Simon Fraser University, Burnaby, British Columbia, Canada.
J Adolesc Health. 2011 Jul;49(1):36-41. doi: 10.1016/j.jadohealth.2010.10.003. Epub 2011 May 26.
Because of growing concerns regarding the heightened vulnerabilities and risk of human immunodeficiency virus infection among youth who exchange sex for survival, we investigated individual risk patterns and structural barriers among young (≤24 years) female sex workers (FSWs) in Vancouver, Canada.
Between 2005 and 2008, a total of 255 street-based FSWs (≥14 years) were enrolled into a community-based prospective cohort, and were asked to participate in baseline and biannual questionnaires administered through interviews and human immunodeficiency virus screening. We used contingency table analysis to compare individual and structural barrier results obtained at baseline for younger (≤24 years) FSWs with those of the older (>25 years) FSWs. For longitudinal data, we used generalized estimating equations throughout the follow-up period to determine factors associated with being a young FSW in the past 6 months.
In comparison with older FSWs (n = 199), youth (n = 56) were more likely to spend fewer years engaging in sex exchange (median: 6.4 [interquartile range: 4.6-9.1] vs. 19.9 [interquartile range: 10.0-26.8]; p ≤ .001), belong to an aboriginal ancestry (59% vs. 44%; p = .052), and be homeless (68% vs. 36%; p ≤ .001). In the multivariate generalized estimating equations analysis, youth reported a significantly elevated proportional odds of being homeless (odds ratio [OR]: 1.26 [confidence interval {CI}: 1.08-1.48]), servicing clients in public places (OR: 1.28 [CI: 1.04-1.57]), injecting heroin on a daily basis (OR: 1.35 [CI: 1.06-1.74]), and a significantly reduced odds of accessing methadone maintenance therapy (OR: .76 [CI: .62-.93]).
This study demonstrates significant displacement of youth who engage in sex exchange to marginalized working and living spaces. The findings of this study bring to attention the critical need for targeted structural interventions including access to youth and gender-specific social housing, safe working spaces, reduction in the amount of harm caused to them, and addiction treatment services for youth engaged in survival sex work.
由于人们越来越关注那些为了生存而进行性交易的青少年在人类免疫缺陷病毒感染方面的脆弱性和风险增加，我们调查了加拿大温哥华的年轻（≤24 岁）女性性工作者（FSW）的个体风险模式和结构障碍。
在 2005 年至 2008 年期间，共有 255 名街头性工作者（≥14 岁）被纳入一项基于社区的前瞻性队列研究，并被要求参加通过访谈和人类免疫缺陷病毒筛查进行的基线和每半年一次的问卷调查。我们使用列联表分析比较了年轻（≤24 岁）FSW 与年长（>25 岁）FSW 在基线时获得的个体和结构障碍结果。对于纵向数据，我们在整个随访期间使用广义估计方程来确定过去 6 个月中年轻 FSW 的相关因素。
与年长的 FSW（n = 199）相比，年轻人（n = 56）更有可能从事性交易的年限较短（中位数：6.4[四分位距：4.6-9.1]与 19.9[四分位距：10.0-26.8]；p≤0.001），属于原住民血统（59%比 44%；p = 0.052），无家可归（68%比 36%；p≤0.001）。在多变量广义估计方程分析中，年轻人报告说，无家可归的可能性显著增加（优势比[OR]：1.26[置信区间{CI}：1.08-1.48]），在公共场所接待客户（OR：1.28[CI：1.04-1.57]），每天注射海洛因（OR：1.35[CI：1.06-1.74]），接受美沙酮维持治疗的可能性显著降低（OR：0.76[CI：0.62-0.93]）。
本研究表明，从事性交易的年轻人明显转移到了边缘工作和生活空间。这项研究的结果提请人们注意，需要采取有针对性的结构性干预措施，包括为从事生存性性工作的青年提供青年和性别特定的社会住房、安全工作空间、减少对他们造成的伤害，以及为从事生存性性工作的青年提供成瘾治疗服务。
