title: Drug sharing with clients as a risk marker for increased violence and sexual and drug-related harms among survival sex workers.
abstract: Previous studies have described links between violence, decreased condom use and drug sharing among intimate partners, though limited information exists about the predictors of drug sharing among female sex workers and their clients. The following analysis explored the association between sharing illicit drugs with clients and sexual and drug-related harms among survival sex workers. A total of 198 women participated in interview-administered questionnaires and confidential HIV testing. Of the total, 117 (59%) reported sharing drugs with clients/johns in the last six months and crack cocaine was the primary drug shared (n=108). In logistic regression analysis, sharing drugs with clients/johns was associated with borrowing a used crack pipe (AOR=5.63; 95%CI: 2.71-9.44; p<0.001), intensive/daily crack cocaine smoking (AOR=3.78; 95%CI:1.60-8.92; p<0.002), inconsistent condom use by a client/john (AOR=3.17; 95%CI:1.48-6.77; p<0.003) and having a recent bad date (verbal harassment, physical and/or sexual assault) (AOR=2.71; 95%CI:1.17-6.32; p=0.021). Sharing illicit drugs with clients/johns may be a crucial risk marker for increased violence and sexual and drug-related harms among survival sex workers. HIV prevention and harm reduction initiatives targeting both women and clients/johns are urgently needed, including enhanced support for community and peer-driven sex work initiatives, to address some of the structural facilitators for HIV transmission.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. kshannon@cfenet.ubc.ca
authors.forename: K
authors.initials: K
authors.lastname: Shannon
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.forename: V
authors.initials: V
authors.lastname: Bright
authors.forename: K
authors.initials: K
authors.lastname: Gibson
authors.forename: M W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D016578:Crack Cocaine; D003617:Dangerous Behavior; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007398:Interpersonal Relations; D016485:Needle Sharing; D012307:Risk Factors; D011477:Sex Work / Q000523:psychology*; D012725:Sexual Behavior / Q000523:psychology*; D015819:Substance Abuse, Intravenous; D011795:Surveys and Questionnaires; D014754:Violence
chemical_list: D016578:Crack Cocaine