The purpose of this application is to use social epidemiological methods to prospectively evaluate the impact of social, environmental, and structural factors on partner-level sexual and drug risk patterns and HIV and sexually transmitted infection (STI) incidence among FSWs and to assess the feasibility of a subsequent HIV/STI intervention targeting FSWs in public place-based settings (e.g. bars, streets). Despite growing evidence of the effectiveness of environmental-structural HIV/STI interventions targeting FSWs, this research has been largely derived from developing country settings and establishment-based venues, and there is limited prospective data on the social and structural context of HIV/STI risk among FSWs in North America. Given recent reports suggest a temporal shift from an injection to a sexually-driven HIV epidemic among street-involved populations in many North American settings, there is a crucial need for more prospective data on the contextual factors promoting and constraining partner-level sexual and drug risk patterns and HIV/STI acquisition. Vancouver, Canada is ideally suited for the proposed study for several reasons. First, due to the quasi-criminalized nature of sex work and large informal tolerance zones, we are in a unique position to evaluate the context of HIV/STI risk among FSWs, not currently feasible in most US cities. Second, unlike many urban environments where the FSW community is fragmented, the current social and legal context of sex work in Canada, our ability to harness strong community FSW support for this application, and new supportive housing models currently operating legally as quasi-brothels demonstrate significant innovation and strong potential for a subsequent intervention stemming from the results of this research. Herein we propose to create an open prospective cohort of 500 active FSWs working in public place-based settings, including interview administered questionnaires and HIV/STI screening at baseline and 6monthly follow-up over a five year period. To our knowledge this study is among the first prospective studies of public place-based sex work in North America and as such, we will be uniquely positioned to evaluate the risk environment and temporal trends in partner-level risks and HIV/STI acquisition among FSWs. This research will address several questions central to the urgent challenges facing HIV/STI prevention capacity in North America and will directly assess the feasibility of a subsequent intervention that will be of critical importance to other developed country settings.

Public Health Relevance

While there is growing concern in many North American cities of a temporal shift from an injection to a sexually-driven HIV epidemic, there has been limited prospective evaluation of the broader risk environment and HIV and sexually transmitted infection (STI) incidence among FSWs. Using social epidemiological methods, this research will address this gap by evaluating the impact of the physical and social environment, gender inequities, and structural factors on partner-level sexual and drug risk patterns and HIV/STI acquisition among an open cohort of 500 FSWs.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-AARR-F (03))
Program Officer
Deeds, Bethany
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of British Columbia
Zip Code
V6 1-Z3
Deering, K N; Montaner, J S; Chettiar, J et al. (2015) Successes and gaps in uptake of regular, voluntary HIV testing for hidden street- and off-street sex workers in Vancouver, Canada. AIDS Care 27:499-506
Goldenberg, Shira M; Liu, Vivian; Nguyen, Paul et al. (2015) International migration from non-endemic settings as a protective factor for HIV/STI risk among female sex workers in Vancouver, Canada. J Immigr Minor Health 17:21-8
Duff, Putu; Shoveller, Jeannie; Feng, Cindy et al. (2015) Pregnancy intentions among female sex workers: recognising their rights and wants as mothers. J Fam Plann Reprod Health Care 41:102-8
Shannon, Kate; Strathdee, Steffanie A; Goldenberg, Shira M et al. (2015) Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet 385:55-71
Argento, Elena; Chettiar, Jill; Nguyen, Paul et al. (2015) Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada. Int J Drug Policy 26:59-66
Muldoon, Katherine A; Deering, Kathleen N; Feng, Cindy X et al. (2015) Sexual relationship power and intimate partner violence among sex workers with non-commercial intimate partners in a Canadian setting. AIDS Care 27:512-9
Argento, Elena; Muldoon, Katherine A; Duff, Putu et al. (2014) High prevalence and partner correlates of physical and sexual violence by intimate partners among street and off-street sex workers. PLoS One 9:e102129
Goldenberg, Shira M; Chettiar, Jill; Simo, Annick et al. (2014) Early sex work initiation independently elevates odds of HIV infection and police arrest among adult sex workers in a Canadian setting. J Acquir Immune Defic Syndr 65:122-8
Lyons, Tara; Kerr, Thomas; Duff, Putu et al. (2014) Youth, violence and non-injection drug use: nexus of vulnerabilities among lesbian and bisexual sex workers. AIDS Care 26:1090-4
Bingham, Brittany; Leo, Diane; Zhang, Ruth et al. (2014) Generational sex work and HIV risk among Indigenous women in a street-based urban Canadian setting. Cult Health Sex 16:440-52

Showing the most recent 10 out of 23 publications