Shannon K, Kerr T, Bright V, Gibson K, Tyndall M W
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.
AIDS Care. 2008 Feb;20(2):228-34. doi: 10.1080/09540120701561270.
Previous studies have described links between violence, decreased condom use and drug sharing among intimate partners, though limited information exists about the predictors of drug sharing among female sex workers and their clients. The following analysis explored the association between sharing illicit drugs with clients and sexual and drug-related harms among survival sex workers. A total of 198 women participated in interview-administered questionnaires and confidential HIV testing. Of the total, 117 (59%) reported sharing drugs with clients/johns in the last six months and crack cocaine was the primary drug shared (n=108). In logistic regression analysis, sharing drugs with clients/johns was associated with borrowing a used crack pipe (AOR=5.63; 95%CI: 2.71-9.44; p<0.001), intensive/daily crack cocaine smoking (AOR=3.78; 95%CI:1.60-8.92; p<0.002), inconsistent condom use by a client/john (AOR=3.17; 95%CI:1.48-6.77; p<0.003) and having a recent bad date (verbal harassment, physical and/or sexual assault) (AOR=2.71; 95%CI:1.17-6.32; p=0.021). Sharing illicit drugs with clients/johns may be a crucial risk marker for increased violence and sexual and drug-related harms among survival sex workers. HIV prevention and harm reduction initiatives targeting both women and clients/johns are urgently needed, including enhanced support for community and peer-driven sex work initiatives, to address some of the structural facilitators for HIV transmission.
以往的研究描述了亲密伴侣之间暴力行为、避孕套使用减少和药物共用之间的联系，不过关于女性性工作者及其客户之间药物共用的预测因素，现有信息有限。以下分析探讨了与客户共用非法药物与生存性工作者的性及与药物相关伤害之间的关联。共有198名女性参与了访谈式问卷调查和保密的艾滋病毒检测。其中，117名（59%）报告在过去六个月内与客户/嫖客共用过药物，主要共用的药物是快克可卡因（n = 108）。在逻辑回归分析中，与客户/嫖客共用药物与借用用过的快克烟管相关（比值比=5.63；95%置信区间：2.71 - 9.44；p<0.001）、大量/每日吸食快克可卡因（比值比=3.78；95%置信区间：1.60 - 8.92；p<0.002）、客户/嫖客不坚持使用避孕套（比值比=3.17；95%置信区间：1.48 - 6.77；p<0.003）以及近期有过不愉快的约会（言语骚扰、身体和/或性侵犯）（比值比=2.71；95%置信区间：1.17 - 6.32；p = 0.021）有关。与客户/嫖客共用非法药物可能是生存性工作者暴力行为增加以及性和药物相关伤害增加的一个关键风险指标。迫切需要针对女性和客户/嫖客的艾滋病毒预防和减少伤害举措，包括加强对社区和同伴驱动的性工作举措的支持，以解决艾滋病毒传播的一些结构性促进因素。
