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Prostitution led to high rates of injection drug use in Canadian Aboriginal youth
Miller CL. CMAJ. 2011;doi:10.1503/cmaj.101257.
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Aboriginal youth who used illicit drugs and those involved in prostitution in the preceding 6 months were more than four times as likely to initiate injection drug use when compared with others, according to researchers for the Cedar Project.
“This study documents an unacceptable number of young, at-risk Aboriginal people transitioning to [injection drug use] every year; however, there are no prevention programs tailored specifically to this population,” the researchers wrote in the Canadian Medical Association Journal. “Support for community-based programs that address the potential for drug dependence within the context of sexual trauma should be prioritized to respond to the dual epidemics of [injection drug use] and bloodborne infection among Aboriginal people.”
The prospective cohort study was conducted between 2003 and 2007 in Vancouver and Prince George, British Columbia, and included 605 Aboriginal illicit drug users aged 14 to 30 years (median age 23 years; 48.3% were women).
Participants were tested for antibodies to HIV and the hepatitis C virus; drug use was confirmed via saliva screens. Primary outcome measures were injection drug use (IDU) at baseline and transition to IDU during the 6 months before follow-up.
Results indicated that 55.4% reported using injection drugs at baseline. Women were more than twice as likely as men to report using injection drugs. The initiation rate for IDU was 11.5 participants per 100 person-years, and the transition to IDU occurred among 14.4% of participants (incidence rate of 19.8%).
The transition to IDU was associated with being female (OR=1.98; 95% CI, 1.06-3.72), involved in prostitution (OR=3.35; 95% CI, 1.75-6.40), having a history of sexually transmitted infection (OR=2.01; 95% CI, 1.07-3.78) and using drugs with prostitution clients (OR=2.51; 95% CI, 1.19-5.32). Multivariate analysis revealed prostitution remained significantly associated with initiation of IDU (adjusted OR=3.94; 95% CI, 1.45-10.71).
“Transition to IDU at a young age not only increases the risk of contracting an infectious disease, it also further entrenches the young person in an increasingly dangerous street life that often involves [prostitution], violence, predation and life-long addiction,” the researchers wrote. “Culturally safe interventions to prevent young Aboriginal people, especially young women, from starting to use injection drugs and reduce harm are urgently required.” – by Ashley DeNyse
Disclosure: The Cedar Project receives ongoing support from the Canadian Institutes of Health Research, which has no role in the preparation of data or manuscripts.
This type of study is vulnerable to many biases, as drug using individuals who are willing to be studied are not necessarily representative of the total population. Nevertheless, it is extremely difficult to conduct these types of studies, and the authors should be congratulated for what they have accomplished. The finding that prostitution preceded the use of drugs is somewhat surprising, as many people think of drug addiction as a cause rather than a consequence of prostitution. These findings are important and suggest that targeting young prostitutes for interventions could potentially be an effective HIV prevention strategy.
–Elizabeth Connick, MD
Infectious Disease
News Editorial Board member
Disclosure: Dr. Connick reports no relevant financial disclosures.
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