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Sex work and HIV incidence among people who inject drugs Kerr, Thomas; Shannon, K.; Ti, Lianping; Strathdee, Steffanie A.; Hayashi, Kanna; Nguyen, Paul; Montaner, Julio; Wood, Evan
Abstract
Objective—Although the global burden of HIV infection among sex workers (SW) has been well recognized, HIV-related risks among sex workers who inject drugs (SW-IDU) have received less attention. We investigated the relationship between sex work and HIV incidence among people who inject drugs (IDU) in a Canadian setting. Design—Prospective cohort study. Methods—Using Kaplan–Meier methods and the extended Cox regression, we compared HIV incidence among SW-IDU and non-SW-IDU in Vancouver, Canada, after adjusting for potential confounders. Results—Between 1996 and 2012, 1647 participants were included in the study, including 512 (31.1%) IDU engaged in sex work. At 5 years the HIV cumulative incidence was higher among SW-IDU in comparison to other IDU (12 vs. 7%, P = 0.001). In unadjusted Cox regression analyses, HIV incidence among SW-IDU was also elevated [relative hazard: 1.69; 95% confidence interval (CI): 1.13–2.53]. However, in a multivariable analysis, sex work did not remain associated with HIV infection (adjusted relative hazard: 0.74; 95% CI: 0.45–1.20), with cocaine injection appearing to account for the elevated risk for HIV infection among SW-IDU. Conclusion—These data suggest that local SW-IDU have elevated rates of HIV infection. However, our exploration of risk factors among SW-IDU demonstrated that drug use patterns and environmental factors, rather than sexual risks, may explain the elevated HIV incidence among SW-IDU locally. Our findings highlight the need for social and structural interventions, including increased access to harm reduction programs and addiction treatment.
Item Metadata
| Title |
Sex work and HIV incidence among people who inject drugs
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| Creator | |
| Contributor | |
| Date Issued |
2016-02
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| Description |
Objective—Although the global burden of HIV infection among sex workers (SW) has been well recognized, HIV-related risks among sex workers who inject drugs (SW-IDU) have received less attention. We investigated the relationship between sex work and HIV incidence among people who inject drugs (IDU) in a Canadian setting.
Design—Prospective cohort study.
Methods—Using Kaplan–Meier methods and the extended Cox regression, we compared HIV incidence among SW-IDU and non-SW-IDU in Vancouver, Canada, after adjusting for potential confounders.
Results—Between 1996 and 2012, 1647 participants were included in the study, including 512 (31.1%) IDU engaged in sex work. At 5 years the HIV cumulative incidence was higher among SW-IDU in comparison to other IDU (12 vs. 7%, P = 0.001). In unadjusted Cox regression analyses, HIV incidence among SW-IDU was also elevated [relative hazard: 1.69; 95% confidence interval (CI): 1.13–2.53]. However, in a multivariable analysis, sex work did not remain associated with HIV infection (adjusted relative hazard: 0.74; 95% CI: 0.45–1.20), with cocaine injection appearing to account for the elevated risk for HIV infection among SW-IDU.
Conclusion—These data suggest that local SW-IDU have elevated rates of HIV infection. However, our exploration of risk factors among SW-IDU demonstrated that drug use patterns and environmental factors, rather than sexual risks, may explain the elevated HIV incidence among SW-IDU locally. Our findings highlight the need for social and structural interventions, including increased access to harm reduction programs and addiction treatment.
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| Language |
eng
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| Date Available |
2018-08-03
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| Provider |
Vancouver : University of British Columbia Library
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| Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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| DOI |
10.14288/1.0369292
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| Affiliation | |
| Citation |
Kerr, T., Shannon, K., Ti, L., Strathdee, S., Hayashi, K., Nguyen, P., … Wood, E. (2016). Sex work and HIV incidence among people who inject drugs (London, England), 30(4), 627–634.
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| Publisher DOI |
10.1097/QAD.0000000000000948
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| Peer Review Status |
Reviewed
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| Scholarly Level |
Faculty; Researcher; Graduate; Other
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| Aggregated Source Repository |
DSpace
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Rights
Attribution-NonCommercial-NoDerivatives 4.0 International