Surviving the sex trade: A comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs

Abstract

In Canada, very little is known about the factors and processes that cause drug-related harm among female intravenous drug users (IDUs). Women who inject drugs and participate in the survival sex trade are considered to be at increased risk for sexual and drug-related harms, including HIV infection. Between September 1999 and September 2000, women participating in the VIDUS cohort in Vancouver and the St. Luc Cohort in Montreal completed interviewer-administered questionnaires. Analyses were conducted to compare the demographic characteristics, sexual risk behaviours, risky injection practices and drug use patterns among women who self-identified as participating in the sex trade with those who did not identify as participating in the sex trade. Logistic regression was used to identify factors independently associated with exchanging sex for money or drugs. HIV prevalence at the study visit (September 1999-2000) was 29% for sex trade workers and 29.2% for non-sex trade workers. While patterns of sexual risk were similar, the risky injection practice and drug use patterns between sex trade workers and non-sex trade workers were markedly different. Logistic regression analysis of cross-sectional data revealed that independent behaviours associated with the sex trade included: greater than once per day use of heroin (adjusted OR 2.7), smokeable crack cocaine (adjusted OR = 3.3) and borrowing used syringes (adjusted OR = 2.0). Creative, client-driven interventions are urgently needed for women who trade sex for money or for drugs.

HIV/AIDS risk among female sex workers who use crack in Southern Brazil

“…2,19,21,24,27 The majority of sex workers in this study had fi rst used crack before they fi rst sold sex, suggesting that crack addiction may force some into turning to sex work to support their addiction. The early initiation (around 8-11 years old) of any drug use among participants may also facilitate addiction, which in turn may increase the likelihood of entry into prostitution as a means of supporting their drug dependence.…”

“…These behaviors place females who use crack cocaine at high risk for HIV/ AIDS, other STIs, tuberculosis, and viral hepatitis. 21 Female crack cocaine users interviewed in our study face a crucial problem: the scarcity, or even inexistence, of health services available to this population. This lack of access to health services is infl uenced by different factors.…”

“…It is fundamental to develop interventions aiming at increasing and maintaining female drug user's autonomy and empowerment to engage in and negotiate safer sexual behaviors. 13,14,21 The early involvement of this population in illicit activities -commercial sex, drug use and drug dealing -usually before adolescence, also infl uence their patterns of drug consumption and engagement in highrisk activities. It is pivotal to develop interventions targeting street children in this area in order to prevent their engagement in high-risk activities and provide the necessary social support.…”

Sexual health, vulnerabilities and risk behaviours among homeless adults

“…[17][18][19] Overall, few individuals reported recent unprotected sex with more than one person, confirming the data of a study among female injection drug users from Vancouver and Toronto. 20 Summarising all vulnerability factors, our data indicate that a significant proportion of individuals and more women than men reported multiple experiences that compromise their sexual health exponentially.…”

Differences between co-users of cocaine and crack among Canadian illicit opioid users

“…For example, IDUs injecting cocaine display higher frequencies of injecting than non-cocaine injectors, often occurring in the form of high-risk injection »binges« (Bourgois et al, 2000). In the VIDUS cohort, cocaine injection has been identified as a predictor of both HIV and HCV prevalence (Patrick et al, 1997;Spittal et al, 2003). Reviews of overdose mortality among IDUs have identified (combination) drug use -specifically involving opioids and cocaine -as a major determinant of overdose fatality (O'Driscoll et al, 2001;Coffin et al, 2003;Darke & Hall, 2003).…”