Original article
Individual and Structural Vulnerability Among Female Youth Who Exchange Sex for Survival

https://doi.org/10.1016/j.jadohealth.2010.10.003Get rights and content

Abstract

Purpose

Because of growing concerns regarding the heightened vulnerabilities and risk of human immunodeficiency virus infection among youth who exchange sex for survival, we investigated individual risk patterns and structural barriers among young (≤24 years) female sex workers (FSWs) in Vancouver, Canada.

Methods

Between 2005 and 2008, a total of 255 street-based FSWs (≥14 years) were enrolled into a community-based prospective cohort, and were asked to participate in baseline and biannual questionnaires administered through interviews and human immunodeficiency virus screening. We used contingency table analysis to compare individual and structural barrier results obtained at baseline for younger (≤24 years) FSWs with those of the older (>25 years) FSWs. For longitudinal data, we used generalized estimating equations throughout the follow-up period to determine factors associated with being a young FSW in the past 6 months.

Results

In comparison with older FSWs (n = 199), youth (n = 56) were more likely to spend fewer years engaging in sex exchange (median: 6.4 [interquartile range: 4.6–9.1] vs. 19.9 [interquartile range: 10.0–26.8]; p ≤ .001), belong to an aboriginal ancestry (59% vs. 44%; p = .052), and be homeless (68% vs. 36%; p ≤ .001). In the multivariate generalized estimating equations analysis, youth reported a significantly elevated proportional odds of being homeless (odds ratio [OR]: 1.26 [confidence interval {CI}: 1.08–1.48]), servicing clients in public places (OR: 1.28 [CI: 1.04–1.57]), injecting heroin on a daily basis (OR: 1.35 [CI: 1.06–1.74]), and a significantly reduced odds of accessing methadone maintenance therapy (OR: .76 [CI: .62–.93]).

Conclusions

This study demonstrates significant displacement of youth who engage in sex exchange to marginalized working and living spaces. The findings of this study bring to attention the critical need for targeted structural interventions including access to youth and gender-specific social housing, safe working spaces, reduction in the amount of harm caused to them, and addiction treatment services for youth engaged in survival sex work.

Section snippets

Methods

The community-based HIV prevention research partnership has been described in detail elsewhere [16]. Briefly, a key component of the Maka project is capacity-building among women involved in survival sex work, which is supported by an open community advisory board. Between 2006 and 2008, street-based FSWs living in the lower mainland of Vancouver, British Columbia, Canada, were enrolled in an open, prospective cohort and were asked to participate in an interview-based questionnaire and

Results

A total of 255 women completed a baseline survey (response rate of 94%) and one follow-up visit and were included in this analyses, with 601 observations available over four visits (median visits = 2, interquartile range [IQR]: 1–3). Approximately, half (47%, n = 121) of the participants to an aboriginal ancestry First nations, Metis, Inuit or non-status First Nations. The median age at baseline was 36 years (IQR: 25–41) and the median age of sex work initiation was 15 years (IQR: 13–21).

Discussion

In this study, we have found evidence of the increased dislocation of young street-based FSWs to isolated and outdoor housing and work environments. Furthermore, youth were more likely to be dependent on heroin, but significantly less likely to access addiction treatment for opiates as compared with their older counterparts. In combination, these findings tell the story of social and structural dislocation among some of the world's most vulnerable young women without access to treatment and

Acknowledgments

This project was funded by a community-based HIV research operating grant from the Canadian Institutes of Health Research. We thank our community partners, collaborators and, in particular, Shari, Laurie, Shauna, Rose, Chanel, and Adrian for sharing their time and expertise. We acknowledge Calvin Lai, Devi Parsad, Erin Gilbert, Laura Housden, Nabeela Khan, and Katherine Chan for their research and administrative support. SJF is supported by a fellowship from the Canadian Institutes for Health

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