AIDS and Behavior

, Volume 20, Issue 5, pp 977–986 | Cite as

Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada

  • Shira M. Goldenberg
  • Julio Montaner
  • Putu Duff
  • Paul Nguyen
  • Sabina Dobrer
  • Silvia Guillemi
  • Kate Shannon
Original Paper


In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010–2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among HIV seropositive participants (n = 74). Over a 2.5-year period, 37.8 % of participants experienced gaps in ART use (i.e., no ART dispensed in a 6-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting.


Antiretroviral therapy Sex workers Structural factors HIV/AIDS Migration 



We thank all those who contributed their time and expertise to this project, including participants, partner agencies, and the AESHA Community Advisory Board. We wish to acknowledge Sarah Allan, Ofer Amram, Eva Breternitz, Jill Chettiar, Kathleen Deering, Sabina Dobrer, Julia Homer, Rhiannon Hughes, Emily Leake, Jane Li, Vivian Liu, Sylvia Machat, Meenakshi Mannoe, Jen Morris, Paul Nguyen, Rachel Nicoletti, Tina Ok, Saba Tadesse-Lee, Chrissy Taylor, Brittney Udall, Peter Vann, Gina Willis, and Jingfei Zhang for their research and administrative support. This research was supported by operating Grants from the US National Institutes of Health (R01DA028648), the Canadian Institutes of Health Research (CIHR) (HHP-98835) CIHR/Public Health Agency of Canada (HEB-330155), and MAC AIDS. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and the Michael Smith Foundation for Health Research. JM is supported with Grants paid to his institution by the British Columbia Ministry of Health. He has also received limited unrestricted funding, through his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Shira M. Goldenberg
    • 1
    • 5
  • Julio Montaner
    • 2
    • 3
  • Putu Duff
    • 1
    • 2
  • Paul Nguyen
    • 2
    • 3
  • Sabina Dobrer
    • 2
    • 3
  • Silvia Guillemi
    • 2
    • 4
  • Kate Shannon
    • 1
    • 2
  1. 1.Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  2. 2.Department of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.British Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  4. 4.Clinical Education and Training Program, British Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  5. 5.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada

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