TY - JOUR
T1 - Adverse health outcomes among people who inject drugs who engaged in recent sex work
T2 - findings from a national survey
AU - Emanuel, E.
AU - Slater, L.
AU - Croxford, S.
AU - Edmundson, C.
AU - Ibitoye, A.
AU - Njoroge, J.
AU - Ijaz, S.
AU - Hope, V.
AU - Platt, L.
AU - Phipps, E.
AU - Desai, M.
N1 - Publisher Copyright:
© 2023
PY - 2023/12
Y1 - 2023/12
N2 - Objectives: This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. Study design: The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. Methods: Trends in sex work among PWID (2011–2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018–2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. Results: Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31–2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74–2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03–11.33], P = 0.043). Conclusions: Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.
AB - Objectives: This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. Study design: The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. Methods: Trends in sex work among PWID (2011–2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018–2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. Results: Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31–2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74–2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03–11.33], P = 0.043). Conclusions: Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.
KW - Infections
KW - Injecting drug use
KW - People who inject drugs
KW - Sex work
KW - Surveys and questionnaires
KW - United Kingdom
UR - http://www.scopus.com/inward/record.url?scp=85175304884&partnerID=8YFLogxK
U2 - 10.1016/j.puhe.2023.09.024
DO - 10.1016/j.puhe.2023.09.024
M3 - Article
AN - SCOPUS:85175304884
SN - 0033-3506
VL - 225
SP - 79
EP - 86
JO - Public Health
JF - Public Health
ER -
