TY - JOUR
T1 - Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation
AU - Wirtz, Andrea L.
AU - Peryshkina, Alena
AU - Mogilniy, Vladimir
AU - Beyrer, Chris
AU - Decker, Michele R.
N1 - Funding Information:
This work was supported by the Global Fund through the Open Health Institute, the Johns Hopkins University Center for AIDS Research ( 1P30AI094189 ), and the National Institute on Drug Abuse ( R03DA03569102 ). We thank the female sex workers who participated in this study, Svetlana Sadretdinova and her team at the Simona Clinic (Kazan, Russia), Marina Malisheva and Julia Burdina and their team at the Krasnyi Yar program (Krasnoyarsk, Russia), Nadezhda Ziryanova and Anna Petrova and their team at the Belaya Siren Project (Tomsk, Russia), Maria Ostrovskaya and Julia Kuznetzova for their coordination, and Shirin Kakayeva, Daesha Ramachandran, and Erin Pearson for qualitative analysis. We remember Marina Nikitina for her dedication to this work in Russia. We gratefully acknowledge the thoughtful feedback of two anonymous peer-reviewers.
Publisher Copyright:
© 2015 Elsevier B.V.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background: Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission - sexual or parenteral transmission for FSW and PWID, respectively - with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities. Methods: In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes. Results: IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI: 2.4-18.9) and former injectors (AOR:4.5; 95%CI: 1.7-11.6), compared to non-injectors. Some 6-8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI: 1.2-6.4), client violence (AOR: 7.3, 95%CI: 2.1-24.7), and police extortion (AOR: 3.0 95%CI: 1.5-5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors. Conclusions: FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.
AB - Background: Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission - sexual or parenteral transmission for FSW and PWID, respectively - with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities. Methods: In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes. Results: IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI: 2.4-18.9) and former injectors (AOR:4.5; 95%CI: 1.7-11.6), compared to non-injectors. Some 6-8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI: 1.2-6.4), client violence (AOR: 7.3, 95%CI: 2.1-24.7), and police extortion (AOR: 3.0 95%CI: 1.5-5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors. Conclusions: FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.
KW - Female sex worker
KW - HIV
KW - Injection drug use
KW - Prevention
KW - Russian Federation
KW - Violence
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U2 - 10.1016/j.drugpo.2015.04.017
DO - 10.1016/j.drugpo.2015.04.017
M3 - Article
C2 - 26003930
AN - SCOPUS:84937523948
SN - 0955-3959
VL - 26
SP - 755
EP - 763
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
IS - 8
ER -