Slides - North American Housing and HIV/AIDS Research Summit

Structural Determinants of Gender-Based
Violence and HIV among Marginalized Women
North American Housing & HIV/AIDS Summit,
Washington, DC - Sept 15th, 2015
Kate Shannon, PhD
Associate Professor, Medicine
University of British Columbia
Canada Research Chair – Global Sexual Health & HIV
Director, Gender & Sexual Health Initiative
BC Centre for Excellence in HIV/AIDS
Gender-Based Violence among Marginalized Women
Living with/ or Affected by HIV
AJ)
• Street-involved and homeless/
marginally housed women experience
elevated odds of violence and HIV
• Violence operates at both structural/
systemic and interpersonal levels
• Amplified risks of violence for:
– Sex workers
– Indigenous and racialized women
– Gender and sexual minority women
(LGBT*2S)
Criminalized Laws, Policing & “Everyday Violence”
“I hear about so many women who have
been infected with HIV during a bad date
or been raped, or molested or something
like that. You know, and these people,
they get away with it.”
“There are so many girls going missing.
Yeah, they’re getting away with it.”
“We’re the bottom of the barrel. Nobody
will miss us.”
“Well you know there’s how many dead
Native women you know. I think a lot of
people think we are shit right, disposable”
Laws, Policies &
Enforcement)
An Evaluation of Sex Workers’
Health Access
Longitudinal cohort initiated in 2005, and extended in
2010 to a cohort of 800+ street/off-street sex workers
across Metro Vancouver
Recruitment through street, venue and online outreach
Eligibility is women (trans* inclusive) age 14+ years and
exchange sex for money in the last month at baseline
Semi-annual interview questionnaires and voluntary
HIV, STI testing, treatment and referral
Ongoing monitoring of health and social outcomes (e.g.
sexual risks, violence, mortality) and access to care
Funded by NIH R01DA028648 (2010-2015; 2015-2020)
Police Harassment, Violence
And HIV/STI Risks)
Am J Public Health
HIV cascade of care among sex workers living with HIV
AESHA, 2010-2014
Linear Mixed Effects
Model of ART
treatment
interruptions
Adj
Odds
Ratios
Cox Proportional Hazard
Regression
VL Rebound
(Plasma HIV RNA)
Adj Hazard
Ratios
95% CI
95% CI
Incarceration
2.53 (1.413.98)
STI Infection (Chlamydia,
Gonorrhea, Syphilis)
1.78 (1.293.65)
Older age
1.13 (1.091.23)
Sexual/ physical violence
1.66 (1.343.82)
Indigenous ancestry
or visible minority
0.83 (0.560.94)
Incarceration
1.50 (1.201.79)
Fear of disclosure of
HIV status
0.75 (0.490.89)
High mobility (within/or
outside Vancouver)
1.49 (1.171.89)
Migration/ mobility
outside Vancouver
0.62 (0.390.82)
Access reproductive
health/pregnancy
0.77 (0.610.92)
Goldenberg et al., AIDS & Behav, 2015;
Duff et al, 2015.
Intimate Partners as Pimps
I would classify it as there are just three steps to going
that way. First they [male partners] invite you
in, they feed you. start giving you drugs and
slowly, pretty soon you’re out there making drugs.
And you have nowhere else to go because this person.
comforts you. And, next thing you know,
you’re working on the street for them. You know
they’re there for you, you can sleep, there’s food
in the fridge. And then, you’re sick [drugsick],
[they] bring you some dope. And you know it just
leads on. and the [next] thing you know you’re
owned. No matter where you go they’ll be right
there to find you.
-Cisgender woman, sex worker, age 29
What works?
Women-Only Supportive Housing Models as Protection
from Violence & HIV
• Decriminalization (through removal of
violence, police harassment and safer
work environments) could avert 3346% of HIV infections over the next
decade
• Scale-up of HIV treatment in heavy
burden settings, such as Kenya, could
avert 34% of infections
– Only feasible alongside structural change
Ackowledgements
Investigators: Shira Goldenberg, Andrea Krusi, Kathleen Deering,
Julio Montaner, Jean Shoveller, Gina Ogilvie, Steffanie Strathdee, Thomas Kerr,
Evan Wood, Lisa Maher, Charlotte Reading, Silvia Guillemi,
Deborah Money, Mary Kestler, Andrea Krusi, Putu Duff, Marie-Claude Boily
Community & Policy Knowledge Users: Sandra Chu, Marcie Summers,
Kate Gibson, Jesse Browne, Katrina Pacey, Alison Symington, Jill Chettiar
Research & Administrative Support: Chrissy Taylor, Jen Morris, Sarah Allan, Peter
Vann, Brittney Udall, Chantelle Fitton, Sandra Cortina, Sylvia Machat, Even Shen, Eva
Breternitz, Julia Homer, Andrea Krusi, Emily Leake, Jane Li, Sylvia Machat, Rachel
Nicoletti, Tina Ok, Sabina Dobrer, Paul Nguyen, Ofer Amram, Flo Ranville, Daniella
Barretto & Peer Research Associate Team
Community Advisory Board/Partners: Women’s Information Safe Haven,
Positive Women’s Network, YouthCO AIDS Society, Oak Tree/ BC Women’s Hospital,
Hustle/Health Initiative for Men, Options for Sexual Health, VCH, BCCDC, PACE,
ATIRA, RainCity, Pivot Legal Society, Canadian HIV/AIDS Legal Network
www.gshi.cfenet.ubc.ca