Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions.
Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010-2013). Lippman and colleagues' Social Cohesion Scale measured SWs' connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20-29, range 4-45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95-0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.
Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Elena
E
Argento
Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Putu
P
Duff
Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Brittany
B
Bingham
Sex Workers United Against Violence (SWUAV), Vancouver, BC, Canada.
Jules
J
Chapman
Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Paul
P
Nguyen
Division of Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, USA.
Steffanie A
SA
Strathdee
Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. gshi@cfenet.ubc.ca.|Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. gshi@cfenet.ubc.ca.
Kate
K
Shannon
D000328:Adult; D002170:Canada; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D021841:Safe Sex; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000523:psychology*; D012924:Social Conditions; D012944:Social Support
Community empowerment; Condom use; HIV prevention; Sex work; Social cohesion