Abstract
Substance-using women who exchange sex for money, drugs or shelter as a means of basic subsistence (ie. survival sex) have remained largely at the periphery of HIV and harm reduction policies and services across Canadian cities. This is notwithstanding global evidence of the multiple harms faced by this population, including high rates of violence and poverty, and enhanced vulnerabilities to HIV transmission among women who smoke or inject drugs. In response, a participatory-action research project was developed in partnership with a local sex work agency to examine the HIV-related vulnerabilities, barriers to accessing care, and impact of current prevention and harm reduction strategies among women in survival sex work. This paper provides a brief background of the health and drug-related harms among substance-using women in survival sex work, and outlines the development and methodology of a community-based HIV prevention research project partnership. In doing so, we discuss some of the strengths and challenges of community-based HIV prevention research, as well as some key ethical considerations, in the context of street-level sex work in an urban setting.
Highlights
Substance-using women working in open street-level sex work markets face a myriad of health risks, including pervasive violence and assault, high rates of poverty and homelessness, drug-related harms, stigma, and social isolation [1,2,3]
Consistent evidence across sex work venues has documented the greatest concentration of harms among sex workers in low status, street-based, open sex work markets that frequently co-exist with open drug use markets [5,6]
In particular the project is guided by the OCAP principles of ownership, control, access and possession initially developed by the First Nations' Governance Committee and subsequently adopted by the Canadian Aboriginal AIDS Network (CAAN)
Summary
Substance-using women working in open street-level sex work markets face a myriad of health risks, including pervasive violence and assault, high rates of poverty and homelessness, drug-related harms, stigma, and social isolation [1,2,3]. The social context and gendered norms of street-entrenched sex work and drug-using populations suggest that both violence and gendered power dynamics mediate microrisk environment and negotiation of risk reduction practices of women in both intimate and client-worker relationships [13,15,16]. Women injectors in survival sex work are significantly more likely to required assistance to inject and to have overlapping sexual and drug use partnerships and large social networks that increase risk of HIV infection [17,18]. Women of Aboriginal ancestry continue to be highly overrepresented in new HIV infections among injection drug users [22], and constitute the majority of women working in the lowest paying tracks across Canadian cities [23]
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