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Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy

British Columbia Centre for Excellence in HIV/AIDS

OBJECTIVES: We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers. METHODS: We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse. RESULTS: In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73). CONCLUSIONS: Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.

Downtown-Eastside (Vancouver, B.C.)

Text

2017-01-18

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/59424

Shannon, K., Strathdee, S. A., Shoveller, J., Rusch, M., Kerr, T., & Tyndall, M. W. (2009). Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy. American Journal of Public Health, 99(4), 659–665.

Reviewed

http://creativecommons.org/licenses/by-nc-nd/4.0/