title: Crystal methamphetamine use among female street-based sex workers: Moving beyond individual-focused interventions.
abstract: Given growing concern of the sexual risks associated with crystal methamphetamine use and the dearth of research characterizing the use of methamphetamine among street-based sex workers (FSWs), this study aimed to characterize the prevalence and individual, social, and structural contexts of crystal methamphetamine use among FSWs in a Canadian setting. Drawing on data from a prospective cohort, we constructed multivariate logistic models to examine independent correlates of crystal methamphetamine among FSWs over a two-year follow-up period using generalized estimating equations. Of a total of 255 street-based FSWs, 78 (32%) reported lifetime crystal methamphetamine use and 24% used crystal methamphetamine during the two-year follow-up period, with no significant associations between methamphetamine use and sexual risk patterns. In a final multivariate GEE model, FSWs who used crystal methamphetamine had a higher proportional odds of dual heroin injection (adjOR=2.98, 95%CI: 1.35-5.22), having a primary male sex partner who procures drugs for them (adjOR=1.79, 95%CI: 1.02-3.14), and working (adjOR=1.62, 95%CI: 1.04-2.65) and living (adjOR=1.41, 95%CI: 1.07-1.99) in marginalized public spaces. The findings highlight the crucial need to move beyond the individual to gender-focused safer environment interventions that mediate the physical and social risk environment of crystal methamphetamine use among FSWs.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. kshannon@cfenet.ubc.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Steffanie
authors.initials: S
authors.lastname: Strathdee
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D000697:Central Nervous System Stimulants; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008694:Methamphetamine; D012309:Risk-Taking; D011477:Sex Work; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D047568:Unsafe Sex
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine
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