Sex trade involvement is associated with elevated HIV incidence among injection drug users in Vancouver

Background: Canada's prostitution laws are under scrutiny, and there has been growing debate about the optimal strategies for reducing the harms associated with prostitution. Methods: We evaluated whether sex trade involvement was associated with elevated HIV incidence in a cohort of injection drug users. HIV incidence rates were calculated using Kaplan-Meier methods and Cox proportional hazards regression. Results: At 48 months after enrolment, the rate of HIV was 11.7% among those who did not report baseline sex trade involvement compared to 16.7% among those who did (p = 0.049). The elevated HIV infection rate associated with sex trade involvement was also observed in a Cox model that considered sex trade involvement as a time-updated covariate (relative hazard = 1.51 [95% CI: 1.02–2.25]). Interpretation: These findings should be useful to those currently considering the optimal legal framework for addressing the community and health related harms associated with prostitution in Canada.