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Access and utilization of HIV treatment and services among women sex workers in Vancouver's Downtown Eastside.

https://arctichealth.org/en/permalink/ahliterature174373
Source
J Urban Health. 2005 Sep;82(3):488-97
Publication Type
Article
Date
Sep-2005
Author
Kate Shannon
Vicki Bright
Janice Duddy
Mark W Tyndall
Author Affiliation
BC Centre for Excellence in HIV AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
Source
J Urban Health. 2005 Sep;82(3):488-97
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - utilization
Canada - epidemiology
Community Health Services - supply & distribution - utilization
Female
HIV Infections - epidemiology - therapy
Health Services Accessibility
Hepatitis C - epidemiology
Humans
Middle Aged
Poverty Areas
Prostitution
Substance-Related Disorders - epidemiology
Urban Population
Abstract
Many HIV-infected women are not realizing the benefits of highly active antiretroviral therapy (HAART) despite significant advancements in treatment. Women in Vancouver's Downtown Eastside (DTES) are highly marginalized and struggle with multiple morbidities, unstable housing, addiction, survival sex, and elevated risk of sexual and drug-related harms, including HIV infection. Although recent studies have identified the heightened risk of HIV infection among women engaged in sex work and injection drug use, the uptake of HIV care among this population has received little attention. The objectives of this study are to evaluate the needs of women engaged in survival sex work and to assess utilization and acceptance of HAART. During November 2003, a baseline needs assessment was conducted among 159 women through a low-threshold drop-in centre servicing street-level sex workers in Vancouver. Cross-sectional data were used to describe the sociodemographic characteristics, drug use patterns, HIV/hepatitis C virus (HCV) testing and status, and attitudes towards HAART. High rates of cocaine injection, heroin injection, and smokeable crack cocaine use reflect the vulnerable and chaotic nature of this population. Although preliminary findings suggest an overall high uptake of health and social services, there was limited attention to HIV care with only 9% of the women on HAART. Self-reported barriers to accessing treatment were largely attributed to misinformation and misconceptions about treatment. Given the acceptability of accessing HAART through community interventions and women specific services, this study highlights the potential to reach this highly marginalized group and provides valuable baseline information on a population that has remained largely outside consistent HIV care.
Notes
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PubMed ID
15944404 View in PubMed
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Negotiating safety and sexual risk reduction with clients in unsanctioned safer indoor sex work environments: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature124544
Source
Am J Public Health. 2012 Jun;102(6):1154-9
Publication Type
Article
Date
Jun-2012
Author
Andrea Krüsi
Jill Chettiar
Amelia Ridgway
Janice Abbott
Steffanie A Strathdee
Kate Shannon
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Source
Am J Public Health. 2012 Jun;102(6):1154-9
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Female
Focus Groups
Housing - standards
Humans
Interviews as Topic
Middle Aged
Occupational Health - standards
Police - supply & distribution
Prostitution
Qualitative Research
Risk Reduction Behavior
Sex Workers
Substance-Related Disorders - epidemiology
Violence - prevention & control
Young Adult
Abstract
We examined how unique, low-barrier, supportive housing programs for women who are functioning as unsanctioned indoor sex work environments in a Canadian urban setting influence risk negotiation with clients in sex work transactions.
We conducted 39 semistructured qualitative interviews and 6 focus groups with women who live in low-barrier, supportive housing for marginalized sex workers with substance use issues. All interviews were transcribed verbatim and thematically analyzed.
Women's accounts indicated that unsanctioned indoor sex work environments promoted increased control over negotiating sex work transactions, including the capacity to refuse unwanted services, negotiate condom use, and avoid violent perpetrators. Despite the lack of formal legal and policy support for indoor sex work venues in Canada, the environmental-structural supports afforded by these unsanctioned indoor sex work environments, including surveillance cameras and support from staff or police in removing violent clients, were linked to improved police relationships and facilitated the institution of informal peer-safety mechanisms.
This study has drawn attention to the potential role of safer indoor sex work environments as venues for public health and violence prevention interventions and has indicated the critical importance of removing the sociolegal barriers preventing the formal implementation of such programs.
Notes
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PubMed ID
22571708 View in PubMed
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Police confrontations among street-involved youth in a Canadian setting.

https://arctichealth.org/en/permalink/ahliterature121717
Source
Int J Drug Policy. 2013 Jan;24(1):46-51
Publication Type
Article
Date
Jan-2013
Author
Lianping Ti
Evan Wood
Kate Shannon
Cindy Feng
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
Source
Int J Drug Policy. 2013 Jan;24(1):46-51
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior
Adult
British Columbia - epidemiology
Crime - psychology
Criminals - psychology
Female
Health Behavior
Homeless Persons - psychology
Homeless Youth - psychology
Humans
Law Enforcement
Life Style
Male
Multivariate Analysis
Odds Ratio
Police
Prospective Studies
Questionnaires
Risk factors
Sex Factors
Sex Workers - psychology
Street Drugs
Substance-Related Disorders - epidemiology - psychology
Time Factors
Violence - psychology
Young Adult
Abstract
Street-level policing has been recognized as a driver of health-related harms among people who inject drugs (IDU). However, the extent of interaction between police and street-involved youth has not been well characterized. We examined the incidence and risk factors for police confrontations among street-involved youth in a Canadian setting.
Using data derived from participants enrolled in the At-Risk Youth Study (ARYS) between 2005 and 2011, we assessed factors associated with being stopped, searched, or detained by police without arrest in the previous six months using generalized estimating equations (GEE) with logit link for binary outcomes.
Among 991 participants followed during the study period, 440 (44.4%) reported being stopped, searched, or detained by police for an incidence density of 49.20 (95% confidence interval [CI]: 36.42-65.01) per 100 person years. In multivariate GEE analyses, factors associated with police confrontations included: male gender (adjusted odds ratio [AOR]=1.35), homelessness (AOR=2.05), recent incarceration (AOR=1.78), daily cannabis use (AOR=1.31), daily heroin injecting (AOR=1.36), crack pipe/syringe sharing (AOR=1.61), injection drug use (AOR=1.37), public drug use (AOR=2.19), sex work involvement (AOR=1.67), and drug dealing (AOR=1.49) (all p
Notes
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PubMed ID
22883543 View in PubMed
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Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers.

https://arctichealth.org/en/permalink/ahliterature149172
Source
BMJ. 2009;339:b2939
Publication Type
Article
Date
2009
Author
Kate Shannon
T. Kerr
S A Strathdee
J. Shoveller
J S Montaner
M W Tyndall
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS St Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada. kshannon@cfenet.ubc.ca
Source
BMJ. 2009;339:b2939
Date
2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - epidemiology
Epidemiologic Methods
Female
Humans
Prostitution - statistics & numerical data
Sexual Partners
Substance-Related Disorders - epidemiology
Unsafe Sex - statistics & numerical data
Violence - statistics & numerical data
Young Adult
Abstract
To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution.
Prospective observational study.
Vancouver, Canada during 2006-8.
Female sex workers 14 years of age or older (inclusive of transgender women) who used illicit drugs (excluding marijuana) and engaged in street level sex work.
Self reported gender based violence.
Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aOR(physicalviolence)) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aOR(rape)) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aOR(clientviolence)) 2.13, 1.26 to 3.62; aOR(physicalviolence) 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aOR(clientviolence) 1.50, 1.08 to 2.57); prior assault by police (aOR(clientviolence) 3.45, 1.98 to 6.02; aOR(rape) 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aOR(physicalviolence) 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aOR(clientviolence) 2.13, 1.26 to 3.62).
Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender based violence against street based female sex workers. Socio-legal policy reforms, improved access to housing and drug treatment, and scale up of violence prevention efforts, including police-sex worker partnerships, will be crucial to stemming violence against female sex workers.
Notes
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PubMed ID
19671935 View in PubMed
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Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy.

https://arctichealth.org/en/permalink/ahliterature152761
Source
Am J Public Health. 2009 Apr;99(4):659-65
Publication Type
Article
Date
Apr-2009
Author
Kate Shannon
Steffanie A Strathdee
Jean Shoveller
Melanie Rusch
Thomas Kerr
Mark W Tyndall
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. kshannon@cfenet.ubc.ca
Source
Am J Public Health. 2009 Apr;99(4):659-65
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Cohort Studies
Community Health Services
Condoms - utilization
Contraception Behavior - ethnology - psychology
Female
Geography
HIV Infections - prevention & control - transmission
Health Policy
Humans
Logistic Models
Middle Aged
Prospective Studies
Prostitution - ethnology - psychology
Questionnaires
Residence Characteristics
Substance-Related Disorders - epidemiology - psychology
Unsafe Sex - ethnology - psychology
Abstract
We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers.
We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse.
In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73).
Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.
Notes
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PubMed ID
19197086 View in PubMed
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Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a canadian setting.

https://arctichealth.org/en/permalink/ahliterature146300
Source
Arch Pediatr Adolesc Med. 2010 Jan;164(1):61-5
Publication Type
Article
Date
Jan-2010
Author
Kate Shannon
Thomas Kerr
Brandon Marshall
Kathy Li
Ruth Zhang
Steffanie A Strathdee
Mark W Tyndall
Julio G S Montaner
Evan Wood
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, Department of Medicine, University of British Columbia, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada. kshannon@cfenet.ubc.ca
Source
Arch Pediatr Adolesc Med. 2010 Jan;164(1):61-5
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - epidemiology
Female
Hepatitis C - epidemiology - transmission
Homeless Youth - statistics & numerical data
Humans
Incidence
Male
Prevalence
Proportional Hazards Models
Prostitution - statistics & numerical data
Risk factors
Substance-Related Disorders - epidemiology
Abstract
To examine whether there were differential rates of hepatitis C virus (HCV) incidence in injecting drug-using youths who did and did not report involvement in survival sex work.
Data were derived from 2 prospective cohort studies of injecting drug users (May 1, 1996, to July 31, 2007). Analyses were restricted to HCV antibody-negative youths who completed baseline and at least 1 follow-up assessment.
Vancouver, British Columbia, Canada.
Of 3074 injecting drug users, 364 (11.8%) were youths (aged 14-24 years) with a median age of 21.3 years and a duration of injecting drug use of 3 years. Main Exposure Survival sex work involvement.
The Kaplan-Meier method and Cox proportional hazards regression were used to compare HCV incidence among youths who did and did not report survival sex work.
Baseline HCV prevalence was 51%, with youths involved in survival sex work significantly more likely to be HCV antibody positive (60% vs 44%; P = .002). In baseline HCV antibody-negative youths, the cumulative HCV incidence at 36 months was significantly higher in those involved in survival sex work (68.4% vs 38.8%; P
PubMed ID
20048243 View in PubMed
Less detail

Youth, violence and non-injection drug use: nexus of vulnerabilities among lesbian and bisexual sex workers.

https://arctichealth.org/en/permalink/ahliterature105442
Source
AIDS Care. 2014;26(9):1090-4
Publication Type
Article
Date
2014
Author
Tara Lyons
Thomas Kerr
Putu Duff
Cindy Feng
Kate Shannon
Author Affiliation
a British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , BC , Canada.
Source
AIDS Care. 2014;26(9):1090-4
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Bisexuality
British Columbia - epidemiology
Female
HIV Infections - epidemiology - prevention & control
Homosexuality, Female
Humans
Prospective Studies
Risk factors
Sex Workers
Substance-Related Disorders - epidemiology
Violence - statistics & numerical data
Vulnerable Populations
Young Adult
Abstract
Despite increasing evidence of enhanced HIV risk among sexual minority populations, and sex workers (SWs) in particular, there remains a paucity of epidemiological data on the risk environments of SWs who identify as lesbian or bisexual. Therefore, this short report describes a study that examined the individual, interpersonal and structural associations with lesbian or bisexual identity among SWs in Vancouver, Canada. Analysis drew on data from an open prospective cohort of street and hidden off-street SWs in Vancouver. Bivariate and multivariable logistic regressions were used to examine the independent relationships between individual, interpersonal, work environment and structural factors and lesbian or bisexual identity. Of the 510 individuals in our sample, 95 (18.6%) identified as lesbian or bisexual. In multivariable analysis, reporting non-injection drug use in the last six months (adjusted odds ratio [AOR] = 2.89; 95% confidence intervals [CI] = 1.42, 5.75), youth =24 years of age (AOR = 2.43; 95% CI = 1.24, 4.73) and experiencing client-perpetrated verbal, physical and/or sexual violence in the last six months (AOR = 1.85; 95% CI = 1.15, 2.98) remained independently associated with lesbian/bisexual identity, after adjusting for potential confounders. The findings demonstrate an urgent need for evidence-based social and structural HIV prevention interventions. In particular, policies and programmes tailored to lesbian and bisexual youth and women working in sex work, including those that prevent violence and address issues of non-injection stimulant use are required.
PubMed ID
24382155 View in PubMed
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7 records – page 1 of 1.