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

Abstract

In Canada, indigenous women are overrepresented among new HIV infections and street-based sex workers. Scholars suggest that Aboriginal women’s HIV risk stems from intergenerational effects of colonisation and racial policies. This research examined generational sex work involvement among Aboriginal and non-Aboriginal women and the effect on risk for HIV acquisition. The sample included 225 women in street-based sex work and enrolled in a community-based prospective cohort, in partnership with local sex work and Aboriginal community partners. Bivariate and multivariate logistic regression modeled an independent relationship between Aboriginal ancestry and generational sex work; and the impact of generational sex work on HIV infection among Aboriginal sex workers. Aboriginal women (48%) were more likely to be HIV-positive, with 34% living with HIV compared to 24% non-Aboriginal. In multivariate logistic regression model, Aboriginal women remained 3 times more likely to experience generational sex work (aOR:2.97; 95%CI:1.5,5.8). Generational sex work was significantly associated with HIV (aOR=3.01, 95%CI: 1.67–4.58) in a confounder model restricted to Aboriginal women. High prevalence of generational sex work among Aboriginal women and 3-fold increased risk for HIV infection are concerning. Policy reforms and community-based, culturally safe and trauma informed HIV prevention initiatives are required for Indigenous sex workers.

The ‘Stolen Generations' of Mothers and Daughters: Child Apprehension and Enhanced HIV Vulnerabilities for Sex Workers of Aboriginal Ancestry

“…While previous studies have noted sex workers of Aboriginal are often work in more visible street-based location [25], the strong association with Aboriginal ancestry remained even after adjusting for street-based sex work. This suggests that other mechanisms, such as poverty and perhaps racist practices, may be contributing to the overrepresentation of children of Aboriginal ancestry in care of the state.…”

Impact of length of injecting career on HIV incidence among people who inject drugs

“…In addition, secondary drug use variables included: syringe borrowing in the last 6 months (yes vs. no); daily use of each of crack smoking, cocaine injection and heroin injection in the last 6 months (yes vs. no); requiring help injecting drugs in the last 6 months (yes vs. no); and enrollment in methadone maintenance therapy (MMT) in the last 6 months (yes vs. no). It was hypothesized that being male [33], age (per 10 years older) [34] and enrollment in methadone maintenance therapy (MMT) in the last 6 months [35] were negatively associated with HIV seroconversion; while having Indigenous ancestry [36], being incarcerated in the last 6 months [37], and participating in sex work [38, 39], unprotected sex [40–42], syringe borrowing [43], requiring help injecting drugs [44], or daily use of cocaine, crack or heroin in the last 6 months [45] were positively associated with HIV seroconversion.…”

Negotiating Violence in the Context of Transphobia and Criminalization

“…Colonialism and the ongoing attempts by the state to destroy Indigenous peoples and cultures, including residential schools and displacement of land (Truth and Reconciliation Commission of Canada, 2015) are inseparable from current health inequities and discrimination experienced by many Indigenous peoples (Adelson, 2005; Bingham, Leo, Zhang, Montaner, & Shannon, 2014; Reading & Wien, 2009). Additionally, many Indigenous persons in Canada continue to experience barriers to economic and employment opportunities due to colonialism and systemic racism (Reading & Wien, 2009).…”