International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

Issue link: http://digitalreprints.elsevier.com/i/364061

Contents of this Issue

Navigation

Page 37 of 153

538 K.N. Deering et al. / International Journal of Drug Policy 25 (2014) 533–542 Table 3 Bivariate associations between three derivations of the index (deciles, quintiles and quartiles) for place of soliciting and place of servicing clients and exchanging sex while high and exchanging sex for drugs. Exchanging sex while high Exchanging sex for drugs ORs [95%CIs] P ORs [95%CIs] P Place of solicitation Deciles 1.04 [1.02–1.06] <0.001 1.02 [1.00–1.04] 0.034 Quintiles 1.08 [1.03–1.12] <0.001 1.04 [1.00–1.08] 0.037 Quartiles 1.11 [1.05–1.18] <0.001 1.06 [1.01–1.12] 0.034 Place of servicing clients Deciles 1.03 [1.01–1.05] 0.012 1.03 [1.01–1.05] 0.007 Quintiles 1.05 [1.01–1.10] 0.021 1.06 [1.01–1.10] 0.011 Quartiles 1.08 [1.01–1.14] 0.020 1.09 [1.03–1.16] 0.004 backward selection approach, which considered the magnitude of change in the coefficient of the exposure variable. Starting with a fixed model, which considered all available variables, potential con- founders were dropped one at a time, using the relative change in the coefficient for the variable related to the exposure variable as a criterion, until the maximum change from the full model exceeded 5%. All analyses were performed using SAS software version 9.3 ("SAS Version 9.3," 2012). Results Characteristics of street-based/outdoor SWs Of 510 SWs within the AESHA cohort, 328 solicited for clients in primarily street-based/outdoor environments (e.g., streets, parks, alleys) and were included in the analyses, with a median age of 34 years (Interquartile range: 29–43 years) and 45.5% (149) of Aboriginal ancestry (First Nations, Metis, Inuit), 18.9% (62) repor- ting being a migrant/new immigrant and 23.5% (77) reporting being a sexual minority. Overall, 77.1% and 45.7% used non-injection and injection drugs in the last six months, respectively. In the last six months, 70.7% (232) reported exchanging sex while high, while 32.6% (107) reported exchanging sex for drugs and 43.3% reported police harassment without arrest. Dual sexual and drug use-related risk and spatial isolation index Table 3 presents bivariate associations between three deriva- tions of the index (deciles, quintiles and quartiles) for place of soliciting and place of servicing clients and the outcomes measur- ing dual drug use and sexual risk (exchanging sex while high and exchanging sex for drugs). Increased spatial isolation of SWs, as measured by our index, was strongly positively and significantly associated with both outcomes. These results were consistent across the index derived using deciles, quintiles and quartiles, and for buffers surrounding SWs' main places of solicitation and of ser- vicing clients. Table 4 presents multivariable associations between three derivations of the index (deciles, quintiles and quartiles) for place of soliciting and place of servicing clients and exchanging sex while high and exchanging sex for drugs. In multivariable analysis, after adjusting for key confounders, exchanging sex for drugs remained positively and significantly associated with the index measuring spatial isolation of SWs, for the index derived for SWs' main place of servicing clients and for deciles (AOR: 1.03, 95%CIs: 1.00–1.05), quintiles (AOR: 1.06, 95%CIs: 1.01–1.10) and quartiles (AOR: 1.09, 95%CIs: 1.02–1.16). Dual sexual and drug use-related risk, police harassment and built environment indicators In bivariate analysis, for individual built environment indicators, as derived for 50 m buffer around SWs' main place of solicitation, exchanging sex while high was significantly associated with the fol- lowing indicators on a P < 0.10-level: length of major roads (0.024); percent commercial zoning (P = 0.006); percent industrial zoning (P = 0.048); and percent parks (P = 0.077). Exchanging sex for drugs was significantly associated with: length of major roads (P = 0.057); and percent parks (P = 0.008). In bivariate analysis, for individual built environment indicators, as derived for 50 m buffer around SWs' main place of servicing, exchanging sex while high was signif- icantly associated with the following indicators on a P < 0.10-level: length of alleys (<0.001); percent commercial zoning (0.063); per- cent industrial zoning (0.026); percent parks (0.074). Exchanging sex for drugs was significantly associated with: length of major roads (0.071); percent commercial zoning (0.005); percent parks (0.001); number of light posts (0.022); and percent building foot- print (0.033). Tables 5a and 6a present multivariable relationships between individual built environment indicators and these two outcomes, developed for buffers surrounding places of solicitation and Table 4 Multivariable associations between three derivations of the index (deciles, quintiles and quartiles) for place of soliciting and place of servicing clients and exchanging sex while high and exchanging sex for drugs. Exchanging sex while high Exchanging sex for drugs AORs [95%CIs] P AORs [95%CIs] P Place of solicitation Deciles 1.01 [0.99–1.04] 1 0.265 1.01 [0.99–1.03] 2 0.251 Quintiles 1.03 [0.98–1.09] 3 0.260 1.03 [0.98–1.07] 4 0.237 Quartiles 1.05 [0.97–1.13] 5 0.234 1.04 [0.98–1.10] 6 0.253 Place of servicing clients Deciles 1.01 [0.98–1.04] 7 0.536 1.03 [1.00–1.05] 8 0.020 Quintiles 1.01 [0.96–1.07] 9 0.668 1.06 [1.01–1.10] 10 0.021 Quartiles 1.01 [0.94–1.10] 11 0.744 1.09 [1.02–1.16] 12 0.009 Adjusted for: Migrant status, age, police harassment without arrest 1 ; Age, homeless, migrant status 2 ; Age, sexual minority, Aboriginal status, homeless, migrant status 3 ; Age, homeless, migrant status, police harassment without arrest 4 ; Age, sexual minority, Aboriginal status, homeless, migrant status 5 ; Age, homeless, migrant status 6 ; Age, sexual minority, Aboriginal status, homeless, migrant status, police harassment without arrest 7 ; Homeless, migrant status 8 ; Age, sexual minority, Aboriginal status, homeless, migrant status, police harassment without arrest 9 ; Homeless, migrant status, police harassment without arrest 10 ; sexual minority, Aboriginal status, homeless, migrant status, police harassment without arrest 11 ; Homeless, migrant status, police harassment without arrest 12 .

Articles in this issue

view archives of International Journal of Drug Policy - 2014 - Volume 25 Issue 3 May 2014