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- Title
Sex-for-Crack exchanges: associations with risky sexual and drug use niches in an urban Canadian city.
- Authors
Duff, Putu; Tyndall, Mark; Buxton, Jane; Zhang, Ruth; Kerr, Thomas; Shannon, Kate
- Abstract
Background While crack cocaine has been associated with elevated sexual risks and transmission of HIV/STIs, particularly in the context of street-based sex work, few empirical studies have examined correlates of direct sex-for-crack exchanges. This study longitudinally examined the correlates of sex-for-crack exchanges and associated effects on sexual risk outcomes among street-based female sex workers (SW) who use drugs in Vancouver, Canada. Methods Data were drawn from a prospective cohort of street-based SWs (2006-2008), restricted to those who smoke crack cocaine. Multivariable generalized estimating equations (GEE) were employed to examine the correlates of exchanging sex for crack. A confounding model using GEE quasi-Poisson regression modeled the independent effect of exchanging sex for crack on number of clients/ week. Results Of 206 SWs, 101 (49%) reported sex-for-crack exchanges over 18 months of follow-up. In multivariable GEE analyses, sharing a crack pipe with a client (aOR = 1.98; 95%CI: 1.27- 3.08) and smoking crack in a group of strangers (e.g., in an alley or crackhouse) (aOR = 1.70; 95%CI: 1.13-2.58) were independently correlated with sex-for-crack exchanges. In our confounding model, exchanging sex for crack (aIRR = 1.34; 95%CI: 1.07-1.69) remained significantly associated with servicing a greater number (>10) of clients/week. Conclusions These findings reveal elevated sexual- and drug- risk patterns among those who exchange sex for crack. The physical and social environment featured prominently in our results as a driver of sex-for-crack exchanges, highlighting the need for gender-sensitive multilevel approaches to harm reduction, STI and HIV prevention that address SWs' environment, individual level factors, and the interplay between them.
- Subjects
VANCOUVER (B.C.); CRACK cocaine; HIV infection risk factors; SEX workers; GENERALIZED estimating equations; HEALTH
- Publication
Harm Reduction Journal, 2013, Vol 10, Issue 1, p1
- ISSN
1477-7517
- Publication type
Article
- DOI
10.1186/1477-7517-10-29