Successes and gaps in uptake of regular, voluntary HIV testing for hidden street- and off-street sex workers in Vancouver, Canada

Abstract

Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and association with regular HIV testing among street- and off-street SWs in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as “An Evaluation of Sex Worker’s Health Access” (AESHA; January 2010–July 2012). This cohort included youth and adult SWs (aged 14+ years). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 seronegative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients [adjusted (multivariable) odds ratios, AOR: 2.59, 95% confidence intervals [95% CIs]: 1.17–5.78], injecting drugs (AOR: 2.33, 95% CIs: 1.17–4.18) and contact with a mobile HIV prevention programme (AOR: 1.76, 95% CIs: 1.09–2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95% CIs: 0.19–0.56) and having a language barrier to health care access (AOR: 0.26, 95% CIs: 0.09–0.73). Our results highlight successes of reaching SWs at high risk of HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support.

Keywords:

• HIV test
• HIV testing
• sex workers
• Vancouver
• prevention
• interventions

Acknowledgements

KD made key contributions to the conceptual and analytic design of the study and drafted the manuscript. TL, BN, SS and JM made key conceptual contributions and reviewed the manuscript. CF performed statistical analysis and reviewed the manuscript. KS made key contributions to the conceptual and analytic design of the study and takes responsibility for the accuracy of the data. We thank all those who contributed their time and expertise to this project, including participants, partner agencies and the AESHA Community Advisory Board. We wish to acknowledge Peter Vann, Calvin Lai, Eric Fu, Ofer Amram, Jill Chettiar, Alex Scot and Kathleen Deering for their research and administrative support.

Additional information

Funding

This research was supported by operating grants from the US National Institutes of Health [R01DA028648] and Canadian Institutes of Health Research [HHP-98835]. KD is supported by postdoctoral fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. KS is supported by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.