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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Socías, M Eugenia; Deering, Kathleen; Montaner, Julio S et al. (2016) Comment on "Hepatitis C and the Sex Trade". Can J Gastroenterol Hepatol 2016:1253208
Socías, M Eugenia; Shoveller, Jean; Bean, Chili et al. (2016) Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada. PLoS One 11:e0155828
Barreto, Daniella; Shannon, Kate; Taylor, Chrissy et al. (2016) Food Insecurity Increases HIV Risk Among Young Sex Workers in Metro Vancouver, Canada. AIDS Behav :
Duff, Putu; Goldenberg, Shira; Deering, Kathleen et al. (2016) Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics. J Acquir Immune Defic Syndr 73:83-90
Krüsi, Andrea; Kerr, Thomas; Taylor, Christina et al. (2016) 'They won't change it back in their heads that we're trash': the intersection of sex work-related stigma and evolving policing strategies. Sociol Health Illn 38:1137-50
Duff, Putu; Ogilvie, Gina; Shoveller, Jean et al. (2016) Barriers to Cervical Screening Among Sex Workers in Vancouver. Am J Public Health 106:366-73
Goldenberg, Shira M; Montaner, Julio; Duff, Putu et al. (2016) Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada. AIDS Behav 20:977-86
Argento, Elena; Duff, Putu; Bingham, Brittany et al. (2016) Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions. AIDS Behav 20:1275-83
Goldenberg, Shira M; Duff, Putu; Krusi, Andrea (2015) Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives. BMC Public Health 15:1241

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