Finally, at the time of the baseline visit, women were provided with a map of Vancouver and asked to indicate using the past 6 months as a reference point areas in which they 1 worked and lived, 2 considered high and low risk to their personal safety, 3 avoided because of violence and policing, and 4 accessed syringes and accessed health services. The dependent variable for all analyses was reporting being pressured by a client into unprotected vaginal or anal intercourse in the past 6 months. 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. Given the known difficulties in accessing a representative sample of sex workers because of the unknown size and boundaries of this population, initial mapping of working areas with more than 60 female sex workers was used to identify sex work strolls for targeted outreach and recruitment. Women account for an increasingly disproportionate number of HIV infections worldwide. Finally, we defined client-perpetrated violence i. Given significant collinearity between displacement because of policing and working in industrial areas, we only entered displacement into the multivariate model.
Given the known difficulties in accessing a representative sample of sex workers because of the unknown size and boundaries of this population, initial mapping of working areas with more than 60 female sex workers was used to identify sex work strolls for targeted outreach and recruitment. Given growing human rights and public health calls globally to address the failings of criminalized or quasi-criminalized prostitution on the health and safety of sex workers, 16 — 18 , 22 , 23 and recent charter challenges to Canada's federal prostitution laws, we aimed to examine the association between environmental—structural factors and the negotiation of condom use with clients among street-level sex workers. 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. Similar to previous analyses, 26 drug use patterns included any cocaine, heroin, or crystal methamphetamine injection in the past 6 months. These challenges and limitations may reflect the inability of interventions to adequately address the dynamic ways in which environmental and structural factors interact with microlevel factors in producing individual HIV risk. Women account for an increasingly disproportionate number of HIV infections worldwide. Finally, we adjusted all models for age because of previous evidence suggesting potential confounding with sexual HIV risk and 1 or more police enforcement strategies. Women's risk of HIV infection is hypothesized to be mediated by macro- and micro-level factors exogenous to the individual that interact to increase vulnerability to HIV infection, factors such as gender, cultural and economic inequities, prohibitive government policies, and institutionalized racism and poverty. Other microlevel drug practices previously shown to enhance sexual risk of HIV included borrowing a used crack pipe and exchanging sexual services while high on drugs. Because all respondents reported smoking crack cocaine, we examined daily versus less-than-daily use. Explanatory Variables The risk environment framework, 8 which postulates that macro- and meso-level factors exogenous to the individual mediate negotiation of individual HIV risk, formed the theoretical basis for the selection of independent variables for all analyses. The dependent variable for all analyses was reporting being pressured by a client into unprotected vaginal or anal intercourse in the past 6 months. The authors track a four-fold connection between the two fields, exploring the mental and physical health of incarcerated populations; the health consequences of crime, substance abuse, violence and risky sexual behaviors; the extent to which high crime rates are linked to poor health outcomes in the same neighborhood; and the results of public health interventions among traditional criminal justice populations. We investigated the relationship between environmental—structural factors and condom-use negotiation with clients among female sex workers. The term survival sex work is used to refer to the exchange of sexual services for money, drugs, or shelter as a means of basic subsistence. To elucidate specific environmental—structural factors associated with the negotiation of sexual HIV risk, we used descriptive and univariate analyses to examine associations with being pressured by a client into unprotected sexual intercourse. Individual variables considered as potential confounders because of their known or a priori hypothesized relationship with negotiation of condom use and at least 1 or more independent variables included HIV status, type and frequency of drug use, pregnancy history, and early sexual and physical abuse. The Downtown Eastside core, considered among the poorest postal codes in North America, has become known for a highly concentrated open drug market, socioeconomic disadvantage, and health inequities, as well as extensive community and health resources. A detailed description of the Maka Project methodology has been published elsewhere. As well as exploring these urgent issues, this anthology features a wealth of remarkable interdisciplinary contributions that see public health researchers focusing on crime, while criminologists attend to public health issues. We used multivariate logistic modeling to estimate the relationship between environmental—structural factors and being pressured by a client into unprotected sexual intercourse. Crime, HIV and Health: Finally, we defined client-perpetrated violence i. Importantly, no associations were observed between drug use practices and being pressured by a client into unprotected sexual intercourse. Given significant collinearity between displacement because of policing and working in industrial areas, we only entered displacement into the multivariate model.
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