title: Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation.
abstract: BACKGROUND
  Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission - sexual or parenteral transmission for FSW and PWID, respectively - with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities.
  
  
  METHODS
  In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes.
  
  
  RESULTS
  IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI: 2.4-18.9) and former injectors (AOR:4.5; 95%CI: 1.7-11.6), compared to non-injectors. Some 6-8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI: 1.2-6.4), client violence (AOR: 7.3, 95%CI: 2.1-24.7), and police extortion (AOR: 3.0 95%CI: 1.5-5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors.
  
  
  CONCLUSIONS
  FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.
authors.affiliation: Johns Hopkins Medical Institute, Department of Emergency Medicine, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA. Electronic address: awirtz1@jhu.edu.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.affiliation: AIDS Infoshare, Moscow, Russian Federation.
authors.forename: Alena
authors.initials: A
authors.lastname: Peryshkina
authors.affiliation: AIDS Infoshare, Moscow, Russian Federation.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mogilniy
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family & Reproductive Health, Baltimore, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D016485:Needle Sharing / Q000009:adverse effects*; D012306:Risk; D012426:Russia; D060386:Sex Workers; D015819:Substance Abuse, Intravenous
keywords: Female sex worker; HIV; Injection drug use; Prevention; Russian Federation; Violence