title: Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a canadian setting.
abstract: OBJECTIVE
  To examine whether there were differential rates of hepatitis C virus (HCV) incidence in injecting drug-using youths who did and did not report involvement in survival sex work.
  
  
  METHODS
  Data were derived from 2 prospective cohort studies of injecting drug users (May 1, 1996, to July 31, 2007). Analyses were restricted to HCV antibody-negative youths who completed baseline and at least 1 follow-up assessment.
  
  
  METHODS
  Vancouver, British Columbia, Canada.
  
  
  METHODS
  Of 3074 injecting drug users, 364 (11.8%) were youths (aged 14-24 years) with a median age of 21.3 years and a duration of injecting drug use of 3 years. Main Exposure Survival sex work involvement.
  
  
  METHODS
  The Kaplan-Meier method and Cox proportional hazards regression were used to compare HCV incidence among youths who did and did not report survival sex work.
  
  
  RESULTS
  Baseline HCV prevalence was 51%, with youths involved in survival sex work significantly more likely to be HCV antibody positive (60% vs 44%; P = .002). In baseline HCV antibody-negative youths, the cumulative HCV incidence at 36 months was significantly higher in those involved in survival sex work (68.4% vs 38.8%; P < .001). The HCV incidence density was 36.8 (95% confidence interval [CI], 24.2-53.5) per 100 person-years in youths reporting survival sex work involvement at baseline compared with 14.1 (9.4-20.3) per 100 person-years in youths not reporting survival sex work. In multivariate Cox proportional hazards analyses, survival sex work was the strongest predictor of elevated HCV incidence (adjusted relative hazard, 2.30; 95% CI, 1.27-4.15).
  
  
  CONCLUSIONS
  This study calls attention to the critical need for evidence-based social and structural HCV prevention efforts that target youths engaged in survival sex work.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, Department of Medicine, University of British Columbia, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada. kshannon@cfenet.ubc.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Brandon
authors.initials: B
authors.lastname: Marshall
authors.forename: Kathy
authors.initials: K
authors.lastname: Li
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
authors.forename: Julio G S
authors.initials: JG
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*