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Jiao S, Bungay V. Intersections of Stigma, Mental Health, and Sex Work: How Canadian Men Engaged in Sex Work Navigate and Resist Stigma to Protect Their Mental Health. JOURNAL OF SEX RESEARCH 2019; 56:641-649. [PMID: 29714528 DOI: 10.1080/00224499.2018.1459446] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Men engaged in sex work experience significant stigma that can have devastating effects for their mental health. Little is known about how male sex workers experience stigma and its effects on mental health or their strategies to prevent its effects in the Canadian context. This study examined the interrelationships between stigma and mental health among 33 Canadian indoor, male sex workers with a specific goal of understanding how stigma affected men's mental health and their protective strategies to mitigate against its effects. Men experienced significant enacted stigma that negatively affected their social supports and ability to develop and maintain noncommercial, romantic relationships. Men navigated stigma by avoidance and resisting internalization. Strategy effectiveness to promote mental health varied based on men's perspectives of sex work as a career versus a forced source of income. Programming to promote men's mental health must take into consideration men's diverse strategies and serve to build social supports.
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Parmley L, Rao A, Young K, Kose Z, Phaswana-Mafuya N, Mcingana M, Lambert A, Hausler H, Baral S, Schwartz S. Female Sex Workers' Experiences Selling Sex during Pregnancy and Post-Delivery in South Africa. Stud Fam Plann 2019; 50:201-217. [PMID: 30997677 DOI: 10.1111/sifp.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nearly 75 percent of female sex workers (FSWs) in Port Elizabeth, South Africa are mothers, many of whom engage in sex work during pregnancy or after delivery. We conducted in-depth interviews with 22 postpartum and 8 pregnant FSWs in Port Elizabeth. Interview guides were used to probe women's experiences, challenges, and concerns about selling sex during pregnancy and post-delivery in a high-HIV-prevalence context. Interviews were transcribed, translated, and coded using thematic analysis. FSWs experienced and feared violence by clients during pregnancy, highlighting the need for safe work environments. Further, FSWs expressed concerns about HIV acquisition and vertical transmission during the perinatal period. Physical challenges related to pregnancy affected women's ability to work. Returning to work post-delivery presented barriers to initiating and practicing exclusive breastfeeding. As a result, many FSWs practiced mixed feeding. Interventions, tailored to respond to FSW's challenges and experiences, may offer improved health outcomes in this context.
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Ulibarri MD, Salazar M, Syvertsen JL, Bazzi AR, Rangel MG, Orozco HS, Strathdee SA. Intimate Partner Violence Among Female Sex Workers and Their Noncommercial Male Partners in Mexico: A Mixed-Methods Study. Violence Against Women 2019; 25:549-571. [PMID: 30156143 PMCID: PMC6391174 DOI: 10.1177/1077801218794302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Utilizing mixed methods, we examined intimate partner violence (IPV) behaviors among 428 female sex workers (FSWs) who use drugs and their noncommercial male partners in Tijuana and Ciudad Juarez, Mexico. Half of all participants reported perpetrating and experiencing at least one type of IPV behavior in the past year. In interviews, drug use emerged as an important theme associated with IPV behaviors, and we found men and women differed in their motivations for engaging in IPV behaviors. Findings highlight how gender and power are interlinked with and may exacerbate drug use and IPV behaviors among marginalized populations.
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Bazzi AR, Yotebieng K, Otticha S, Rota G, Agot K, Ohaga S, Syvertsen JL. PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya. J Int AIDS Soc 2019; 22:e25266. [PMID: 30983147 PMCID: PMC6462807 DOI: 10.1002/jia2.25266] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/05/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Female and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre-exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention. METHODS From 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences. RESULTS Among 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past-month alcohol use and 91% of women and 82% of men reported past-month drug use. Violence was pervasive, with most women and men reporting past-year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non-stigmatizing PrEP delivery initiatives designed with input from sex workers. CONCLUSIONS Through a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.
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Orchard T, Murie A, Elash HL, Bunch M, Middleton C, Sadakhom D, Oiamo T, Benoit C. "People like us": spatialised notions of health, stigma, power and subjectivity among women in street sex work. CULTURE, HEALTH & SEXUALITY 2019; 21:478-494. [PMID: 30378467 DOI: 10.1080/13691058.2018.1490455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
Most spatially-oriented studies about health, safety and service provision among women in street sex work have taken place in large urban cities and document how the socio-legal and moral surveillance of geographical spaces constrain their daily movements and compromise their ability to care for themselves. Designed to contribute new knowledge about the broader socio-cultural and environmental landscape of sex work in smaller urban centres, we conducted qualitative interviews and social mapping activities with thirty-three women working in a medium-sized Canadian city. Our findings demonstrate a socio-spatial convergence regarding service provision, violence, and stigma, which is common in sex trading spaces that double as service landscapes for poor populations. Women in this study employ unique agential strategies to navigate these competing forces, many of which draw upon the multivalent uses of different urban spaces to optimise service access, reduce the propensity for violence, and manage their health with dignity. Their use of the spatialised term 'everywhere' as an idiom of distress regarding issues of power, agency and their desire to take part in wider civic discourse are also explored. These data contribute new insights about spatialised notions of health, stigma, agency, and subjectivity among women in sex work and how they manage 'risky' environments.
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Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Barnhart D, Mboggo E, Oldenburg CE, Bärnighausen T, Spiegelman D. HIV risk and pre-exposure prophylaxis interest among female bar workers in Dar es Salaam: cross-sectional survey. BMJ Open 2019; 9:e023272. [PMID: 30898799 PMCID: PMC6475445 DOI: 10.1136/bmjopen-2018-023272] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Female bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW's sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa. DESIGN Cross-sectional survey covering respondents' work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC). SETTING Eight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM). PARTICIPANTS 66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit. RESULTS Half of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive. CONCLUSIONS FBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.
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Evens E, Lanham M, Santi K, Cooke J, Ridgeway K, Morales G, Parker C, Brennan C, de Bruin M, Desrosiers PC, Diaz X, Drago M, McLean R, Mendizabal M, Davis D, Hershow RB, Dayton R. Experiences of gender-based violence among female sex workers, men who have sex with men, and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:9. [PMID: 30832664 PMCID: PMC6399914 DOI: 10.1186/s12914-019-0187-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Female sex workers, MSM, and transgender women-collectively referred to as key populations (KPs)-are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs' human rights. METHODS Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. RESULTS Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and-for transgender women and MSM-religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. CONCLUSIONS Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations' human rights.
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Page K, Carrico AW, Stein E, Evans J, Sokunny M, Maly P, Sophal C, Neak Y, Ngak S, McCulloch C, Maher L. Cluster randomized stepped-wedge trial of a multi-level HIV prevention intervention to decrease amphetamine-type stimulants and sexual risk in Cambodian female entertainment and sex workers. Drug Alcohol Depend 2019; 196:21-30. [PMID: 30659994 PMCID: PMC6392432 DOI: 10.1016/j.drugalcdep.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/04/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND HIV prevention for female entertainment and sex workers (FESW) may be optimized by addressing individual and structural risks. We examined the impact of a sequentially delivered intervention to decrease sexual risk, amphetamine-type stimulant (ATS) use, and improve economic well-being in Cambodian FESW. METHODS A cluster randomized stepped-wedge trial was conducted in 10 Cambodian provinces to test multi-level intervention in high risk FESW. After baseline screening in 1198 women, those screening positive for ATS use disorder were allocated to a 12-week conditional cash transfer intervention followed by a 4-week cognitive-behavioural aftercare group (CCT + AC). At six months, ATS abstinent participants were offered a microenterprise (ME) opportunity. Co-primary outcomes assessed in 600 FESW at each 6-, 12- and 18-month follow-up assessments, included: 1) number of sexual partners (past three months); and 2) ATS urine toxicology positive (Tox+) results. Secondary outcomes included indicators of economic well-being. RESULTS Relative to baseline, FESW reported fewer sexual partners at all follow-up assessments with a significant 50% decrease at 12-months (Adjusted Rate Ratio [ARR] = 0.50; 95%CI: 0.25, 0.95). Women had 60% lower odds of being ATS Tox+ (Adjusted Odds Ratio [AOR] = 0.40; 95%CI: 0.25, 0.65) at 6-months, and continued but non-significant reductions at 12- and 18-months. Improvements in economic well-being indicators were observed at 12- and 18-months. CONCLUSIONS Findings support the robust effectiveness of the sequentially delivered CCT + AC and ME interventions for boosting HIV prevention for Cambodian FESW. Further research is needed to inform the scale up and improve durability of this comprehensive approach with FESW in Southeast Asia.
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Toomistu T. Playground love: sex work, pleasure, and self-affirmation in the urban nightlife of Indonesian waria. CULTURE, HEALTH & SEXUALITY 2019; 21:205-218. [PMID: 29658829 DOI: 10.1080/13691058.2018.1459847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
Indonesian transgender women, locally and internationally recognised as waria, share some lifestyle patterns that have emerged under conditions of limited social acceptance. These patterns include involvement in sex work. The high number of waria who are sex workers is usually explained in economic terms. However, their presence in certain locations around the city known for waria sex work is not only for work, and quite often not even for sex. Waria street nightlife fosters waria agency, which emerges from self-affirmation through pleasurable bodily practices involving intimate (sexual partners) and both proximate (other waria and men nearby) and distant others (structuring ideals). Drawing on fieldwork conducted between 2010 and 2015 in Java and West Papua, this paper describes the political and economic organisation of sex work among waria, then highlights the social and sensorial qualities of waria street nightlife.
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Tomko C, Park JN, Allen ST, Glick J, Galai N, Decker MR, Footer KH, Sherman SG. Awareness and Interest in HIV Pre-Exposure Prophylaxis Among Street-Based Female Sex Workers: Results from a US Context. AIDS Patient Care STDS 2019; 33:49-57. [PMID: 30632769 PMCID: PMC6386071 DOI: 10.1089/apc.2018.0182] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) has the potential to be an empowering HIV prevention tool among female sex workers (FSW), yet little is known about PrEP awareness and interest in this population. Sex workers and Police Promoting Health in Risky Environments (SAPPHIRE) is a prospective cohort study of street-based FSW in Baltimore, MD. A cross-sectional analysis explored awareness and interest in PrEP among HIV-negative FSW. Multivariable Poisson regressions modeled associations between individual, interpersonal, and structural variables and PrEP awareness and interest. Of n = 232 FSW, 66% were white, half were less than 35 years old, 59% injected drugs daily, and 66% sold sex daily. Only 21% of FSW were aware of PrEP, though 74% were interested. PrEP awareness was associated with experiencing client condom coercion [adjusted incidence rate ratio (aIRR) = 0.50, 95% CI: 0.28-0.90] and condomless sex with an intimate partner (aIRR = 0.54, 95% CI: 0.30-0.98). PrEP interest was associated with perceiving PrEP as "very easy" to take (aIRR = 1.91, 95% CI: 1.49-2.45) and moving to an unfamiliar geographic area to sell sex (aIRR = 1.20, 95% CI: 1.04-1.39). Women who had a current gonorrhea or chlamydia infection were less likely to be interested in PrEP (aIRR = 0.75, 95% CI: 0.59-0.95). Though PrEP awareness among FSW is low, there are FSW who are significantly more likely to express interest in PrEP and outreach efforts should target these women. Results suggest that women-controlled HIV prevention methods may be important for reducing incidence among FSW.
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Markova MV, Abdriakhimova TB, Grishina OV, Savina MV, Kosenko CA, Falyova HE, Markov AR. Phenomenon of self-destructive behavior in female sex workers: discriptors, predictors, typology, psychological correction. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2019; 72:1774-1780. [PMID: 31622265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Introduction: Engaging in sex, which is obligatory associated with the extraordinary risks of harm to their own safety and physical health, can be considered as one of the variants of self-destruction. The aim is to analyze the leading descriptors and predictors of self-destructive behavior among female sex workers, on the basis of which to propose measures for their psycho-correction. PATIENTS AND METHODS Materials and methods: The main group of the study was 135 women - female sex workers, a comparative group of 50 women who had no relation to such activities. The research methods were clinical-psychological, socio-demographic, psycho diagnostic, mathematical-statistical. RESULTS Results: Suicidal mood was investigated as a descriptor of self-destructive behavior in female sex workers. Features of suicidal ideas and the basis of committing suicide are revealed. The motivating emotions of a suicidal act are shame, anger and resentment. Psychological protection as a mechanism for maintaining risky sexual behavior has been studied. Identified destructive forms of primitive level mechanisms of psychological defense. It was revealed that in women engaged in prostitution the overall viability is not sufficiently formed, mainly due to the low level of inclusion. The presence of sacrifice in the form of increased propensity to active victim behavior has been established. An increased tendency toward an active type of victim behavior has been established. Leading individual psychological and behavioral patterns in the genesis of self-destructive behavior in female sex workers have been identified and its clinical and psychological options have been singled out. Based on the data obtained, a program of measures for differentiated psycho-correction of self-destructive behavior among female sex workers was developed. CONCLUSION Conclusions: As a result of work, the conceptualization of occupation of prostitution as a self-destructive behavior is grounded. The isolation of its specific pathognomonic psycho-emotional, individual psychological and behavioral features, made it possible to propose effective measures of its psycho-correction and of psycho-processing.
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Onyango MA, Adu-Sarkodie Y, Adjei RO, Agyarko-Poku T, Kopelman CH, Green K, Wambugu S, Clement NF, Wondergem P, Beard J. Love, power, resilience and vulnerability: relationship dynamics between female sex workers in Ghana and their intimate partners. CULTURE, HEALTH & SEXUALITY 2019; 21:31-45. [PMID: 29669473 DOI: 10.1080/13691058.2018.1446550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
Little is known about female sex workers' daily lives or emotional relationships. Using relational-cultural theory, this study explored the relationship dynamics between sex workers and their intimate partners in Kumasi, Ghana. We collected qualitative data from 37 male intimate partners through 24 in-depth interviews and two focus group discussions (FGDs) with 13 male partners. We also conducted three FGDs with 20 women involved in sex work. Relationships between sex workers and their intimate partners were mutual, reciprocal and transactional. Male partners provided protection for financial support, a place to sleep and intimacy. Both men and women described their relationships in terms of friendship, love and a hopeful future. Women were reluctant to quit sex work because they depended on it for income. Most respondents did not use condoms in these romantic relationships, citing trust, love, faithfulness and commitment. Both men and women described high levels of violence in their relationships. The context of sex work heightens vulnerability but also appears to facilitate resilience and creative coping strategies. The relational dynamics between sex workers and their intimate partners in Ghana merit further exploration to examine the extent to which women involved in sex work hold and exert power within these relationships.
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Ito S, Lépine A, Treibich C. The effect of sex work regulation on health and well-being of sex workers: Evidence from Senegal. HEALTH ECONOMICS 2018; 27:1627-1652. [PMID: 29978530 PMCID: PMC6173294 DOI: 10.1002/hec.3791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/31/2018] [Accepted: 05/24/2018] [Indexed: 05/14/2023]
Abstract
Senegal is the only African country where sex work is legal and regulated by a health policy. Senegalese female sex workers (FSWs) are required to register with a health facility and to attend monthly routine health checks aimed at testing and treating sexually transmitted infections (STIs). Compliance to those routine visits is recorded on a registration card that must be carried by FSWs in order to avoid sanctions in case of police arrests. Although this policy was first introduced in 1969 to limit the spread of STIs, there is no evidence so far of its impact on FSWs' health and well-being. The paper aims to fill this gap by exploiting a unique data set of registered and unregistered Senegalese FSWs. Using propensity score matching, we find that registration has a positive effect on FSWs' health. However, we find that registration reduces FSWs' subjective well-being. This finding is explained by the fact that registered FSWs are found to engage in more sex acts, in riskier sex acts, have less social support from their peers, and are more likely to experience violence from clients and police officers. We prove that those results are robust to the violation of the conditional independence assumption, to misspecification of the propensity score model, and that covariate balance is achieved. The results suggest that more efforts should be deployed to reduce the stigma associated with registration and to address the poor well-being of FSWs, which is counterproductive to HIV prevention efforts.
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Underhill K, Guthrie KM, Colleran C, Calabrese SK, Operario D, Mayer KH. Temporal Fluctuations in Behavior, Perceived HIV Risk, and Willingness to Use Pre-Exposure Prophylaxis (PrEP). ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2109-2121. [PMID: 29327091 PMCID: PMC6041197 DOI: 10.1007/s10508-017-1100-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 07/25/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
Individual perceptions of HIV risk influence willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention. Among men who have sex with men (MSM) and male sex workers (MSWs), temporal or episodic changes in risk behavior may influence perceived risk and PrEP acceptability over time. We investigated fluctuations in perceived HIV risk and PrEP acceptability, comparing MSWs against MSM who do not engage in sex work. We conducted 8 focus groups (n = 38) and 56 individual interviews among MSM and MSWs in Providence, RI. Perceived HIV risk shaped willingness to use PrEP among both MSWs and MSM who did not engage in sex work, and risk perceptions changed over time depending on behavior. For MSWs, perceived risk cycled according to patterns of substance use and sex work activity. These cycles yielded an "access-interest paradox": an inverse relationship between willingness to use and ability to access PrEP. MSM who did not engage in sex work also reported temporal shifts in risk behavior, perceived risk, and willingness to use PrEP, but changes were unrelated to access. MSM attributed fluctuations to seasonal changes, vacations, partnerships, behavioral "phases," and episodic alcohol or drug use. Efforts to implement PrEP among MSM and street-based MSWs should address temporal changes in willingness to use PrEP, which are linked to perceived risk. Among MSWs, confronting the access-interest paradox may require intensive outreach during high-risk times and efforts to address low perceived risk during times of reduced sex work.
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Roberts ST, Flaherty BP, Deya R, Masese L, Ngina J, McClelland RS, Simoni J, Graham SM. Patterns of Gender-Based Violence and Associations with Mental Health and HIV Risk Behavior Among Female Sex Workers in Mombasa, Kenya: A Latent Class Analysis. AIDS Behav 2018; 22:3273-3286. [PMID: 29603110 PMCID: PMC6146064 DOI: 10.1007/s10461-018-2107-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gender-based violence (GBV) is common among female sex workers (FSWs) and is associated with multiple HIV risk factors, including poor mental health, high-risk sexual behavior, and sexually transmitted infections (STIs). Prior studies have focused on GBV of one type (e.g. physical or sexual) or from one kind of perpetrator (e.g., clients or regular partners), but many FSWs experience overlapping types of violence from multiple perpetrators, with varying frequency and severity. We examined the association between lifetime patterns of GBV and HIV risk factors in 283 FSWs in Mombasa, Kenya. Patterns of GBV were identified with latent class analysis based on physical, sexual, or emotional violence from multiple perpetrators. Cross-sectional outcomes included depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, disordered alcohol and other drug use, number of sex partners, self-reported unprotected sex, prostate-specific antigen (PSA) in vaginal secretions, and a combined unprotected sex indicator based on self-report or PSA detection. We also measured HIV/STI incidence over 12 months following GBV assessment. Associations between GBV patterns and each outcome were modeled separately using linear regression for mental health outcomes and Poisson regression for sexual risk outcomes. Lifetime prevalence of GBV was 87%. We identified 4 GBV patterns, labeled Low (21% prevalence), Sexual (23%), Physical/Moderate Emotional (18%), and Severe (39%). Compared to women with Low GBV, those with Severe GBV had higher scores for depressive symptoms, PTSD symptoms, and disordered alcohol use, and had more sex partners. Women with Sexual GBV had higher scores for disordered alcohol use than women with Low GBV, but similar sexual risk behavior. Women with Physical/Moderate Emotional GBV had more sex partners and a higher prevalence of unprotected sex than women with Low GBV, but no differences in mental health. HIV/STI incidence did not differ significantly by GBV pattern. The prevalence of GBV was extremely high in this sample of Kenyan FSWs, and different GBV patterns were associated with distinct mental health and sexual risk outcomes. Increased understanding of how health consequences vary by GBV type and severity could lead to more effective programs to reduce HIV risk in this vulnerable population.
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Quinn C, Nakyanjo N, Ddaaki W, Burke VM, Hutchinson N, Kagaayi J, Wawer MJ, Nalugoda F, Kennedy CE. HIV Partner Notification Values and Preferences Among Sex Workers, Fishermen, and Mainland Community Members in Rakai, Uganda: A Qualitative Study. AIDS Behav 2018; 22:3407-3416. [PMID: 29372453 DOI: 10.1007/s10461-018-2035-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
HIV partner notification involves contacting sexual partners of people who test HIV positive and referring them to HIV testing, treatment, and prevention services. To understand values and preferences of key and general populations in Rakai, Uganda, we conducted 6 focus group discussions and 63 in-depth interviews in high prevalence fishing communities and low prevalence mainland communities. Participants included fishermen and sex workers in fishing communities, male and female mainland community members, and healthcare providers. Questions explored three approaches: passive referral, provider referral, and contract referral. Qualitative data were coded and analyzed using a team-based matrix approach. Participants agreed that passive referral was most suitable for primary partners. Provider referral was acceptable in fishing communities for notifying multiple, casual partners. Healthcare providers voiced concerns about limited time, resources, and training for provider-assisted approaches. Options for partner notification may help people overcome barriers to HIV serostatus disclosure and help reach key populations.
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Walters SM, Rivera AV, Reilly KH, Anderson BJ, Bolden B, Wogayehu A, Neaigus A, Braunstein S. Exchange Sex Among Persons Who Inject Drugs in the New York Metropolitan Area: The Importance of Local Context, Gender and Sexual Identity. AIDS Behav 2018; 22:2773-2787. [PMID: 29468492 DOI: 10.1007/s10461-018-2039-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exchanging sex for money or drugs is known to increase risk for HIV among persons who inject drugs (PWID). To better understand determinants of exchange sex among PWID we examined factors associated with exchange sex in the New York metropolitan area-defined as New York City (NYC), NY; Newark, NJ; and Long Island, NY-using data from the 2012 National HIV Behavioral Surveillance system cycle on injection drug use. Of the 1160 PWID in this analysis, 24% reported exchange sex, with differences in gender and sexual identity by location. In multivariable analysis gay/bisexual men, heterosexual women, and lesbian, gay, or bisexual (LGB) women were more likely to exchange sex compared to heterosexual men. Exchange sex was also associated with race/ethnicity, homelessness, incarceration, location, and non-injection crack and cocaine use. We find that heterosexual women and LGB women who injected drugs residing in Newark were more likely to report exchange sex compared to NYC. This study highlights how local conditions impact exchange sex.
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Berger BO, Grosso A, Adams D, Ketende S, Sithole B, Mabuza XS, Mavimbela MJ, Baral S. The Prevalence and Correlates of Physical and Sexual Violence Affecting Female Sex Workers in Swaziland. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:2745-2766. [PMID: 26872508 DOI: 10.1177/0886260516629385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Female sex workers (FSW) have a heightened vulnerability to violence and negative sexual/reproductive health outcomes. Limited research has examined how experiencing physical and sexual violence (PSV) mediates risk for poor health outcomes among FSW in Swaziland. The present analyses aim to contribute to literature linking violence with poor health outcomes, high-risk behaviors, and reduced health service-seeking among FSW. Data were analyzed from a cross-sectional study conducted in Swaziland between July and September 2011 with 325 adult women who reported exchanging sex for money, goods, or favors in the last 12 months, recruited through respondent-driven sampling (RDS). Logistic regression was used to assess the relationship between PSV and ancillary violence/abuse exposures, risk behaviors, and sexual/reproductive and mental health outcomes. PSV was conceptualized as either ever having been beaten up as a result of selling sex or ever being forced to have sex since the age of 18, or both. Prevalence of PSV in this sample was 59.0% in crude estimation, and 48.4% (95% confidence interval [CI]:[39.2,57.6]) with RDS weighting. Separate RDS-weighted estimates of being beaten up as a result of sex work and ever being forced to have sex were 32.4% (95%CI=[24.4,40.4]) and 33.1% (95%CI =[25.0,41.2%]), respectively. Experiencing PSV was associated with being blackmailed (adjusted odds ratio [aOR]= 1.93, 95%CI= [1.07,3.52]), non-injection drug use in the last 12 months (aOR= 1.84, 95%CI= [1.02,3.33]), and feeling afraid to seek health services as a result of selling sex (aOR = 1.74, 95%CI= [1.01,2.99]). Given these findings, violence prevention strategies should be prioritized in programs that address Swazi FSW health, empowerment, and safety.
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Shannon K, Crago AL, Baral SD, Bekker LG, Kerrigan D, Decker MR, Poteat T, Wirtz AL, Weir B, Boily MC, Butler J, Strathdee SA, Beyrer C. The global response and unmet actions for HIV and sex workers. Lancet 2018; 392:698-710. [PMID: 30037733 PMCID: PMC6384122 DOI: 10.1016/s0140-6736(18)31439-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/05/2023]
Abstract
Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5-11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. Although important progress has been made in biomedical interventions with pre-exposure prophylaxis and early ART feasibility and demonstration projects, limited coverage and retention suggest that sustained investment in community and structural interventions is required for sex workers to benefit from the preventive interventions and treatments that other key populations have. Evidence-based progress on full decriminalisation grounded in health and human rights-a key recommendation in our Lancet Series-has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.
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Tokar A, Broerse JEW, Blanchard J, Roura M. HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review. AIDS Behav 2018; 22:2435-2457. [PMID: 29464430 PMCID: PMC6097720 DOI: 10.1007/s10461-018-2043-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
HIV testing uptake continues to be low among Female Sex Workers (FSWs). We synthesizes evidence on barriers and facilitators to HIV testing among FSW as well as frequencies of testing, willingness to test, and return rates to collect results. We systematically searched the MEDLINE/PubMed, EMBASE, SCOPUS databases for articles published in English between January 2000 and November 2017. Out of 5036 references screened, we retained 36 papers. The two barriers to HIV testing most commonly reported were financial and time costs—including low income, transportation costs, time constraints, and formal/informal payments—as well as the stigma and discrimination ascribed to HIV positive people and sex workers. Social support facilitated testing with consistently higher uptake amongst married FSWs and women who were encouraged to test by peers and managers. The consistent finding that social support facilitated HIV testing calls for its inclusion into current HIV testing strategies addressed at FSW.
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Yi S, Tuot S, Chhoun P, Pal K, Chhim K, Ngin C, Brody C. Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study. PLoS One 2018; 13:e0198095. [PMID: 29965968 PMCID: PMC6028079 DOI: 10.1371/journal.pone.0198095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/14/2018] [Indexed: 12/05/2022] Open
Abstract
Background In Cambodian context, female entertainment workers (FEWs) are young women working at establishments such as karaoke bars, restaurants, beer gardens or massage parlors. FEWs may sell sex to male patrons and are considered a high-risk group for HIV. This study aimed to identify factors associated with recent HIV testing among FEWs in Cambodia to inform future prevention activities. Methods Data were collected in 2014 as part of the evaluation of a larger HIV prevention project. A two-stage cluster sampling method was used to select participants from Phnom Penh and Siem Reap for face-to-face interviews using a structured questionnaire. A logistic regression model was constructed to identify independent factors associated with recent HIV testing. Results Data were collected from 667 FEWs with a mean age of 25.6 (SD = 5.5). Of total, 81.7% reported ever having had an HIV test, and 52.8% had at least one test in the past six months. After adjustment for other covariates, factors independently associated with recent HIV testing included living in Phnom Penh (AOR = 2.17, 95% CI = 1.43–3.28), having received HIV education in the past six months (AOR = 3.48, 95% CI = 2.35–5.15), disagreeing with a statement that ‘I would rather not know if I have HIV’ (AOR = 2.15, 95% CI = 1.41–3.30), agreeing with a statement that ‘getting tested for HIV helps people feel better’ (AOR = 0.32, 95% CI = 0.13–0.81) and not using a condom in the last sexual intercourse with a non-commercial partner (AOR = 0.48, 95% CI = 0.26–0.88). Conclusions FEWs with greater knowledge and positive attitudes towards HIV testing got tested for HIV more frequently than those with lesser knowledge and less positive attitudes. These findings suggest that future interventions should focus on disseminating tailored health messages around testing practices as well as specific topics such as condom use with non-commercial partners.
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Sosa-Rubí SG, Salinas-Rodríguez A, Montoya-Rodríguez AA, Galárraga O. The Relationship Between Psychological Temporal Perspective and HIV/STI Risk Behaviors Among Male Sex Workers in Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1551-1563. [PMID: 29380090 PMCID: PMC5955784 DOI: 10.1007/s10508-017-1123-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
Men who have sex with men (MSM) face a disproportionate burden of HIV incidence and HIV prevalence, particularly young men who have sex with men. The aim of this article was to analyze the relation between a psychological temporal perspective and HIV/sexually transmitted infection (STI) risk behaviors among male sex workers (MSWs), a potentially highly present-oriented group of MSM. A total sample of 326 MSWs were included and responded to a validated psychological scale: the Zimbardo's Time Perspective Inventory; they also reported how frequently they engaged in protective behaviors against HIV and other STI risks behaviors, including condom use with casual and regular partners, as well as prior HIV testing. We adjusted structural equation models to analyze the relation between a psychological temporal perspective and HIV/STI risk behaviors. We found that orientation toward the past was correlated with decreased condom use with casual partners (β = - 0.18; CI95% - 0.23, - 0.12). Future orientation was not associated with condom use with casual partners. Regarding condom use with regular partners, past and present orientation were related to lower likelihood of condom use (β = - 0.23; CI95% - 0.29, - 0.17; β = - 0.11; CI95% - 0.19, - 0.02), whereas future orientation increased the likelihood of condom use with regular partners (β = 0.40; CI95% 0.31, 0.50). Time orientation (past, present, or future) did not predict the probability of having an HIV test. The design of HIV/STI prevention programs among vulnerable populations, such as MSM and MSWs, should consider specific time-frame mechanisms that can importantly affect sexual risk behavior decisions.
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Carrasco MA, Nguyen TQ, Barrington C, Perez M, Donastorg Y, Kerrigan D. HIV Stigma Mediates the Association Between Social Cohesion and Consistent Condom Use Among Female Sex Workers Living with HIV in the Dominican Republic. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1529-1539. [PMID: 29687290 DOI: 10.1007/s10508-018-1186-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
Evidence indicates that social cohesion is a successful strategy to improve consistent condom use (CCU) among female sex workers. However, the individual and layered or combined effect that various types of overlapping stigmas may have on CCU between female sex workers living with HIV and their clients and steady partners has not been analyzed. Drawing on the Abriendo Puertas cohort of female sex workers living with HIV in the Dominican Republic, we used structural equation modeling to test the hypothesis that both HIV stigma and sex work stigma mediate the association between social cohesion and CCU and that they have a layered effect. The results indicated that HIV stigma mediated the association between social cohesion and CCU with clients and partners, while sex work-related stigma did not. There was no evidence of a layered HIV stigma and sex work stigma effect, which may be due to methodological limitations to handle highly correlated latent variables. Findings highlight the need to address internalized HIV stigma within the context of community-based approaches to enhance their HIV prevention impact. This will help to reduce the risk of HIV re-infection with a new distinct HIV viral strain, STI infection, and onward HIV transmission among female sex workers living with HIV.
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Akoku DA, Tihnje MA, Vukugah TA, Tarkang EE, Mbu RE. Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon. PLoS One 2018; 13:e0198853. [PMID: 29912969 PMCID: PMC6005536 DOI: 10.1371/journal.pone.0198853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/25/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction The purpose of this study was to examine the relationship between socio-demographic characteristics, risky sexual behaviour, alcohol use and transactional sex among female bar workers in Yaounde, Cameroon. Materials and methods A cross-sectional survey was conducted among a representative sample of 410 female bar workers, recruited through a modified version of venue-based cluster sampling technique from May to June 2017. Transactional sex was defined as having received money/gifts in exchange for sex with any sexual partner in the past 12 months. Logistic regression models were performed to identify the factors associated with transactional sex. The level of statistical significance was set at p< = 0.05. Results About 14.9% (n = 61) of respondents reported to have engaged in transactional sex, 83.7% (n = 338) had multiple sexual partners at the time of the study, 14.4% (n = 55) had sex with one or more of their male customers in the past 6 months. Almost 73.4% (n = 301) reported alcohol use. Of these, 37.2% (n = 112) were frequent alcohol consumers. About 17.6% (n = 72) reported to have had unprotected sex under the influence of alcohol in the past 6 months. Multivariate logistic regression analysis showed that those who engaged in transactional sex were more likely to have had sex with a male customer in the past 6 months (aOR = 7.34; 95% CI, 3.63–16.98), had sex under the influence of alcohol in the past 6 months (aOR = 2.42; 95% CI, 1.18–4.96) and frequent alcohol consumers (aOR = 2.06; 95%CI, 1.04–4.10). Respondents who had their last sexual intercourse 4 weeks or more prior to the study (aOR = 0.26; 95% CI, 0.08–0.84) were less likely to have engaged in transactional sex. Conclusions Our study concludes that female bar workers are exposed to male customers and engage in risky sexual practices including transaction sex. Most of them also consume alcohol which increases their risk of HIV and STI acquisition. They are a high-risk group that need to be targeted with HIV prevention interventions.
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Eakle R, Mutanha N, Mbogua J, Sibanyoni M, Bourne A, Gomez G, Venter F, Rees H. Designing PrEP and early HIV treatment interventions for implementation among female sex workers in South Africa: developing and learning from a formative research process. BMJ Open 2018; 8:e019292. [PMID: 29903784 PMCID: PMC6009452 DOI: 10.1136/bmjopen-2017-019292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this research was to design relevant, tailored oral pre-exposure prophylaxis (PrEP) and early antiretroviral (ART) interventions for female sex workers (FSWs) in South Africa. This paper examines the methods, process and outcomes of employing an inductive approach to formative research exploring intervention feasibility and acceptability. SETTING Research was conducted in several sex work-related settings including five sites in and around clinics and stakeholder offices. PARTICIPANTS Participants in this research included stakeholders, experts in the field and FSWs. This included at least 25 separate engagements, 14 local organisations and 8 focus group discussions (FGDs) with 69 participants, in addition to ad hoc meetings. RESULTS The first set of outcomes consisted of five selected methods: (1) stakeholder consultations; (2) site assessments and selection; (3) field observations and mapping; (4) development of supportive structures to encourage retention and intervention adherence; (5) FGDs conducted with FSWs to explore specifics of acceptability. In terms of feasibility, two sites were selected in central Johannesburg and Pretoria out of five considered. The urban site contexts varied, necessitating adjustments to intervention implementation. There was overall support for PrEP and early ART from stakeholders and FSWs. Concerns included potential issues with adherence to PrEP (and early ART), possible reduction in condom use, resistance to antiretrovirals and burden on scarce resources. These concerns indicated where special attention should be focused on education, messaging and programming as well as development of supportive structures. CONCLUSIONS The inductive approach allowed for a wide range of perspectives, defining population needs and accessibility. This research illustrated how similar sex work environments can vary and how implementation of interventions may not be uniform across contexts. Lessons learnt in details could assist in future project designs and implementation of new interventions where feasibility, social and cultural factors affecting acceptability must be considered.
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