Youth violence and non-injection drug use: Nexus of vulnerabilities among lesbian and bisexual sex workers

摘要

Despite increasing evidence of enhanced HIV risk among sexual minority populations, and sex workers in particular, there remains a paucity of epidemiological data on the risk environments of sex workers who identify as lesbian or bisexual. Therefore, this short report describes a study that examined the individual, interpersonal and structural associations with lesbian or bisexual identity among sex workers in Vancouver, Canada. Analysis drew on data from an open prospective cohort of street and hidden off-street sex workers in Vancouver. Bivariate and multivariable logistic regression were used to examine the independent relationships between individual-, interpersonal, work environment- and structural-factors and lesbian or bisexual identity. Of the 510 individuals in our sample, 95 [18.6%] identified as lesbian or bisexual. In multivariable analysis, reporting non-injection drug use in the last 6 months (adjusted odds ratio [AOR]= 2.89; 95% confidence intervals [CI]= 1.42, 5.75), youth ≤ 24 years of age (AOR= 2.43; 95% CI = 1.24, 4.73) and experiencing client-perpetrated verbal, physical and/or sexual violence in the last 6 months (AOR= 1.85; 95% CI= 1.15, 2.98) remained independently associated with lesbian/bisexual identity, after adjusting for potential confounders. The findings demonstrate an urgent need for evidence-based social and structural HIV prevention interventions. In particular, policies and programs tailored to lesbian and bisexual youth and women working in sex work, including those that prevent violence and address issues of non-injection stimulant use are required.