Patterns and Epidemiology of Illicit Drug Use Among Sex Workers Globally: A Systematic Review

Jenny Iversen,Pike Long,Lisa Maher,Alexandra Lutnick

doi:10.1007/978-3-030-64171-9_6

Jenny Iversen, Pike Long + Show 2 more

Open Access

https://doi.org/10.1007/978-3-030-64171-9_6

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Publication Date: Jan 1, 2021
Citations: 5	License type: CC BY 4.0

Affiliation: UNSW Sydney, Burnet Institute, Film Independent

Abstract

AbstractIntroduction: Sex workers who use drugs represent two distinct populations, yet programmatic and policy responses are siloed and failed to acknowledge the ways in which populations overlap and needs intersect. Although prevalence of drug use among sex workers is believed to be higher than the general population, no published estimates of global prevalence exist. We aimed to estimate the prevalence of lifetime illicit drug use among sex workers overall, by gender (cis, transgender, and non-binary), and sub-region.Methods: We searched electronic databases for studies measuring the prevalence of illicit drug use among sex workers from the past decade [2009–2018]. Data were combined to generate pooled prevalence and associated 95% confidence intervals of lifetime use using a random effects model. Countries were categorised into geographic sub-regions, and sub-regional pooled estimates of lifetime use among female sex workers generated and mapped.Results: Among 86 studies in 46 countries, pooled prevalence of lifetime illicit drug use among sex workers was 35% (95% CI 30–41%). There was significant diversity (I2 > 90.0%, P < 0.01), and prevalence ranged from 1.2% to 84%. Most studies reported lifetime drug use among female sex workers (32 studies from 20 countries), and pooled prevalence in this sub-group was 29% (95% CI 24–34%). Insufficient data precluded generation of estimates for male and transgender sex workers.Conclusions: Our review identified significant gaps in data quality and availability. Future research in partnership with sex workers is necessary to explore the diversity of populations and contexts in which drug use and sex work intersect, inform more accurate estimates of prevalence, identify differences in risks and exposures, and guide the creation, implementation, and evaluation of programmes and services.

Highlights

Potential harms associated with illicit drug use in the context of sex work include increased vulnerability to: infectious disease such as HIV and other sexually transmitted infections (STI), violence, stigma and discrimination, criminalisation, and exploitation [1–10]
Using data from 86 studies in 46 countries, we estimated global pooled prevalence of lifetime illicit drug use in sex workers of 35%, with estimates ranging from 1.2% to 84%
The majority of studies included in the review reported prevalence of lifetime illicit drug use among female sex workers (32 studies from 20 countries), and global pooled prevalence among this sub-group was 29%

Summary

Introduction

Potential harms associated with illicit drug use in the context of sex work include increased vulnerability to: infectious disease such as HIV and other sexually transmitted infections (STI), violence, stigma and discrimination, criminalisation, and exploitation [1–10]. Both illicit and licit drug use have been associated with increased exposure to violence against sex workers. A Russian study observed that recent injection drug use was significantly associated with police-perpetrated sexual violence against sex workers [14], and in China sex workers who reported drug use were more likely than those who did not report violence by clients [15].

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