Résumé :
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[BDSP. Notice produite par INIST-CNRS Bl9mR0x8. Diffusion soumise à autorisation]. Objectives. We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers. Methods. We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse. Results. In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR]=3.39 ; 95% confidence interval [Cl]=1.00,9.36), working away from main streets because of policing (OR=3.01 ; 95% Cl=1.39,7.44), borrowing a used crack pipe (OR=2.51 ; 95% Cl=1.06,2.49), client-perpetrated violence (OR=2.08 ; 95% Cl=1.06,4.49), and servicing clients in cars or in public spaces (OR=2.00 ; 95% Cl=1.65,5.73). Conclusions. Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers'health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers'ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.
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