Sex-for-Crack exchanges: associations with risky sexual and drug use niches in an urban Canadian city.
BACKGROUND
While crack cocaine has been associated with elevated sexual risks and transmission of HIV/STIs, particularly in the context of street-based sex work, few empirical studies have examined correlates of direct sex-for-crack exchanges. This study longitudinally examined the correlates of sex-for-crack exchanges and associated effects on sexual risk outcomes among street-based female sex workers (SW) who use drugs in Vancouver, Canada.


METHODS
Data were drawn from a prospective cohort of street-based SWs (2006-2008), restricted to those who smoke crack cocaine. Multivariable generalized estimating equations (GEE) were employed to examine the correlates of exchanging sex for crack. A confounding model using GEE quasi-Poisson regression modeled the independent effect of exchanging sex for crack on number of clients/week.


RESULTS
Of 206 SWs, 101 (49%) reported sex-for-crack exchanges over 18 months of follow-up. In multivariable GEE analyses, sharing a crack pipe with a client (aOR = 1.98; 95%CI: 1.27-3.08) and smoking crack in a group of strangers (e.g., in an alley or crackhouse) (aOR = 1.70; 95% CI: 1.13-2.58) were independently correlated with sex-for-crack exchanges. In our confounding model, exchanging sex for crack (aIRR = 1.34; 95% CI: 1.07-1.69) remained significantly associated with servicing a greater number (>10) of clients/week.


CONCLUSIONS
These findings reveal elevated sexual- and drug- risk patterns among those who exchange sex for crack. The physical and social environment featured prominently in our results as a driver of sex-for-crack exchanges, highlighting the need for gender-sensitive multilevel approaches to harm reduction, STI and HIV prevention that address SWs' environment, individual level factors, and the interplay between them.
Putu
P
Duff
Mark
M
Tyndall
Jane
J
Buxton
Ruth
R
Zhang
Thomas
T
Kerr
British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, CANADA. kshannon@cfenet.ubc.ca.
Kate
K
Shannon
D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D016578:Crack Cocaine; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D011446:Prospective Studies; D012309:Risk-Taking; D011477:Sex Work / Q000523:psychology* / Q000706:statistics & numerical data; D060386:Sex Workers / Q000523:psychology*; D012931:Social Environment; D015819:Substance Abuse, Intravenous; D047568:Unsafe Sex; D014754:Violence
D016578:Crack Cocaine