The Cedar Project: Understanding Barriers to Consistent Condom use over Time in a Cohort of Young Indigenous People who use Drugs

Abstract

ABSTRACT Little information exists on the use of condoms as protective barriers to sexually transmitted infections (STIs) among indigenous people in Canada. This study explores risk factors of inconsistent condom use (during consensual sex) over time among participants in the Cedar Project, a prospective cohort study of indigenous young people living in Vancouver and Prince George, British Columbia, who use drugs. Due to the serial measurements for each study subject, generalized estimating equations modeling with logit link was used to accommodate the temporal correlation within subjects. For young women, inconsistent condom use over time was predicted by having a recent STI (adjusted odds ratio [AOR] = 1.76, 95% confidence interval [CI] [1.12, 2.79]), smoking crack daily (AOR = 1.63, 95%CI [1.02, 2.61]), and having experienced recent sexual abuse (AOR = 2.07, 95%CI [1.20, 3.56]). Among young men, living in Prince George (AOR = 1.63, 95%CI [1.14, 2.39]) and daily crack smoking (AOR = 1.56, 95%CI [1.02, 2.40]) were associated with inconsistent condom use over time. Among participants who used injection drugs, inconsistent condom use was associated with smoking crack daily (AOR = 1.59, 95%CI [1.04, 2.43]) and sharing needles (AOR = 1.78, 95%CI [1.26, 2.51]). The availability and effectiveness of sexual health services must be prioritized for indigenous people, and the design of culturally safe sexual health programs requires the meaningful involvement of young indigenous people.