Despite increasing evidence of enhanced HIV risk among sexual minority populations, and sex workers (SWs) in particular, there remains a paucity of epidemiological data on the risk environments of SWs who identify as lesbian or bisexual. Therefore, this short report describes a study that examined the individual, interpersonal and structural associations with lesbian or bisexual identity among SWs in Vancouver, Canada. Analysis drew on data from an open prospective cohort of street and hidden off-street SWs in Vancouver. Bivariate and multivariable logistic regressions were used to examine the independent relationships between individual, interpersonal, work environment and structural factors and lesbian or bisexual identity. Of the 510 individuals in our sample, 95 (18.6%) identified as lesbian or bisexual. In multivariable analysis, reporting non-injection drug use in the last six months (adjusted odds ratio [AOR] = 2.89; 95% confidence intervals [CI] = 1.42, 5.75), youth ≤24 years of age (AOR = 2.43; 95% CI = 1.24, 4.73) and experiencing client-perpetrated verbal, physical and/or sexual violence in the last six months (AOR = 1.85; 95% CI = 1.15, 2.98) remained independently associated with lesbian/bisexual identity, after adjusting for potential confounders. The findings demonstrate an urgent need for evidence-based social and structural HIV prevention interventions. In particular, policies and programmes tailored to lesbian and bisexual youth and women working in sex work, including those that prevent violence and address issues of non-injection stimulant use are required.

Drug treatment courts (DTCs) in Canada are often framed as a progressive approach to managing people with addictions who come into contact with the law. In the specialized courts, participants are considered to have a health issue (addiction) that is best managed through a judicial system. Thus, participants in DTCs are considered to be a different type of subject than those in the traditional judicial system. Using data from a 25-month critical ethnography in the Ottawa DTC, this article explores how participants in DTCs are constructed as addicted subjects. Key characteristics of the addicted subject in the Ottawa DTC are presented:

Social capital as social relations: the
contribution of normative structures
Bill Reimer, Tara Lyons, Nelson Ferguson and
Geraldina Polanco
Abstract
This paper presents a framework for social capital that highlights the normative
structures through which it is manifested. The primary focus is on the ways that
norms structure the relationships in which social capital is embedded. To this end,
we introduce four types of normative structures which condition social capital:
market, bureaucratic, associative, and communal. A field site in Japan is used to
illustrate how different aspects of social capital interact. This case analysis also
serves to make an important distinction between the availability and use of social
capital.The central arguments are that 1) social capital is organized in different ways
by the normative structures in which it is embedded; 2) there are important inter-
actions between these different aspects of social capital that are often overlooked by
simpler frameworks; 3) a useful distinction can be made between available social
capital and used social capital; 4) access to social capital can be used to analyze
power relations; and 5) distinguishing different aspects of social capital makes areas
visible that are overlooked by other understandings of social capital. We conclude
by identifying the utility of our perspective for informing public policy and guiding
future research.

Background

While considerable research has been undertaken on addiction treatment, the experiences of transgender individuals who use drugs are rarely explored in such research, as too often transgender individuals are excluded entirely or grouped with those of sexual minority groups. Consequently, little is known about the treatment experiences in this population. Thus, we sought to qualitatively investigate the residential addiction treatment experiences of transgender individuals who use illicit drugs in a Canadian setting.

Methods
In-depth semi-structured interviews were conducted with 34 transgender individuals in Vancouver, Canada between June 2012 and May 2013. Participants were recruited from three open prospective cohorts of individuals who use drugs and an open prospective cohort of sex workers. Theory-driven and data-driven approaches were used to analyze the data and two transgender researcher assistants aided with the coding and the interpretation of data in a process called participatory analysis.

Results
Fourteen participants had previous experience of addiction treatment and their experiences varied according to whether their gender identity was accepted in the treatment programs. Three themes emerged from the data that characterized individuals’ experiences in treatment settings: (1) enacted stigma in the forms of social rejection and violence, (2) transphobia and felt stigma, and (3) “trans friendly” and inclusive treatment. Participants who reported felt and enacted stigma, including violence, left treatment prematurely after isolation and conflicts. In contrast, participants who felt included and respected in treatment settings reported positive treatment experiences.

Conclusions
The study findings demonstrate the importance of fostering respect and inclusivity of gender diverse individuals in residential treatment settings. These findings illustrate the need for gender-based, anti-stigma policies and programs to be established within existing addiction treatment programs. Additionally, it is vital to establish transgender and/or LGBTQ specific treatment programs as recommended by the participants in this study.

Individuals who use illicit drugs and belong to a sexual minority group often contend with elevated risks for adverse health outcomes. However, little is known about women who use drugs and have sex with women. We therefore sought to identify socio-demographic, substance use patterns, and exposures to social-structural factors associated with reporting sexual activity among women participating in three open prospective cohort studies of individuals who use illicit drugs in Vancouver, Canada. Generalized estimating equations was used to identify substance use patterns, violence and other social and structural drivers of health-related harm among women who reported having sex with women (WSW) between December 2005 and May 2012. In multivariate analyses, younger age (adjusted odds ratio [AOR] = 2.89; 95% confidence interval [CI] = 1.81, 4.60), violence (AOR = 1.78; 95% CI = 1.22, 2.59) and homelessness (AOR = 1.42; 95% CI = 1.00, 2.02) were associated with WSW. WSW were also less likely to report enrollment in addiction treatment (AOR = 0.68; 95% CI = 0.46, 0.99). In a second model, sexual violence (AOR = 3.47; 95% CI = 2.08, 5.78) in the previous 6 months was also found to be positively associated with WSW. These findings indicate a critical need for more thorough understandings of the intersections between sexual relationships, exposure to violence and enrollment in addiction treatment among women who use illicit drugs, as well as the development of programs to address the unique needs of this population.

A growing body of international evidence suggests that sex workers face a disproportionate burden of violence, with
significant variations across social, cultural, and economic contexts. Research on trans sex workers has documented
high incidents of violence; however, investigations into the relationships between violence and social-structural
contexts are limited. Therefore, the objective of this study was to qualitatively examine how social-structural contexts
shape trans sex workers’ experiences of violence. In-depth semistructured interviews were conducted with 33 trans
sex workers in Vancouver, Canada, between June 2012 and May 2013. Three themes emerged that illustrated how
social-structural contexts of transphobia and criminalization shaped violent experiences: (a) transphobic violence, (b)
clients’ discovery of participants’ gender identity, and (c) negative police responses to experiences of violence. The
findings demonstrate the need for shifts in sex work laws and culturally relevant antistigma programs and policies to
address transphobia.