Interpersonal and structural factors associated with receptive syringe-sharing among a prospective cohort of female sex workers who inject drugs

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Abstract

Aims: To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. Design: Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. Setting: Baltimore, MD, USA. Participants: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1% white and 62.9% in a relationship/married. Measurements: Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. Findings: Nearly all FSW-IDU used heroin (97.1%) or crack cocaine (89.7%). Recent RSS was reported by 18.3%. Syringes were accessed from needle exchange programs (64.6%), pharmacies (29.7%), street sellers (30.3%) or personal networks (29.1%). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9%, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95% confidence interval (CI) = 1.09–4.33], having an intimate partner who injected drugs (aOR = 2.18, 95% CI = 0.98–4.85), being injected by others (aOR = 4.95, 95% CI = 2.42–10.10) and obtaining syringes from a street seller (aOR = 1.88, 95% CI = 0.94–3.78) or from a member of their personal network (aOR = 4.43, 95% CI = 2.21–8.90). Conclusions: Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.

Original languageEnglish (US)
JournalAddiction
DOIs
StatePublished - Jan 1 2019

Fingerprint

Needle Sharing
Sex Workers
Pharmaceutical Preparations
Syringes
Odds Ratio
Confidence Intervals
Hepacivirus
Needle-Exchange Programs
HIV
Crack Cocaine
Baltimore
Injections
Pharmacies
Heroin
Police
Violence
Cohort Studies
Demography

Keywords

  • HIV risk
  • injection drug use
  • intimate partners
  • sex work
  • substance use
  • women

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

@article{3fd344ee9527415a8aa77378e7e55c69,
title = "Interpersonal and structural factors associated with receptive syringe-sharing among a prospective cohort of female sex workers who inject drugs",
abstract = "Aims: To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. Design: Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. Setting: Baltimore, MD, USA. Participants: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1{\%} white and 62.9{\%} in a relationship/married. Measurements: Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. Findings: Nearly all FSW-IDU used heroin (97.1{\%}) or crack cocaine (89.7{\%}). Recent RSS was reported by 18.3{\%}. Syringes were accessed from needle exchange programs (64.6{\%}), pharmacies (29.7{\%}), street sellers (30.3{\%}) or personal networks (29.1{\%}). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9{\%}, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95{\%} confidence interval (CI) = 1.09–4.33], having an intimate partner who injected drugs (aOR = 2.18, 95{\%} CI = 0.98–4.85), being injected by others (aOR = 4.95, 95{\%} CI = 2.42–10.10) and obtaining syringes from a street seller (aOR = 1.88, 95{\%} CI = 0.94–3.78) or from a member of their personal network (aOR = 4.43, 95{\%} CI = 2.21–8.90). Conclusions: Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.",
keywords = "HIV risk, injection drug use, intimate partners, sex work, substance use, women",
author = "Park, {Ju Nyeong} and Katherine Footer and Decker, {Michele R} and Catherine Tomko and Allen, {Sean Travis} and Noya Galai and Susan Sherman",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/add.14567",
language = "English (US)",
journal = "Addiction",
issn = "0965-2140",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Interpersonal and structural factors associated with receptive syringe-sharing among a prospective cohort of female sex workers who inject drugs

AU - Park, Ju Nyeong

AU - Footer, Katherine

AU - Decker, Michele R

AU - Tomko, Catherine

AU - Allen, Sean Travis

AU - Galai, Noya

AU - Sherman, Susan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. Design: Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. Setting: Baltimore, MD, USA. Participants: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1% white and 62.9% in a relationship/married. Measurements: Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. Findings: Nearly all FSW-IDU used heroin (97.1%) or crack cocaine (89.7%). Recent RSS was reported by 18.3%. Syringes were accessed from needle exchange programs (64.6%), pharmacies (29.7%), street sellers (30.3%) or personal networks (29.1%). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9%, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95% confidence interval (CI) = 1.09–4.33], having an intimate partner who injected drugs (aOR = 2.18, 95% CI = 0.98–4.85), being injected by others (aOR = 4.95, 95% CI = 2.42–10.10) and obtaining syringes from a street seller (aOR = 1.88, 95% CI = 0.94–3.78) or from a member of their personal network (aOR = 4.43, 95% CI = 2.21–8.90). Conclusions: Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.

AB - Aims: To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. Design: Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. Setting: Baltimore, MD, USA. Participants: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1% white and 62.9% in a relationship/married. Measurements: Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. Findings: Nearly all FSW-IDU used heroin (97.1%) or crack cocaine (89.7%). Recent RSS was reported by 18.3%. Syringes were accessed from needle exchange programs (64.6%), pharmacies (29.7%), street sellers (30.3%) or personal networks (29.1%). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9%, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95% confidence interval (CI) = 1.09–4.33], having an intimate partner who injected drugs (aOR = 2.18, 95% CI = 0.98–4.85), being injected by others (aOR = 4.95, 95% CI = 2.42–10.10) and obtaining syringes from a street seller (aOR = 1.88, 95% CI = 0.94–3.78) or from a member of their personal network (aOR = 4.43, 95% CI = 2.21–8.90). Conclusions: Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.

KW - HIV risk

KW - injection drug use

KW - intimate partners

KW - sex work

KW - substance use

KW - women

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U2 - 10.1111/add.14567

DO - 10.1111/add.14567

M3 - Article

C2 - 30694587

AN - SCOPUS:85062340781

JO - Addiction

JF - Addiction

SN - 0965-2140

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