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Access and utilization of HIV treatment and services among women sex workers in Vancouver’s downtown eastside

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Abstract

Many HIV-infected women are not realizing the benefits of highly active antiretroviral therapy (HAART) despite significant advancements in treatment. Women in Vancouver’s Downtown Eastside (DTES) are highly marginalized and struggle with multiple morbidities, unstable housing, addiction, survival sex, and elevated risk of sexual and drug-related harms, including HIV infection. Although recent studies have identified the heightened risk of HIV infection among women engaged in sex work and injection drug use, the uptake of HIV care among this population has received little attention. The objectives of this study are to evaluate the needs of women engaged in survival sex work and to assess utilization and acceptance of HAART. During November 2003, a baseline needs assessment was conducted among 159 women through a low-threshold drop-in centre servicing street-level sex workers in Vancouver. Cross-sectional data were used to describe the sociodemographic characteristics, drug use patterns, HIV/hepatitis C virus (HCV) testing and status, and attitudes towards HAART. High rates of cocaine injection, heroin injection, and smokeable crack cocaine use reflect the vulnerable and chaotic nature of this population. Although preliminary findings suggest an overall high uptake of health and social services, there was limited attention to HIV care with only 9% of the women on HAART. Self-reported barriers to accessing treatment were largely attributed to misinformation and misconceptions about treatment. Given the acceptability of accessing HAART through community interventions and women specific services, this study highlights the potential to reach this highly marginalized group and provides valuable baseline information on a population that has remained largely outside consistent HIV care.

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Authors and Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 1081 Burrard Street, V6Z 1Y6, Vancouver, British Columbia, Canada

    Kate Shannon &  Mark W. Tyndall MD, ScD

  2. Women’s Information and Safe House (WISH) Drop-in Centre Society, Vancouver, British Columbia, Canada

    Vicki Bright &  Janice Duddy

  3. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Mark W. Tyndall MD, ScD

Authors
  1. Kate Shannon
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  2. Vicki Bright
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  3. Janice Duddy
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  4. Mark W. Tyndall MD, ScD
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Correspondence to Mark W. Tyndall MD, ScD.

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Shannon, K., Bright, V., Duddy, J. et al. Access and utilization of HIV treatment and services among women sex workers in Vancouver’s downtown eastside. J Urban Health 82, 488–497 (2005). https://doi.org/10.1093/jurban/jti076

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