HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Int J Drug Policy. 2021 May;91:102798. doi: 10.1016/j.drugpo.2020.102798. Epub 2020 Jun 3.
Female sex workers (FSWs) experience adversities regarding social determinants of health (SDH) and behavioural factors including illicit drug use. This study aimed to assess the clustered impact of SDH on illicit drug use among FSWs in Iran.
We surveyed 1,347 FSWs in 13 major cities in 2015. Latent class analysis was conducted to identify distinct classes of five measured SDH including low education, unemployment, unstable housing, last-year incarceration and sexual violence. We examined the association of these classes with five illicit drug use patterns using multivariable generalized linear model with Poisson family and log link, and reported adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI).
We identified five SDH classes: Class 1: no SDH adversities; Class 2: mainly unemployment; Class 3: low education and unemployment; Class 4: sexual violence and unemployment; and Class 5: multiple SDH adversities. The prevalence of last-month drug use ranged from 7.0% in Class 1 to 53.3% in Class 5. Compared to FSWs in Class 1, those in Class 2 (aPR: 2.47, 95% CI: 1.15, 5.27), Class 3 (aPR: 3.69, 95% CI: 1.62, 8.36), Class 4 (aPR: 4.49, 95% CI: 1.71, 11.78) and Class 5 (aPR: 6.35, 95% CI: 2.42, 16.69) were more likely to report last-month drug use. The same patterns were observed for specific drugs of opium use, crystal methamphetamine use, and heroin-crack use, as well as poly-drug use.
Socio-structural determinants are clustered together and elevate the likelihood of illicit drug use among FSWs. Our findings highlighted the significance of assessing and addressing such key determinants of health in drug use harm reduction programs targeting FSWs.
女性性工作者(FSWs)在社会决定因素(SDH)和行为因素方面经历了逆境,包括非法药物使用。本研究旨在评估伊朗 FSWs 中五个社会决定因素对非法药物使用的综合影响。
我们于 2015 年在 13 个主要城市调查了 1347 名 FSWs。采用潜在类别分析方法,确定了五个社会决定因素包括低教育、失业、住房不稳定、去年监禁和性暴力的五个不同类别。我们使用具有泊松家族和对数链接的多变量广义线性模型,研究了这些类别与五种非法药物使用模式之间的关系,并报告了调整后的患病率比(aPR)及其 95%置信区间(CI)。
我们确定了五个社会决定因素类别:第 1 类:无社会决定因素逆境;第 2 类:主要失业;第 3 类:低教育和失业;第 4 类:性暴力和失业;第 5 类:多种社会决定因素逆境。上个月药物使用的流行率从第 1 类的 7.0%到第 5 类的 53.3%不等。与第 1 类的 FSWs 相比,第 2 类(aPR:2.47,95%CI:1.15,5.27)、第 3 类(aPR:3.69,95%CI:1.62,8.36)、第 4 类(aPR:4.49,95%CI:1.71,11.78)和第 5 类(aPR:6.35,95%CI:2.42,16.69)更有可能报告上个月的药物使用情况。对于鸦片使用、冰毒使用、海洛因-可卡因使用以及多药物使用等特定药物,也观察到了相同的模式。
社会结构决定因素聚集在一起,增加了 FSWs 非法药物使用的可能性。我们的研究结果强调了在针对 FSWs 的药物使用减少伤害计划中评估和解决这些关键健康决定因素的重要性。