Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work
Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work
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DOI：
10.1016/j.drugpo.2007.11.024
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发表时间：
2008-04-01
影响因子：
4.4
通讯作者：
Tyndall, M. W.
中科院分区：
文献类型：
--
作者：
Shannon, K.;Rusch, M.;Tyndall, M. W.
背景资料：在街头性工作和使用毒品的人群中，有越来越多的证据支持场所的作用，包括场所的物理环境和社会意义，在调节健康和减少伤害服务的有效性和覆盖面方面。社会地图被用来探索卫生服务和注射器的可用性如何可能在地理层面上的影响，避免物理设置，由于暴力和警务之间，从事街头性工作的女性通过一个以社区为基础的研究伙伴关系和在6个月内由同行领导的广泛外联活动，妇女被邀请参加访谈----问卷调查，并绘制其社区、工作条件和资源获取情况的地图，结果使用ArcGIS软件和地理信息系统街道地图汇编。在二次分析中，使用逻辑回归对地理关联进行建模（使用似然比和p < 0.05的显著性），并运行分层模型以评估基于年龄、种族和药物使用的不同回避模式。结果如下：调查结果显示，一个高度集中的核心领域的健康和注射器的可用性和避免物理设置，由于暴力和警务的198名妇女在街头一级的性工作在温哥华，加拿大之间的一个显着的地理关系。特别令人关切的是，这种相关性在年轻妇女和土著妇女、活跃的注射毒品使用者和每日吸食快克可卡因者中显著升高，这表明在这些弱势群体中采取干预措施存在重大的环境-结构障碍。由此导致的性工作被转移到主要是工业环境和小巷，使妇女进一步得不到健康和社会支持，并减少了获得更安全注射和药物使用的机会随身物品这项研究提供了重要的证据，环境结构层面的预防和更安全的环境干预措施，支持法律的改革，促进更安全的性工作环境，包括空间。方案规划、同侪预防、外联和移动的资源以及同侪监督的安全性工作环境。(c)2007 Elsevier B. V.保留所有权利。
Background: Within street-based sex work and substance-using populations, there is growing evidence to support the role of place, both physical setting and social meanings attached to place, in mediating the effectiveness and reach of health and harm reduction services.Methods: Social mapping was used to explore how health service and syringe availability maybe impacted at the geographic level by avoidance of physical settings due to violence and policing among women in street-level sex work. Through a community-based research partnership and extensive peer-led outreach over a 6-month period, women were invited to participate in interview-questionnaires and mapping of their community, working conditions, and access to resources.Results were compiled used ArcGIS software and GIS street maps. In secondary analysis, logistic regression was used to model the geographic association (using likelihood ratio and significance at p < 0.05) and stratified models were run to assess differential patterns of avoidance based on age, ethnicity and drug use. Results: The findings reveal a significant geographic relationship between a heavily concentrated core area of health and syringe availability and avoidance of physical settings due to violence and policing by 198 women in street-level sex work in Vancouver, Canada. Of particular concern, this correlation is significantly elevated among younger and Aboriginal women, active injection drug users, and daily crack cocaine smokers, suggesting significant environmental-structural barriers to interventions among these vulnerable populations.Conclusions: The resultant displacement of sex work to primarily industrial settings and side streets pushes women further from health and social supports and reduces access to safer injection and drug use paraphernalia. This study offers important evidence for environmental-structural level prevention and safer environment interventions, supported by legal reforms, that facilitate safer sex work environments, including spatial. programming, peer-based prevention, outreach and mobile resources, and peer-supervised safer sex work settings. (c) 2007 Elsevier B.V. All rights reserved.