Substance use and sexually transmitted infections, barriers to sexual health care and the role of enhanced outreach services on STI trends among an inner-city population in Vancouver, Canada

In high risk communities such as Vancouver’s Downtown Eastside (DTES), persistently high rates of sexually transmitted infections (STIs) warrants further research. This thesis examines prevalence of STIs from two perspectives: (1) factors associated with increased STIs, and (2) factors influencing access to treatment. The Community Health And Safety Evaluation (CHASE) afforded a population sample in which to examine drug use patterns associated with STIs, STI trends and program influences. An extension of CHASE, the Women’s Night (WN) survey, enabled further examination of program impact, assessing STI screening in this setting. Factors influencing access of sexual health care were assessed among the WN population, focusing on a novel STI-related stigma scale. Examining drug use patterns and STIs revealed that, among HIV-negative women, crack cocaine use was independently associated with STIs (AOR: 2.6, 95% CI: 1.1-6.5), while among HIV-positive women, episodic drug use remained independently associated with STIs (AOR: 5.8, 95% CI: 1.4-23.5). Interaction between drugs was not seen, although estimated odds for dual-users of crack and crystal methamphetamine was additive, suggesting specific risks associated with drug type. CHASE and regional STI trends were similar, although for gonorrhoea and syphilis CHASE prevalences were ten times higher. A recent syphilis outbreak was evident in both the CHASE and regional data. Shifted peaks in the CHASE cohort may reflect the influence of enhanced partner tracing and peer-based networking strategies. The WN program had a low cross-sectional prevalence of chlamydia (2%) despite active sex work and high drug use. Nearly 75% of the WN population reported a pap smear, and approximately 50% reporting STI testing in the past year. Accessing pap smears was influenced positively by education (OR: 4.5, 95% CI: 1.1-18.0) and negatively by injection drug use (OR: 0.25, 95% CI: 0.08-0.86). STI-stigma was not associated with accessing pap smears; however, internal stigma was associated with STI testing (OR: 0.43; 95% CI: 0.20-0.91). Developing strategies for engaging hard-to-reach populations, developing less stigmatizing messages of prevention, and breaking down barriers that prevent regular sexual health care among women are important and necessary steps in reducing the impact of STIs.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat