British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, CANADA.
Harm Reduct J. 2013 Nov 15;10:29. doi: 10.1186/1477-7517-10-29.
While crack cocaine has been associated with elevated sexual risks and transmission of HIV/STIs, particularly in the context of street-based sex work, few empirical studies have examined correlates of direct sex-for-crack exchanges. This study longitudinally examined the correlates of sex-for-crack exchanges and associated effects on sexual risk outcomes among street-based female sex workers (SW) who use drugs in Vancouver, Canada.
Data were drawn from a prospective cohort of street-based SWs (2006-2008), restricted to those who smoke crack cocaine. Multivariable generalized estimating equations (GEE) were employed to examine the correlates of exchanging sex for crack. A confounding model using GEE quasi-Poisson regression modeled the independent effect of exchanging sex for crack on number of clients/week.
Of 206 SWs, 101 (49%) reported sex-for-crack exchanges over 18 months of follow-up. In multivariable GEE analyses, sharing a crack pipe with a client (aOR = 1.98; 95%CI: 1.27-3.08) and smoking crack in a group of strangers (e.g., in an alley or crackhouse) (aOR = 1.70; 95% CI: 1.13-2.58) were independently correlated with sex-for-crack exchanges. In our confounding model, exchanging sex for crack (aIRR = 1.34; 95% CI: 1.07-1.69) remained significantly associated with servicing a greater number (>10) of clients/week.
These findings reveal elevated sexual- and drug- risk patterns among those who exchange sex for crack. The physical and social environment featured prominently in our results as a driver of sex-for-crack exchanges, highlighting the need for gender-sensitive multilevel approaches to harm reduction, STI and HIV prevention that address SWs' environment, individual level factors, and the interplay between them.
虽然可卡因吸食者与性风险升高和艾滋病毒/性传播感染（STIs）传播有关，特别是在街头性工作的情况下，但很少有实证研究检查直接性交易与可卡因之间的相关性。本研究纵向检查了与性交易可卡因相关的因素，以及这些因素对在加拿大温哥华使用毒品的街头女性性工作者（SW）的性风险结果的影响。
数据来自于一个前瞻性的街头 SW 队列（2006-2008 年），仅限于吸食可卡因的人群。多变量广义估计方程（GEE）用于检查交换性交易可卡因的相关性。使用 GEE 拟泊松回归模型的混杂模型，独立地模拟了交换性交易可卡因对每周客户数量的影响。
在 206 名 SW 中，有 101 名（49%）在 18 个月的随访中报告了性交易可卡因。在多变量 GEE 分析中，与客户共用可卡因烟斗（OR = 1.98；95%CI：1.27-3.08）和在一群陌生人中吸食可卡因（例如，在小巷或可卡因窝点）（OR = 1.70；95%CI：1.13-2.58）与性交易可卡因独立相关。在我们的混杂模型中，交换性交易可卡因（IRR = 1.34；95%CI：1.07-1.69）与服务更多（>10）客户/周仍然显著相关。
这些发现揭示了那些用性交易可卡因的人存在更高的性和药物风险模式。物理和社会环境在我们的结果中作为性交易可卡因的驱动因素显著突出，强调需要采取以性别为敏感的多层次方法来减少伤害、性传播感染和艾滋病毒预防，以解决 SW 的环境、个人层面因素以及它们之间的相互作用。
