title: Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada.
abstract: BACKGROUND
  Women engaged in survival sex work face multiple sexual and drug-related harms that directly enhance their vulnerability to HIV infection. Although research on injection-drug-using women has explored predictors of sex work and HIV infection, little information currently exists on the complex vulnerabilities to HIV transmission faced by survival sex workers in this setting. This analysis aimed to determine HIV prevalence among women engaged in survival sex work, and explore sexual and drug-related vulnerabilities associated with baseline infection.
  
  
  METHODS
  Descriptive and univariate analysis were used to explore associations with baseline HIV infection. Variables found to be associated with baseline infection at the univariate level (p<0.05) were entered into a fixed logistic regression model, adjusted for age.
  
  
  RESULTS
  Of a total of 198 women, baseline HIV prevalence was 26%. In multivariate logistic regression, baseline HIV infection was associated with early age of sex work initiation (<18 years) (aOR=1.8, 95% CI: 1.3-2.2), Aboriginal ethnicity (aOR=2.1, 95% CI: 1.4-3.8), daily cocaine injection (aOR=2.2, 95% CI: 1.3-3.5), intensive, daily crack smoking (aOR=2.7, 95% CI: 2.1-3.9), and unprotected sex with an intimate partner (aOR=2.8, 95% CI: 1.9-3.6).
  
  
  CONCLUSIONS
  Innovative and evidence-based strategies are urgently needed that address the sexual and drug-related vulnerabilities to HIV infection among survival sex workers and in particular, interventions targeting the precursors to early initiation into sex work.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. kshannon@cfenet.ubc.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Vicki
authors.initials: V
authors.lastname: Bright
authors.forename: Kate
authors.initials: K
authors.lastname: Gibson
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D006293:Health Promotion; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D011634:Public Health; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D040241:Social Marketing; D011795:Surveys and Questionnaires; D017741:Survivors; D016387:Women's Health