I wrote a while ago about a media report that really got it wrong about rates of HIV infection among Vancouver sex workers. I alerted University of Victoria professor Cecilia Benoit to the error, as she has done considerable competent research work around sex workers, and she in turn wrote a great piece for Harm Reduction magazine (where the original piece appeared) that sets things straight.
Follow this link to find her response, which serves as a fine reminder that we can't be too careful when reading any research document, not to mention the media's interpretation of it.
Showing posts with label HIV/AIDS. Show all posts
Showing posts with label HIV/AIDS. Show all posts
Sunday, April 19, 2009
Wednesday, March 18, 2009
Update on HIV/sex worker issue
I noted a couple weeks ago a report on HIV/AIDS that had wrongly been presented in the media as being about all Vancouver sex workers, even though the study had actually involved only street-entrenched and addicted outdoor sex workers in the Downtown Eastside. Here's a March 14 letter from the authors of the study that sets things straight on that subject:
RE: Unintended results of research (14 March 2009)
by Druyts, Hogg, Montaner
British Columbia Centre for Excellence in HIV/AIDS
We thank Dr. Goodyear for his response to our article. We fully agree with
his concerns surrounding the recent coverage of our work on HIV prevalence
in British Columbia, Canada. Dr. Goodyear has expressed difficulty in
seeing how this study will benefit the individuals who participated in the
research. Of note, estimates of HIV prevalence among at-risk groups are
vital in planning for the development and provision of appropriate policy
and programmatic responses. We wish to affirm that it is our overarching
goal to ensure that there are adequate services for all individuals living
with HIV infection in Vancouver. The WHO has consistently shown that less
than 10% of sex workers have adequate access to HIV prevention and care
resources.
Our paper did not aim to highlight HIV infection among sex workers in
particular. Instead, we sought to model the estimate of HIV prevalence at
the city level and related gaps in services in Vancouver. Also of note,
all the studies considered in our paper received institutional ethical
approval.
We acknowledge that prevalence estimates are rarely perfect and are
limited by uncertainty surrounding population size and potential biases
inherent in source data. We would like to clarify that the estimate of HIV
prevalence among female sex workers in 2006 is based on data collected
among survival sex workers predominantly located in Vancouver’s Downtown
Eastside, who live in poverty and all who inject and/or smoke illicit
drugs. This estimate therefore does not reflect indoor sex workers, such
as sex workers in establishment-based venues, bars, or escort services. We
are fully aware that female sex workers in Vancouver do not constitute a
homogeneous group. This could have been further stressed in the published
paper.
Perhaps most importantly, we recognize that sex workers have been unfairly
stigmatized in the past by medical research as vectors of disease, and it
was not our intention to perpetuate this in any way. We have acknowledged
in our article that detailed data on sex work clients were not available.
As a global assessment of HIV prevention needs, our article did not seek
to review the factors that enhance vulnerability to HIV infection among
marginalized populations, such as survival sex workers. However, as
mentioned by Dr. Goodyear, we feel it is important to acknowledge that
many pivotal studies both in Canada, including some of our own, and
globally have demonstrated that criminalized sex work legislation,
enforcement-based strategies and violence greatly reduces sex workers’
ability to safely negotiate condom use with clients as well as other HIV
risk reduction strategies.
Finally, we concur with UNAIDS and WHO that structural approaches to HIV
prevention are crucial both for the health of sex workers and clients.
This includes policy changes such as the removal of criminal sanctions
targeting sex workers.
Eric Druyts, Robert Hogg and Julio Montaner
http://www.harmreductionjournal.com/content/6/1/5/comments
I noted a couple weeks ago a report on HIV/AIDS that had wrongly been presented in the media as being about all Vancouver sex workers, even though the study had actually involved only street-entrenched and addicted outdoor sex workers in the Downtown Eastside. Here's a March 14 letter from the authors of the study that sets things straight on that subject:
RE: Unintended results of research (14 March 2009)
by Druyts, Hogg, Montaner
British Columbia Centre for Excellence in HIV/AIDS
We thank Dr. Goodyear for his response to our article. We fully agree with
his concerns surrounding the recent coverage of our work on HIV prevalence
in British Columbia, Canada. Dr. Goodyear has expressed difficulty in
seeing how this study will benefit the individuals who participated in the
research. Of note, estimates of HIV prevalence among at-risk groups are
vital in planning for the development and provision of appropriate policy
and programmatic responses. We wish to affirm that it is our overarching
goal to ensure that there are adequate services for all individuals living
with HIV infection in Vancouver. The WHO has consistently shown that less
than 10% of sex workers have adequate access to HIV prevention and care
resources.
Our paper did not aim to highlight HIV infection among sex workers in
particular. Instead, we sought to model the estimate of HIV prevalence at
the city level and related gaps in services in Vancouver. Also of note,
all the studies considered in our paper received institutional ethical
approval.
We acknowledge that prevalence estimates are rarely perfect and are
limited by uncertainty surrounding population size and potential biases
inherent in source data. We would like to clarify that the estimate of HIV
prevalence among female sex workers in 2006 is based on data collected
among survival sex workers predominantly located in Vancouver’s Downtown
Eastside, who live in poverty and all who inject and/or smoke illicit
drugs. This estimate therefore does not reflect indoor sex workers, such
as sex workers in establishment-based venues, bars, or escort services. We
are fully aware that female sex workers in Vancouver do not constitute a
homogeneous group. This could have been further stressed in the published
paper.
Perhaps most importantly, we recognize that sex workers have been unfairly
stigmatized in the past by medical research as vectors of disease, and it
was not our intention to perpetuate this in any way. We have acknowledged
in our article that detailed data on sex work clients were not available.
As a global assessment of HIV prevention needs, our article did not seek
to review the factors that enhance vulnerability to HIV infection among
marginalized populations, such as survival sex workers. However, as
mentioned by Dr. Goodyear, we feel it is important to acknowledge that
many pivotal studies both in Canada, including some of our own, and
globally have demonstrated that criminalized sex work legislation,
enforcement-based strategies and violence greatly reduces sex workers’
ability to safely negotiate condom use with clients as well as other HIV
risk reduction strategies.
Finally, we concur with UNAIDS and WHO that structural approaches to HIV
prevention are crucial both for the health of sex workers and clients.
This includes policy changes such as the removal of criminal sanctions
targeting sex workers.
Eric Druyts, Robert Hogg and Julio Montaner
http://www.harmreductionjournal.com/content/6/1/5/comments
Thursday, March 05, 2009
If you see this Vancouver Sun article in YOUR local paper, please write a letter to the editor!
I'm an advocate for the rights of sex workers, and one of the biggest problems out there is that all the study, research and reporting is almost exclusively about the experiences of marginalized "survival" sex workers - who make up just 10-20 per cent of all sex workers - yet is presumed to be the experience of all sex workers.
Case in point: an article from the March 4 Vancouver Sun, a shorter version of which ran in the Victoria Times Colonist and Edmonton Journal today (and perhaps other publications - those are just the ones I'm aware of) on HIV/AIDS prevalence among "female sex workers" in Vancouver. I tracked down the original study and the error begins there, as the information they wrote about came from three studies of survival sex workers in the Downtown Eastside, yet the language they use makes it sound as though the findings are representative of Vancouver sex workers overall.
So here's my letter to the editor that I've fired off in various directions this morning, followed by the Sun article. I've got the original study as well if anyone wants me to send them a copy - e-mail me at patersoncommunications@gmail.com. Thanks for caring.
Letter to the editor
Re: “One quarter of female prostitutes HIV-positive,” March 5
I’m writing to correct a blatant error in the reporting of findings from a B.C. Excellence in HIV/AIDS study.
This study was essentially a review of existing literature around HIV/AIDS prevalence among high-risk populations in Vancouver, including survival sex workers in the Downtown Eastside. However, the reporting of it wrongly extrapolated its findings to include all sex workers - the vast majority of whom are indoor workers (escorts, erotic massage, independents) who were never among the groups studied.
One of the primary myths around sex work is that those who do the work are vectors of disease. For those who work in the frequently miserable conditions of outdoor survival sex work, HIV/AIDS is obviously a risk due to high addiction rates and perhaps more unwillingness to turn away customers who refuse to use a condom.
Indoor sex work is a very different industry, however - one that has gone virtually unstudied and unreported on in Canada.
An estimated 80-90 per cent of Canadian sex workers are indoor workers. The limited studies that have been done on the tens of thousands of Canadians who work in the indoor industry have found dramatically lower rates of HIV/AIDS, violence, coercion and misery. Yet this group of workers is routinely lumped in with survival street workers for the purpose of sweeping statements on the fate and health of sex workers overall.
Sex workers are extremely stigmatized as it is, and feel the tremendous impact of that on their lives every single day. Research and reporting that overlooks the numerous differences between indoor and outdoor sex work can only perpetuate that.
Jody Paterson
Victoria, B.C.
Original article from Vancouver Sun, March 4
One-quarter of Vancouver’s female sex trade workers infected with HIV
Pamela Fayerman, Vancouver Sun
Published: Wednesday, March 04, 2009
VANCOUVER - Twenty-six per cent of Vancouver's female sex trade workers are infected with HIV, as are 17 per cent of the city's injection-drug users, a new B.C. study shows.
The study, by researchers at the B.C. Centre for Excellence in HIV/AIDS and published in the Harm Reduction Journal, is the first in Canada to estimate the per-capita prevalence ranges for high risk groups, using United Nations/World Health Organization software, 2006 Statistics Canada data and other sources such as population surveys.
Gay men, the local population of which is said to be 20,000, including male sex trade workers, have an estimated HIV prevalence rate of 15 per cent.
The overall prevalence of HIV in Vancouver is about 1.21 per cent, six times higher than the national rate.
"Drugs and sex are the preferred routes for transmission. Female sex trade workers get paid more money for having unprotected sex with johns," explained co-author Dr. Julio Montaner, who is president of the International AIDS Society and head of the division of HIV/AIDS at the University of B.C.
There are up to 520 female sex trade workers in Vancouver. Montaner, asked if the high HIV prevalence among prostitutes should trigger a warning to visitors during the 2010 Olympics, said:
"I don't want to jump on the Olympics bandwagon with this. There should be public advisories everywhere about this, not just because of the Olympics. People who avail themselves to this industry should know you better watch out.
"At home, tourists and transients may behave like star citizens and then, when people go to places like Vancouver, Vegas or Thailand, they party it up," he said.
Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said she had not yet read the report, so she couldn't say whether a targeted public health campaign for those who pay or trade for sex is required.
"Our message has always been that you should assume sex trade workers are HIV positive," Daly said.
"It is a high-risk activity for all kinds of infections and therefore you need to practise safe sex.
"During the Olympics, we are going to be distributing 100,000 condoms to athletes and hotels along with educational information. Whether it will specifically mention the sex trade I cannot say at this point," she said.
The high prevalence of HIV among female sex-trade workers is an emerging trend, given that in the 1980s, most infections were among gay men and in the second wave of the epidemic, injection drug users were hit hard.
"We always knew we had a significant problem, because of factors like our benign climate causing people to drift here, being a port city, and having so much poverty and so many homeless people on the Downtown Eastside," Montaner said, adding that it is difficult to know if men who buy sex from infected prostitutes are also getting infected.
"We don't have any way of accessing the johns to ask them those questions," he said. "And if we see them in our clinics, it's not like they volunteer if they got it that way. They would be more likely to report that they got it through having casual sex, or with multiple partners."
Montaner said HIV experts have made a pitch to the provincial government to "seek out and treat" HIV-infected individuals who are not on medications. It's estimated there are about 13,000 B.C. residents infected with HIV - 11,000 males and 2,000 females - but fewer than a third of them are taking such medications.
Montaner believes the number on medications should be more like 7,500. He said that would reduce the number of new infections each year from 400 to 300.
"The premier, the health minister and other government officials have been very supportive about this kind of progressive approach.
"But now with the economic downturn, we are in a waiting mode. We need an outreach program that brings treatment to the people, to make it more accessible," he said, referring to his vision of clinics in high-risk neighborhoods where such medications would be distributed.
Currently, the drugs are not taken by HIV-infected patients until their immune systems have deteriorated to a certain level. The delay-until-you-can-no-longer-delay approach is intended to save money and stall the potentially unpleasant side effects of medications. But it also means that untreated HIV patients can transmit infections.
Under another proposed strategy by Montaner's group, the "highly active antiretroviral therapy" (HAART) medications would be taken by infected patients far earlier in their disease process, so they wouldn't get the opportunity to transmit the disease.
HAART is said to be nearly 100-per-cent effective at preventing HIV by suppressing viral loads to undetectable levels and preventing people from developing full-blown AIDS by boosting the immune system. A report from the B.C. Centre for Disease Control shows that in 2007, there were only 61 full-blown AIDS cases in B.C, the lowest number since 1994, largely because of the availability of such lifesaving medications.
Sun Health Issues Reporter
pfayerman@vancouversun.com
I'm an advocate for the rights of sex workers, and one of the biggest problems out there is that all the study, research and reporting is almost exclusively about the experiences of marginalized "survival" sex workers - who make up just 10-20 per cent of all sex workers - yet is presumed to be the experience of all sex workers.
Case in point: an article from the March 4 Vancouver Sun, a shorter version of which ran in the Victoria Times Colonist and Edmonton Journal today (and perhaps other publications - those are just the ones I'm aware of) on HIV/AIDS prevalence among "female sex workers" in Vancouver. I tracked down the original study and the error begins there, as the information they wrote about came from three studies of survival sex workers in the Downtown Eastside, yet the language they use makes it sound as though the findings are representative of Vancouver sex workers overall.
So here's my letter to the editor that I've fired off in various directions this morning, followed by the Sun article. I've got the original study as well if anyone wants me to send them a copy - e-mail me at patersoncommunications@gmail.com. Thanks for caring.
Letter to the editor
Re: “One quarter of female prostitutes HIV-positive,” March 5
I’m writing to correct a blatant error in the reporting of findings from a B.C. Excellence in HIV/AIDS study.
This study was essentially a review of existing literature around HIV/AIDS prevalence among high-risk populations in Vancouver, including survival sex workers in the Downtown Eastside. However, the reporting of it wrongly extrapolated its findings to include all sex workers - the vast majority of whom are indoor workers (escorts, erotic massage, independents) who were never among the groups studied.
One of the primary myths around sex work is that those who do the work are vectors of disease. For those who work in the frequently miserable conditions of outdoor survival sex work, HIV/AIDS is obviously a risk due to high addiction rates and perhaps more unwillingness to turn away customers who refuse to use a condom.
Indoor sex work is a very different industry, however - one that has gone virtually unstudied and unreported on in Canada.
An estimated 80-90 per cent of Canadian sex workers are indoor workers. The limited studies that have been done on the tens of thousands of Canadians who work in the indoor industry have found dramatically lower rates of HIV/AIDS, violence, coercion and misery. Yet this group of workers is routinely lumped in with survival street workers for the purpose of sweeping statements on the fate and health of sex workers overall.
Sex workers are extremely stigmatized as it is, and feel the tremendous impact of that on their lives every single day. Research and reporting that overlooks the numerous differences between indoor and outdoor sex work can only perpetuate that.
Jody Paterson
Victoria, B.C.
Original article from Vancouver Sun, March 4
One-quarter of Vancouver’s female sex trade workers infected with HIV
Pamela Fayerman, Vancouver Sun
Published: Wednesday, March 04, 2009
VANCOUVER - Twenty-six per cent of Vancouver's female sex trade workers are infected with HIV, as are 17 per cent of the city's injection-drug users, a new B.C. study shows.
The study, by researchers at the B.C. Centre for Excellence in HIV/AIDS and published in the Harm Reduction Journal, is the first in Canada to estimate the per-capita prevalence ranges for high risk groups, using United Nations/World Health Organization software, 2006 Statistics Canada data and other sources such as population surveys.
Gay men, the local population of which is said to be 20,000, including male sex trade workers, have an estimated HIV prevalence rate of 15 per cent.
The overall prevalence of HIV in Vancouver is about 1.21 per cent, six times higher than the national rate.
"Drugs and sex are the preferred routes for transmission. Female sex trade workers get paid more money for having unprotected sex with johns," explained co-author Dr. Julio Montaner, who is president of the International AIDS Society and head of the division of HIV/AIDS at the University of B.C.
There are up to 520 female sex trade workers in Vancouver. Montaner, asked if the high HIV prevalence among prostitutes should trigger a warning to visitors during the 2010 Olympics, said:
"I don't want to jump on the Olympics bandwagon with this. There should be public advisories everywhere about this, not just because of the Olympics. People who avail themselves to this industry should know you better watch out.
"At home, tourists and transients may behave like star citizens and then, when people go to places like Vancouver, Vegas or Thailand, they party it up," he said.
Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said she had not yet read the report, so she couldn't say whether a targeted public health campaign for those who pay or trade for sex is required.
"Our message has always been that you should assume sex trade workers are HIV positive," Daly said.
"It is a high-risk activity for all kinds of infections and therefore you need to practise safe sex.
"During the Olympics, we are going to be distributing 100,000 condoms to athletes and hotels along with educational information. Whether it will specifically mention the sex trade I cannot say at this point," she said.
The high prevalence of HIV among female sex-trade workers is an emerging trend, given that in the 1980s, most infections were among gay men and in the second wave of the epidemic, injection drug users were hit hard.
"We always knew we had a significant problem, because of factors like our benign climate causing people to drift here, being a port city, and having so much poverty and so many homeless people on the Downtown Eastside," Montaner said, adding that it is difficult to know if men who buy sex from infected prostitutes are also getting infected.
"We don't have any way of accessing the johns to ask them those questions," he said. "And if we see them in our clinics, it's not like they volunteer if they got it that way. They would be more likely to report that they got it through having casual sex, or with multiple partners."
Montaner said HIV experts have made a pitch to the provincial government to "seek out and treat" HIV-infected individuals who are not on medications. It's estimated there are about 13,000 B.C. residents infected with HIV - 11,000 males and 2,000 females - but fewer than a third of them are taking such medications.
Montaner believes the number on medications should be more like 7,500. He said that would reduce the number of new infections each year from 400 to 300.
"The premier, the health minister and other government officials have been very supportive about this kind of progressive approach.
"But now with the economic downturn, we are in a waiting mode. We need an outreach program that brings treatment to the people, to make it more accessible," he said, referring to his vision of clinics in high-risk neighborhoods where such medications would be distributed.
Currently, the drugs are not taken by HIV-infected patients until their immune systems have deteriorated to a certain level. The delay-until-you-can-no-longer-delay approach is intended to save money and stall the potentially unpleasant side effects of medications. But it also means that untreated HIV patients can transmit infections.
Under another proposed strategy by Montaner's group, the "highly active antiretroviral therapy" (HAART) medications would be taken by infected patients far earlier in their disease process, so they wouldn't get the opportunity to transmit the disease.
HAART is said to be nearly 100-per-cent effective at preventing HIV by suppressing viral loads to undetectable levels and preventing people from developing full-blown AIDS by boosting the immune system. A report from the B.C. Centre for Disease Control shows that in 2007, there were only 61 full-blown AIDS cases in B.C, the lowest number since 1994, largely because of the availability of such lifesaving medications.
Sun Health Issues Reporter
pfayerman@vancouversun.com
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