title: Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada.
abstract: In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010-2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among HIV seropositive participants (n = 74). Over a 2.5-year period, 37.8 % of participants experienced gaps in ART use (i.e., no ART dispensed in a 6-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting.
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada. sgoldenberg@cfenet.ubc.ca.|Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. sgoldenberg@cfenet.ubc.ca.
authors.forename: Shira M
authors.initials: SM
authors.lastname: Goldenberg
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Putu
authors.initials: P
authors.lastname: Duff
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Sabina
authors.initials: S
authors.lastname: Dobrer
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.|Clinical Education and Training Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
mesh_terms: D000328:Adult; D001955:British Columbia; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D060386:Sex Workers; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology*
keywords: Antiretroviral therapy; HIV/AIDS; Migration; Sex workers; Structural factors