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Int J Drug Policy. 2015 Aug;26(8):755-63. doi: 10.1016/j.drugpo.2015.04.017. Epub 2015 Apr 25.

Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation.

Author information

1
Johns Hopkins Medical Institute, Department of Emergency Medicine, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA. Electronic address: awirtz1@jhu.edu.
2
AIDS Infoshare, Moscow, Russian Federation.
3
Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA.
4
Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family & Reproductive Health, Baltimore, USA.

Abstract

BACKGROUND:

Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission - sexual or parenteral transmission for FSW and PWID, respectively - with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities.

METHODS:

In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes.

RESULTS:

IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI: 2.4-18.9) and former injectors (AOR:4.5; 95%CI: 1.7-11.6), compared to non-injectors. Some 6-8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI: 1.2-6.4), client violence (AOR: 7.3, 95%CI: 2.1-24.7), and police extortion (AOR: 3.0 95%CI: 1.5-5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors.

CONCLUSIONS:

FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.

KEYWORDS:

Female sex worker; HIV; Injection drug use; Prevention; Russian Federation; Violence

PMID:
26003930
PMCID:
PMC4873958
DOI:
10.1016/j.drugpo.2015.04.017
[Indexed for MEDLINE]
Free PMC Article

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