Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy
Shannon, K.; Strathdee, S.A.; Shoveller, J.; Rusch, M.; Kerr, T.; Tyndall, M.W.
American Journal of Public Health 99(4): 659-665
2009
ISSN/ISBN: 0090-0036 PMID: 19197086 DOI: 10.2105/ajph.2007.129858Document Number: 204925
We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers. We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse. In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73). Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.