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Kate Shannon, PhD, Steffanie A. Strathdee, PhD, Jean Shoveller, PhD, Melanie Rusch, PhD, Thomas Kerr, PhD and Mark W. Tyndall, MD, ScD

Kate Shannon, Steffanie A. Strathdee, Thomas Kerr, and Mark W. Tyndall are with the British Columbia Centre for Excellence in HIV/AIDS, Vancouver. At the time of the study, Kate Shannon and Jean Shoveller were with the School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver. Steffanie A. Strathdee and Melanie Rusch are with the Division of International Health and Cross Cultural Medicine, University of California, San Diego. Thomas Kerr and Mark W. Tyndall are also with the Department of Medicine at the University of British Columbia, Vancouver.

Correspondence: Requests for reprints should be sent to Kate Shannon, BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada (e-mail: kshannon{at}cfenet.ubc.ca).

Objectives. We investigated the relationship between environmental–structural factors and condom-use negotiation with clients among female sex workers.

Methods. We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental–structural factors and being pressured by a client into unprotected sexual intercourse.

Results. In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73).

Conclusions. Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental–structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.

This article has been cited by other articles:

				K. Shannon, T Kerr, S A Strathdee, J Shoveller, J S Montaner, and M W Tyndall Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers BMJ, August 11, 2009; 339(aug11_3): b2939 - b2939. [Abstract] [Full Text] [PDF]