Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Int J Drug Policy. 2023 Nov;121:104212. doi: 10.1016/j.drugpo.2023.104212. Epub 2023 Oct 3.
Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic.
Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs.
Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also.
Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
性工作者是一个高度被定罪的群体，她们在吸毒人群（PWUD）中占比过高，并且在过量预防和减少伤害服务方面存在差距。加拿大不列颠哥伦比亚省继续面临着非法毒品供应造成的明显药物中毒危机，这种情况在 COVID-19 大流行期间加剧了。我们的目的是研究在 COVID-19 大流行的第一年期间，使用毒品的性工作者中经历非法毒品供应（例如供应的可用性、质量、成本或获取毒品的途径）发生负面变化的流行率和结构相关性。
从 2020 年 4 月至 2021 年期间，对温哥华的一个前瞻性、基于社区的女性性工作者队列（AESHA）进行了横断面问卷调查。使用二变量和多变量逻辑回归来研究在 COVID-19 期间吸毒的性工作者中，毒品供应负面变化的结构相关性。
在 179 名使用毒品的性工作者中，68.2%报告在 COVID-19 期间经历了毒品供应的负面变化，54.2%最近使用了过量预防场所，44.7%报告最近遇到了医疗保健障碍。在调整了注射毒品使用的多变量分析中，报告非法药物供应发生负面变化的女性更有可能经历最近的医疗保健障碍（AOR 2.28，95%CI 1.12-4.62）；最近使用过量预防场所的女性（AOR 1.75，95%CI 0.86-3.54）也面临着略高的风险。
超过三分之二的参与者在 COVID-19 大流行的第一年期间经历了非法药物供应的负面变化。在经历非法药物供应负面变化和使用过量预防服务之间存在关联，突出了女性采取措施应对与过量相关的风险的自主性。那些经历直接服务结构性障碍的高度定罪的女性也容易受到非法药物供应波动的影响。减轻健康后果需要针对性工作者的需求量身定制的干预措施。
