title: Women Who Use Drugs and Have Sex with Women in a Canadian Setting: Barriers to Treatment Enrollment and Exposure to Violence and Homelessness.
abstract: Individuals who use illicit drugs and belong to a sexual minority group often contend with elevated risks for adverse health outcomes. However, little is known about women who use drugs and have sex with women. We therefore sought to identify sociodemographic, substance use patterns, and exposures to social-structural factors associated with reporting sexual activity among women participating in three open prospective cohort studies of individuals who use illicit drugs in Vancouver, Canada. Generalized estimating equations were used to identify substance use patterns, violence, and other social and structural drivers of health-related harm among women who reported having sex with women (WSW) between December 2005 and May 2012. In multivariate analyses, younger age (adjusted odds ratio [AOR] 2.89; 95 % confidence interval [CI] 1.81, 4.60), violence (AOR 1.78; 95 % CI 1.22, 2.59), and homelessness (AOR 1.42; 95 % CI 1.00, 2.02) were associated with WSW. WSW were also less likely to report enrollment in addiction treatment (AOR 0.68; 95 % CI 0.46, 0.99). In a second model, sexual violence (AOR 3.47; 95 % CI 2.08, 5.78) in the previous 6 months was also found to be positively associated with WSW. These findings indicate a critical need for more thorough understandings of the intersections between sexual relationships, exposure to violence, and enrollment in addiction treatment among women who use illicit drugs, as well as the development of programs to address the unique needs of this population.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Lyons
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Sociology, University of British Columbia, 6303 Northwest Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Richardson
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Annick
authors.initials: A
authors.lastname: Simo
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.|Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D000069581:Exposure to Violence / Q000523:psychology*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D018452:Homosexuality, Female / Q000523:psychology*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D055815:Young Adult
keywords: Homelessness; Sexual orientation; Substance use; Treatment; Violence; Women who have sex with women; Youth