{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:57:46Z","timestamp":1753869466913,"version":"3.41.2"},"reference-count":53,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T00:00:00Z","timestamp":1647907200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Sex workers are disproportionately impacted by the HIV pandemic across global contexts, in part due to social and structural contexts of stigma and criminalization. Among women living with HIV, there is a dearth of longitudinal information regarding dynamics of sex work engagement and associated social and health outcomes. In order to better understand the social contexts and health needs of sex working women living with HIV, this study aimed to understand recent sex work prevalence and its longitudinal associations with stigma, psychosocial and clinical HIV outcomes among women living with HIV in Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a three\u2010wave prospective cohort survey at 18\u2010month intervals with women living with HIV aged 16 and older in three Canadian provinces between 2013 and 2018. We used generalized estimating equations to examine longitudinal associations between recent (past 6\u2010month) sex work with three types of outcomes: psychosocial (recent violence, recent injection drug use, hazardous alcohol use, clinical depression and post\u2010traumatic stress disorder), clinical HIV (CD4 count and viral load) and stigma (HIV\u2010related stigma, racial discrimination and gender discrimination). Equations were adjusted for socio\u2010demographic factors associated with sex work across all three waves: province, age, income, gender identity, sexual orientation, education level, ethnicity and housing security.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Discussion<\/jats:title><jats:p>Of 1422 participants, 129 (9.1%) reported recent sex work during at least one wave (82 at baseline, 73 at first follow\u2010up and 32 at second follow\u2010up). In adjusted analyses, recent sex work was associated with psychosocial outcomes, including: past 3\u2010month violence (adjusted odds ratio [AOR] = 2.47, 95% CI = 1.70, 3.60), past 6\u2010month injection drug use (AOR = 3.49, 95% CI = 2.21\u20135.52), hazardous alcohol use (AOR = 2.00, 95% CI = 1.04\u20133.89) and depression (AOR = 1.51, 95% CI = 1.06\u20132.15). In unadjusted analyses, sex work was also associated with clinical HIV outcomes and gender discrimination, but not racial discrimination\/HIV\u2010related stigma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among women living with HIV in Canada, sex work engagement is dynamic, and sex workers are more likely to report recent violence, recent injection drug use, problematic alcohol use and clinical depression. Violence prevention and support, harm reduction, mental health promotion and sex work\u2010affirming programs could be employed to optimize health and rights for sex working women living with HIV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25874","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T04:59:58Z","timestamp":1648011598000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recent sex work and associations with psychosocial outcomes among women living with HIV: findings from a longitudinal Canadian cohort study"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8035-433X","authenticated-orcid":false,"given":"Carmen H.","family":"Logie","sequence":"first","affiliation":[{"name":"Factor\u2010Inwentash Faculty of Social Work University of Toronto  Toronto Ontario Canada"},{"name":"Women's College Research Institute Women's College Hospital, Toronto, Ontario, Canada and United Nations University Institute for Water, Environment and Health  Hamilton Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4432-6016","authenticated-orcid":false,"given":"Nina","family":"Sokolovic","sequence":"additional","affiliation":[{"name":"Women's College Research Institute Women's College Hospital, Toronto, Ontario, Canada and United Nations University Institute for Water, Environment and Health  Hamilton Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Kazemi","sequence":"additional","affiliation":[{"name":"Ontario Institute for Studies in Education University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Smith","sequence":"additional","affiliation":[{"name":"Ontario Institute for Studies in Education University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaz","family":"Islam","sequence":"additional","affiliation":[{"name":"Ontario Institute for Studies in Education University of Toronto  Toronto Ontario Canada"},{"name":"Alliance for South Asian AIDS Prevention  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Simon Fraser University  Burnaby British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Gormley","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Simon Fraser University  Burnaby British Columbia Canada"},{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0329-1926","authenticated-orcid":false,"given":"Angela","family":"Kaida","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Simon Fraser University  Burnaby British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"de Pokomandy","sequence":"additional","affiliation":[{"name":"Department of Family Medicine McGill University  Montreal Quebec Canada"},{"name":"Chronic Viral Illness Service McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Loutfy","sequence":"additional","affiliation":[{"name":"Ontario Institute for Studies in Education University of Toronto  Toronto Ontario Canada"},{"name":"Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the CHIWOS Research Team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,3,22]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Worldwide more than half of new HIV infections now among key populations and their sexual partners. 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