Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy

Am J Public Health. 2009 Apr;99(4):659-65. doi: 10.2105/AJPH.2007.129858. Epub 2009 Feb 5.

Abstract

Objectives: We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers.

Methods: We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse.

Results: In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73).

Conclusions: Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • British Columbia
  • Cohort Studies
  • Community Health Services
  • Condoms / statistics & numerical data*
  • Contraception Behavior / ethnology
  • Contraception Behavior / psychology*
  • Female
  • Geography
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • Health Policy
  • Humans
  • Logistic Models
  • Middle Aged
  • Prospective Studies
  • Residence Characteristics
  • Sex Work / ethnology
  • Sex Work / psychology*
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology
  • Surveys and Questionnaires
  • Unsafe Sex / ethnology
  • Unsafe Sex / psychology*