Purpose Although numerous factors associated with increased risk of HIV infection have been identified among injection drug users in Vancouver's downtown east side (DTES), few studies have systematically compared the intersection of gender on such variables. This study provides a preliminary assessment of the underlying context of social, economic, and health-related factors thought to play a role in the observation that women living in the DTES are at an increased risk of HIV infection and have had limited success with antiretroviral treatment.
Methods Data were acquired through the Community Health and Safety Evaluation (CHASE) project database, a large (n = 3,530) prospective open cohort study assessing priority health issues in the DTES. Data were stratified by gender and HIV status and analyzed using descriptive and univariate statistics. Variables included frequency of drug use, housing stability, food security, and access to health services.
Summary HIV-positive women have a significantly lower health rating compared to HIV-negative women in the same community (OR 1.567; 95% CI: 1.043-2.354). HIV infection among women was also associated with more frequent injection cocaine and crystal methamphetamine use as well as the use of non-injection crack. In contrast to HIV-positive men, women with HIV were more likely to report limited clinic hours (OR 1.591; 95% CI: 1.035-2.446), difficulty keeping appointments (OR 1.792; 95% CI: 1.206-2.665), and poor treatment by health care professionals (OR 1.689; 95% CI: 1.128-2.291) as barriers to care.
Conclusions Despite knowledge of health care service and high levels of self-reported service use, barriers to accessing consistent and appropriate health care continue to exist. Even with frequent use of needle exchange services, injection drug use continues to be associated with HIV infection. More detailed analyses of the patterns of women's drug use and the interpersonal relationships associated with this use are clearly needed. The context within which HIV risk exists for women living in the DTES is unique and involves among other things issues of stigma, violence, and limited power and agency. We suggest that the structure of current prevention and treatment services may not be well suited to the reality of life for women in the DTES.
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