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

Abstract

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.

Keywords

Antiretroviral therapy Sex workers Structural factors HIV/AIDS Migration 

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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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