title: Early sex work initiation independently elevates odds of HIV infection and police arrest among adult sex workers in a Canadian setting.
abstract: OBJECTIVE
  To explore factors associated with early sex work initiation and model the independent effect of early initiation on HIV infection and prostitution arrests among adult sex workers (SWs).
  
  
  METHODS
  Baseline data (2010-2011) were drawn from a cohort of SWs who exchanged sex for money within the last month and were recruited through time location sampling in Vancouver, Canada. Analyses were restricted to adults ≥18 years old.
  
  
  METHODS
  SWs completed a questionnaire and HIV/sexually transmitted infection testing. Using multivariate logistic regression, we identified associations with early sex work initiation (<18 years old) and constructed confounder models examining the independent effect of early initiation on HIV and prostitution arrests among adult SWs.
  
  
  RESULTS
  Of 508 SWs, 193 (38.0%) reported early sex work initiation, with 78.53% primarily street-involved SWs and 21.46% off-street SWs. HIV prevalence was 11.22%, which was 19.69% among early initiates. Early initiates were more likely to be Canadian born [adjusted odds ratio (AOR): 6.8, 95% confidence interval (CI): 2.42 to 19.02], inject drugs (AOR: 1.6, 95% CI: 1.0 to 2.5), and to have worked for a manager (AOR: 2.22, 95% CI: 1.3 to 3.6) or been coerced into sex work (AOR: 2.3, 95% CI: 1.14 to 4.44). Early initiation retained an independent effect on increased risk of HIV infection (AOR: 2.5, 95% CI: 1.3 to 3.2) and prostitution arrests (AOR: 2.0, 95% CI: 1.3 to 3.2).
  
  
  CONCLUSIONS
  Adolescent sex work initiation is concentrated among marginalized, drug, and street-involved SWs. Early initiation holds an independent increased effect on HIV infection and criminalization of adult SWs. Findings suggest the need for evidence-based approaches to reduce harm among adult and youth SWs.
authors: *Department of Medicine, Division of Global Public Health, University of California, San Diego, CA; †Department of Medicine, Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; and ‡Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.
authors: Shira M
authors: SM
authors: Goldenberg
authors: Jill
authors: J
authors: Chettiar
authors: Annick
authors: A
authors: Simo
authors: Jay G
authors: JG
authors: Silverman
authors: Steffanie A
authors: SA
authors: Strathdee
authors: Julio S G
authors: JS
authors: Montaner
authors: Kate
authors: K
authors: Shannon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
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