International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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Page 32 of 153

International Journal of Drug Policy 25 (2014) 533–542 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Piloting a 'spatial isolation' index: The built environment and sexual and drug use risks to sex workers Kathleen N. Deering a,b,∗ , Melanie Rusch a,c , Ofer Amram a,d , Jill Chettiar a,e , Paul Nguyen a , Cindy X. Feng f , Kate Shannon a,b,e a Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada b Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada c Vancouver Island Health Authority, Victoria, Canada d Department of Geography, Faculty of Environment, Simon Fraser University, Burnaby, Canada e School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada f School of Public Health, Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada a r t i c l e i n f o Article history: Received 22 April 2013 Received in revised form 10 October 2013 Accepted 6 December 2013 Keywords: Sex workers Sex work Drug use HIV risk Spatial analysis a b s t r a c t Background: Employing innovative mapping and spatial analyses of individual and neighbourhood envi- ronment data, we examined the social, physical and structural features of overlapping street-based sex work and drug scenes and explored the utility of a 'spatial isolation index' in explaining exchanging sex for drugs and exchanging sex while high. Methods: Analyses drew on baseline interview and geographic data (January 2010–October 2011) from a large prospective cohort of street and off-street sex workers (SWs) in Metropolitan Vancouver and external publically-available, neighbourhood environment data. An index measuring 'spatial isolation' was developed from seven indicators measuring features of the built environment within 50 m buffers (e.g., industrial or commercial zoning, lighting) surrounding sex work environments. Bivariate and mul- tivariable logistic regression was used to examine associations between the two outcomes (exchanged sex for drugs; exchanged sex while high) and the index, as well as each individual indicator. Results: Of 510 SWs, 328 worked in street-based/outdoor environments (e.g., streets, parks, alleys) and were included in the analyses. In multivariable analysis, increased spatial isolation surrounding street-based/outdoor SWs' main places of servicing clients as measured with the index was significantly associated with exchanging sex for drugs. Exchanging sex for drugs was also significantly positively asso- ciated with an indicator of the built environment suggesting greater spatial isolation (increased percent of parks) and negatively associated with those suggesting decreased spatial isolation (increased percent commercial areas, increased count of lighting, increased building footprint). Exchanging sex while high was negatively associated with increased percent of commercial zones but this association was removed when adjusting for police harassment. Conclusions: The results from our exploratory study highlight how built environment shapes risks within overlapping street-based sex work and drug scenes through the development of a novel index comprised of multiple indicators of the built environment available through publicly available data, This study informs the important role that spatially-oriented responses, such as safer-environment interventions, and structural responses, such as decriminalization of sex work can play in improving the health, safety and well-being of SWs. © 2013 Elsevier B.V. All rights reserved. Introduction Increasing theoretical, qualitative and social epidemiological work has elucidated the important role of place, including the ∗ Corresponding author at: Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6Z 1Y6. Tel.: +1 604 682 2344x66268; fax: +1 604 806 9044. E-mail addresses:, (K.N. Deering). dynamic interplay between social context and physical and struc- tural environments, on influencing health risks experienced by vulnerable and marginalized populations, including sex workers (SWs) and people who use drugs (Tempalski & McQuie, 2009). Rhodes' 'risk environment framework' has been particularly use- ful in re-conceptualizing drug use harms, including drug-related harms, as being produced by social situations and places rather than solely by individual 'risk behaviours', with the 'risk environment' defined as the "space. . .in which a variety of factors interact to increase the chances of drug-related harm" (Rhodes, 2002). Related 0955-3959/$ – see front matter © 2013 Elsevier B.V. All rights reserved.

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