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It can also lead to extreme isolation, and sharply increased drug use. Sold by. Amazon Music Stream millions of songs.

Since we had repeated measures available over a two-year period, we analyzed data longitudinally. In sub-analyses, initial experiences of CM use were examined, including median age of first use, person with whom they first used CM e. The Prostitutes Crystal of CM use were categorized as: Prostitutes Crystal individual e.

Methamphetamine- using HIV-positive men who have sex with men: correlates of polydrug use.

Given prior evidence of enhanced sexual and drug-related harms among Aboriginal women and youth who use drugs in this setting, Aboriginal ethnicity e. In addition, we examined risks specific to sex work transactions, including: median number of clients per week, unprotected sexual transactions, client-perpetrated Prostitutes Crystal, exchanging sex while high on drugs, and sharing drugs with clients. Analyses included FSWs who completed baseline and at least one follow-up visit over the two-year period.

Baseline variables considered included demographic variables Prostitutes Crystal. All other variables were treated as time-updated Prostitutes Crystal that referred to experiences occurring during the previous six-month period. We examined bivariate associations Prostitutes Crystal tested for potential collinearity or effect-modification between individual, partner, environmental—structural variables and CM use using generalized estimating equations GEE and a working correlation matrix.

We used GEE for binary outcomes with logit link for the analysis of correlated data since the factors potentially associated with CM use during follow-up were repeated time-dependent measures. GEE models account for the correlation between repeated measures for each subject, and data from every participant follow-up visit were considered in the analyses.

Individual, interpersonal and contextual characteristics of street-based FSWs, stratified by crystal methamphetamine use over two-year follow-up. The median age of initiation of CM use was Prostitutes Crystal years IQR: 16—34 years while the median age of first injecting drugs was 17 years IQR: 15—23 yearsreflecting the relatively recent introduction of CM use in this setting. Close to one-third of Prostitutes Crystal sample reported lifetime CM use, with one quarter using CM use over the two-year follow-up period.

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Over half of FSWs who Prostitutes Crystal methamphetamine reported first using CM with a primary non-commercial sex partner, and we Prostitutes Crystal two fold Prostitutes Crystal odds of CM use among FSWs who had a primary sex partner who procured drugs for them.

Further, CM use remained independently associated with working and living in marginalized public spaces. Importantly, our findings contrast with earlier hypotheses that CM use among FSWs may facilitate enhanced sexual risks, with no statistically significant associations observed between CM use and Prostitutes Crystal of clients, or unprotected sex with clients or non-commercial partners among FSWs.

These findings however do not discount the potential use of methamphetamine as an occupational stressor among sex workers, as observed in northern Mexican border cities, where methamphetamine use among FSWs is associated with occupational stressors, such as the need to stay awake Cruz et al.

Instead, in this study of street-based FSWs, CM use appears to be more important within the context of intimate drug-using sexual partnerships suggesting a gendered pattern of risk colliding along the intersections of street-based sex and drug markets.

Prostitutes Crystal findings accord with the limited qualitative research Cruz et al. In this study, the particularly nuanced relationship of drug procurement by primary Prostitutes Crystal sex partners of FSWs may confer a Prostitutes Crystal risk environment of CM use within sexual partnerships, as Prostitutes Crystal described among crack users over the last two decades Maher, In particular, qualitative accounts of crack-using primary partnerships have consistently documented Prostitutes Crystal risk environments, including risk of infectious disease transmission, among younger FSWs who work to obtain the money for drugs for both themselves and their partner and rely on Prostitutes Crystal male partners often serving as pimps or sugar daddies to procure drugs for them Shannon et al.

This emerging pattern of risk among FSWs who use CM rely on male sex partners to procure drugs for them extends earlier work suggesting that CM use Prostitutes Crystal substitute cocaine as a cheaper or more easily accessible stimulant in settings with a proximal vulnerability to an established stimulant drug use pattern Case et al.

Further, though the results did not remain significant in multivariate analyses, FSWs who use CM in our study were marginally less likely to smoke crack cocaine suggesting a potential shift in stimulant use may be emerging in this population. Qualitative research studies among heroin and cocaine-using couples have demonstrated how drug user's sexual relationships can act as key sites of risk Prostitutes Crystal that directly modify individual drug use practices and facilitate positive social norms [ Rhodes et al.

Specifically, the overtly gendered collusion among sexual partnerships to procure and use drugs was shown to reinforce and produce interpersonal risks, as well as protective mechanisms Simmons and Singer, Among male-female intimate partners, drug involvement has been previously found to be directly associated with male psychological dominance, increased physical and sexual violence and concomitant sexual HIV risks El-Bassel et al.

Evidence also suggests that female IDUs tend to have greater overlap in their sexual and drug use networks relative to their male counterparts [ Sherman et al. These Prostitutes Crystal underscore the need to scale up gender-sensitive and couple-focused harm reduction and treatment interventions, recognizing the nuanced importance of drug-using sexual partnerships in both maintaining risky and preventative practices.

Additionally, given that the majority Prostitutes Crystal FSWs who use methamphetamine in this study were poly users of heroin injection, interventions will need to account for dual opiate dependency in shaping risk Prostitutes Crystal and environments.

Evidence among methamphetamine-using MSM has shown CM to most be frequently used in combination with other drugs Patterson et al. Poly-drug use has been shown to drastically elevate the potential for drug toxicity and overdose mortality, as well as transient immune suppression Leri et al.

The established components of this social equation of risk have been postulated to include proximal vulnerability to established stimulant drug use patterns; social dislocation due to economic disparities, migration or poverty; an available supply and locally produced or manufactured drug; and geographic proximity to drug use environment Case et al.

Of particular importance, our findings suggest that CM use is Prostitutes Crystal linked to street-based sex work in marginalized public spaces, suggesting social dislocation and features of the physical and social environment may shape access and availability of CM use or specific Prostitutes Crystal networks and socio-spatial patterns of CM use. Prostitutes Crystal further exploration is needed of the contexts of space that may shape CM patterns among FSWs, their partners and clients, these findings point to the critical need for policies and interventions that modify the risk environment Prostitutes Crystal, and ensure safer sex work spaces in proximity to harm reduction and treatment Prostitutes Crystal.

While CM use in Prostitutes Crystal study was not associated with specific sexual risk patterns, the Prostitutes Crystal of CM by FSWs in more marginalized public spaces may point to potential pathways to Prostitutes Crystal risk.

For Prostitutes Crystal, we have previously observed elevated rates of Prostitutes Crystal unprotected sex by clients among street-based FSWs displaced to working in industrial settings Shannon et al. As such, structural interventions that mitigate the risk environment of street-based sex work such as safer sex work sites and scaled up mobile outreach interventions to outlying and isolated spaces may help to neutralize the gendered nature of drug acquisition and co-dependence in these sexual partnerships.

Strengths and limitations: the self-reported nature of responses may have been subject to social desirability biases that could have underestimated risky sexual and drug use practices and attenuated results Prostitutes Crystal the null.

Secondly, the observational nature of this research precludes determining causality, although the longitudinal analyses using GEE may account for the impact of repeated measures and temporal bias.

Thirdly, the Prostitutes Crystal small sample size may have diluted our ability to detect associations, such as the association between methamphetamine use and younger age.

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Finally, our results may not be generalizable to FSWs working in indoor venues, such as massage parlours or escort agencies. In summary, our findings suggest the potential of an emerging CM epidemic among street-based FSWs and their non-commercial partners with the that the greatest concentration of harms among FSWs working and living in marginalized public spaces.

As such, this research highlights the critical importance of safer environment interventions that mediate the risk environment and context of CM use in Prostitutes Crystal harms, including gender-sensitive and couple-focused interventions that tailored to FSWs and their intimate drug-using partners. National Center for Biotechnology Information Prostitutes Crystal, U. Drug Alcohol Depend. Author manuscript; available in PMC Jul 9. Author information Copyright and License information Disclaimer.

Copyright notice. The publisher's final Prostitutes Crystal version of this article is available at Drug Alcohol Depend. See Prostitutes Crystal articles in PMC that cite the published article.

Abstract Given growing concern of the sexual risks associated with crystal methamphetamine use Prostitutes Crystal the dearth of research characterizing the use of methamphetamine among street-based sex workers FSWsthis study aimed to characterize the prevalence and individual, social, and structural contexts of crystal methamphetamine use among FSWs in a Canadian setting.

Keywords: methamphetamine use, gender inequities, street-based sex workers, risk environment, safer environment interventions. Study population and sampling Data are drawn from Prostitutes Crystal community-based HIV prevention research partnership that has been described in detail elsewhere Shannon et al.

Measures Since Prostitutes Crystal had repeated measures available over a two-year period, we analyzed data longitudinally.

Statistical analyses Analyses included FSWs who completed baseline and at least one follow-up visit over the Prostitutes Crystal period.

Table 1 Individual, Prostitutes Crystal and contextual characteristics of street-based FSWs, stratified by crystal methamphetamine use over two-year follow-up.

Open in a separate Prostitutes Crystal. Fisher's exact test was used to compare proportions if one or more counts was less than or equal to five. Footnotes Contributors: KS had full access to the data, conceptualized the paper Prostitutes Crystal analyses, wrote the initial draft, and was responsible for integrating all co-authors feedback.

RZ conducted the statistical analyses. All authors provided feedback on the manuscript and approved the final version. Methamphetamine use linked to rising HIV Prostitutes Crystal. Trends in production, trafficking and consumption of methamphetamine and cocaine in Mexico.

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Finally, our results may not be generalizable to FSWs working in indoor venues, such as massage parlours or escort agencies.

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Drawing on data from a prospective cohort, we constructed multivariate logistic models to examine independent correlates of crystal methamphetamine among FSWs over a two-year follow-up period using generalized estimating equations.

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