Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.
BMJ Sex Reprod Health. 2020 Oct;46(4):301-307. doi: 10.1136/bmjsrh-2019-200408. Epub 2020 Mar 17.
Sex workers (SWs) face a disproportionate burden of HIV/sexually transmitted infections (STIs), violence and other human rights violations. While recent HIV prevention research has largely focused on the HIV cascade, condoms remain a cornerstone of HIV prevention, requiring further research attention. Given serious concerns regarding barriers to condom use, including policing, violence and 'end-demand' sex work criminalisation, we evaluated structural correlates of difficulty accessing condoms among SWs in Vancouver over an 8-year period.
Baseline and prospective data were drawn from a community-based cohort of women SWs (2010-2018). SWs completed semi-annual questionnaires administered by a team that included lived experience (SWs). Multivariable logistic regression using generalised estimating equations (GEE) modelled correlates of difficulty accessing condoms over time.
Among 884 participants, 19.1% reported difficulty accessing condoms during the study. In multivariable GEE analysis, exposure to end-demand legislation was not associated with improved condom access; identifying as a sexual/gender minority (adjusted odds ratio (aOR) 1.62, 95% CI 1.16 to 2.27), servicing outdoors (aOR 1.52, 95% CI 1.17 to 1.97), physical/sexual workplace violence (aOR 1.98, 95% CI 1.44 to 2.72), community violence (aOR 1.79, 95% CI 1.27 to 2.52) and police harassment (aOR 1.66, 95% CI 1.24 to 2.24) were associated with enhanced difficulty accessing condoms.
One-fifth of SWs faced challenges accessing condoms, suggesting the need to scale-up SW-tailored HIV/STI prevention. Despite the purported goal of 'protecting communities', end-demand criminalisation did not mitigate barriers to condom access, while sexual/gender minorities and those facing workplace violence, harassment or those who worked outdoors experienced poorest condom accessibility. Decriminalisation of sex work is needed to support SWs' labour rights, including access to HIV/STI prevention supplies.
性工作者（SW）面临不成比例的艾滋病毒/性传播感染（STI）、暴力和其他侵犯人权的负担。虽然最近的艾滋病毒预防研究主要集中在艾滋病毒传播途径上，但避孕套仍然是艾滋病毒预防的基石，需要进一步研究关注。鉴于对使用避孕套的障碍存在严重关切，包括警察干预、暴力和“终结性需求”性工作合法化，我们评估了在 8 年期间，温哥华性工作者获取避孕套的困难与结构性因素之间的相关性。
从一个基于社区的女性性工作者（SW）队列中（2010-2018 年）收集基线和前瞻性数据。SW 每半年通过一个包括经验丰富的团队（SW）进行问卷调查。使用广义估计方程（GEE）的多变量逻辑回归模型分析了随着时间推移，获取避孕套困难的相关因素。
在 884 名参与者中，19.1%的人在研究期间报告难以获得避孕套。在多变量 GEE 分析中，接触终结性需求立法并未改善避孕套的可及性；确定为性/性别少数群体（调整后的优势比（aOR）为 1.62，95%置信区间（CI）为 1.16 至 2.27）、在户外服务（aOR 为 1.52，95%CI 为 1.17 至 1.97）、身体/性工作场所暴力（aOR 为 1.98，95%CI 为 1.44 至 2.72）、社区暴力（aOR 为 1.79，95%CI 为 1.27 至 2.52）和警察骚扰（aOR 为 1.66，95%CI 为 1.24 至 2.24）与获取避孕套的难度增加相关。
五分之一的性工作者面临获取避孕套的挑战，这表明需要扩大针对性工作者的艾滋病毒/性传播感染预防措施。尽管终结性需求合法化的目的是“保护社区”，但它并没有减轻获取避孕套的障碍，而性/性别少数群体以及那些面临工作场所暴力、骚扰或在户外工作的人，获得避孕套的机会最差。需要将性工作合法化，以支持性工作者的劳动权利，包括获得艾滋病毒/性传播感染预防用品的权利。
