AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Volume 27, Issue 4, 2015, Pages 499-506

Successes and gaps in uptake of regular, voluntary HIV testing for hidden street- and off-street sex workers in Vancouver, Canada (Article)

Deering K.N.* , Montaner J.S. , Chettiar J. , Jia J. , Ogilvie G. , Buchner C. , Feng C. , Strathdee S.A. , Shannon K.
  • a Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
  • b Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
  • c BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
  • d BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
  • e BC Centre for Disease Control, Vancouver, BC, Canada, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  • f Vancouver Coastal Health, Vancouver, BC, Canada
  • g BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
  • h Faculty of Medicine, University of California, San Diego, San Diego, CA, United States
  • i Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

Abstract

Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and association with regular HIV testing among street- and off-street SWs in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as "An Evaluation of Sex Worker's Health Access" (AESHA; January 2010-July 2012). This cohort included youth and adult SWs (aged 14+ years). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 seronegative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients [adjusted (multivariable) odds ratios, AOR: 2.59, 95% confidence intervals [95% CIs]: 1.17-5.78], injecting drugs (AOR: 2.33, 95% CIs: 1.17-4.18) and contact with a mobile HIV prevention programme (AOR: 1.76, 95% CIs: 1.09-2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95% CIs: 0.19-0.56) and having a language barrier to health care access (AOR: 0.26, 95% CIs: 0.09-0.73). Our results highlight successes of reaching SWs at high risk of HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support. © 2014 Taylor & Francis.

Author Keywords

Vancouver HIV testing Interventions HIV test prevention Sex workers

Index Keywords

immigrant voluntary program explanatory variable diagnostic kit sexual behavior Human immunodeficiency virus infection human HIV test violence condom Condoms statistics and numerical data priority journal Logistic Models HIV Seropositivity sex worker Human immunodeficiency virus prevalence Cross-Sectional Studies condom use cross-sectional study migrant psychology patient safety sexual minority Adolescent male Canada Humans female preventive health service risk factor Risk Factors contact examination prostitution high risk population Health Knowledge, Attitudes, Practice serodiagnosis Article infection prevention adult Social Environment migration health care access utilization cohort analysis Sex Workers statistical model Transients and Migrants Reagent Kits, Diagnostic attitude to health intravenous drug abuse
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84923105777&doi=10.1080%2f09540121.2014.978730&partnerID=40&md5=e7c7358b42e9194107150388c7184980
DOI: 10.1080/09540121.2014.978730
ISSN: 09540121
Cited by: 17
Original Language: English