Abstract
This research aimed to determine the effect of food insecurity on sexual HIV risk with clients among youth sex workers (YSWs) <30 years in Metro Vancouver, Canada. Data were drawn from a prospective community cohort of sex workers (2010–2013). We examined the independent relationship between YSWs’ food insecurity and being pressured into sex without a condom by clients (“client condom refusal”). Of 220 YSWs, 34.5 % (n = 76) reported client condom refusal over the 3.5-year study period and 76.4 % (n = 168) reported any food insecurity. Adjusting for other HIV risk pathways, food insecurity retained an independent effect on client condom refusal (AOR 2.08, 95 % CI 1.23–3.51), suggesting that food insecurity is significantly associated with HIV risk among YSWs. This study indicates a critical relationship between food insecurity and HIV risk, and demonstrates YSWs’ particular vulnerability. Public policies for food assistance as a harm reduction measure may be key to addressing this disparity.
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References
Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.
Bryant T, Raphael D, Schrecker T, Labonte R. Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy. 2011;101(1):44–58.
Anema A, Vogenthaler N, Frongillo E, Kadiyala S, Weiser S. Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities. Curr HIV/AIDS Rep. 2009;6(4):224–31.
Anderson S. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(11 Suppl):1555–600.
Tsai AC, Hung KJ, Weiser SD. Is food insecurity associated with HIV risk? Cross-sectional evidence from sexually active women in Brazil. PLoS Med. 2012;9(4):e1001203.
Weiser SD, Tsai AC, Gupta R, Frongillo EA, Kawuma A, Senkungu J, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012;26(1):67–75.
Weiser SD, Fernandes KA, Brandson EK, Lima VD, Anema A, Bangsberg DR, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52(3):342–9.
Weiser SD, Frongillo EA, Ragland K, Hogg RS, Riley ED, Bangsberg DR. Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2009;24(1):14–20.
Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94(6):1729S–39S.
Tsai AC, Bangsberg DR, Emenyonu N, Senkungu JK, Martin JN, Weiser SD. The social context of food insecurity among persons living with HIV/AIDS in rural Uganda. Soc Sci Med. 2011;73(12):1717–24.
Weiser SD, Leiter K, Bangsberg DR, Butler LM, Percy-de Korte F, Hlanze Z, et al. Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med. 2007;4(10):e260.
Dank, M Yahner J, Kuniko Madden, Banuelos I, Yu L, Ritchie A, Mora M, Conner B. Surviving the streets of New York: Experiences of LGBTQ youth, YMSM, and YWSW engaged in survival sex. New York: United States of America: Urban Institute, 2015.
Chettiar J, Shannon K, Wood E, Zhang R, Kerr T. Survival sex work involvement among street-involved youth who use drugs in a Canadian setting. J Public Health. 2010;32(3):322–7.
Krüsi A, Pacey K, Bird L, Taylor C, Chettiar J, Allan S, et al. Criminalisation of clients: reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada—a qualitative study. BMJ Open. 2014;4(6):e005191.
Duff P, Shoveller J, Dobrer S, Ogilvie G, Montaner J, Chettiar J, et al. The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale. J Epidemiol Community Health. 2015;69:666–72.
Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner JS, Tyndall MW. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers 2009;23:06:15.
Sales JM, Milhausen RR, DiClemente RJ. A decade in review: building on the experiences of past adolescent STI/HIV interventions to optimise future prevention efforts. Sex Transm Infect. 2006;82(6):431–6.
Goldenberg SM, Chettiar J, Simo A, Silverman JG, Strathdee SA, Montaner J, et al. Early sex work initiation independently elevates odds of HIV infection and police arrest among adult sex workers in a Canadian setting. J Acquir Immune Defic Syndr. (1999). 2014;65(1):122–8.
HIV and Young People Who Sell Sex: A Technical Brief: World Health Organization; 2015. Available from: http://www.unaids.org/sites/default/files/media_asset/2015_young_people_who_sell_sex_en.pdf.
Dachner N, Tarasuk V. Homeless, “squeegee kids”: Food insecurity and daily survival. Soc Sci Med. 2002;54(7):1039–49.
Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009;13(5):841–8.
Kalichman SC, Cherry C, Amaral C, White D, Kalichman MO, Pope H, et al. Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta, Georgia. J Urban Health. 2010;87(4):631–41.
Shannon K, Bright V, Allinott S, Alexson D, Gibson K, Tyndall MW. Community-based HIV prevention research among substance-using women in survival sex work: The Maka Project Partnership. Harm Reduct J. 2007;4:20–5.
Argento E, Duff P, Bingham B, Chapman J, Nguyen P, Strathdee SA, et al. Social cohesion among sex workers and client condom refusal in a Canadian setting: implications for structural and community-led interventions. AIDS Behav. 2016;20(6):1275–83.
Keenan DP, Olson C, Hersey JC, Parmer SM. Measures of food insecurity/security. J Nutr Educ. 2001;33:S49–58.
Anema A, Chan K, Chen Y, Weiser S, Montaner JSG, Hogg RS. Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada. PLoS ONE. 2013;8(5):e61277.
Zerafati Shoae N, Omidvar N, Ghazi-Tabatabaie M, Houshiar Rad A, Fallah H, Mehrabi Y. Is the adapted Radimer/Cornell questionnaire valid to measure food insecurity of urban households in Tehran, Iran? Public Health Nutr. 2007;10(08):855–61.
Himmelgreen DA, Romero Daza N, Vega M, Brenes Cambronero H, Amador E. “The tourist season goes down but not the prices”. Tourism and food insecurity in Rural Costa Rica. Ecol Food Nutr. 2006;45(4):295–321.
Goldenberg SM, Chettiar J, Nguyen P, Dobrer S, Montaner J, Shannon K. Complexities of short-term mobility for sex work and migration among sex workers: violence and sexual risks, barriers to care, and enhanced social and economic opportunities. J Urban Health. 2014;91(4):736–51.
Socías ME, Shoveller J, Bean C, Nguyen P, Montaner J, Shannon K. Universal coverage without universal access: Institutional barriers to health care among women sex workers in Vancouver, Canada. PLoS ONE. 2016;11(5):e0155828.
Socías ME, Deering K, Horton M, Nguyen P, Montaner JS, Shannon K. Social and structural factors shaping high rates of incarceration among sex workers in a Canadian setting. J Urban Health. 2015;92(5):966–79.
Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–36.
Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics. 2001;57(1):120–5.
Roshanafshar S, Hawkins E. Food Insecurity in Canada. Statistics Canada, 2015 March 25, 2015. Report No.
Ntumbanzondo M, Dubrow R, Niccolai LM, Mwandagalirwa K, Merson MH. Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo. AIDS Care. 2006;18(7):777–85.
Shannon K, Kerr T, Bright V, Gibson K, Tyndall MW. Drug sharing with clients as a risk marker for increased violence and sexual and drug-related harms among survival sex workers. AIDS Care. 2008;20(2):228–34.
Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92.
Miewald C, McCann E. Foodscapes and the geographies of poverty: sustenance, strategy, and politics in an urban neighborhood. Antipode. 2014;46(2):537–56.
Antoniades M, Tarasuk V. A survey of food problems experienced by Toronto street youth. Can J Public Health. 1998;89(6):371–5.
Hamelin AM, Mercier C, Bedard A. The food environment of street youth. J Hunger Environ Nutr. 2006;1(3):69–98.
Sanders T. A continuum of risk? The management of health, physical and emotional risks by female sex workers. Soc Health Illn. 2004;26(5):557–74.
Gangamma R, Slesnick N, Toviessi P, Serovich J. Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. J Youth Adolescence. 2008;37(4):456–64.
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813–21.
Hatzenbuehler ML, Jun H-J, Corliss HL, Bryn Austin S. Structural stigma and sexual orientation disparities in adolescent drug use. Addict Behav. 2015;46:14–8.
Ryan C, Rivers I. Lesbian, gay, bisexual and transgender youth: victimization and its correlates in the USA and UK. Cult Health Sex. 2003;5(2):103–19.
Dachner N, Gaetz S, Poland B, Tarasuk VJ. An ethnographic study of meal programs for homeless and under-housed individuals in Toronto. J Health Care Poor Underserved. 2009;20(3):846–53.
HungerCount 2014 Toronto: Food Banks Canada; 2014 [cited 2015 June 2015]. Available from: http://www.foodbankscanada.ca/getmedia/7739cdff-72d5-4cee-85e9-54d456669564/HungerCount_2014_EN.pdf.aspx?ext=.pdf.
Kim SR, Goldenberg SM, Duff P, Nguyen P, Gibson K, Shannon K. Uptake of a women-only, sex-work-specific drop-in center and links with sexual and reproductive health care for sex workers. Int J Gynecol Obstet. 2015;128(3):201–5.
Riches G. Food banks and food security: welfare reform, human rights and social policy. Lessons from Canada? Soc Policy Adm. 2002;36(6):648–63.
Marlatt GA. Addiction ‘96 “Treatment Across The Addictions” Harm reduction: Come as you are. Addict Behav. 1996;21(6):779–88.
Shannon K, Rusch M, Shoveller J, Alexson D, Gibson K, Tyndall MW. Mapping violence and policing as an environmental–structural barrier to health service and syringe availability among substance-using women in street-level sex work. Int J Drug Policy. 2008;19(2):140–7.
Radimer KL, Olson CM, Campbell CC. Development of indicators to assess hunger. J Nutr. 1990;120(11 Suppl):1544–8.
Acknowledgments
We thank all those who contributed their time and expertise to this project, particularly participants, AESHA community advisory board members and partner agencies. We wish to acknowledge Chrissy Taylor, Jennifer Morris, Tina Ok, Rachel Nicoletti, Julia Homer, Emily Leake, Rachel Croy, Emily Groundwater, Meenakshi Mannoe, Silvia Machat, Jasmine McEachern, Brittany Udall, Chris Rzepa, Jingfei Zhang, Xin (Eleanor) Li, Krista Butler, Peter Vann, Sarah Allan and Jill Chettiar for their research and administrative support. We would also like to thank Eugenia Socias for her feedback on earlier versions of this article. This research was supported by operating grants from the US National Institutes of Health (R01DA028648) and Canadian Institutes of Health Research (HHP-98835), and MacAIDS. KS is partially supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research.
Funding
This research was supported by operating grants from the US National Institutes of Health (R01DA028648) and Canadian Institutes of Health Research (HHP-98835), and MacAIDS.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Barreto, D., Shannon, K., Taylor, C. et al. Food Insecurity Increases HIV Risk Among Young Sex Workers in Metro Vancouver, Canada. AIDS Behav 21, 734–744 (2017). https://doi.org/10.1007/s10461-016-1558-8
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DOI: https://doi.org/10.1007/s10461-016-1558-8