title: Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy.
abstract: OBJECTIVE
  We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers.
  
  
  METHODS
  We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse.
  
  
  RESULTS
  In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73).
  
  
  CONCLUSIONS
  Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. kshannon@cfenet.ubc.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
authors.forename: Melanie
authors.initials: M
authors.lastname: Rusch
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D001955:British Columbia; D015331:Cohort Studies; D003153:Community Health Services; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000208:ethnology / Q000523:psychology*; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006291:Health Policy; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011446:Prospective Studies; D012111:Residence Characteristics; D011477:Sex Work / Q000208:ethnology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000208:ethnology / Q000523:psychology*