3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

WOMEN SURVIVAL SEX WORKERS IN VANCOUVER's DOWNTOWN EASTSIDE: A HIDDEN HIV EPIDEMIC

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuOa0405

Shannon K.¹, Bright V.², Duddy J.³, Oleson M.¹, Gibson K.⁴, Tyndall M.W.^5
1British Columbia Centre for Excellence in HIV/AIDS, Maka Initiative, Vancouver, Canada, ²AIDS Vancouver, Maka Initiative, Vancouver, Canada, ³Maka Initiative, Vancouver, Canada, ⁴Women's Information and Safe House (WISH) Drop-In Centre Society, Vancouver, Canada, ⁵British Columbia Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada

INTRODUCTION: Women engaged in survival sex work in Vancouver's Downtown Eastside (DTES) face multiple vulnerabilities including violence, entrenched poverty, and sexual and drug related harms. Despite high rates of HIV transmission among women injection drug users, less is known about the specific risk behaviours associated with HIV infection among survival sex workers.

METHODS: In collaboration with WISH (Women's Information and Safe House), the Maka Initiative conducted confidential HIV testing and interviews with 198 women survival sex workers, exploring sociodemographic characteristics, drug use, and sexual risk behaviours. Univariate and multivariate analyses were used to explore associations with HIV infection.

RESULTS: The median age of initiation into sex work was 19 years (IQrange:15-26). There were 115 (55%) women who self-identified as Aboriginal. In terms of mobility, 72% reported having clients from outside the DTES, and 30% primarily worked on strolls in other parts of Vancouver. HIV prevalence was 26%, while self-reported HCV was 71%. Factors associated with HIV infection included cocaine injection (Adjusted Odds Ratio, AOR=2.4, 95%CI:1.3-3.5), daily crack use (AOR=2.4, 95%CI:1.6-4.0), using drugs with clients (AOR=1.7, 95%CI:1.4-3.1), never using a condom with intimate partners (AOR=2.8, 95% CI:1.9-3.6), inconsistent condom use with clients (AOR=2.2, 95%CI:1.7-2.8) and age of sex work initiation <18years (AOR=1.8, 95%CI:1.3-2.2).

CONCLUSIONS: HIV infection among survival sex workers in Vancouver is associated with risky drug use patterns, inconsistent condom use, and early age of initiation into sex work. Given the high levels of mobility along with inconsistent condom use, there is a growing potential for HIV transmission to clients in other parts of the city. With 26% of women already HIV positive, there is an urgent need to expand HIV prevention and care strategies that address the multiple risks faced by these women as well as the serious public health consequences of continued neglect.

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Prevention | TuOa0405 | Kate Shannon
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