Sex work amongst people who inject drugs in England, Wales and Northern Ireland: Findings from a National Survey of Health Harms and Behaviours

Abstract

a b s t r a c t Background: We provide the first national prevalence estimate of sex work amongst people who inject drugs (PWID) in England, Wales and Northern Ireland and investigate to what extent sex work is associ- ated with blood-borne virus (BBV) infection. Methods: PWID, recruited through drug services, provided a dried-blood spot and completed a ques- tionnaire. Demographics and risk behaviours were examined by gender and sex work status. Factors associated with BBV infection were explored using logistic regression. Results: Amongst 2400 PWID (75% men), 14% had experience of sex work (men: 8%; women: 31%). Sex workers (SWs) had been injecting longer than non-SWs (men: 14 vs. 12 years; women: 11 vs. 6 years) and more frequently shared needles/syringes (men: 23% vs. 14%; women: 28% vs. 18%). Proportionally more male SWs were non UK-born (12% vs. 7%) and had more same-sex partners (19% vs. 3%) than non-SWs. Amongst women, more SWs had a recent injection-site infection (46% vs. 31%), been imprisoned (58% vs. 48%) or homeless (57% vs. 40%). Sex work was not associated with BBV infection. Conclusion: Services, including needle and syringe programmes, need to cater for the gendered differences in vulnerabilities amongst PWID, specifically addressing the complex needs of SWs.