archives@tulane.edu / Background: Although engagement and retention in HIV care and treatment is a critical issue across populations, it is of particular importance among female sex workers (FSWs) as they are disproportionately affected by HIV due to high rates of sexual risk behaviors and large sexual networks. Drug use is one of the most consistent and salient barriers to successful engagement in HIV care and treatment. For many FSWs, drug use is a common part of their daily lives. While individual-level factors likely explain a substantial portion of variability in drug use behavior, evidence demonstrates that differences in health behaviors and outcomes cannot be fully explained by individual-level factors alone. Previous explorations of drug-related harms have found that neighborhoods and social networks are two important environments that impact substance use behavior and associated health outcomes; yet, there has been little research on the interacting effects of networks and neighborhoods on drug use among FSWs living with HIV.
Objective: Using innovative geospatial and social network methods, the purpose of this pilot study was 1) to characterize the physical and social risk environments of a small cohort of FSWs living with HIV in the Dominican Republic (DR), and 2) to examine the association between their daily activity patterns and social relationships on illicit drug use.
Methods: A micro-longitudinal observational study design was employed. Data collection activities included: (1) semi-structured questionnaire, (2) daily activity space mapping, (3) daily behavior diary, (4) social network survey; and (5) secondary data. Statistical analysis included spatial mapping, social network analysis, univariate and bivariate means analysis, generalized estimating equations (GEE) with repeated measures, interaction and effect modification.
Results: Findings suggest that social networks, specifically drug networks and sex and drug networks, and daily activity path and location-based risk exposures are independently associated with risk of daily drug use, and that network risk profile modifies the association between location-based risk exposure and daily drug use. Results from Paper 1 show that participants exposed to a higher number of risk outlets within 200 meters of their weekly activity paths weighted by time exposed had an increased risk of daily drug use (RRadj: 2.83, 95%CI: 1.14, 7.03). Similarly, per unit increase in risk outlet exposure within 200 meters of sex work locations was associated with an increased risk of daily drug use (RRadj: 1.03, 95%CI: 1.00, 1.05). Paper 2 results indicate that participants with more drug using members and sexual partners who were also drug users in their social networks were 8.89 (95%CI: 2.62, 30.33) and 6.08 (95 CI%: 1.20, 30.92) times more likely to use drugs compared to those with fewer drug using members and sexual partners who used drugs. Finally, paper 3 results suggest that the joint effects of networks and activity space are greater than individual effects alone and that drug network and sex and drug network modify the association between sex work location risk environment exposure and daily drug use. No differences were detected among individuals with large drug and sex and drug networks, but among individuals with small drug and sex and drug networks, per unit increase in risk outlet exposure within 200-meters of sex work locations was associated with an increased risk of daily drug use.
Conclusions: This research provides significant information on the overlapping and diverging characteristics of the social factors and physical spaces that shape drug use in the broader context of sex work, HIV, and vulnerability in a low-and middle-income country (LMIC) setting. Findings may be used to inform integrated care interventions that are geographically targeted and address the social processes and structures that influence drug harms and HIV treatment in a highly stigmatized and vulnerable population. / 1 / Erica Ann Felker-Kantor
| Identifer | oai:union.ndltd.org:TULANE/oai:http://digitallibrary.tulane.edu/:tulane_120482 |
| Date | 2020 August 1900 |
| Contributors | Felker-Kantor, Erica (author), Theall, Katherine (Thesis advisor), School of Public Health & Tropical Medicine Global Community Health and Behavioral Sciences (Degree granting institution) |
| Publisher | Tulane School of Public Health |
| Source Sets | Tulane University |
| Language | English |
| Detected Language | English |
| Type | Text |
| Format | electronic, pages: 214 |
| Rights | No embargo, Copyright is in accordance with U.S. Copyright law. |
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