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Early Sex Work Initiation Independently Elevates Odds of HIV Infection and Police Arrest Among Adult Sex Workers in a Canadian Setting

Goldenberg, Shira M. PhD, MSc*,†; Chettiar, Jill; Simo, Annick BSc, MSc; Silverman, Jay G. PhD*; Strathdee, Steffanie A. PhD*; Montaner, Julio S. G. MD, FRCPC, FCCP†,‡; Shannon, Kate PhD, MPH†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2014 - Volume 65 - Issue 1 - p 122–128
doi: 10.1097/QAI.0b013e3182a98ee6
Epidemiology and Prevention

Objectives: To explore factors associated with early sex work initiation and model the independent effect of early initiation on HIV infection and prostitution arrests among adult sex workers (SWs).

Design: Baseline data (2010–2011) were drawn from a cohort of SWs who exchanged sex for money within the last month and were recruited through time location sampling in Vancouver, Canada. Analyses were restricted to adults ≥18 years old.

Methods: SWs completed a questionnaire and HIV/sexually transmitted infection testing. Using multivariate logistic regression, we identified associations with early sex work initiation (<18 years old) and constructed confounder models examining the independent effect of early initiation on HIV and prostitution arrests among adult SWs.

Results: Of 508 SWs, 193 (38.0%) reported early sex work initiation, with 78.53% primarily street-involved SWs and 21.46% off-street SWs. HIV prevalence was 11.22%, which was 19.69% among early initiates. Early initiates were more likely to be Canadian born [adjusted odds ratio (AOR): 6.8, 95% confidence interval (CI): 2.42 to 19.02], inject drugs (AOR: 1.6, 95% CI: 1.0 to 2.5), and to have worked for a manager (AOR: 2.22, 95% CI: 1.3 to 3.6) or been coerced into sex work (AOR: 2.3, 95% CI: 1.14 to 4.44). Early initiation retained an independent effect on increased risk of HIV infection (AOR: 2.5, 95% CI: 1.3 to 3.2) and prostitution arrests (AOR: 2.0, 95% CI: 1.3 to 3.2).

Conclusions: Adolescent sex work initiation is concentrated among marginalized, drug, and street-involved SWs. Early initiation holds an independent increased effect on HIV infection and criminalization of adult SWs. Findings suggest the need for evidence-based approaches to reduce harm among adult and youth SWs.

*Department of Medicine, Division of Global Public Health, University of California, San Diego, CA;

Department of Medicine, Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; and

Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.

Correspondence to: Kate Shannon, PhD, MPH, Department of Medicine, University of British Columbia, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6 Canada (e-mail:

Supported by operating grants from the US National Institutes of Health (NIH; R01DA028648) and Canadian Institutes of Health Research (HHP-98835). S.M.G. is supported by a Canadian Institutes of Health Research fellowship. J.S.G.M. is supported by an Avante Garde award from US NIH (DP1DA026182). K.S. is supported by US NIH (R01DA028648), Michael Smith Foundation for Health Research, and the Canadian Institutes of Health Research. S.A.S. is supported through US NIH (R01 DA023877).

The authors have no conflicts of interest to disclose.

S.M.G. and K.S. conceptualized the study. S.M.G. led the analyses and drafted the manuscript. K.S. had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. J.C. coordinated field data collection. A.S. conducted the statistical analyses, and all authors interpreted the results. A.S., J.C., J.G.S., S.A.S., J.M., and K.S. critically revised and edited the article and participated in interpretation of the findings.

Received April 16, 2013

Accepted August 12, 2013

© 2014 by Lippincott Williams & Wilkins