UBC Theses and Dissertations
The social, structural and environmental production of HIV transmission risk among women in survival sex work : evidence from the Maka project partnership Shannon, Kate
Background: Given the limited contextual understanding of the HIV risk environment of survival sex workers in resource rich settings, the objectives of this thesis were: To explore the role of social and structural violence and gendered power relations in mediating women’s negotiation of HIV prevention; To examine the relationship between drug sharing with clients and the negotiation of sexual and drug transmission risk; To model the impact of early sexual abuse on subsequent HIV infection; To investigate the relationship between environmental and structural factors and the negotiation of condom use with clients. Methods: Qualitative and quantitative data were drawn from a community-based research project partnership in Vancouver, Canada. Women engaged in street-based sex work were invited through targeted peer outreach and time-space sampling to participate in interview-administered questionnaires, HIV screening, and social mapping. Additionally, women were purposively sampled to participate in focus group discussions about the contextual factors shaping HIV prevention. Results: Analysis of the narratives of sex workers revealed the paramount role of social and structural violence in mediating women’s agency and access to resources and ability to practice HIV prevention. Drug sharing with clients was shown to be an important risk marker for elevated violence and unprotected sex. Early sexual abuse before 12 years was independently associated with HIV infection, and any sexual abuse before 18 years was associated with suicidal ideations and generational vulnerability to sex work. Finally, structural and environmental barriers, including violence, displacement, and servicing clients in public spaces, were shown to elevate women’s sexual HIV risk through being pressured into unprotected sex by a client. Conclusions: The findings support the urgent need for social and environmental-structural HIV prevention efforts, in particular legal reforms, concomitantly with gender-sensitive harm reduction, that facilitate sex worker’s ability to negotiate condom use in safer sex work environments.
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