title: Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics.
abstract: Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada.
  
  
  
  Analyses drew on data (2010-2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed-effects models were used to identify longitudinal correlates of undetectable pVL (<50 copies/mL).
  
  
  
  Of the 72 SWs living with HIV who had ever used ART, 38.9% had an undetectable pVL at baseline. Although 84.7% had undetectable pVL at least once over the study period, 18.1% exhibited sustained undetectable pVL. In multivariable generalized linear mixed-effects model analyses, ≥95% pharmacy refill adherence (adjusted odds ratio (AOR) = 4.21; 95% confidence interval (CI) 2.16 to 8.19) and length of time since diagnosis (AOR = 1.06; 95% CI: 1.00 to 1.13) were positively correlated with undetectable pVL. Having an intimate male partner (AOR = 0.35; 95% CI: 0.16 to 0.78) and being homelessness were negatively correlated with undetectable pVL (AOR = 0.22; 95% CI: 0.10 to 0.47).
  
  
  
  There is a need to more closely consider the social and structural contexts that shape SWs' experiences on ART and impact treatment outcomes, including the gendered power dynamics within intimate partnerships. Future research on HIV care among SWs is urgently needed, alongside structural and community-led interventions to support SWs' access to and retention in care.
authors: *British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada;†Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada; and‡Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors: Putu
authors: P
authors: Duff
authors: Shira
authors: S
authors: Goldenberg
authors: Kathleen
authors: K
authors: Deering
authors: Julio
authors: J
authors: Montaner
authors: Paul
authors: P
authors: Nguyen
authors: Sabina
authors: S
authors: Dobrer
authors: Kate
authors: K
authors: Shannon
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001955:British Columbia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology*; D006801:Humans; D008297:Male; D011477:Sex Work; D012747:Sexual Partners; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents