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Type of submission: Oral
Conference track: Research
Topics: Innovative Harm Reduction Programmes; Sex Work and Harm Reduction
Presenting author: Elena Argento
Elena Argento, Melissa Braschel, Kenneth Tupper, Evan Wood, Kate Shannon
Background: Sex workers experience disproportionately elevated rates of social and health-related risks and harms, including psychological distress and suicide. Significant gaps remain in empirical research examining factors associated with suicide among sex workers. This study aimed to longitudinally examine whether psychedelic drug use can have a protective effect on the incidence of suicidality (suicide ideation or attempts) among a community-based cohort of sex workers.
Methods: Longitudinal data (January 2010 – August 2014) were drawn from a prospective cohort of women sex workers, known as AESHA (An Evaluation of Sex Workers Health Access). Participants were recruited through community outreach to street, indoor, and online venues and completed bi-annual interviewer-administered questionnaires. Cox proportional hazards regression was used to model predictors of new suicidality over 56 months of follow-up.
Findings: Nearly half (46%) of participants had ever thought about or attempted suicide and were thus excluded from the present analyses. Of 290 sex workers eligible at baseline, 11% (n=31) reported recent suicidality during follow-up, with an incidence density of 4.42 per 100 person-years (95% Confidence Interval [CI] 3.10-6.30). In multivariable analysis, psychedelic use was associated with a 55% reduced hazard for suicidality (Adjusted Hazard Ratio [AHR] 0.45; 95%CI 0.20-1.02). Crystal methamphetamine use (AHR 3.10; 95%CI 1.39-6.94) and childhood abuse (AHR 2.90; 95%CI 1.18-7.15) remained independent predictors of suicidality.
Interpretation: The high rate of suicidality among sex workers is a critical public health concern. In the context of emerging evidence on the therapeutic potential of psychedelics to treat mental health and substance use issues, our findings demonstrate that psychedelic use is independently associated with reduced suicidality, while other drug use and childhood trauma predispose sex workers to suicidality. While observational, this study supports calls for further research and innovative interventions to address suicide risk, including investigation of the potential therapeutic utility of psychedelics.