Argento Elena, Strathdee Steffanie A, Goldenberg Shira, Braschel Melissa, Montaner Julio, Shannon Kate
Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
Drug Alcohol Depend. 2017 Jun 1;175:198-204. doi: 10.1016/j.drugalcdep.2017.02.014. Epub 2017 Apr 19.
Despite rapid increases in crystal methamphetamine (CM) use worldwide and established gendered patterns of use, empirical research on CM injection initiation among sex workers is limited. Given the wide range of harms associated with CM, alongside stimulant effects including sexual dis-inhibition and prolonged awake-ness, this study aimed to longitudinally investigate socio-structural predictors of initiating CM injection among sex workers in Vancouver, Canada.
Data (2010-2014) were drawn from a community-based cohort of women sex workers: AESHA (An Evaluation of Sex Workers Health Access). Participants completed bi-annual interviewer-administered questionnaires and HIV/STI testing. Kaplan Meier methods and Cox proportional hazards regression were used to model predictors of CM injection initiation among CM injection-naïve participants.
Of 455 participants eligible at baseline, 14.3% (n=65) injected CM for the first time over follow-up, with an incidence density of 6.79 per 100 person-years (95% Confidence Interval [CI] 5.30-8.69). In multivariable analysis, injection heroin use (Adjusted Hazard Ratio [AHR] 6.11; 95%CI 3.24-11.52), having an intimate partner who injects drugs (AHR 2.93; 95%CI 1.57-5.46), workplace violence (AHR 2.85; 95%CI 1.74-4.67), HIV seropositivity (AHR 2.69; 95%CI 1.45-5.00), and childhood abuse (AHR 1.86; 95%CI 0.99-3.49) were independently associated with initiating CM injection.
Findings underscore the gendered and social risk environment of CM injection initiation among sex workers. The strong influences of historical/workplace violence, coupled with heroin injection (known to be self-medicating for post-traumatic stress) as a primary risk pathway, emphasize the urgency of increasing access to integrated, trauma-informed addiction treatment and HIV care for marginalized women.
尽管全球范围内甲基苯丙胺（CM）的使用迅速增加，且存在既定的性别化使用模式，但关于性工作者中开始注射CM的实证研究有限。鉴于与CM相关的广泛危害，以及包括性抑制解除和长时间清醒在内的刺激作用，本研究旨在纵向调查加拿大温哥华性工作者中开始注射CM的社会结构预测因素。
数据（2010 - 2014年）取自一个以社区为基础的女性性工作者队列：AESHA（性工作者健康获取评估）。参与者每两年完成一次由访谈员管理的问卷调查和艾滋病毒/性传播感染检测。采用Kaplan Meier方法和Cox比例风险回归对未注射过CM的参与者中开始注射CM的预测因素进行建模。
在基线时符合条件的455名参与者中，14.3%（n = 65）在随访期间首次注射CM，发病密度为每100人年6.79例（95%置信区间[CI] 5.30 - 8.69）。在多变量分析中，注射海洛因（调整后风险比[AHR] 6.11；95%CI 3.24 - 11.52）、有注射毒品的亲密伴侣（AHR 2.93；95%CI 1.57 - 5.46）、工作场所暴力（AHR 2.85；95%CI 1.74 - 4.67）、艾滋病毒血清阳性（AHR 2.69；95%CI 1.45 - 5.00）和童年期受虐（AHR 1.86；95%CI 0.99 - 3.49）与开始注射CM独立相关。
研究结果强调了性工作者中开始注射CM的性别化和社会风险环境。历史/工作场所暴力的强烈影响，再加上海洛因注射（已知是用于自我治疗创伤后应激）作为主要风险途径，凸显了增加为边缘化女性提供综合的、创伤知情的成瘾治疗和艾滋病毒护理的紧迫性。
