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HIV, sexually transmitted infections, and indoor commercial sex workers : application of social network analysis to assess the potential for diasese propagation Remple, Valencia Paulette


Keywords: Social network analysis, HIV/AIDS, sexually transmitted infections, commercial sex workers Objectives: The study objectives were: (a) to determine the structure and characteristics of the sexual networks of the indoor commercial sex industry and (b) to determine the potential for sexually transmitted infection (STI) transmission to the general population. Methods: In-person, structured interviews were conducted with 49 indoor female sex workers (FSW) from seven indoor sex establishments in the Greater Vancouver Regional District. Interviews elicited demographic, sexual behaviour, and sexual health information from respondents (egocentric data), information about respondents' sexual relationships (dyadic data), and proxy demographic and sexual behaviour information about respondents' most recent 5-10 sex partners (network data). Social network analysis (SNA) was used to examine the network structures and characteristics. Results: FSW respondents provided data on 234 sexual partners, 205 (88%) of whom were commercial clients. There was a single, connected sexual network of 553 individuals with a high frequency of dense, cyclic microstructures. There was a high degree of sexual bridging between sex establishments, between age and ethnic groups, and between the commercial sex core and the general population. Two types of clients could be categorized as high-risk from the network perspective, including those who bridged between sex establishments and those who were house regulars (clients who had sex with all the workers at an establishment). All known HIV and STI infection in sexual partners was in high-risk clients. Conclusions: SNA is a valuable tool with which to examine STI risk at the individual, dyadic, and network levels. The indoor commercial sex industry likely comprises a fully connected sexual network. The structural properties of the network suggest that if STI were introduced, even a small decrease in the amount of condom use or an increase in the number of infected individuals could support the transmission of these pathogens within the commercial sex network and to the general population. SNA also provides the tools with which to plan STI control programs, including the identification of prominent network members who may be important targets for STI control strategies.

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