Food Insecurity Increases HIV Risk Among Young Sex Workers in Metro Vancouver, Canada
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.
KeywordsSex work Youth HIV Food insecurity
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.
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.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
- 4.Anderson S. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(11 Suppl):1555–600.Google Scholar
- 12.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.Google Scholar
- 15.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.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.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.Google Scholar
- 19.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.
- 29.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.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Roshanafshar S, Hawkins E. Food Insecurity in Canada. Statistics Canada, 2015 March 25, 2015. Report No.Google Scholar
- 47.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.