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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
4R01DA028648-04
Application #
8496660
Study Section
Special Emphasis Panel (ZRG1-AARR-F (03))
Program Officer
Deeds, Bethany
Project Start
2010-07-15
Project End
2015-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
4
Fiscal Year
2013
Total Cost
$385,247
Indirect Cost
$28,537
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
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Lyons, Tara; Krüsi, Andrea; Pierre, Leslie et al. (2017) Negotiating Violence in the Context of Transphobia and Criminalization: The Experiences of Trans Sex Workers in Vancouver, Canada. Qual Health Res 27:182-190
Duff, P; Sou, J; Chapman, J et al. (2017) Poor working conditions and work stress among Canadian sex workers. Occup Med (Lond) 67:515-521
Landsberg, Adina; Shannon, Kate; Krüsi, Andrea et al. (2017) Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting. J Urban Health 94:563-571
Barreto, Daniella; Shannon, Kate; Taylor, Chrissy et al. (2017) Food Insecurity Increases HIV Risk Among Young Sex Workers in Metro Vancouver, Canada. AIDS Behav 21:734-744
Argento, Elena; Strathdee, Steffanie A; Goldenberg, Shira et al. (2017) Violence, trauma and living with HIV: Longitudinal predictors of initiating crystal methamphetamine injection among sex workers. Drug Alcohol Depend 175:198-204
Boily, Marie-Claude; Shannon, Kate (2017) Criminal law, sex work, HIV: need for multi-level research. Lancet HIV 4:e98-e99
Sou, Julie; Goldenberg, Shira M; Duff, Putu et al. (2017) Recent im/migration to Canada linked to unmet health needs among sex workers in Vancouver, Canada: Findings of a longitudinal study. Health Care Women Int 38:492-506
Puri, Nitasha; Shannon, Kate; Nguyen, Paul et al. (2017) Burden and correlates of mental health diagnoses among sex workers in an urban setting. BMC Womens Health 17:133
Goldenberg, Shira M; Montaner, Julio; Braschel, Melissa et al. (2017) Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care. Int J Infect Dis 55:31-37

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