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P3.099 Sex Work as an Emerging Risk Factor For HIV Seroconversion Among Injection Drug Users in the SurvUDI Network
  1. K Blouin1,
  2. P Leclerc2,
  3. C Morissette2,
  4. É Roy3,
  5. C Blanchette4,
  6. R Parent1,
  7. B Serhir5,
  8. M Alary4 the SurvUDI Working Group
  1. 1Institut national de santé publique du Québec, Unité des infections transmissibles sexuellement et par le sang, Québec, QC, Canada
  2. 2Direction de Santé Publique de l’Agence de la santé et des services sociaux de Montréal, Montréal, QC, Canada
  3. 3Université de Sherbrooke à Longueuil, Département des Sciences de la Santé Communautaire, Longueuil, QC, Canada
  4. 4Université Laval, Unité de Recherche en Santé des Populations/Centre de recherche du CHU de Québec, Québec, QC, Canada
  5. 5Institut national de santé publique du Québec, Laboratoire de santé publique du Québec, Sainte-Anne de Bellevue, QC, Canada


Background Previous analyses of SurvUDI data have shown an emerging positive association between sex work and HIV incidence among injection drug users (IDUs).

Objective To characterise the association between sex work and HIV seroconversion among IDUs in the SurvUDI network between 2004 and 2010.

Methods Participants who had injected in the past 6 months were recruited across the Province of Quebec and Ottawa, Canada, mainly in harm reduction programmes. They completed a questionnaire and provided saliva for HIV antibody testing. Multiple visits were linked through an encrypted identifying code. The association between sex work (defined as reporting at least one client sex partner in the last six months) and HIV seroconversion was tested with a Cox proportional hazards model. Time-dependent covariables tested as potential confounders were age (< 25 vs. ≥ 25 years), sex, cocaine as the most often injected drug, injection with strangers, injection with a needle previously used by someone else, and consistent condom use (defined as always using a condom for vaginal and anal sex with casual, client and paid sex partners, with no sex partners as reference category). Covariables were retained as confounders when they changed the adjusted hazard ratio (AHR) by > 10% when removed from the complete model.

Results Sixty-four HIV seroconversions were observed during 3020 person-years of follow-up. In the final multivariate model, HIV incidence was significantly associated with sex work (AHR = 1.94, 95% CI: 1.09–3.46, p < 0.03) and injection with a needle previously used by someone else (AHR = 3.13, 95% CI: 1.88–5.22, p < 0.0001), adjusted for age. Sex did not modify the association with sex work.

Conclusion Sex work is independently associated with HIV incidence among IDUs. Further studies are needed to understand whether this association is related to sexual transmission or if sex work is an intermediate variable between other unknown vulnerability factors and HIV transmission.

  • HIV incidence
  • Sex work

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