Moreheart Sarah, Shannon Kate, Hayashi Kanna, Bartels Wiebke, Krüsi Andrea, Goldenberg Shira Miriam
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Department of Medicine, University of British Columbia, 2755 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall St, Vancouver, BC, V6T 1Z3, Canada.
Int J Drug Policy. 2025 May;139:104784. doi: 10.1016/j.drugpo.2025.104784. Epub 2025 Apr 1.
Amidst the ongoing toxic drug crisis, sex workers who use drugs face high overdose risk alongside structural barriers to harm reduction services. Previous work has noted that occupational violence and peer-led programs can influence health outcomes for sex workers. Given the potential for community-administered take-home naloxone (THN) to reduce overdose-related harm, we evaluated longitudinal trends and uptake of THN administration, and the associations between exposure to sex work-specific programs and occupational violence and harassment with THN administration over 5.5-years (2018-2024).
Data was derived from An Evaluation of Sex Workers' Health Access, a prospective, community-based cohort of sex workers in Vancouver, Canada from September 2018-March 2024. We plotted semi-annual trends of THN administration (Aim 1) and used bivariate logistic regression with generalized estimating equations (GEE) to characterize uptake of THN administration (Aim 2). Lastly, we employed bivariate and multivariable GEE to evaluate the association between exposure to sex-work specific programs and occupational violence and harassment with THN administration (Aim 3).
Among 427 participants, 57.9 % (N = 247) reported administering THN at least once. Exposure to sex work-specific programs was strongly associated with THN administration (Adjusted Odds Ratio [AOR] 1.26, 95 % Confidence Interval [CI] 1.02-1.55), as was exposure to violence from clients (AOR 1.72, 95 %CI 1.22-2.41) and community (AOR 1.76, 95 %CI 1.25-2.46), and police harassment (AOR 1.54, 95 %CI 1.07-2.21).
Over 5.5 years, over half of participants administered THN, which was associated with exposure to sex work-specific programs and occupational violence. Violence from clients, community members, and police independently increased the likelihood of THN administration. Findings suggest that marginalized sex workers, particularly those who use drugs in occupational settings, are uniquely positioned to respond to overdoses. This supports the feasibility of implementing sex worker-specific overdose interventions and highlights the need to expand community-based, sex worker-led safety, violence prevention, and care interventions to strengthen overdose prevention efforts and improve naloxone cascade metrics.
在持续的毒品危机中，吸毒的性工作者面临着很高的过量用药风险，同时在获取减少伤害服务方面存在结构性障碍。先前的研究指出，职业暴力和同伴主导的项目会影响性工作者的健康状况。鉴于社区发放可带回家使用的纳洛酮（THN）有减少过量用药相关伤害的潜力，我们评估了5.5年（2018 - 2024年）期间THN发放的纵向趋势和接受情况，以及接触性工作特定项目、职业暴力和骚扰与THN发放之间的关联。
数据来自《性工作者健康获取评估》，这是一项基于社区的前瞻性队列研究，研究对象为2018年9月至2024年3月期间加拿大温哥华的性工作者。我们绘制了THN发放的半年趋势图（目标1），并使用广义估计方程（GEE）的二元逻辑回归来描述THN发放的接受情况（目标2）。最后，我们采用二元和多变量GEE来评估接触性工作特定项目、职业暴力和骚扰与THN发放之间的关联（目标3）。
在427名参与者中，57.9%（N = 247）报告至少有一次发放THN。接触性工作特定项目与THN发放密切相关（调整后的优势比[AOR]为1.26，95%置信区间[CI]为1.02 - 1.55），来自客户的暴力（AOR为1.72，95%CI为1.22 - 2.41）、社区暴力（AOR为1.76，95%CI为1.25 - 2.46）以及警察骚扰（AOR为1.54，95%CI为1.07 - 2.21）也与THN发放密切相关。
在5.5年的时间里，超过一半的参与者发放了THN，这与接触性工作特定项目和职业暴力有关。来自客户、社区成员和警察的暴力独立增加了THN发放的可能性。研究结果表明，边缘化的性工作者，特别是那些在职业环境中吸毒的性工作者，在应对过量用药方面具有独特的地位。这支持了实施针对性工作者的过量用药干预措施的可行性，并强调需要扩大基于社区、由性工作者主导的安全、暴力预防和护理干预措施，以加强过量用药预防工作并改善纳洛酮级联指标。
