@article{ref1,
title="Sex-for-crack exchanges: Associations with risky sexual and drug use niches in an urban Canadian city",
journal="Harm reduction journal",
year="2013",
author="Duff, Putu and Tyndall, Mark and Buxton, Jane and Zhang, Ruth and Kerr, Thomas and Shannon, Kate",
volume="10",
number="1",
pages="29-29",
abstract="BACKGROUND: While crack cocaine has been associated with elevated sexual risks and transmission of HIV/STIs, particularly in the context of street-based sex work, few empirical studies have examined correlates of direct sex-for-crack exchanges. This study longitudinally examined the correlates of sex-for-crack exchanges and associated effects on sexual risk outcomes among street-based female sex workers (SW) who use drugs in Vancouver, Canada.   METHODS: Data were drawn from a prospective cohort of street-based SWs (2006--2008), restricted to those who smoke crack cocaine. Multivariable generalized estimating equations (GEE) were employed to examine the correlates of exchanging sex for crack. A confounding model using GEE quasi-Poisson regression modeled the independent effect of exchanging sex for crack on number of clients/ week.   RESULTS: Of 206 SWs, 101 (49%) reported sex-for-crack exchanges over 18 months of follow-up. In multivariable GEE analyses, sharing a crack pipe with a client (aOR = 1.98; 95%CI: 1.27-3.08) and smoking crack in a group of strangers (e.g., in an alley or crackhouse) (aOR = 1.70; 95%CI: 1.13-2.58) were independently correlated with sex-for-crack exchanges. In our confounding model, exchanging sex for crack (aIRR = 1.34; 95%CI: 1.07-1.69) remained significantly associated with servicing a greater number (>10) of clients/week.   CONCLUSIONS: These findings reveal elevated sexual- and drug- risk patterns among those who exchange sex for crack. The physical and social environment featured prominently in our results as a driver of sex-for-crack exchanges, highlighting the need for gender-sensitive multilevel approaches to harm reduction, STI and HIV prevention that address SWs' environment, individual level factors, and the interplay between them.<p /> <p>Language: en</p>",
language="en",
issn="1477-7517",
doi="10.1186/1477-7517-10-29",
url="http://dx.doi.org/10.1186/1477-7517-10-29"
}