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)
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Study Section
Special Emphasis Panel (ZRG1-AARR-F (03))
Program Officer
Deeds, Bethany
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University of British Columbia
Zip Code
V6 1-Z3
Barreto, Daniella; Shoveller, Jeannie; Braschel, Melissa et al. (2018) The Effect of Violence and Intersecting Structural Inequities on High Rates of Food Insecurity among Marginalized Sex Workers in a Canadian Setting. J Urban Health :
Prangnell, Amy; Shannon, Kate; Nosova, Ekaterina et al. (2018) Workplace violence among female sex workers who use drugs in Vancouver, Canada: does client-targeted policing increase safety? J Public Health Policy 39:86-99
Duff, Putu K; Money, Deborah M; Ogilvie, Gina S et al. (2018) Severe menopausal symptoms associated with reduced adherence to antiretroviral therapy among perimenopausal and menopausal women living with HIV in Metro Vancouver. Menopause 25:531-537
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
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
Goldenberg, Shira M; Krüsi, Andrea; Zhang, Emma et al. (2017) Structural Determinants of Health among Im/Migrants in the Indoor Sex Industry: Experiences of Workers and Managers/Owners in Metropolitan Vancouver. PLoS One 12:e0170642
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
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
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

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