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Gender, Victimization, and Commercial Sex: A Comparative Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2109-11-07
Abstract: 

This article critically examines and compares adult male and female experiences selling sex in Canada’s off-street sex industry. Findings indicate that gender disparities exist when it comes to the work of selling sex: male providers are better insulated from violence and exploitation because of their gender, while female sex workers are forced to navigate multiple layers of oppression to assure safer working conditions. Despite these differences, this data suggests that prioritizing overarching labour issues, instead of gendered experiences working in commercial sex, can function to increase all sex workers’ safety and access to justice.

Document type: 
Article
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Coercion Into Addiction Treatment and Subsequent Substance Use Patterns Among People Who Use Illicit Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-09-06
Abstract: 

Background and Aims: Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment.

 

Design: Data from three linked prospective cohort studies of PWUD were used. McNemar’s test and non-linear growth curve modeling were employed to: a) assess changes in substance use patterns before and after coerced addiction treatment and b) compare these changes with changes in PWUD who 1) voluntarily accessed and 2) did not access treatment.

 

Setting: Vancouver, Canada.

 

Participants: 3,196 community-recruited PWUD.

 

Measurements: The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment.

 

Findings: Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar’s test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all p>0.05). In sub-analyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician.

 

Conclusions: Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.

Document type: 
Article

Street-Involved Youth Engaged In Sex Work at Increased Risk of Syringe Sharing

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-12
Abstract: 

Syringe sharing places street-involved young people at risk of acquiring HIV and hepatitis C. While markers of economic marginalization, such as homelessness, have been linked with syringe sharing and have led to targeted interventions, the relationship between syringe sharing and other markers of economic vulnerability, such as sex work, are not well documented among young people. This study examines whether those engaged in sex work are at increased risk of syringe borrowing and syringe lending among street-involved youth who use injection drugs in Vancouver, Canada. Between September 2005 and May 2014, data was collected from the At-Risk Youth Study (ARYS), a prospective cohort of street involved youth aged 14-26. Generalized estimating equations with a confounding model building approach was used to examine the relationship between sex work and syringe borrowing and lending. 498 youth reported injecting drugs at some point during the study period and were therefore included in the analysis. In multivariable analysis, youth who engaged in sex work were at an elevated risk of both syringe borrowing (Adjusted Odds Ratio (AOR) = 2.17, 95% Confidence Interval [CI] = 1.40-3.36) and syringe lending (AOR = 1.66, 95% CI = 1.07-2.59). Our study found that youth engaged in street-based sex work were at a significantly higher risk of both syringe borrowing and lending among youth who use injection drugs in Vancouver. Ready access to clean syringes, safer working conditions for sex workers to enable risk reduction measures, and increased access to addiction treatment are identified as promising opportunities for reducing syringe sharing in this setting.

Document type: 
Article
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Characterizing Men Who Have Sex with Men and Use Injection Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-07-20
Abstract: 

We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous six months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age (Adjusted Odds Ratio [AOR]=0.96), childhood sexual abuse (AOR=2.65), sex work (AOR=3.33), crystal methamphetamine use (AOR=1.30), borrowing used syringes (AOR=1.39), inconsistent condom use (AOR=1.76), and HIV seropositivity (AOR=3.82). MSM were less likely to be Hepatitis C-positive (AOR=0.43) and to have accessed addiction treatment in the previous six months (AOR=0.83) (all p<0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.

Document type: 
Article

Homelessness and Incarceration Associated With Relapse into Stimulant and Opioid Use among Youth Who Are Street-Involved in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-05-09
Abstract: 

Introduction and Aims: While much research has sought to identify the factors associated with initiation and cessation of various forms of drug use among vulnerable youth, little is known about relapse into drug use in this population. We sought to characterize relapse into stimulant and opioid use among street-involved youth in Vancouver, Canada.

Design and Methods: Data were collected between 2005 and 2017 from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth who use illicit drugs in Vancouver. Multivariable extended Cox regression was utilized to identify factors associated with relapse into harder drug use among youth who had previously ceased using stimulants and/or opioids for six months or longer.

Results: Among 246 participants who reported a period of cessation lasting six months or longer, 165 (67.1%) relapsed at some point during study follow-up. Youth who were recently incarcerated (adjusted hazard ratio [AHR]: 1.47), homeless (AHR: 1.40), or had a history of daily stimulant use (AHR: 1.64) were significantly more likely to report relapse, while youth of who identified as white (AHR: 0.78) were significantly less likely to report relapse (all p <0.05).

Discussion: Relapse into harder drug use was common among youth in our setting, and incarceration, homelessness, and daily stimulant use (pre-cessation) were found to be positively associated with relapse among street-involved youth.

Conclusions: Findings suggest that increased access to youth housing supports and alternatives to the criminalization of drug use may help to reduce the rates of relapse into harder drugs in this population.

Document type: 
Article

Increased Burden of Suicidality Among Young Street-Involved Sex Workers who Use Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-11
Abstract: 

Abstract: Background: The risks of suicidality among street-involved youth who use drugs and engage in sex work is not well described. This study sought to evaluate if street-involved youth who engage in sex work were at an elevated risk for attempting suicide.

Methods: Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth who use drugs in Vancouver, Canada. Multivariable generalized estimating equation analyses were employed to examine whether youth who engaged in sex work were at elevated risk of attempting suicide, controlling for possible confounders.

Results: Between September 2005 and May 2015, 1210 youth were recruited into the cohort, of whom, 173 (14.3%) reported recently attempting suicide at some point during the study period. In multivariable analysis, youth who engaged in sex work were significantly more likely to report a recent suicide attempt (adjusted odds ratio=1.93; 95% confidence interval: 1.28-2.91).

Conclusions: Street-involved youth who engage in sex work were observed to be at a significantly higher risk for suicidality. Systematic discrimination and unaddressed trauma may contribute to the observed increased burden of suicidality among this population. Interventions that support the mental health and well-being of street-involved youth who engage in sex work are urgently needed.

Document type: 
Article
File(s): 

Perceived Devaluation Among a Cohort of Street-Involved Youth in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-12-11
Abstract: 

Abstract: Background: Perceived devaluation is a barrier to seeking mental and physical health services among people who use illicit drugs.

Objective: Assessing the prevalence and correlates of perceived devaluation within a cohort of street-involved youth.

Methods: Data were drawn from an open prospective cohort of street-involved youth who use illicit drugs (aged 14-26 at study enrollment) between December 2013 and May 2015 in Vancouver, Canada. Perceived devaluation was measured using an adapted version of Perceived Devaluation and Discrimination scale. Multivariable generalized estimating equations were constructed to examine factors independently associated with high perceived devaluation. Results: Among 411 street-involved youth, 95.1% reported high perceived devaluation at some point during the study period. In a multivariable analysis, youth who reported high perceived devaluation were significantly more likely to engage in: unprotected sex (Adjusted Odds Ratio [AOR] = 1.56, 95% Confidence Interval: 1.03-2.37); heavy alcohol use (AOR = 2.31, 95% CI: 1.22-4.36); and daily heroin use (AOR = 2.07, 95% CI: 1.16-3.70). Youth who resided in the Downtown Eastside neighbourhood were significantly less likely to report high perceived devaluation (AOR = 0.41, 95% CI: 0.26-0.65).

Conclusion: Perceived devaluation was extremely prevalent among street-involved youth in our sample. We also observed that youth most in need of health and social services were significantly more likely to report high levels of perceived devaluation which may result in a reluctance to seek out key services and supports. These findings highlight the need to implement stigma reduction interventions for vulnerable youth in this setting. 

Document type: 
Article

3,4-Methylenedioxymethamphetamine (MDMA; Ecstasy) Use and Transitions to Injection Drug Use Among Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-20
Abstract: 

Background: Despite the popularity of MDMA (ecstasy) among young people across North America and Europe, MDMA is rarely explored in studies of young people at highrisk of injecting drugs. We conducted a study among street-involved youth who use illicit drugs in Vancouver, Canada to understand if use of MDMA is associated with initiation of injection drugs. 

Methods: We followed injection-naïve participants in the At-Risk Youth Study (ARYS), an ongoing prospective cohort of street-involved youth who use illicit drugs aged 14-26. Bivariate and multivariate extended Cox models with time-updated variables were used to examine the association between MDMA use and initiation of injection drug use between September 2005 to May 2015. 

Results: Among 483 youth, 306 (63.4%) had a history of MDMA use and 218 (45.1%) had used MDMA in the previous six months at baseline. A total of 105 (21.7%) youth initiated injection drug use over the 10-year period, yielding an incidence density of 8.51 (95% Confidence Interval [CI]: 6.96 – 10.30) per 100 person-years. MDMA use was not significantly associated with initiating injection drugs at the bivariate- (Hazard Ratio: 0.93; 95% CI: 0.61 – 1.42) or multivariate- (Adjusted Hazard Ratio: 0.88; 95% CI: 0.57- 1.35) level after adjusting for unemployment, homelessness, and crystal methamphetamine use. 

Conclusions: Amid ongoing frequent use of MDMA among some young people in North America, we did not observe an elevated risk of injection initiation among those who used MDMA in this cohort of street-involved youth.

Document type: 
Article

"Secure Care": More Harm Than Good

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-10-15
Document type: 
Article
File(s): 

Regular MDMA Use is Associated with Decreased Risk of Drug Injection Among Street-Involved Youth Who Use Illicit Drugs.

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-01
Abstract: 

OBJECTIVES:

Childhood trauma is common among street-involved youth and is associated with injection drug use. Illicit 3,4-Methylenedioxymethamphetamine (MDMA) use is also common among street-involved youth, and data suggest this substance has clinical utility in management of post-traumatic stress disorder (PTSD) and associated harms. Despite this, little is known about co-occurring patterns of MDMA use and injection drug use.

METHODS:

Data were derived from a prospective cohort of street-involved youth using illicit drugs in Vancouver, Canada. Using multivariable generalized estimating equation logistic regression, we examined the association between MDMA use and the use of injection drugs, adjusting for confounders such as polysubstance use and sociodemographic factors.

RESULTS:

4941 surveys from 1208 participants between September 2005 and May 2015 were included. Of these, 829 (68.6%) were male, 815 (67.5%) reported white ethnicity, and median age was 21.7 years. Overall, 599 (49.6%) participants reported MDMA use, 544 (45.0%) reported injection drug use, and 244 (20.2%) reported concurrent MDMA and injection drug use at least once during the study period. In multivariable analyses, regular MDMA use was significantly negatively associated with injection drug use (Adjusted Odds Ratio [AOR] = 0.57, 95% CI: 0.46-0.69).

DISCUSSION:

After accounting for socio-demographic factors and polysubstance use, periods of reported regular MDMA use were negatively associated with reported injection drug use among this cohort. These findings suggest that, unlike the use of most other non-injection drugs, illicit MDMA use does not appear to promote injection drug use but rather is associated with a reduced likelihood of injection drug use.

Document type: 
Article
File(s):