Youth, violence and non-injection drug use: nexus of vulnerabilities among lesbian and bisexual sex workers

Abstract

Despite increasing evidence of enhanced HIV risk among sexual minority populations, and sex workers in particular, there remains a paucity of epidemiological data on the risk environments of sex workers who identify as lesbian or bisexual. Therefore, this short report describes a study that examined the individual, interpersonal and structural associations with lesbian or bisexual identity among sex workers in Vancouver, Canada. Analysis drew on data from an open prospective cohort of street and hidden off-street sex workers in Vancouver. Bivariate and multivariable logistic regression were used to examine the independent relationships between individual-, interpersonal, work environment- and structural-factors and lesbian or bisexual identity. Of the 510 individuals in our sample, 95 [18.6%] identified as lesbian or bisexual. In multivariable analysis, reporting non-injection drug use in the last 6 months (adjusted odds ratio [AOR]= 2.89; 95% confidence intervals [CI]= 1.42, 5.75), youth ≤ 24 years of age (AOR= 2.43; 95% CI = 1.24, 4.73) and experiencing client-perpetrated verbal, physical and/or sexual violence in the last 6 months (AOR= 1.85; 95% CI= 1.15, 2.98) remained independently associated with lesbian/bisexual identity, after adjusting for potential confounders. The findings demonstrate an urgent need for evidence-based social and structural HIV prevention interventions. In particular, policies and programs tailored to lesbian and bisexual youth and women working in sex work, including those that prevent violence and address issues of non-injection stimulant use are required.

Social and Structural Factors Shaping High Rates of Incarceration among Sex Workers in a Canadian Setting

“…44 The intersection of multiple stigmatized identities has been proposed as a possible explanation of the high rates of substance use among LGBT*2S sex workers. [45][46][47][48][49] This drug dependency, in turn, could further exacerbate LGBT sex workers' risk of incarceration, potentially through police targeting, 27,50 as it was observed in our study. Trans*-sex workers seem to be a particularly vulnerable group within this already marginalized population.…”

Correlates of a lifetime history of sexually transmitted infections among women who have sex with women in Toronto, Canada: results from a cross-sectional internet-based survey

“…Yet, a growing body of evidence demonstrates that WSW do engage in sexual risk practices, including sex work,1 5 6 injection5 and non-injection1 6 substance use and sex with men,7–10 with low implementation of safer sex practices 4 11 12. Research illustrates that WSW are susceptible to STIs from male and female partners, including chlamydia, human papillomavirus (HPV) and herpes 1 3–5 10 12–16.…”

Structural barriers to condom access in a community-based cohort of sex workers in Vancouver, Canada: influence of policing, violence and end-demand criminalisation

“…Where sex work is uniquely stigmatised and singled out from other occupations, SWs’ use of public space becomes restricted by community, which can exacerbate stigma, perpetuate barriers to health and safety, and increase adversarial police interactions due to community complaints 12 15 22. The barriers faced by sexual/gender minorities may relate to intersectional stigmas related to sex work, sexual orientation, and gender identity.…”

“…While numerous studies have reported on patterns of condom use among SWs and their clients,8–10 few have focused on condom accessibility, despite its importance within a rights-based response to HIV and evidence of suboptimal access to health and social services for SWs 11 12. Research has linked barriers to consistent condom use to individual-level factors including younger age13 and drug use,14 as well as structural factors such as migration/mobility,8 sexual/gender minority status,15 lower educational attainment,13 and socioeconomic status 3 16. A 2015 global review highlighted the central role of structural determinants in HIV/STI prevention in sex work,3 with criminalisation and policing,9 17 unsafe work environments,18 and availability and accessibility of healthcare8 10 all strongly linked to sexual risk negotiation and the burden of HIV/STIs.…”