Canadian Journal of Public Health

, Volume 98, Issue 6, pp 465–469 | Cite as

Sexual and Drug-related Vulnerabilities for HIV Infection Among Women Engaged in Survival Sex Work in Vancouver, Canada

  • Kate ShannonEmail author
  • Vicki Bright
  • Kate Gibson
  • Mark W. Tyndall



Women engaged in survival sex work face multiple sexual and drug-related harms that directly enhance their vulnerability to HIV infection. Although research on injection-drug-using women has explored predictors of sex work and HIV infection, little information currently exists on the complex vulnerabilities to HIV transmission faced by survival sex workers in this setting. This analysis aimed to determine HIV prevalence among women engaged in survival sex work, and explore sexual and drug-related vulnerabilities associated with baseline infection.


Descriptive and univariate analysis were used to explore associations with baseline HIV infection. Variables found to be associated with baseline infection at the univariate level (p<0.05) were entered into a fixed logistic regression model, adjusted for age.


Of a total of 198 women, baseline HIV prevalence was 26%. In multivariate logistic regression, baseline HIV infection was associated with early age of sex work initiation (<18 years) (aOR=1.8, 95% CI: 1.3-2.2), Aboriginal ethnicity (aOR=2.1, 95% CI: 1.4-3.8), daily cocaine injection (aOR=2.2, 95% CI: 1.3-3.5), intensive, daily crack smoking (aOR=2.7, 95% CI: 2.1-3.9), and unprotected sex with an intimate partner (aOR=2.8, 95% CI: 1.9-3.6).


Innovative and evidence-based strategies are urgently needed that address the sexual and drug-related vulnerabilities to HIV infection among survival sex workers and in particular, interventions targeting the precursors to early initiation into sex work.

MeSH terms

Prostitution HIV infections harm reduction 



Les femmes qui dépendent du commerce du sexe pour leur survie sont exposées à de nombreuses pratiques risquées, liées au sexe et à la drogue, qui augmentent directement leur vulnérabilité aux infections à VIH. Des études sur les utilisateurs de drogue injectable se sont penchées sur les variables prédictives du travail du sexe et de l’infection à VIH, mais on en sait encore très peu sur les risques complexes de transmission du VIH auxquels s’exposent les femmes qui dépendent du commerce du sexe pour leur survie. Dans le présent article, nous cherchons à déterminer la prévalence du VIH chez ces femmes et nous analysons les pratiques risquées, liées au sexe et à la drogue, associées à la primo-infection.


L’association de diverses variables à la primo-infection à VIH a été étudiée au moyen d’analyses descriptives et univariées. Les variables jugées significatives selon les analyses univariées (p<0,05) ont été entrées dans un modèle de régression logistique fixe ajusté selon l’âge.


Sur 198 femmes, 26 % étaient séropositives pour le VIH au départ. Selon l’analyse de régression logistique multivariée, la primo-infection à VIH était associée à l’initiation précoce (avant 18 ans) au travail du sexe (RCa=1,8; IC de 95 % = 1,3-2,2), à l’appartenance ethnique autochtone (RCa=2,1; IC de 95 % = 1,4-3,8), à l’injection quotidienne de cocaïne (RCa=2,2; IC de 95 % = 1,3-3,5), à l’habitude quotidienne et intensive de fumer du crack (RCa=2,7; IC de 95 % = 2,1-3,9) et aux relations sexuelles non protégées avec un partenaire intime (RCa=2,8; IC de 95 % = 1,9-3,6).


Il existe un urgent besoin d’instaurer des stratégies novatrices fondées sur les preuves pour combattre les pratiques risquées, liées au sexe et à la drogue, qui augmentent la vulnérabilité aux infections à VIH chez les femmes qui dépendent du commerce du sexe pour leur survie–et en particulier, des mesures d’intervention qui ciblent les précurseurs de l’initiation précoce au travail du sexe.


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Copyright information

© The Canadian Public Health Association 2007

Authors and Affiliations

  • Kate Shannon
    • 1
    • 2
    Email author
  • Vicki Bright
    • 1
  • Kate Gibson
    • 3
  • Mark W. Tyndall
    • 1
    • 2
  1. 1.British Columbia Centre for Excellence in HIV/AIDSSt. Paul’s HospitalVancouverCanada
  2. 2.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.WISH Drop-in Centre SocietyVancouverCanada

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