title: Short-term cessation of sex work and injection drug use: evidence from a recurrent event survival analysis.
abstract: OBJECTIVE
  This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation.
  
  
  METHODS
  We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico.
  
  
  RESULTS
  Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation.
  
  
  CONCLUSIONS
  Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry.
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA. Electronic address: togaines@ucsd.edu.
authors: Tommi L
authors: TL
authors: Gaines
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA.
authors: Lianne A
authors: LA
authors: Urada
authors: Federacion Mexicana de Asociaciones Privadas, Ave. Malecon e Ing. M Cardona, No. 788 Zona Centro, 32000 Cd., Juarez, Chihuahua, Mexico.
authors: Gustavo
authors: G
authors: Martinez
authors: BC Center for Excellence in HIV/AIDS and Division of AIDS, Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, Canada.
authors: Shira M
authors: SM
authors: Goldenberg
authors: Colegio de la Frontera Norte, Baja California, Mexico.
authors: Gudelia
authors: G
authors: Rangel
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA.
authors: Elizabeth
authors: E
authors: Reed
authors: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive MC0680, La Jolla, CA 92093-0680, USA.
authors: Thomas L
authors: TL
authors: Patterson
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA.
authors: Steffanie A
authors: SA
authors: Strathdee
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D040261:Harm Reduction; D006556:Heroin Dependence / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D008800:Mexico / Q000453:epidemiology; D016485:Needle Sharing; D015995:Prevalence; D016016:Proportional Hazards Models; D012008:Recurrence; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016019:Survival Analysis; D047568:Unsafe Sex / Q000517:prevention & control*
keywords: Injection drug use; Mexico; Recurrent event survival analysis; Sex work cessation
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