Violence, trauma and living with HIV: Longitudinal predictors of initiating crystal methamphetamine injection among sex workers
Violence, trauma and living with HIV: Longitudinal predictors of initiating crystal methamphetamine injection among sex workers
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DOI：
10.1016/j.drugalcdep.2017.02.014
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发表时间：
2017-06-01
影响因子：
4.2
通讯作者：
Shannon, Kate
中科院分区：
文献类型：
--
作者：
Argento, Elena;Strathdee, Steffanie A.;Shannon, Kate
背景资料：尽管世界范围内甲基苯丙胺晶体（CM）的使用迅速增加，并建立了性别使用模式，但性工作者中CM注射开始的实证研究有限。鉴于广泛的危害与CM，以及刺激性的影响，包括性去抑制和长期清醒，本研究旨在纵向调查社会结构的预测因素，启动CM注射之间的性工作者在温哥华，Canada.Methods：数据（2010-2014）来自一个以社区为基础的队列的女性性工作者：AESHA（性工作者健康访问的评价）。参与者完成了两年一次的访谈问卷和艾滋病毒/性传播感染检测。Kaplan Meier方法和考克斯比例风险回归被用来建模预测CM注射初始CM injection-naive participants.Results：455名参与者在基线合格，14.3%（n = 65）注射CM的第一次超过随访，发病率密度为6.79每100人年（95%置信区间[CI] 5.30-8.69）。在多变量分析中，注射海洛因（调整后的风险比[AHR] 6.11; 95%CI 3.24-11.52），有一个注射毒品的亲密伴侣（AHR 2.93; 95%CI 1.57-5.46），工作场所暴力（AHR 2.85; 95%CI 1.74-4.67），HIV血清阳性（AHR 2.69; 95%CI 1.45-5.00），儿童期虐待（AHR 1.86; 95%CI 0.99-3.49）与启动CM injection.Conclusions：研究结果强调了性工作者启动CM注射的性别和社会风险环境。历史/工作场所暴力的强烈影响，加上注射海洛因（已知是治疗创伤后应激障碍的自我药物）作为主要风险途径，突出表明迫切需要增加边缘化妇女获得综合的、了解创伤的成瘾治疗和艾滋病毒护理的机会。
Background: Despite rapid increases in crystal methamphetamine (CM) use worldwide and established gendered patterns of use, empirical research on CM injection initiation among sex workers is limited. Given the wide range of harms associated with CM, alongside stimulant effects including sexual dis-inhibition and prolonged awakeness, this study aimed to longitudinally investigate socio-structural predictors of initiating CM injection among sex workers in Vancouver, Canada.Methods: Data (2010-2014) were drawn from a community-based cohort of women sex workers: AESHA (An Evaluation of Sex Workers Health Access). Participants completed bi-annual interviewer-administered questionnaires and HIV/STI testing. Kaplan Meier methods and Cox proportional hazards regression were used to model predictors of CM injection initiation among CM injection-naive participants.Results: Of 455 participants eligible at baseline, 14.3% (n = 65) injected CM for the first time over follow-up, with an incidence density of 6.79 per 100 person-years (95% Confidence Interval [CI] 5.30-8.69). In multivariable analysis, injection heroin use (Adjusted Hazard Ratio [AHR] 6.11; 95%CI 3.24-11.52), having an intimate partner who injects-drugs (AHR 2.93; 95%CI 1.57-5.46), workplace violence (AHR 2.85; 95%CI 1.74-4.67), HIV seropositivity (AHR 2.69; 95%CI 1.45-5.00), and childhood abuse (AHR 1.86; 95%CI 0.99-3.49) were independently associated with initiating CM injection.Conclusions: Findings underscore the gendered and social risk environment of CM injection initiation among sex workers. The strong influences of historical/workplace violence, coupled with heroin injection (known to be self medicating for post-traumatic stress) as a primary risk pathway, emphasize the urgency of increasing access to integrated, trauma-informed addiction treatment and HIV care for marginalized women.