Format

Send to

Choose Destination
BMJ Open. 2018 Jan 31;8(1):e019388. doi: 10.1136/bmjopen-2017-019388.

Impact of sex work on risk behaviours and their association with HIV positivity among people who inject drugs in Eastern Central Canada: cross-sectional results from an open cohort study.

Author information

1
Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada.
2
École de santé publique, Université de Montréal, Montréal, Québec, Canada.
3
Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada.
4
Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec - Université Laval, Québec City, Quebec, Canada.
5
Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada.
6
Sérologie, Virologie et biologie moléculaire, Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne de Bellevue, Québec, Canada.
7
Département des Sciences de la Santé Communautaire, Université de Sherbrooke - Campus de Longueuil, Longueuil, Québec, Canada.

Abstract

OBJECTIVES:

The objectives of this study were: (1) to examine the correlates of HIV positivity among participants who injected drugs and engaged in sex work (PWID-SWs) in the SurvUDI network between 2004 and 2016, after stratification by sex, and (2) to compare these correlates with those of sexually active participants who did not engage in sex work (PWID non-SWs).

DESIGN AND SETTING:

This biobehavioural survey is an open cohort of services where participants who had injected in the past 6 months were recruited mainly through harm reduction programmes in Eastern Central Canada.

PARTICIPANTS:

Data from 5476 participants (9223 visits in total; 785 not included in multivariate analyses due to missing values) were included.

METHODS:

Participants completed an interviewer-administered questionnaire and provided saliva samples for anti-HIV antibody testing. Generalised estimating equations taking into account multiple participations were used.

RESULTS:

Baseline HIV prevalence was higher among SWs compared with non-SWs (women: 13.0% vs 7.7%; P<0.001, and men: 17.4% vs 10.8%; P<0.001). PWID-SWs were particularly susceptible to HIV infection as a result of higher levels of vulnerability factors and injection risk behaviours. They also presented different risk-taking patterns than their non-SWs counterparts, as shown by differences in correlates of HIV positivity. Additionally, the importance of sex work for HIV infection varies according to gender, as suggested by a large proportion of injection risk behaviours associated with HIV among women and, conversely, a stronger association between sexual behaviours and HIV positivity observed among men.

CONCLUSION:

These results suggest that sex work has an impact on the risk of HIV acquisition and that risk behaviours vary according to gender. Public health practitioners should take those specificities into account when designing HIV prevention interventions aimed at PWIDs.

KEYWORDS:

Canada; HIV prevalence; injection; risk factors; sex work

PMID:
29391367
PMCID:
PMC5829837
DOI:
10.1136/bmjopen-2017-019388
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center