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Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions

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Abstract

Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010–2013). Lippman and colleagues’ Social Cohesion Scale measured SWs’ connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20–29, range 4–45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95–0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.

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Acknowledgments

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 Peter Vann, Gina Willis, Sarah Allan, Annick Simo, Sabina Dobrer, Ofer Amram, Jill Chettiar, Jennifer Morris, and Kathleen Deering for their research and administrative support. This work is supported by operating grants from the US National Institutes of Health (R01DA028648) and Canadian Institutes of Health Research (HHP-98835). KS is supported by US National Institutes of Health (R01DA028648), Canadian Institutes of Health Research and Michael Smith Foundation for Health Research. SAS is supported by a NIDA MERIT award (R37DA019829).

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Authors and Affiliations

  1. Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Elena Argento, Putu Duff, Brittany Bingham, Paul Nguyen & Kate Shannon

  2. Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Putu Duff & Kate Shannon

  3. Sex Workers United Against Violence (SWUAV), Vancouver, BC, Canada

    Jules Chapman

  4. Division of Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, USA

    Steffanie A. Strathdee

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  1. Elena Argento
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  2. Putu Duff
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  3. Brittany Bingham
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  4. Jules Chapman
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  5. Paul Nguyen
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  6. Steffanie A. Strathdee
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  7. Kate Shannon
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Correspondence to Kate Shannon.

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Argento, E., Duff, P., Bingham, B. et al. Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions. AIDS Behav 20, 1275–1283 (2016). https://doi.org/10.1007/s10461-015-1230-8

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