title: Client demands for unsafe sex: the socioeconomic risk environment for HIV among street and off-street sex workers.
abstract: OBJECTIVE
  Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural, and client-related factors associated with being offered and accepting more money after clients' demand for sex without a condom.
  
  
  METHODS
  Cross-sectional study using baseline (February 2010 to October 2011) data from a longitudinal cohort of 510 SWs.
  
  
  METHODS
  A 2-part multivariable regression model was used to identify factors associated with 2 separate outcomes: (1) being offered more money for sex without a condom in the last 6 months; and (2) accepting more money, among those who had been offered more money.
  
  
  RESULTS
  The sample included 490 SWs. In multivariable analysis, being offered more money for sex without a condom was more likely for SWs who used speedballs, had higher average numbers of clients per week, had difficulty accessing condoms, and had clients who visited other SWs. Accepting more money for sex without a condom was more likely for SWs self-reporting as a sexual minority and who had experienced client violence and used crystal methamphetamine less than daily (versus none) and less likely for SWs who solicited mainly indoors for clients (versus outdoor/public places).
  
  
  CONCLUSIONS
  These results highlight the high demand for sex without a condom by clients of SWs. HIV prevention efforts should shift responsibility toward clients to reduce offers of more money for unsafe sex. Programs that mitigate the social and economic risk environments of SWs alongside the removal of criminal sanctions on sex work to enable condom use within safer indoor workspaces are urgently required.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Deering
authors.forename: Tara
authors.initials: T
authors.lastname: Lyons
authors.forename: Cindy X
authors.initials: CX
authors.lastname: Feng
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
mesh_terms: D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000523:psychology; D002170:Canada; D017280:Condoms / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000523:psychology*; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult