Informing community-based interventions to address unmet overdose prevention and sexual health needs of marginalized women during and beyond COVID-19

Women sex workers experience severe negative health impacts and are profoundly underserved by traditional systems of healthcare and community supports. Tailored and community-based interventions are needed to address the HIV and Sexually Transmitted Blood Borne Infection (STBBI) and overdose prevention needs of women sex workers, as conventional interventions have low uptake and are often insufficiently equipped to support their unique and gendered needs and realities. Sex workers face heightened barriers to accessing HIV/STI, harm reduction, and overdose prevention services due to structural factors such as stigma, criminalization, and compounding access barriers amid the COVID-19 pandemics. While a substantial proportion of sex workers use drugs, few sex worker-specific overdose prevention services exist. Evidence from the global south suggests that community-led and sex worker (peer) delivered HIV/STI services hold strong promise for advancing sex workers' health equity and are WHO/UNAIDS recommended best practices, few such models have been evaluated in Canada. This research will: 1. Examine patterns and determinants of engagement with peer-led/community-based HIV/STBBI and overdose services and supports; 2. Evaluate impacts of the COVID-19 pandemic on inequities in access and determinants of engagement with HIV/STBBI and overdose services and supports; and 3. Develop a set of 'best practices' for peer-led/community-based interventions to address ongoing overdose and sexual health inequities during and beyond the COVID-19 pandemic. This research builds on and will be nested within the AESHA project (An Evaluation of Sex Workers' Health Access) at the Centre for Gender & Sexual Health Equity (CGSHE) (Funding: CIHR/NIH, PI: Goldenberg, 2020-2025), North America's longest running prospective cohort of >900 women sex workers (trans inclusive) who complete detailed semi-annual questionnaires, voluntary STBBI testing, and a novel COVID-19 supplementary questionnaire.