Kate Shannon ^1*, Steffanie A. Strathdee ², Jean Shoveller ³, Melanie Rusch ², Thomas Kerr ¹, Mark W. Tyndall ¹

¹ BC Centre for Excellence in HIV/AIDS; Faculty of Medicine, University of British Columbia
² Division of International Health and Cross Cultural Medicine, University of California San Diego
³ Faculty of Medicine, University of British Columbia

^* To whom correspondence should be addressed. E-mail: kshannon{at}cfenet.ubc.ca.

	Abstract

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

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. We used multivariate logistic modeling to estimate the relationship between environmental–structural factors and being pressured by a client into unprotected intercourse.

Results. In multivariate analyses, being pressured to have 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, 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.

Key Words: Gender, Health Policy, HIV/AIDS, Prevention, Sexual Health, Women's Health

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]