Sex work and HIV incidence among people who inject drugs.

Abstract

OBJECTIVE:

Although the global burden of HIV infection among sex workers (SW) has been well recognized, HIV-related risks among sex workers who inject drugs (SW-IDU) have received less attention. We investigated the relationship between sex work and HIV incidence among people who inject drugs (IDU) in a Canadian setting.

DESIGN:

Prospective cohort study.

METHODS:

Using Kaplan-Meier methods and the extended Cox regression, we compared HIV incidence among SW-IDU and non-SW-IDU in Vancouver, Canada, after adjusting for potential confounders.

RESULTS:

Between 1996 and 2012, 1647 participants were included in the study, including 512 (31.1%) IDU engaged in sex work. At 5 years the HIV cumulative incidence was higher among SW-IDU in comparison to other IDU (12 vs. 7%, P = 0.001). In unadjusted Cox regression analyses, HIV incidence among SW-IDU was also elevated [relative hazard: 1.69; 95% confidence interval (CI): 1.13-2.53]. However, in a multivariable analysis, sex work did not remain associated with HIV infection (adjusted relative hazard: 0.74; 95% CI: 0.45-1.20), with cocaine injection appearing to account for the elevated risk for HIV infection among SW-IDU.

CONCLUSION:

These data suggest that local SW-IDU have elevated rates of HIV infection. However, our exploration of risk factors among SW-IDU demonstrated that drug use patterns and environmental factors, rather than sexual risks, may explain the elevated HIV incidence among SW-IDU locally. Our findings highlight the need for social and structural interventions, including increased access to harm reduction programs and addiction treatment.

• Authors: Thomas Kerr, Kate Shannon, Lianping Ti, Steffanie Strathdee, Kanna Hayashi, Paul Nguyen, Julio Montaner, Evan Wood
• Journal: AIDS (London, England) (AIDS) Vol. 30 Issue 4 Pg. 627-34 (Feb 20 2016) ISSN: 1473-5571 [Electronic] England
• PMID: 26558725 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Canada (epidemiology)
• Female
• HIV Infections (epidemiology)
• Humans
• Incidence
• Male
• Occupational Exposure
• Prospective Studies
• Sex Workers
• Substance Abuse, Intravenous (complications)