSWs was recruited from 56 commercial sex venues in Guangxi Autonomous Region in China. Bivariate comparison was used to compare demographic characteristics and source of emotional or tangible social support across frequency of ATS use among FSWs. The relationship between social support and ATS use was examined using multiple ordinal logistic regression models controlling for the potential confounding effects of demographic variables. RESULTS The multiple ordinal logistic regression indicated that FSWs who were from younger age groups (aOR = 10.88 for age group <20; aOR = 2.80 for age group 20-23), and from all higher-income venues (aOR = 1.96 for venue level 1; aOR = 2.28 for venue level 2; aOR = 1.81 for venue level 3) tended to use ATS more frequently. They also tended to use ATS more frequently when they depended on their boyfriends (aOR = 1.08) for emotional support or on their co-workers for tangible support (aOR = 1.17). CONCLUSIONS Different types of social support from different sources can be either positively or negatively associated with ATS use among FSWs, therefore, the future intervention efforts should differentiate and target different types and different sources of social support in response to the living and work conditions of FSWs.
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Affiliation(s)
- Qun Zhao
- a School of Public Administration , Nanjing University of Information Science & Technology , Nanjing , China
| | - Yuchen Mao
- b Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , SC , USA
| | - Xiaoming Li
- a School of Public Administration , Nanjing University of Information Science & Technology , Nanjing , China
| | - Yuejiao Zhou
- c Institute of HIV/AIDS Control and Prevention , Guangxi CDC , Nanning , China
| | - Zhiyong Shen
- c Institute of HIV/AIDS Control and Prevention , Guangxi CDC , Nanning , China
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28
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Wagner KD, Syvertsen JL, Verdugo SR, Molina JL, Strathdee SA. A mixed methods study of the social support networks of female sex workers and their primary noncommercial male partners in Tijuana, Mexico. JOURNAL OF MIXED METHODS RESEARCH 2017; 12:437-457. [PMID: 30245602 PMCID: PMC6145804 DOI: 10.1177/1558689816688974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Female sex workers (FSWs) are at risk for multiple health harms, including HIV. This article describes a mixed methods study of the social support networks of 19 FSWs and their primary male sex partners in Tijuana, Mexico. We collected quantitative and qualitative social network data, including quantitative network measures, qualitative narratives, and network visualizations. Methodologically, we illustrate how a convergent mixed methods approach to studying personal social support networks of female sex workers can yield a more holistic understanding of network composition and role. From a health-related perspective, we show how migration/deportation and stigma shape social networks and might be leveraged to support HIV prevention interventions. We believe others can benefit from a mixed methods approach to studying social networks.
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Affiliation(s)
- Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno
| | | | - Silvia R Verdugo
- Division of Global Public Health, Department of Medicine, University of California San Diego and Secretaria de Servicios de Salud Tijuana, Praderas de la Mesa, Baja California, Mexico
| | - Jose Luis Molina
- Department of Social and Cultural Anthropology, Universitat Autonoma de Barcelona
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego
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29
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Goldenberg SM, Montaner J, Braschel M, Socias E, Guillemi S, Shannon K. Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care. Int J Infect Dis 2016; 55:31-37. [PMID: 28027990 DOI: 10.1016/j.ijid.2016.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) represents a significant cause of morbidity and mortality globally. While sex workers may face elevated HCV risks through both drug and sexual pathways, incidence data among sex workers are severely lacking. HCV incidence and predictors of HCV seroconversion among women sex workers in Vancouver, BC were characterized in this study. METHODS Questionnaire and serological data were drawn from a community-based cohort of women sex workers (2010-2014). Kaplan-Meier methods and Cox regression were used to model HCV incidence and predictors of time to HCV seroconversion. RESULTS Among 759 sex workers, HCV prevalence was 42.7%. Among 292 baseline-seronegative sex workers, HCV incidence density was 3.84/100 person-years (PY), with higher rates among women using injection drugs (23.30/100 PY) and non-injection crack (6.27/100 PY), and those living with HIV (13.27/100 PY) or acute sexually transmitted infections (STIs) (5.10/100 PY). In Cox analyses adjusted for injection drug use, age (hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.86-1.01), acute STI (HR 2.49, 95% CI 1.02-6.06), and non-injection crack use (HR 2.71, 95% CI 1.18-6.25) predicted time to HCV seroconversion. DISCUSSION While HCV incidence was highest among women who inject drugs, STIs and the use of non-injection stimulants appear to be pathways to HCV infection, suggesting potential dual sexual/drug transmission. Integrated HCV services within sexual health and HIV/STI programs are recommended.
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Affiliation(s)
- Shira M Goldenberg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Melissa Braschel
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Socias
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
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Clingan SE, Fisher DG, Pedersen WC, Reynolds GL, Xandre P. Impulsiveness, and trait displaced aggression among drug using female sex traders. Addict Behav 2016; 60:24-31. [PMID: 27082265 DOI: 10.1016/j.addbeh.2016.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/09/2016] [Accepted: 03/29/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study compared women who sex trade for drugs, money, or both compared to neither (did not sex trade), and introduced the concept of trait displaced aggression to the literature on sex trading. METHODS Female participants (n=1055) were recruited from a low-income area of southern California. Measures included: the Risk Behavior Assessment (RBA), Barratt Impulsivity Scale (BIS), Eysenck Impulsiveness Scale (EIS), and the Displaced Aggression Questionnaire (DAQ). RESULTS Women who traded sex for both drugs and money used crack cocaine, powder cocaine, and alcohol significantly more, scored higher on the BIS, and the EIS, and were significantly older. Those who only sex traded for drugs used more amphetamine, heroin, and injected drugs more days. They were also higher on the DAQ and all of the DAQ subscales. Those who traded for money only used marijuana more and were more likely to use marijuana before sex. CONCLUSIONS This study may help address specific issues unique to those who sex trade for different commodities in that the drugs used are different and the underlying personality characteristics are different.
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Affiliation(s)
- Sarah E Clingan
- Psychology Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA
| | - Dennis G Fisher
- Psychology Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA.
| | - William C Pedersen
- Psychology Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA
| | - Grace L Reynolds
- Health Care Administration Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA
| | - Pamela Xandre
- School of Nursing, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA
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Watt MH, Kimani SM, Skinner D, Meade CS. "Nothing Is Free": A Qualitative Study of Sex Trading Among Methamphetamine Users in Cape Town, South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:923-933. [PMID: 25567071 PMCID: PMC4496309 DOI: 10.1007/s10508-014-0418-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/22/2014] [Accepted: 10/06/2014] [Indexed: 06/04/2023]
Abstract
South Africa is facing an established epidemic of methamphetamine, known locally as "tik." Globally, methamphetamine has been linked to high rates of sexual risk behaviors, including sex trading. The goal of this study was to qualitatively examine the experiences of sex trading among methamphetamine users in Cape Town, South Africa. Individual in-depth interviews were conducted with 30 active methamphetamine users (17 men and 13 women) recruited from the community. Interviews were conducted in local languages using a semi-structured guide that included questions on sex trading experiences and perceptions of sex trading among methamphetamine users. Interviews were audio-recorded, transcribed, and analyzed using analytic memos and coding with constant comparison techniques. The data revealed that in a setting of high levels of addiction and poverty, sex was an important commodity for acquiring methamphetamine. Women were more likely to use sex to acquire methamphetamine, but men reported opportunistic cases of trading sex for methamphetamine. Four models of sex trading emerged: negotiated exchange, implicit exchange, relationships based on resources, and facilitating sex exchange for others. The expectation of sex trading created a context in which sexual violence against female methamphetamine users was common. Multiple sexual partners and inconsistent condom use in acts of sex trading put methamphetamine users at high risk of HIV. Interventions in this setting should address addiction, which is the primary driver of sex trading among methamphetamine users. Harm reduction interventions may include education about HIV and other sexually transmitted infections, availability of condoms and HIV testing, and sexual violence prevention.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA.
| | - Stephen M Kimani
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA
| | - Donald Skinner
- Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Christina S Meade
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Occupational and demographic factors associated with drug use among female sex workers at the China-Myanmar border. Drug Alcohol Depend 2016; 161:42-9. [PMID: 26897586 DOI: 10.1016/j.drugalcdep.2016.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Within the last decade, the use of amphetamine type stimulants (ATS) has swelled in Myanmar. Regionally, female sex workers have reported turning to ATS for occupational reasons. In doing so, drug-using female sex workers (FSW) face compounded risks for HIV and other sexually transmitted infections (STI). Here, we examine the factors that impact FSW drug use in Muse, a town along the China-Myanmar border. METHODS In 2012, 101 FSW were recruited from entertainment venues and brothels along the Myanmar-Chinese border. Participants participated in a self-administered behavioral survey covering demographics, drug use, sex work, and risk behaviors. Bivariate and regression analyses were conducted in SPSS. RESULTS Thirty four percent of respondents indicated current drug use. ATS derivatives were the most commonly used drugs (87.5%) with injection drug use being nearly non-existent in the sample. Drug using FSWs were older, had engaged in sex work longer, had more Chinese clients, and were more likely to have a previous boyfriend who had used drugs. They were also 3.5 times more likely to report a STI. Client condom use, HIV testing rates, and familiarity with public health resources did not statistically differ by drug use status. CONCLUSION More research is needed to examine how romantic and professional sexual relationships push-and-pull FSW into using drugs. Our results suggest that diverse safer sex strategies, beyond client condom use, should be promoted with drug using FSWs, including strategies that acknowledge the impact of ATS use.
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Argento E, Shannon K, Nguyen P, Dobrer S, Chettiar J, Deering KN. The role of dyad-level factors in shaping sexual and drug-related HIV/STI risks among sex workers with intimate partners. Drug Alcohol Depend 2015; 157:166-73. [PMID: 26585612 PMCID: PMC4678956 DOI: 10.1016/j.drugalcdep.2015.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/30/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite high HIV burden among sex workers (SWs) globally, and relatively high prevalence of client condom use, research on potential HIV/STI risk pathways of intimate partnerships is limited. This study investigated partner/dyad-level factors associated with inconsistent condom use among SWs with intimate partners in Vancouver, Canada. METHODS Baseline data (2010-2013) were drawn from a community-based prospective cohort of women SWs. Multivariable generalized estimating equations logistic regression examined dyad-level factors associated with inconsistent condom use (<100% in last six months) with up to three male intimate partners per SW. Adjusted odds ratios and 95% confidence intervals were reported (AOR[95%CI]). RESULTS Overall, 369 SWs reported having at least one intimate partner, with 70.1% reporting inconsistent condom use. Median length of partnerships was 1.8 years, with longer duration linked to inconsistent condom use. In multivariable analysis, dyad factors significantly associated with increased odds of inconsistent condom use included: having a cohabiting (5.43[2.53-11.66]) or non-cohabiting intimate partner (2.15[1.11-4.19]) (versus casual partner), providing drugs (3.04[1.47-6.30]) or financial support to an intimate partner (2.46[1.05-5.74]), physical intimate partner violence (2.20[1.17-4.12]), and an intimate partner providing physical safety (2.08[1.11-3.91]); non-injection drug use was associated with a 68% reduced odds (0.32[0.17-0.60]). CONCLUSIONS Our study highlights the complex role of dyad-level factors in shaping sexual and drug-related HIV/STI risk pathways for SWs from intimate partners. Couple and gender-focused interventions efforts are needed to reduce HIV/STI risks to SWs through intimate partnerships. This research supports further calls for integrated violence and HIV prevention within broader sexual/reproductive health efforts for SWs.
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Affiliation(s)
- Elena Argento
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kate Shannon
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Paul Nguyen
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Sabina Dobrer
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Jill Chettiar
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Kathleen N Deering
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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Lorvick J, Lutnick A, Wenger LD, Bourgois P, Cheng H, Kral AH. Non-partner violence against women who use drugs in San Francisco. Violence Against Women 2014; 20:1285-98. [PMID: 25288597 DOI: 10.1177/1077801214552910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article examines non-partner violence among women who use methamphetamine (N = 322), recruited in an inner-city neighborhood of San Francisco. The combined prevalence of non-partner physical or sexual violence in the past 6 months was 28%, roughly equal to the prevalence of partner violence (26%). In multivariate analysis, factors associated with non-partner violence included frequent subsistence difficulty (adjusted odds ratio [AOR] = 2.43, 95% confidence interval [CI] = [1.3, 4.6]) and sex trade (AOR = 2.27, 95% CI = [1.4, 4.1]). Having a steady male partner was not protective against non-partner violence. Violence perpetrated by non-partners should be considered when assessing social and structural factors that influence women's health.
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Maxwell JC. A new survey of methamphetamine users in treatment: who they are, why they like "meth," and why they need additional services. Subst Use Misuse 2014; 49:639-44. [PMID: 24093526 DOI: 10.3109/10826084.2013.841244] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The quality and quantity of illicit methamphetamine has recently increased due to introduction of a new precursor, 1-phenyl-2-propanone (P2P). This paper updates the problems associated with methamphetamine use. Methamphetamine-using clients (N = 222) entering a Texas program participated in computer-assisted interviews in 2010 and 2011 about routes of administration, other drugs used, severity of dependence, mental and physical health, perceived risks and benefits of use, family history, and abuse and neglect experienced as children and adults. Special needs of this population include therapies for trauma, gender-focused counseling, safe housing, and prevention messages to discourage use of the drug.
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Affiliation(s)
- Jane Carlisle Maxwell
- Center for Social Work Research, University of Texas at Austin , Austin, Texas , USA
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Fast D, Kerr T, Wood E, Small W. The multiple truths about crystal meth among young people entrenched in an urban drug scene: a longitudinal ethnographic investigation. Soc Sci Med 2014; 110:41-8. [PMID: 24721446 DOI: 10.1016/j.socscimed.2014.03.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 03/06/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
Transitions into more harmful forms of illicit drug use among youth have been identified as important foci for research and intervention. In settings around the world, the transition to crystal methamphetamine (meth) use among youth is considered a particularly dangerous and growing problem. Epidemiological evidence suggests that, particularly among young, street-involved populations, meth use is associated with numerous sex- and drug-related "risks behaviors" and negative health outcomes. Relatively few studies, however, have documented how youth themselves understand, experience and script meth use over time. From 2008 to 2012, we conducted over 100 in-depth interviews with 75 street-entrenched youth in Vancouver, Canada, as well as ongoing ethnographic fieldwork, in order to examine youth's understandings and experiences of meth use in the context of an urban drug scene. Our findings revealed positive understandings and experiences of meth in relation to other forms of drug addiction and unaddressed mental health issues. Youth were simultaneously aware of the numerous health-related harms and social costs associated with heavy meth use. Over time, positive understandings of meth may become entirely contradictory to a lived reality in which escalating meth use is a factor in further marginalizing youth, although this may not lead to cessation of use. Recognition of these multiple truths about meth, and the social structural contexts that shape the scripting of meth use among youth in particular settings, may help us to move beyond moralizing debates about how to best educate youth on the "risks" associated with meth, and towards interventions that are congruent with youth's lived experiences and needs across the lifecourse.
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Affiliation(s)
- Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., Canada V6Z 1Y6.
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., Canada V6Z 1Y6; Department of Medicine, University of British Columbia, Canada.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., Canada V6Z 1Y6; Department of Medicine, University of British Columbia, Canada.
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., Canada V6Z 1Y6; Faculty of Health Sciences, Simon Fraser University, Canada.
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Methamphetamine use among women attending sexually transmitted disease clinics in Los Angeles County. Sex Transm Dis 2014; 40:632-8. [PMID: 23859909 DOI: 10.1097/01.olq.0000430801.14841.75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Methamphetamine (meth) use is a continuing problem in the United States and is associated with increased risk of HIV and sexually transmitted infections (STIs). However, few studies have examined the meth use/STI risk association among women. METHODS We conducted a cross-sectional study of women attending public sexually transmitted disease clinics in Los Angeles County, California, from 2009 to 2010. Routinely collected clinic intake data were used to compare the prevalence of meth use among women with different demographics/sexual behaviors. Multivariable logistic regression was used to identify predictors of meth use. RESULTS There were 1.4% (n = 277) women who reported meth use, with a mean age of 29 years. Prevalence was highest among Whites and those reporting both male and female partners. Most women who reported meth use also reported polysubstance use. In a multivariable model controlling for age, race/ethnicity, condom use, having a new sex partner, and other illicit substance use, women who reported sex with an injection drug user were nearly 10 times more likely to report meth use as compared with those who did not (adjusted odds ratio [AOR], 9.90; 95% confidence interval [CI], 5.86-16.75). Other factors associated with meth use included sex with a recently incarcerated partner (AOR, 3.24; 95% CI, 2.16-4.86), anonymous partner (AOR, 2.49; 95% CI, 1.54-4.04), and transactional sex (AOR, 3.26; 95% CI, 1.69-6.32). Women who tested positive for chlamydia/gonorrhea were 1.48 times more likely to use meth as compared with those who did not. CONCLUSIONS Female meth users have high-risk behaviors that could increase their risk for STIs/HIV.
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McKenna SA. Navigating the risk environment: structural vulnerability, sex, and reciprocity among women who use methamphetamine. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:112-5. [PMID: 24140170 DOI: 10.1016/j.drugpo.2013.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/02/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Drug users' risk sexual practices contribute to their increased risk for contracting HIV and other sexually transmitted infections. Use of methamphetamine has been associated with a number of high-risk sexual practices such as frequent sexual contacts, multiple sex partners, unprotected sex, and exchange sex. The media construct women who use methamphetamine as engaging in exchange sex to support their drug habit. Despite an abundance of data on exchange sex among heroin and crack users that suggest the importance of examining these practices in context, they remain understudied among female methamphetamine users. METHODS This article draws on ongoing ethnographic research with female methamphetamine users. RESULTS The research participants' risk environment(s) contribute to their structural vulnerability and shape behaviour in ways that are sometimes deemed transactional and risky by research, public health, or harm reduction professionals. CONCLUSION Understanding the embeddedness of sexual practices in structural context and networks of reciprocity is essential to understanding implications for policy and harm reduction.
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Affiliation(s)
- Stacey A McKenna
- University of Colorado Denver, Department of Health & Behavioral Sciences, Campus Box 188, PO Box 173364, Denver, CO 80217-3364, USA.
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Hiller SP, Syvertsen JL, Lozada R, Ojeda VD. Social support and recovery among Mexican female sex workers who inject drugs. J Subst Abuse Treat 2013; 45:44-54. [PMID: 23375570 DOI: 10.1016/j.jsat.2012.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 12/07/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
This qualitative study describes social support that female sex workers who inject drugs (FSW-IDUs) receive and recovery efforts in the context of relationships with family and intimate partners. We conducted thematic analysis of in-depth interviews with 47 FSW-IDUs enrolled in an intervention study to reduce injection/sexual risk behaviors in Tijuana, Mexico. FSW-IDUs received instrumental and emotional social support, which positively and negatively influenced recovery efforts. Participants reported how some intimate partners provided conflicting positive and negative support during recovery attempts. Problematic support (i.e., well-intended support with unintended consequences) occurred in strained family relationships, limiting the positive effects of support. Mexican drug treatment programs should consider addressing social support in recovery curricula through evidence-based interventions that engage intimate partners, children and family to better reflect socio-cultural and contextual determinants of substance abuse.
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Affiliation(s)
- Sarah P Hiller
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, La Jolla, CA 92093-0507, USA
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Urada LA, Strathdee SA, Morisky DE, Schilling RF, Simbulan NP, Estacio LR, Raj A. Sex work and its associations with alcohol and methamphetamine use among female bar and spa workers in the Philippines. Asia Pac J Public Health 2013; 26:138-46. [PMID: 23343641 DOI: 10.1177/1010539512471969] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.
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Affiliation(s)
- Lianne A Urada
- 1University of California, San Diego, School of Medicine, La Jolla, CA, USA
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Liu D, Wang Z, Chu T, Chen S. Gender difference in the characteristics of and high-risk behaviours among non-injecting heterosexual methamphetamine users in Qingdao, Shandong Province, China. BMC Public Health 2013; 13:30. [PMID: 23311624 PMCID: PMC3585885 DOI: 10.1186/1471-2458-13-30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 01/10/2013] [Indexed: 11/27/2022] Open
Abstract
Background Despite the increasing risk of HIV infections, few studies concerning the characteristics of non-injecting heterosexual methamphetamine (MA) users and related risk behaviours have been conducted in China. Methods Gender differences in socio-demographic characteristics, perception of MA and STD/HIV, MA use practices, and sexual behaviours related to MA use were examined among 398 non-injecting heterosexual MA users (288 males, 110 females). Results Male MA users were more likely to be married, local, and self-employed; female MA users were more likely to be young, single, engaged in commercial service or unemployed. Female MA users usually start MA use at an earlier age than males (24.3 vs. 31.3 years old), with shorter abuse durations (2.6 vs. 2.9 years), higher frequency of MA use (3.6 vs. 2.4 times per week), and higher likelihood of using MA with heterosexual partners (100% vs. 78.1%). More male MA users have had multiple sex partners (96.9% vs. 77.3%) and sex exchanges (72.9% vs. 46.4%). Among 277 males who had had sex with commercial sex workers (CSW), 69.4% never used condoms, and among 77 males who had had sex with multiple partners who are commercial sex workers and always or usually used condoms, 87.0% never changed condoms when changing partners. Conclusion There may be gender difference in the characteristics of high-risk behaviours among non-injecting heterosexual MA users. The findings suggest the integration of specific risk reduction strategies into intervention programs for non-injecting heterosexual MA user populations may significantly improve program goals.
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Affiliation(s)
- Dianchang Liu
- Shandong Clinical College of Skin Diseases, Anhui Medical University, 27397, Jingshi Lu, Jinan, Shandong, 250022, China
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Condom negotiations among female sex workers in the Philippines: environmental influences. PLoS One 2012; 7:e33282. [PMID: 22448241 PMCID: PMC3308968 DOI: 10.1371/journal.pone.0033282] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 02/06/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Social and structural influences of condom negotiation among female sex workers (FSWs) remain understudied. This study assesses environmental and individual factors associated with condom negotiation among FSWs at high risk for acquiring HIV in a large urban setting of Metro Manila, Philippines. METHODS Female bar/spa workers (N = 498), aged 18 and over, underwent interview-led surveys examining their sexual health practices in the context of their risk environments. Data were collected from April 2009-January 2010 from 54 venues. Multiple logistic regressions were conducted to assess socio-behavioral factors (e.g., age, education, length of time employed as an entertainer, and alcohol/drug use) and socio-structural factors (e.g., venue-level peer/manager support, condom rule/availability, and sex trafficking) associated with condom negotiation, adjusting for individuals nested within venues. RESULTS Of 142 FSWs who traded sex in the previous 6 months (included in the analysis), 24% did not typically negotiate condom use with venue patrons. Factors in the physical environment--trafficked/coerced into work (AOR = 12.92, 95% CI = 3.34-49.90), economic environment--sex without a condom to make more money (AOR = 1.52, 95% CI 1.01-2.30), policy environment--sex without a condom because none was available (AOR = 2.58, 95% CI = 1.49-4.48), and individual risk--substance use (AOR = 2.36, 95% CI = 1.28-4.35) were independently associated with FSWs' lack of condom negotiation with venue patrons. CONCLUSIONS Factors in the physical, economic, and policy environments, over individual (excepting substance use) and social level factors, were significantly associated with these FSWs' condom negotiations in the Philippines. Drawing upon Rhodes' risk environment framework, these results highlight the need for policies that support safer sex negotiations among sex workers in the context of their risk environments. Interventions should reduce barriers to condom negotiation for FSWs trafficked/coerced into their work, substance using, and impacted by economic conditions and policies that do not support condom availability.
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Couture MC, Evans JL, Sothy NS, Stein ES, Sichan K, Maher L, Page K. Correlates of amphetamine-type stimulant use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia. Drug Alcohol Depend 2012; 120:119-26. [PMID: 21820251 PMCID: PMC3226861 DOI: 10.1016/j.drugalcdep.2011.07.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/25/2011] [Accepted: 07/09/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Amphetamine-type stimulant (ATS) use has increased in Cambodia and emerged as a significant problem among female sex workers (FSWs), potentially contributing to increased risk of HIV. We examined the prevalence of ATS use and its effect on sexual risk behaviors, and sexually transmitted infections (STI) among FSWs in Phnom Penh, Cambodia. METHODS A one-year prospective study among young women engaged in sex work in brothels, entertainment establishments and on a freelance basis. Socio-demographics, sexual risks, and recent ATS use were assessed by self-report. Blood and urine samples were collected to detect HIV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Bivariate and multivariate longitudinal analyses were conducted to assess the effects of ATS use on number of sex partners, inconsistent condom use with paying partners and incident STI. RESULTS ATS use was higher among women working freelance (35.6%) and in brothels (34.8%) compared to women working in entertainment establishments (17.7%) or in multiple venues (14.8%). ATS users reported more sex partners and days drunk in the previous month. In multivariate longitudinal analysis, ATS use was associated with having a higher number of sex partners (adjusted relative ratio 1.49; 95% CI: 1.00-2.21) and incident STI (adjusted odds ratio 5.41; 95% CI: 1.15-25.48), but not inconsistent condom use with paying partner. CONCLUSION ATS users had more sex partners, high level of alcohol use, and were at increased risk of STI. Our findings underscore ATS use as an important emerging risk exposure that should be integrated into HIV prevention interventions targeting this population.
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Affiliation(s)
- Marie-Claude Couture
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA
| | | | - Neth San Sothy
- National Center for HIV/AIDS, Dermatology and STD. #245H, Sreet 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia
| | - Ellen S. Stein
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA
| | - Keo Sichan
- Cambodian Women’s development Agengy, #19, Street 242, Sangkat Boeng Prolit, Khan 7 Makara, Phnom Penh, Cambodia
| | - Lisa Maher
- University of New South Wales, National Centre in HIV Epidemiology and Clinical Research, CFI Building, Corner Boundary and West Streets, Darlinghurst NSW 2010, Australia
| | - Kimberly Page
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA,Corresponding author: K. Page, University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA., , Phone: 415-597-4954., Fax: 415-597-8299
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Marshall BDL, Wood E, Shoveller JA, Patterson TL, Montaner JSG, Kerr T. Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: a multi-cohort gender-based analysis. BMC Public Health 2011; 11:20. [PMID: 21214930 PMCID: PMC3022697 DOI: 10.1186/1471-2458-11-20] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 01/07/2011] [Indexed: 11/13/2022] Open
Abstract
Background Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users. Methods Beginning in 2005 and ending in 2008, 2109 drug users were enroled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (n = 248). Logistic regression using generalized estimating equations (GEE) was used to examine the independent correlates of MA use over time. All analyses were stratified by biological sex at birth. Results At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74, p < 0.001) and females (OR = 1.80, p = 0.003) were more likely to report recent MA use. In multivariate analysis, MA use among sexual minority males was associated with younger age (adjusted odds ratio [AOR] = 0.93 per year older, p = 0.011), Aboriginal ancestry (AOR = 2.59, p = 0.019), injection drug use (AOR = 3.98, p < 0.001), having a legal order or area restriction (i.e., "no-go zone") impact access to services or influence where drugs are used or purchased (AOR = 4.18, p = 0.008), unprotected intercourse (AOR = 1.62, p = 0.048), and increased depressive symptoms (AOR = 1.67, p = 0.044). Among females, MA use was associated with injection drug use (AOR = 2.49, p = 0.002), Downtown South residency (i.e., an area known for drug use) (AOR = 1.60, p = 0.047), and unprotected intercourse with sex trade clients (AOR = 2.62, p = 0.027). Conclusions Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.
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Affiliation(s)
- Brandon D L Marshall
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
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