451
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Paz-Bailey G, Noble M, Salo K, Tregear SJ. Prevalence of HIV Among U.S. Female Sex Workers: Systematic Review and Meta-analysis. AIDS Behav 2016; 20:2318-2331. [PMID: 26914165 DOI: 10.1007/s10461-016-1332-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10 years. The pooled estimate of HIV prevalence was 17.3 % (95 % CI 13.5-21.9 %); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32 %) and statistical heterogeneity was substantial (I(2) = 0.89, Q = 123; p < 0.001). Although the variance across the 14 studies was high, prevalence was generally high (10 % or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high.
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452
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Su Y, Ding G, Reilly KH, Norris JL, Liu H, Li Z, Wang G, Fang G, Wang N. Loss to follow-up and HIV incidence in female sex workers in Kaiyuan, Yunnan Province China: a nine year longitudinal study. BMC Infect Dis 2016; 16:526. [PMID: 27686152 PMCID: PMC5041379 DOI: 10.1186/s12879-016-1854-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Longitudinal studies of female sex workers (FSWs) are vulnerable to loss to follow-up (LTFU) due to this population’s high mobility and low willingness to self-identify as FSWs. LTFU in cohort studies is a critical problem and may lead to bias in estimation of incidence and exposure-outcome associations. The aim of this study was to analyze LTFU and HIV incidence and their associated factors in a 9-year longitudinal study of FSWs in Kaiyuan, Yunnan Province, China. Methods This analysis includes all HIV-1 seronegative FSWs who were recruited into a prospective study in Kaiyuan with at least one follow-up visit after enrollment from March 2006 to November 2013. Participants were visited in 6-month intervals after enrollment. Their demographic and behavioral data and blood specimens for HIV and sexual transmitted disease testing were collected at enrollment and at each follow-up visit. The administrative censoring date was December 31, 2014. Participants were considered LTFU if their last visit occurred 1 year or more before the administrative censoring date. Univariate and multivariable Cox regression models with time-independent variables were used to investigate the hazard ratios (HR) and 95 % confidence intervals (CI) of the factors associated with LTFU and HIV acquisition. Results Of the 1158 FSWs, 950 were defined as LTFUs (LTFU rate: 29.69, 95 % CI: 27.85–31.62 per 100 person years [PYs]), and 33 experienced HIV seroconversions (cumulative incidence: 1.06, 95 % CI: 0.74–1.47 per 100 PYs). After adjustment, we found that FSWs who used drugs were less likely to be LTFU compared with non-drug users (adjust hazard ratio [AHR]= 0.62, 95 % CI: 0.51–0.76), though FSWs who used drug were associated with a higher risk of HIV acquisition (AHR = 3.06, 95 % CI: 1.49–6.30). Also, FSWs who always used condoms with clients in the previous month were associated with a higher risk of LTFU (AHR = 1.51, 95 % CI: 1.15–1.97), while they were negative associated with new HIV infection (AHR = 0.28, 95 % CI: 0.12–0.61). Conclusions A high LTFU rate exists in the Kaiyuan FSW cohort study, and LTFU did not occur at random. Participants retained in the cohort tended to be at higher risk of HIV acquisition, which may result in an overestimate of the incidence of HIV infection from the Kaiyuan FSW cohort.
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Affiliation(s)
- Yingying Su
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guowei Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kathleen H Reilly
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jessie L Norris
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huixin Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zheng Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guixiang Wang
- Kaiyuan Center for Disease Control and Prevention, Kaiyuan, China
| | - Ganggang Fang
- Kaiyuan Center for Disease Control and Prevention, Kaiyuan, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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453
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Abstract
PURPOSE OF REVIEW We explore the potential benefits of integrating preexposure prophylaxis (PrEP) into combination HIV prevention for female sex workers (FSWs) and the likely challenges to implementation. RECENT FINDINGS Evidence for the biological effectiveness of PrEP in women who can adhere to daily dosing is strong. FSWs in many countries bear the brunt of the HIV epidemic. Current combination prevention approaches enable many FSWs to remain HIV-free, but in some settings FSWs are unable to mitigate their risk. PrEP provides a new prevention tool for these women. To benefit, HIV-negative FSWs need to perceive that they are at risk, be motivated and able to take PrEP daily and to attend health services for prescription refill and clinical monitoring. FSWs face particular structural challenges to PrEP uptake and use, including stigmatizing health services; fear of disclosure to other FSWs and clients; fear of the authorities; lack of social support; substance use; unplanned travel and risk compensation many of which can be addressed through combination prevention approaches. SUMMARY For those FSWs who are unable to mitigate their HIV risk, PrEP, if adequately supported and integrated with combination prevention, may empower them to remain HIV-free.
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454
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Abstract
Worldwide, a disproportionate burden of HIV, tuberculosis, and hepatitis is present among current and former prisoners. This problem results from laws, policies, and policing practices that unjustly and discriminatorily detain individuals and fail to ensure continuity of prevention, care, and treatment upon detention, throughout imprisonment, and upon release. These government actions, and the failure to ensure humane prison conditions, constitute violations of human rights to be free of discrimination and cruel and inhuman treatment, to due process of law, and to health. Although interventions to prevent and treat HIV, tuberculosis, hepatitis, and drug dependence have proven successful in prisons and are required by international law, they commonly are not available. Prison health services are often not governed by ministries responsible for national public health programmes, and prison officials are often unwilling to implement effective prevention measures such as needle exchange, condom distribution, and opioid substitution therapy in custodial settings, often based on mistaken ideas about their incompatibility with prison security. In nearly all countries, prisoners face stigma and social marginalisation upon release and frequently are unable to access health and social support services. Reforms in criminal law, policing practices, and justice systems to reduce imprisonment, reforms in the organisation and management of prisons and their health services, and greater investment of resources are needed.
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Affiliation(s)
- Leonard S Rubenstein
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
| | - Joseph J Amon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Health and Human Rights Division, Human Rights Watch, New York, NY, USA
| | - Megan McLemore
- Health and Human Rights Division, Human Rights Watch, New York, NY, USA
| | - Patrick Eba
- UNAIDS, Geneva, Switzerland; College of Law and Management Studies, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Kate Dolan
- National Drug and Alcohol Research Centre, Sydney, NSW, Australia
| | - Rick Lines
- Harm Reduction International, London, UK
| | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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455
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Urada LA, Simmons J, Wong B, Tsuyuki K, Condino-Enrera G, Hernandez LI, Simbulan NP, Raj A. A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study. Int J Public Health 2016; 61:945-957. [PMID: 27600733 DOI: 10.1007/s00038-016-0875-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study evaluated a brief human rights-focused HIV community mobilization intervention for sex workers in the Philippines, a country with one of the fastest rising number of HIV cases worldwide. METHODS Five single-session group interventions to reduce sexual risk and increase HIV testing among 86 sex workers in Manila were evaluated with pre-post-test data via Wilcoxon's signed-ranks and Mann-Whitney tests. The 4-h intervention, Kapihan (August-November, 2013), integrated human rights with HIV skill-building. Demographic data, violence/trafficking victimization, human rights knowledge, and intentions to HIV test and treat were collected. RESULTS Participants were median aged 23; female (69 %); had children (55; 22 % had 3+ children); used drugs (past 3 months: 16 %); sexually/physically abused by clients (66 %); 20 % street sex workers ever took an HIV test. Pre-post-test scores significantly improved in knowledge of HIV (z = -8.895, p < 0.001), reproductive health (z = -3.850, p < 0.001), human rights (z = -4.391, p < 0.001), ethical rights of research participants (z = -5.081, p < 0.001), and intentions to HIV test (z = -4.868, p < 0.001). CONCLUSIONS Integrating human rights into HIV interventions may empower sex workers to address their health and human rights and test for HIV.
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Affiliation(s)
- Lianne A Urada
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA. .,College of Health and Human Services, School of Social Work, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Janie Simmons
- National Development and Research Institutes, Inc., 71 W 23rd St, New York, NY, 10010, USA
| | - Betty Wong
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Kiyomi Tsuyuki
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Gerlita Condino-Enrera
- Woodwater Center for Healing, 8 Nicanor Reyes St, Loyola Heights, Quezon City, Philippines
| | - Laufred I Hernandez
- Department of Behavioral Sciences, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Nymia Pimentel Simbulan
- College of Arts and Science and College of Public Health, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Anita Raj
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
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456
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Large Price Premiums for Unprotected Sex Among Female Sex Workers in Kenya: A Potential Challenge for Behavioral HIV Prevention Interventions. J Acquir Immune Defic Syndr 2016; 72:e20-2. [PMID: 27097367 DOI: 10.1097/qai.0000000000000929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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457
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Kerrigan D, Barrington C, Donastorg Y, Perez M, Galai N. Abriendo Puertas: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2016; 20:1919-27. [PMID: 27016102 DOI: 10.1007/s10461-016-1376-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Female sex workers (FSW) are disproportionately affected by HIV. Yet, few interventions address the needs of FSW living with HIV. We developed a multi-level intervention, Abriendo Puertas (Opening Doors), and assessed its feasibility and effectiveness among a cohort of 250 FSW living with HIV in the Dominican Republic. We conducted socio-behavioral surveys and sexually transmitted infection and viral load testing at baseline and 10-month follow-up. We assessed changes in protected sex and adherence to antiretroviral therapy (ART) with logistic regression using generalized estimating equations. Significant pre-post intervention changes were documented for adherence (72-89 %; p < 0.001) and protected sex (71-81 %; p < 0.002). Higher intervention exposure was significantly associated with changes in adherence (AOR 2.42; 95 % CI 1.23-4.51) and protected sex (AOR 1.76; 95 % CI 1.09-2.84). Illicit drug use was negatively associated with both ART adherence and protected sex. Abriendo Puertas is feasible and effective in improving behavioral HIV outcomes in FSW living with HIV.
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Affiliation(s)
- Deanna Kerrigan
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA.
| | - Clare Barrington
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Noya Galai
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA.,Department of Statistics, The University of Haifa, Mt Carmel, Israel
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458
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Krüsi A, Kerr T, Taylor C, Rhodes T, Shannon K. 'They won't change it back in their heads that we're trash': the intersection of sex work-related stigma and evolving policing strategies. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:1137-50. [PMID: 27113456 PMCID: PMC5012919 DOI: 10.1111/1467-9566.12436] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In Vancouver, Canada, there has been a continuous shift in the policing of sex work away from arresting sex workers, which led to the implementation of a policing strategy that explicitly prioritised the safety of sex workers and continued to target sex workers' clients. We conducted semi-structured interviews with 26 cisgender and five transgender women street-based sex workers about their working conditions. Data were analysed thematically and by drawing on concepts of structural stigma and vulnerability. Our results indicated that despite police rhetoric of prioritising the safety of sex workers, participants were denied their citizenship rights for police protection by virtue of their 'risky' occupation and were thus responsiblised for sex work related violence. Our findings further suggest that sex workers' interactions with neighbourhood residents were predominantly shaped by a discourse of sex workers as a 'risky' presence in the urban landscape and police took swift action in removing sex workers in the case of complaints. This study highlights that intersecting regimes of stigmatisation and criminalisation continued to undermine sex workers citizenship rights to police protection and legal recourse and perpetuated labour conditions that render sex workers at increased risk for violence and poor health.
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Affiliation(s)
- Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
- Faculty of Medicine, University of British Columbia, CANADA
| | - Tthomas Kerr
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
- Faculty of Medicine, University of British Columbia, CANADA
| | - Christina Taylor
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, CANADA
- Faculty of Medicine, University of British Columbia, CANADA
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459
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Wilson KS, Deya R, Yuhas K, Simoni J, Vander Stoep A, Shafi J, Jaoko W, Hughes JP, Richardson BA, McClelland RS. A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya. AIDS Behav 2016; 20:2054-64. [PMID: 27094785 DOI: 10.1007/s10461-016-1399-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We conducted a prospective cohort study to test the hypothesis that intimate partner violence (IPV) is associated with unprotected sex in HIV-positive female sex workers in Mombasa, Kenya. Women completed monthly visits and quarterly examinations. Any IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the current or most recent emotional partner ('index partner'). Unprotected sex with any partner was measured by self-report and prostate specific antigen (PSA) test. Recent IPV was associated with significantly higher risk of unprotected sex (adjusted relative risk [aRR] 1.91, 95 % CI 1.32, 2.78, p = 0.001) and PSA (aRR 1.54, 95 % CI 1.17, 2.04, p = 0.002) after adjusting for age, alcohol use, and sexual violence by someone besides the index partner. Addressing IPV in comprehensive HIV programs for HIV-positive women in this key population is important to improve wellbeing and reduce risk of sexual transmission of HIV.
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460
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Duff P, Goldenberg S, Deering K, Montaner J, Nguyen P, Dobrer S, Shannon K. Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics. J Acquir Immune Defic Syndr 2016; 73:83-90. [PMID: 27513573 PMCID: PMC4985019 DOI: 10.1097/qai.0000000000001022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada. METHODS Analyses drew on data (2010-2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed-effects models were used to identify longitudinal correlates of undetectable pVL (<50 copies/mL). RESULTS Of the 72 SWs living with HIV who had ever used ART, 38.9% had an undetectable pVL at baseline. Although 84.7% had undetectable pVL at least once over the study period, 18.1% exhibited sustained undetectable pVL. In multivariable generalized linear mixed-effects model analyses, ≥95% pharmacy refill adherence (adjusted odds ratio (AOR) = 4.21; 95% confidence interval (CI) 2.16 to 8.19) and length of time since diagnosis (AOR = 1.06; 95% CI: 1.00 to 1.13) were positively correlated with undetectable pVL. Having an intimate male partner (AOR = 0.35; 95% CI: 0.16 to 0.78) and being homelessness were negatively correlated with undetectable pVL (AOR = 0.22; 95% CI: 0.10 to 0.47). DISCUSSION/CONCLUSIONS There is a need to more closely consider the social and structural contexts that shape SWs' experiences on ART and impact treatment outcomes, including the gendered power dynamics within intimate partnerships. Future research on HIV care among SWs is urgently needed, alongside structural and community-led interventions to support SWs' access to and retention in care.
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Affiliation(s)
- Putu Duff
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
| | - Shira Goldenberg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, CANADA
| | - Kathleen Deering
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
| | - Sabina Dobrer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA
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461
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Tracas A, Bazzi AR, Artamonova I, Rangel MG, Staines H, Ulibarri MD. Changes in Condom Use Over Time Among Female Sex Workers and Their Male Noncommercial Partners and Clients. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:312-24. [PMID: 27427926 PMCID: PMC5356484 DOI: 10.1521/aeap.2016.28.4.312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Female sex workers (FSWs) often report inconsistent condom use with clients and noncommercial male partners, yet changes in condom use with various partner types during participation in observation studies remains underexplored. This longitudinal study of 214 FSWs and their male, noncommercial partners in the Mexico-U.S. border region, where HIV prevalence among FSWs continues to be high, utilized negative binomial regressions to examine changes in condom use with intimate partners and clients (regular and nonregular) over 24 months. Condom use decreased over time among couples in Ciudad Juarez, but there was no change in condom use among couples in Tijuana. FSWs' condom use with regular and nonregular clients significantly increased over time, which is consistent with previous research finding behavioral changes when participating in observational studies. Findings suggest the need for continued efforts to promote condom use among FSWs and their noncommercial male partners in addition to clients.
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Affiliation(s)
- Ashley Tracas
- Department of Psychology, San Diego State University, San Diego, California
| | - Angela Robertson Bazzi
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
| | - Irina Artamonova
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - M Gudelia Rangel
- Comisión de Salud Fronteriza México-Estado Unidos, Tijuana, Baja California, México
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahua, México
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, La Jolla
- California School of Professional Psychology, Alliant International University, San Diego, California
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462
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Beattie TS, Isac S, Bhattacharjee P, Javalkar P, Davey C, Raghavendra T, Nair S, Ramanaik S, Kavitha DL, Blanchard JF, Watts C, Collumbien M, Moses S, Heise L. Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India. BMC Public Health 2016; 16:660. [PMID: 27473180 PMCID: PMC4966746 DOI: 10.1186/s12889-016-3356-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are at increased risk of HIV and STIs compared to women in the general population, and frequently experience violence in their working and domestic lives from a variety of perpetrators, which can enhance this risk. While progress has been made in addressing violence by police and clients, little work has been done to understand and prevent violence by intimate partners (IPs) among FSW populations. METHODS Samvedana Plus is a multi-level intervention programme that works with FSWs, their IPs, the sex worker community, and the general population, and aims to reduce violence and increase consistent condom use within these 'intimate' relationships. The programme involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The programme will aim to cover 800 FSWs and their IPs living in 47 villages in Bagalkot district, northern Karnataka. The study is designed to assess two primary outcomes: the proportion of FSWs who report: (i) physical or sexual partner violence; and (ii) consistent condom use in their intimate relationship, within the past 6 months. The evaluation will employ a cluster-randomised controlled trial design, with 50 % of the village clusters (n = 24) randomly selected to receive the intervention for the first 24 months and the remaining 50 % (n = 23) receiving the intervention thereafter. Statisticians will be blinded to treatment arm allocation. The evaluation will use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months) and endline (24 months). The evaluation design will involve quantitative and qualitative assessments with (i) all FSWs who report an IP (ii) IPs; and process/ implementation monitoring. Baseline data collection was completed in April 2015, and endline data collection is anticipated in May 2017. CONCLUSIONS This is an innovative intervention programme that aims to address violence by IPs as part of HIV prevention programming with FSWs. Reducing violence is expected to reduce vulnerability to HIV acquisition, and help women to work and live without fear of violence. TRIAL REGISTRATION Clinical Trials NCT02807259 Jun 24 2016 (retrospectively registered).
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | - Calum Davey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Sapna Nair
- Karnataka Health Promotion Trust, Bangalore, India
| | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | | | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Lori Heise
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
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463
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Strategies for reducing police arrest in the context of an HIV prevention programme for female sex workers: evidence from structural interventions in Karnataka, South India. J Int AIDS Soc 2016; 19:20856. [PMID: 27435708 PMCID: PMC4951536 DOI: 10.7448/ias.19.4.20856] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/11/2016] [Accepted: 04/26/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Female sex workers (FSWs) frequently experience violence in their work environments, violating their basic rights and increasing their vulnerability to HIV infection. Structural interventions addressing such violence are critical components of comprehensive HIV prevention programmes. We describe structural interventions developed to address violence against FSWs in the form of police arrest, in the context of the Bill and Melinda Gates Foundation's India AIDS Initiative (Avahan) in Karnataka, South India. We examine changes in FSW arrest between two consecutive time points during the intervention and identify characteristics that may increase FSW vulnerability to arrest in Karnataka. Methods Structural interventions with police involved advocacy work with senior police officials, sensitization workshops, and integration of HIV and human rights topics in pre-service curricula. Programmes for FSWs aimed to enhance collectivization, empowerment and awareness about human rights and to introduce crisis response mechanisms. Three rounds of integrated behavioural and biological assessment surveys were conducted among FSWs from 2004 to 2011. We conducted bivariate and multivariate analyses using data from the second (R2) and third (R3) survey rounds to examine changes in arrests among FSWs over time and to assess associations between police arrest, and the sociodemographic and sex work-related characteristics of FSWs. Results Among 4110 FSWs surveyed, rates of ever being arrested by the police significantly decreased over time, from 9.9% in R2 to 6.1% in R3 (adjusted odds ratio (AOR) [95% CI]=0.63 [0.48 to 0.83]). Arrests in the preceding year significantly decreased, from 5.5% in R2 to 2.8% in R3 (AOR [95% CI]=0.59 [0.41 to 0.86]). FSWs arrested as part of arbitrary police raids also decreased from 49.6 to 19.5% (AOR [95% CI]=0.21 [0.11 to 0.42]). Certain characteristics, including financial dependency on sex work, street- or brothel-based solicitation and high client volumes, were found to significantly increase the odds of arrest for participants. Conclusion Structural interventions addressing police arrest of FSWs are feasible to implement. Based on our findings, the design of violence prevention and response interventions in Karnataka can be tailored to focus on FSWs, who are disproportionately vulnerable to arrest by police. Context-specific structural interventions can reduce police arrests, create a safer work environment for FSWs and protect fundamental human rights.
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464
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Policing practices as a structural determinant for HIV among sex workers: a systematic review of empirical findings. J Int AIDS Soc 2016; 19:20883. [PMID: 27435716 PMCID: PMC4951541 DOI: 10.7448/ias.19.4.20883] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/13/2016] [Accepted: 04/24/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Sex workers are disproportionately infected with HIV worldwide. Significant focus has been placed on understanding the structural determinants of HIV and designing related interventions. Although there is growing international evidence that policing is an important structural HIV determinant among sex workers, the evidence has not been systematically reviewed. Methods We conducted a systematic review of quantitative studies to examine the effects of policing on HIV and STI infection and HIV-related outcomes (condom use; syringe use; number of clients; HIV/STI testing and access) among cis and trans women sex workers. Databases included PubMed, Embase, Scopus, Sociological Abstracts, Popline, Global Health (OVID), Web of Science, IBSS, IndMed and WHOLIS. We searched for studies that included police practices as an exposure for HIV or STI infection or HIV-related outcomes. Results Of the 137 peer-reviewed articles identified for full text review, 14 were included, representing sex workers' experiences with police across five settings. Arrest was the most commonly explored measure with between 6 and 45% of sex workers reporting having ever been arrested. Sexual coercion was observed between 3 and 37% of the time and police extortion between 12 and 28% across studies. Half the studies used a single measure to capture police behaviours. Studies predominantly focused on “extra-legal policing practices,” with insufficient attention to the role of “legal enforcement activities”. All studies found an association between police behaviours and HIV or STI infection, or a related risk behaviour. Conclusions The review points to a small body of evidence that confirms policing practices as an important structural HIV determinant for sex workers, but studies lack generalizability with respect to identifying those police behaviours most relevant to women's HIV risk environment.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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466
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Semple SJ, Pitpitan EV, Chavarin CV, Strathdee SA, Mendoza DV, Aarons GA, Patterson TL. Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities. Glob Public Health 2016; 12:1538-1552. [PMID: 27416059 DOI: 10.1080/17441692.2016.1206603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.
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Affiliation(s)
- Shirley J Semple
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Eileen V Pitpitan
- b Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Claudia V Chavarin
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Steffanie A Strathdee
- b Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Doroteo V Mendoza
- c Evaluation and Research Department , Mexican Foundation for Family Planning (Mexfam) , Mexico City , Mexico
| | - Gregory A Aarons
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Thomas L Patterson
- a Department of Psychiatry , University of California , San Diego , CA , USA
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467
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Lim RBT, Wong ML, Cheung ONY, Tham DKT, Tai BC, Chan R. Factors associated with consistent condom use and STIs among foreign female entertainment workers: results from a cross-sectional survey in Singapore. Sex Transm Infect 2016; 93:118-124. [PMID: 27388458 DOI: 10.1136/sextrans-2015-052530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/10/2016] [Accepted: 06/18/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We assessed the prevalence of consistent condom use and laboratory-confirmed STIs among foreign female entertainment workers (FEWs) who engaged in paid or casual sex in Singapore and the factors associated with these characteristics. METHODS A cross-sectional survey, using time-location sampling, was conducted on 220 FEWs (115 Vietnamese and 105 Thai) in 2015. For multivariable analysis, we used a mixed-effects Poisson regression model with backward stepwise approach to account for clustering by venue and to obtain the adjusted prevalence ratios (aPRs) of factors associated with consistent condom use and STI positivity, respectively. RESULTS Consistent condom use with paid or casual partners in the past month was 39.6% and 36.2% for vaginal and oral sex, respectively. The prevalence of STI (cervical chlamydia, cervical gonorrhoea or pharyngeal gonorrhoea) positivity was 13.6%. In multivariable analysis, consistent condom use for both vaginal and oral sex increased with high self-perceived risk of getting STI/HIV (vaginal: aPR 2.09; 95% CI 1.26 to 3.46; oral: aPR 2.41; 95% CI 1.23 to 4.69) and condom negotiation (vaginal: aPR 3.74; 95% CI 2.07 to 6.75; oral: aPR 2.81; 95% CI 1.51 to 5.26). STI positivity decreased with consistent condom use for vaginal sex (aPR 0.22; 95% CI 0.07 to 0.75) and increased with number of sexual partners (aPR 1.43; 95% CI 1.07 to 1.92). CONCLUSION In addition to advocating for policy decisions to provide a safer work environment, behavioural interventions on condom negotiation skills and condom use and biomedical interventions on STI/HIV testing and treatment interventions are needed among the FEWs in Singapore. TRIAL REGISTRATION NUMBER NCT02780986; pre-results.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Olive N Y Cheung
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dede Kam Tyng Tham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Roy Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Sexually Transmitted Infections Control, National Skin Centre, Singapore, Singapore
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468
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Abdulhaqq SA, Zorrilla C, Kang G, Yin X, Tamayo V, Seaton KE, Joseph J, Garced S, Tomaras GD, Linn KA, Foulkes AS, Azzoni L, VerMilyea M, Coutifaris C, Kossenkov AV, Showe L, Kraiselburd EN, Li Q, Montaner LJ. HIV-1-negative female sex workers sustain high cervical IFNɛ, low immune activation, and low expression of HIV-1-required host genes. Mucosal Immunol 2016; 9:1027-38. [PMID: 26555708 PMCID: PMC4864149 DOI: 10.1038/mi.2015.116] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/30/2015] [Indexed: 02/04/2023]
Abstract
Sex workers practicing in high HIV endemic areas have been extensively targeted to test anti-HIV prophylactic strategies. We hypothesize that in women with high levels of genital exposure to semen changes in cervico-vaginal mucosal and/or systemic immune activation will contribute to a decreased susceptibility to HIV-1 infection. To address this question, we assessed sexual activity and immune activation status (in peripheral blood), as well as cellular infiltrates and gene expression in ectocervical mucosa biopsies in female sex workers (FSWs; n=50), as compared with control women (CG; n=32). FSWs had low-to-absent HIV-1-specific immune responses with significantly lower CD38 expression on circulating CD4(+) or CD8(+) T-cells (both: P<0.001) together with lower cervical gene expression of genes associated with leukocyte homing and chemotaxis. FSWs also had increased levels of interferon-ɛ (IFNɛ) gene and protein expression in the cervical epithelium together with reduced expression of genes associated with HIV-1 integration and replication. A correlative relationship between semen exposure and elevated type-1 IFN expression in FSWs was also established. Overall, our data suggest that long-term condomless sex work can result in multiple changes within the cervico-vaginal compartment that would contribute to sustaining a lower susceptibility for HIV-1 infection in the absence of HIV-specific responses.
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Affiliation(s)
| | - Carmen Zorrilla
- Maternal-Infant Study Center (CEMI), University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00963
| | - Guobin Kang
- University of Nebraska, School of Biological Sciences and Nebraska Center for Virology, Lincoln, NE 68583
| | | | - Vivian Tamayo
- Maternal-Infant Study Center (CEMI), University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00963
| | - Kelly E. Seaton
- Duke Human Vaccine Institute, Duke University, Durham, NC 27710
| | | | - Sheyla Garced
- Maternal-Infant Study Center (CEMI), University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00963
| | | | - Kristin A. Linn
- Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia, PA 19104
| | - Andrea S. Foulkes
- University of Massachusetts, Division of Biostatistics and Epidemiology, Amherst, MA 01003
| | | | | | | | | | | | | | - Qingsheng Li
- University of Nebraska, School of Biological Sciences and Nebraska Center for Virology, Lincoln, NE 68583
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469
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Izulla P, McKinnon LR, Munyao J, Ireri N, Nagelkerke N, Gakii G, Gelmon L, Nangami M, Kaul R, Kimani J. Repeat Use of Post-exposure Prophylaxis for HIV Among Nairobi-Based Female Sex Workers Following Sexual Exposure. AIDS Behav 2016; 20:1549-55. [PMID: 25969181 DOI: 10.1007/s10461-015-1091-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As ART-based prevention becomes available, effectively targeting these interventions to key populations such as female sex workers (FSW) will be critical. In this study we analyze patterns of repeated post-exposure prophylaxis (PEP) access in the context of a large FSW program in Nairobi. During close to 6000 person-years of follow-up, 20 % of participants (n = 1119) requested PEP at least once and 3.7 % requested PEP more than once. Repeat PEP users were younger, had a higher casual partner volume, and were more likely to use condoms with casual and regular partners, have a regular partner, and test for HIV prior to enrolment. Barriers to PEP included stigma, side effects, and lack of knowledge, suggesting repeated promotion may be required for higher rates of uptake. A small subset of FSW, potentially those with heightened risk perception, showed a higher frequency of PEP use; these individuals may be most amenable to rollout of pre-exposure prophylaxis.
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470
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Montain J, Ti L, Hayashi K, Nguyen P, Wood E, Kerr T. Impact of length of injecting career on HIV incidence among people who inject drugs. Addict Behav 2016; 58:90-4. [PMID: 26921723 DOI: 10.1016/j.addbeh.2016.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 11/30/2015] [Accepted: 02/14/2016] [Indexed: 02/01/2023]
Abstract
We examined the relationship between duration of injecting career and HIV seroconversion among people who inject drugs (PWID) in Vancouver, Canada. Data were derived from HIV-negative PWID enrolled in a prospective cohort study. We employed Kaplan-Meier methods and Cox regression to investigate the effect of length of time since injection drug use initiation on time to HIV seroconversion. In multivariable Cox analysis, duration of injecting career was negatively associated with time to HIV seroconversion (adjusted hazard ratio=0.82; 95% confidence interval [CI]: 0.69-0.97). Our findings highlight the need for interventions that target individuals who participate in high-risk drug use behaviors.
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471
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Argento E, Taylor M, Jollimore J, Taylor C, Jennex J, Krusi A, Shannon K. The Loss of Boystown and Transition to Online Sex Work: Strategies and Barriers to Increase Safety Among Men Sex Workers and Clients of Men. Am J Mens Health 2016; 12:1994-2005. [PMID: 27352925 DOI: 10.1177/1557988316655785] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Men sex workers in Vancouver have largely transitioned from street to online solicitation coinciding with losing "Boystown," the main outdoor sex work stroll for men. This article explores strategies and barriers to increase safety among men and trans sex workers and clients of men in Vancouver, Canada. Qualitative interviews were conducted (2012-2013) with 61 self-identifed men who currently buy and/or sell sex in a community-based research project known as CHAPS (Community Health Assessment of Men Who Purchase and Sell Sex). Drawing on a socioecological framework, thematic analysis of interview transcripts was conducted utilizing ATLAS.ti 7 software among men (39 workers; 8 buyers). Narratives indicate that gentrification and urban planning led to social isolation and loss of social support networks among men in the sex industry. Concurrently, the restructuring of sex work to online increased workers' safety and control. Narratives reveal how the Internet can provide greater opportunities to negotiate terms of sex work and enhanced screening using webcams, reducing risks of violence, stigma, and police harassment for both workers and clients compared with the street. This study highlights how losing Boystown led to a loss of community and solidarity: key protective measures for sex workers. Online solicitation increased workers' capacity to screen prospective clients and prevent violence. Recent legal reforms in Canada to further criminalize sex work raise significant concern for human rights and health of individuals in the sex industry, and point to the critical need to include voices of men and trans sex workers and buyers in policy discussions.
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Affiliation(s)
- Elena Argento
- 1 Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,2 University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Taylor
- 3 HUSTLE, Health Initiative for Men, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- 3 HUSTLE, Health Initiative for Men, Vancouver, British Columbia, Canada
| | - Chrissy Taylor
- 1 Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - James Jennex
- 3 HUSTLE, Health Initiative for Men, Vancouver, British Columbia, Canada
| | - Andrea Krusi
- 1 Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,2 University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- 1 Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,2 University of British Columbia, Vancouver, British Columbia, Canada
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472
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Mishra S, Boily MC, Schwartz S, Beyrer C, Blanchard JF, Moses S, Castor D, Phaswana-Mafuya N, Vickerman P, Drame F, Alary M, Baral SD. Data and methods to characterize the role of sex work and to inform sex work programs in generalized HIV epidemics: evidence to challenge assumptions. Ann Epidemiol 2016; 26:557-569. [PMID: 27421700 DOI: 10.1016/j.annepidem.2016.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/06/2016] [Accepted: 06/03/2016] [Indexed: 01/15/2023]
Abstract
In the context of generalized human immunodeficiency virus (HIV) epidemics, there has been limited recent investment in HIV surveillance and prevention programming for key populations including female sex workers. Often implicit in the decision to limit investment in these epidemic settings are assumptions including that commercial sex is not significant to the sustained transmission of HIV, and HIV interventions designed to reach "all segments of society" will reach female sex workers and clients. Emerging empiric and model-based evidence is challenging these assumptions. This article highlights the frameworks and estimates used to characterize the role of sex work in HIV epidemics as well as the relevant empiric data landscape on sex work in generalized HIV epidemics and their strengths and limitations. Traditional approaches to estimate the contribution of sex work to HIV epidemics do not capture the potential for upstream and downstream sexual and vertical HIV transmission. Emerging approaches such as the transmission population attributable fraction from dynamic mathematical models can address this gap. To move forward, the HIV scientific community must begin by replacing assumptions about the epidemiology of generalized HIV epidemics with data and more appropriate methods of estimating the contribution of unprotected sex in the context of sex work.
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Affiliation(s)
- Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Sheree Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Delivette Castor
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC
| | - Nancy Phaswana-Mafuya
- HIV/AIDS, STI, and Tuberculosis Department, Human Sciences Research Council, Port Elizabeth, South Africa
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Fatou Drame
- Department of Geography, Université Gaston-Berger, St. Louis, Senegal
| | - Michel Alary
- Département de médecine sociale et préventive, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
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473
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Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers. Int J Infect Dis 2016; 49:100-6. [PMID: 27312580 DOI: 10.1016/j.ijid.2016.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Sex workers face stigma, discrimination, and violence across the globe and are almost 14 times more likely to be HIV-infected than other women in low- and middle-income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions to be sustainable, it is important to understand micro-level social and structural factors that influence sexual behaviours of sex workers. This study assessed the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers (FSWs) in Nepal. METHODS This quantitative study included 610 FSWs who were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai Highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioural information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills), and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex. RESULTS The HIV prevalence was 1%; this is presumably representative, with a large sample of FSWs in Nepal. The prevalence of unprotected sex with clients was high (24%). For each additional adverse physical, social, and economic condition, the probability of non-use of condoms with clients increased substantially: one problem = 12% (p<0.005), two problems = 19% (p<0.001), and three to five problems = 38% (p<0.001). CONCLUSIONS Interactions between two or more adverse conditions linked to physical, social, and economic environments increased the risk of unprotected sex among Nepalese FSWs.
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474
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Shrestha R, Karki P, Copenhaver M. The Use of Female Sex Workers Among Men in Nepal: Prevalence, STIs/HIV-Related Risk Behaviors, and Gender Ideology. ACTA ACUST UNITED AC 2016; 6:11-17. [PMID: 27358577 PMCID: PMC4922505 DOI: 10.4137/ppri.s39664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heterosexual sex involving female sex workers (FSWs) is widely documented for its role in facilitating the spread of sexually transmitted infections (STIs)/HIV. Critical to such studies, and increasingly considered essential to HIV prevention efforts, is the gender constructs and power dynamics within relationships. However, little efforts have been made, which focus on male clients of FSWs, particularly on the relationship between gender ideologies and men’s sexual contact with FSWs, within the Nepali context. The present study aims to fill this critical gap by assessing the prevalence of use of FSWs and its association with STIs/HIV-related risk behaviors and gender ideologies among Nepali men. We used data from the nationally representative Nepal Demographic Health Survey (NDHS) 2011. For the purpose of analyses, we included a sample of 4,121 men, aged 15–49 years. During data analyses, we used multivariate logistic regression models, adjusted for the following variables: age, region, residence, religion, educational level, wealth index, employment status, and cigarette smoking status. Of the total sample, approximately 5% reported the use of FSWs in their lifetime. In regression models, men who had sex with FSWs were more likely to report a history of STIs [adjusted odds ratio (aOR): 3.03; 95% confidence interval (CI): 1.69–5.43; P < 0.001], not using condom all the time (aOR: 1.31; 95% CI: 1.05–2.12; P = 0.010), more than one sexual partner (aOR: 3.75; 95% CI: 2.18–5.23; P < 0.001), and have had early sexual debut (aOR: 2.60; 95% CI: 1.85–3.67; P < 0.001). Respondents reporting the endorsement of violence against wives (aOR: 1.65; 95% CI: 1.01–2.84; P = 0.04) and male sexual entitlement (aOR: 1.63; 95% CI: 1.21–2.32; P = 0.001) were significantly more likely to report sexual contact with FSWs. Our findings highlight the need to develop and implement specifically tailored interventions toward male clients of FSWs, with a particular emphasis on promoting equitable gender roles and beliefs.
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Affiliation(s)
- Roman Shrestha
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Pramila Karki
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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475
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Decker MR, Lyons C, Billong SC, Njindam IM, Grosso A, Nunez GT, Tumasang F, LeBreton M, Tamoufe U, Baral S. Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice. Sex Transm Infect 2016; 92:599-604. [PMID: 27280972 DOI: 10.1136/sextrans-2015-052463] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/06/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon. METHODS FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models. RESULTS Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78). DISCUSSION Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie Lyons
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Serge Clotaire Billong
- Comité national de lutte contre le sida (CNLS), Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon
| | - Iliassou Mfochive Njindam
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashley Grosso
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gnilane Turpin Nunez
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Florence Tumasang
- PEPFAR DSF Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon
| | | | | | - Stefan Baral
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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476
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Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions. AIDS Behav 2016; 20:1275-83. [PMID: 26499335 DOI: 10.1007/s10461-015-1230-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010-2013). Lippman and colleagues' Social Cohesion Scale measured SWs' connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20-29, range 4-45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95-0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.
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477
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Parker R, Aggleton P, Perez-Brumer AG. The trouble with 'Categories': Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion. Glob Public Health 2016; 11:819-23. [PMID: 27193965 DOI: 10.1080/17441692.2016.1185138] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This double Special Issue of Global Public Health presents a collection of articles that seek more adequately to represent sexual and gender diversities and to begin to rethink the relationship to HIV prevention and health promotion - in both the resource rich nations of the global North, as well as in the more resource constrained nations of the global South. Reckoning with the reality that today the global response to HIV has failed to respond to the needs of gay, bisexual and other men who have sex with men, and transgender persons, we turn our attention to processes and practices of categorisation and classification, and the entanglement of the multiple social worlds that constitute our understanding of each of these categories and people within the categories. Jointly, these articles provide critical perspectives on how defining and redefining categories may impact the conceptual frameworks and empirical evidence that inform global understandings of HIV infection, those communities most vulnerable, and our collective response to the evolving HIV epidemic.
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Affiliation(s)
- Richard Parker
- a Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA.,b ABIA (Brazilian Interdisciplinary AIDS Association) , Rio de Janeiro , Brazil
| | - Peter Aggleton
- c Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Amaya G Perez-Brumer
- a Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA
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478
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Legendre-Dugal M, Bradley J, Rajaram SP, Lowndes CM, Ramesh BM, Washington R, Moses S, Blanchard J, Alary M. Association between treatment for gonorrhoea and chlamydia and lower condom use in a cross-sectional study of female sex workers in southern India. BMJ Open 2016; 6:e009774. [PMID: 27194314 PMCID: PMC4874098 DOI: 10.1136/bmjopen-2015-009774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess whether having received grey packets containing treatment for gonorrhoea and chlamydia was associated with condom use among female sex workers (FSWs) in 5 districts of southern India covered by the Avahan programme where both periodic presumptive treatment (PPT) and syndromic management were used to control these sexually transmitted infections (STIs) among FSWs. SETTING Cross-sectional study of FSWs recruited in the field in 5 districts of southern India (Bangalore, Belgaum, Bellary, Guntur and Mumbai) in 2006-2007. PARTICIPANTS 1378 self-identified FSWs out of 1442 were approached to participate in the study (participation rate: 95.6%). The only exclusion criterion was to be aged <18 years. PRIMARY AND SECONDARY OUTCOME MEASURES Consistent condom use (CCU) with new or occasional clients, and with the most recent repeat client as assessed using a questionnaire administered through face-to-face interviews. RESULTS Using the Poisson regression to model the association between the number of grey packets received in the past 3-12 months and reported CCU, adjusting for factors associated with condom use and other potential confounders in our data, CCU was lowest among FSWs who had received ≥3 grey packets in the past 3-12 months with their new or occasional clients (adjusted prevalence ratio (APR): 0.70, 95% CI 0.57 to 0.84, p<0.001) and with the most recent repeat client (APR 0.63, 95% CI 0.51 to 0.78, p<0.001). Tests for trends showed that CCU with both types of clients decreased with the number of grey packets received (p<0.001). CONCLUSIONS Since we could not distinguish grey packets used for PPT from those given for syndromic management, these results could be either due to a perception of protection conferred by PPT or by the fact that inconsistent condom users are more at risk for STIs. Further research on the potential disinhibiting effect of PPT is warranted.
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Affiliation(s)
- Marianne Legendre-Dugal
- Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Janet Bradley
- Centre de recherche du CHU de Québec, Québec, Canada
- CHARME-Project, Bangalore, Karnataka, India
| | - Subramanian Potty Rajaram
- CHARME-Project, Bangalore, Karnataka, India
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | | | | | - Reynold Washington
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
- St. John's Research Institute, Bangalore, Karnataka, India
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michel Alary
- Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
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479
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Structural determinants of inconsistent condom use with clients among migrant sex workers: findings of longitudinal research in an urban canadian setting. Sex Transm Dis 2016; 42:312-6. [PMID: 25970307 DOI: 10.1097/olq.0000000000000276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migrant women in sex work experience unique risks and protective factors related to their sexual health. Given the dearth of knowledge in high-income countries, we explored factors associated with inconsistent condom use by clients among migrant female sex workers over time in Vancouver, BC. METHODS Questionnaire and HIV/sexually transmitted infection testing data from a longitudinal cohort, An Evaluation of Sex Workers Health Access, were collected from 2010 to 2013. Logistic regression using generalized estimating equations was used to model correlates of inconsistent condom use by clients among international migrant sex workers over a 3-year study period. RESULTS Of 685 participants, analyses were restricted to 182 (27%) international migrants who primarily originated from China. In multivariate generalized estimating equations analyses, difficulty accessing condoms (adjusted odds ratio [AOR], 3.76; 95% confidence interval [CI], 1.13-12.47) independently correlated with increased odds of inconsistent condom use by clients. Servicing clients in indoor sex work establishments (e.g., massage parlors) (AOR, 0.34; 95% CI, 0.15-0.77), and high school attainment (AOR, 0.22; 95% CI, 0.09-0.50) had independent protective effects on the odds of inconsistent condom use by clients. CONCLUSIONS Findings of this longitudinal study highlight the persistent challenges faced by migrant sex workers in terms of accessing and using condoms. Migrant sex workers who experienced difficulty in accessing condoms were more than 3 times as likely to report inconsistent condom use by clients. Laws, policies, and programs promoting access to safer, decriminalized indoor work environments remain urgently needed to promote health, safety, and human rights for migrant workers in the sex industry.
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480
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Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada. PLoS One 2016; 11:e0155828. [PMID: 27182736 PMCID: PMC4868318 DOI: 10.1371/journal.pone.0155828] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
Background Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC), sex workers’ experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC. Methods Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers’ Health Access). Multivariable logistic regression analyses, using generalized estimating equations (GEE), were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013). Results In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4%) women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%), limited hours of operation (36.5%), and perceived disrespect by health care providers (26.1%). In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10–1.94), workplace- (AOR = 1.31, 95% CI 1.05–1.63), and community-level violence (AOR = 1.41, 95% CI 1.04–1.92), as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03–1.69), a mental illness diagnosis (AOR = 1.66, 95% CI 1.34–2.06), and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59–7.57) emerged as independent correlates of institutional barriers to health services. Discussion Despite Canada’s UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex workers’ health and human rights.
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481
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Perez-Brumer AG, Oldenburg CE, Reisner SL, Clark JL, Parker RG. Towards 'reflexive epidemiology': Conflation of cisgender male and transgender women sex workers and implications for global understandings of HIV prevalence. Glob Public Health 2016; 11:849-65. [PMID: 27173599 DOI: 10.1080/17441692.2016.1181193] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The HIV epidemic has had a widespread impact on global scientific and cultural discourses related to gender, sexuality, and identity. 'Male sex workers' have been identified as a 'key population' in the global HIV epidemic; however, there are methodological and conceptual challenges for defining inclusion and exclusion of transgender women within this group. To assess these potential implications, this study employs self-critique and reflection to grapple with the empiric and conceptual implications of shifting understandings of sexuality and gender within the externally re-created etic category of 'MSM' and 'transgender women' in epidemiologic HIV research. We conducted a sensitivity analysis of our previously published meta-analysis which aimed to identify the scope of peer-reviewed articles assessing HIV prevalence among male sex workers globally between 2004 and 2013. The inclusion of four studies previously excluded due to non-differentiation of cisgender male from transgender women participants (studies from Spain, Thailand, India, and Brazil: 421 total participants) increased the overall estimate of global HIV prevalence among 'men' who engage in sex work from 10.5% (95% CI 9.4-11.5%) to 10.8% (95% CI 9.8-11.8%). The combination of social science critique with empiric epidemiologic analysis represents a first step in defining and operationalising 'reflexive epidemiology'. Grounded in the context of sex work and HIV prevention, this paper highlights the multiplicity of genders and sexualities across a range of social and cultural settings, limitations of existing categories (i.e. 'MSM', 'transgender'), and their global implications for epidemiologic estimates of HIV prevalence.
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Affiliation(s)
- Amaya G Perez-Brumer
- a Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA
| | - Catherine E Oldenburg
- b Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Sari L Reisner
- b Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Division of General Pediatrics , Boston Children's Hospital/Harvard Medical School , Boston , MA , USA.,d The Fenway Institute, Fenway Community Health , Boston , MA , USA
| | - Jesse L Clark
- e Department of Medicine , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Richard G Parker
- a Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA.,f ABIA (Brazilian Interdisciplinary AIDS Association) , Rio de Janeiro , Brazil
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482
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Goldenberg SM, Brouwer KC, Jimenez TR, Miranda SM, Mindt MR. Enhancing the Ethical Conduct of HIV Research with Migrant Sex Workers: Human Rights, Policy, and Social Contextual Influences. PLoS One 2016; 11:e0155048. [PMID: 27159157 PMCID: PMC4861265 DOI: 10.1371/journal.pone.0155048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Migrant sex workers are often highly marginalized and disproportionately experience health and social inequities, including high prevalence of HIV, sexually transmitted infections, and human rights violations. In recent years, research involving migrant sex workers has increased, yet many knowledge gaps remain regarding how best to protect research participant rights and welfare. Our objective was to identify key challenges and opportunities related to the responsible conduct of HIV research with migrant sex workers. METHODS Focus groups and interviews conducted with 33 female sex workers ≥18 years old at the Guatemala-Mexico border from June 2013-February 2014 were analyzed. Participants were recruited through community outreach by a local HIV prevention organization to sex work establishments such as bars, hotels, street corners, and truck stops. RESULTS Key themes influencing research engagement for migrant sex workers included researcher mistrust and fear related to research participation, rooted in the social isolation frequently faced by recent migrants; intersecting concerns related to immigration status, fear of criminalization, and compliance with sex work regulations; and perceived benefits and risks of HIV/STI testing for migrants (e.g., immigration implications, stigma) represent potential barriers and opportunities for the responsible conduct of research involving migrant sex workers. CONCLUSIONS Results highlight the intersection between the human rights vulnerabilities of migrant sex workers and barriers to research participation, including social isolation of migrants and policy/legal barriers related to immigration and sex work. Findings illustrate the need for researchers to develop population-tailored procedures to address fears related to immigration and criminalization, and to reinforce positive and non-stigmatizing relationships with migrant sex workers. Community-led efforts to reduce stigma and foster community organization and supports for migrant sex workers are recommended, as are broader policy shifts that move away from punitive legal approaches towards approaches that safeguard and prioritize the human rights of migrant sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, 608–1081 Burrard Street (St. Paul's Hospital), Vancouver, BC, V6Z 1Y6, Canada
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | - Teresita Rocha Jimenez
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | | | - Monica Rivera Mindt
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
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483
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Smith LR, Patterson TL, Magis-Rodriguez C, Ojeda VD, Burgos JL, Rojas SA, Zúñiga ML, Strathdee SA. Engagement in the HIV Care Continuum among Key Populations in Tijuana, Mexico. AIDS Behav 2016; 20:1017-25. [PMID: 26354518 DOI: 10.1007/s10461-015-1186-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In Tijuana, Mexico, HIV is concentrated in sub-epidemics of key populations: persons who inject drugs (PWID), sex workers (SW), and men who have sex with men (MSM). To date, data on engagement in the HIV care continuum among these key populations, particularly in resource-constrained settings, are sparse. We pooled available epidemiological data from six studies (N = 3368) to examine HIV testing and treatment uptake in these key populations; finding an overall HIV prevalence of 5.7 %. Of the 191 identified HIV-positive persons, only 11.5 % knew their HIV-positive status and 3.7 % were on ART. Observed differences between these HIV-positive key populations suggest PWID (vs. non-PWID) were least likely to have previously tested or initiate HIV care. MSM (vs. non-MSM) were more likely to have previously tested but not more likely to know their HIV-positive status. Of persons aware of their HIV-positive status, SW (vs. non-SW) were more likely to initiate HIV care. Findings suggest engagement of key populations in HIV treatment is far below estimates observed for similarly resource-constrained generalized epidemics in sub-Saharan Africa. These data provide one of the first empirical-snapshots highlighting the extent of HIV treatment disparities in key populations.
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484
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Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada. AIDS Behav 2016; 20:977-86. [PMID: 26148850 DOI: 10.1007/s10461-015-1102-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010-2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among HIV seropositive participants (n = 74). Over a 2.5-year period, 37.8 % of participants experienced gaps in ART use (i.e., no ART dispensed in a 6-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting.
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485
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Thirumurthy H, Masters SH, Mavedzenge SN, Maman S, Omanga E, Agot K. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV 2016; 3:e266-74. [PMID: 27240789 DOI: 10.1016/s2352-3018(16)00041-2] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple self-tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. METHODS In this cohort study, HIV-negative women aged 18-39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV tests. Participants enrolled at the health facility received three self-tests and those at the drop-in centre received five self-tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how self-tests were used. Outcomes included the number of self-tests distributed by participants, the proportion of participants whose sexual partners used a self-test, couples testing, and sexual behaviour after self-testing. FINDINGS Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed self-tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one self-test to commercial sex clients. Among self-tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among tests received by primary and non-primary sexual partners, two (4%) of 53 tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p<0·0001); condoms were used in all eight intercourse events after positive results compared with 104 (44%) after of negative results (p<0·0018). Four participants reported intimate partner violence as a result of self-test distribution: two in the post-partum care group and two female sex workers. No other adverse events were reported. INTERPRETATION Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programmes. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Harsha Thirumurthy
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Samuel H Masters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eunice Omanga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
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486
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Draughon Moret JE, Carrico AW, Evans JL, Stein ES, Couture MC, Maher L, Page K. The impact of violence on sex risk and drug use behaviors among women engaged in sex work in Phnom Penh, Cambodia. Drug Alcohol Depend 2016; 161:171-7. [PMID: 26883684 PMCID: PMC4792670 DOI: 10.1016/j.drugalcdep.2016.01.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/15/2016] [Accepted: 01/30/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Violence, substance use, and HIV disproportionately impact female entertainment and sex workers (FESW), but causal pathways remain unclear. METHODS We examined data from an observational cohort of FESW age 15-29 in Phnom Penh, Cambodia for associations between violence exposure and sexual risk and drug use. Validated measures of physical and sexual violence were assessed at baseline. Self-reported outcomes measured quarterly over the next 12-months included past month sexual partners, consistent condom use by partner type, sex while high, and amphetamine type stimulant (ATS) use. Biomarkers measured quarterly included prostate specific antigen (PSA) and urine toxicology. Generalized estimating equations were fit adjusting for age, education, marital status and sex work venue. RESULTS Of 220 women, 48% reported physical or sexual violence in the preceding 12-months. Physical violence was associated with increased number of sex partners (adjusted incidence rate ratio [aIRR] 1.33; 95% CI: 1.04-1.71), greater odds of sex while high (adjusted odds ratio [aOR] 2.42; 95% CI: 1.10-5.33), increased days of ATS use (aIRR 2.74; 95% CI: 1.29-5.84) and increased odds of an ATS+ urine screen (aOR 2.80, 95%CI: 1.38-5.66). Sexual violence predicted decreased odds of consistent condom use with non-paying partners (aOR 0.24; 95% CI: 0.10-0.59) and greater odds of a PSA+ vaginal swab (aOR 1.83; 95% CI: 1.13-2.93). CONCLUSIONS Physical and sexual violence are prevalent among Cambodian FESW and associated with subsequent sexual risk and drug use behaviors. Clinical research examining interventions targeting structural and interpersonal factors impacting violence is needed to optimize HIV/AIDS prevention among FESW.
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Affiliation(s)
- Jessica E Draughon Moret
- The Betty Irene Moore School of Nursing at UC Davis, 4610 X Street, #4202 Sacramento, CA 95817, United States.
| | - Adam W Carrico
- University of California San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143, United States.
| | - Jennifer L Evans
- UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.
| | - Ellen S Stein
- UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.
| | - Marie-Claude Couture
- University of San Francisco, School of Nursing and Health Professions, Department of Population Sciences, 2130 Fulton St., San Francisco, CA 94117, United States.
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, UNSW Australia, Sydney, NSW 2052, Australia.
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States.
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487
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Kohler PK, Campos PE, Garcia PJ, Carcamo CP, Buendia C, Hughes JP, Mejia C, Garnett GP, Holmes KK. Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru. Int J STD AIDS 2016; 27:402-10. [PMID: 25941053 PMCID: PMC4742423 DOI: 10.1177/0956462415584488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.
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Affiliation(s)
- Pamela K Kohler
- Departments of Global Health, Psychosocial & Community Health, University of Washington, Seattle, WA, USA
| | | | - Patricia J Garcia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Clara Buendia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Carolina Mejia
- Department of Health Services, University of Washington, Seattle, USA
| | - Geoff P Garnett
- HIV/AIDS and TB, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - King K Holmes
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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488
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Štulhofer A, Sinković M, Božić J, Baćak V. Victimization and HIV Risks Among Croatian Female Sex Workers: Exploring the Mediation Role of Depressiveness and the Moderation Role of Social Support. Violence Against Women 2016; 23:67-88. [PMID: 27020378 DOI: 10.1177/1077801216636241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess the association between victimization and HIV vulnerability among Croatian female sex workers (FSWs), a survey involving 157 FSWs recruited from Croatia's two largest urban areas was conducted in 2014. A majority of participants reported direct and indirect victimization, which was found to be significantly associated with condom use at most recent noncommercial sexual intercourse and sexually transmitted infection (STI) diagnosis in the past 12 months. The association between victimization and STI diagnosis was partially mediated by depressiveness and moderated by social support. The buffering role of social support points to the importance of including counseling services in HIV prevention programs in Croatia.
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489
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Oldenburg CE, Perez-Brumer AG, Reisner SL, Mayer KH, Mimiaga MJ, Hatzenbuehler ML, Bärnighausen T. Human rights protections and HIV prevalence among MSM who sell sex: Cross-country comparisons from a systematic review and meta-analysis. Glob Public Health 2016; 13:414-425. [PMID: 26979302 DOI: 10.1080/17441692.2016.1149598] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Laws and policies can affect the HIV risk of key populations through a number of direct and indirect pathways. We investigated the association between HIV prevalence among men who engage in transactional sex and language in the penal code protecting sexual minorities, including men who have sex with men (MSM), and sex workers. HIV prevalence among men who engage in transactional sex was assessed through meta-analysis of published literature and country surveillance reports. Meta-regression was used to determine the association between HIV prevalence and protective laws for sexual minorities and sex workers. Sixty-six reports representing 28 countries and 31,924 individuals were included in the meta-analysis. Controlling for multiple study- and country-level variables, legal protection for sexual minorities was associated with a 10.9% (95% CI: 3.8-18.0%) and sex workers associated with a 7.0% (95% CI: 1.3-12.8%) decrease in country-level HIV prevalence among men who engage in transactional sex. Laws that seek to actively protect sex workers and MSM may be necessary to decrease HIV risk for this key population.
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Affiliation(s)
- Catherine E Oldenburg
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Amaya G Perez-Brumer
- b Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA
| | - Sari L Reisner
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c The Fenway Institute, Fenway Community Health , Boston , MA , USA
| | - Kenneth H Mayer
- c The Fenway Institute, Fenway Community Health , Boston , MA , USA.,d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,e Department of Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Matthew J Mimiaga
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,e Department of Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA.,f Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - Mark L Hatzenbuehler
- b Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA
| | - Till Bärnighausen
- d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,g Wellcome Trust Africa Centre for Health and Population Studies , Mtubatuba , South Africa
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490
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Prakash R, Manthri S, Tayyaba S, Joy A, Raj SS, Singh D, Agarwal A. Effect of Physical Violence on Sexually Transmitted Infections and Treatment Seeking Behaviour among Female Sex Workers in Thane District, Maharashtra, India. PLoS One 2016; 11:e0150347. [PMID: 26933884 PMCID: PMC4774990 DOI: 10.1371/journal.pone.0150347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Violence against sex workers can heighten their vulnerability to HIV and other sexually transmitted infections (STIs). Evidence suggests the risk of acquiring STI/HIV infections among female sex workers (FSWs) who have experienced violence to be almost three-times higher than FSWs, who have not experienced violence. Moreover, an experience of physical and sexual violence makes it difficult for them to negotiate safer sex with their partners and often act as a barrier to utilization of prevention services. METHODS This study utilizes data from 2785 FSWs aged 18 years and above who participated in a cross-sectional behavioural study conducted during 2013-14 in Thane district, Maharashtra. A probability-based two-stage cluster sampling method was used for data collection. This study assesses the effect of physical violence on self-reported STI symptoms (any STI and multiple STIs) and treatment seeking for the last STI symptom using propensity score matching method. RESULTS About 18% of sampled FSWs reported physical violence at the time of the survey. The likelihood of experiencing such violence was significantly higher among FSWs who solicited clients at public places, engaged in other economic activities apart from sex work, had savings, and reported high client volume per week. FSWs experiencing violence were also inconsistent condom users while engaging in sex with regular partners and clients. The average adjusted effect of violence clearly depicted an increase in the risk of any STI (11%, p<0.05) and multiple STIs (8%, p<0.10) and reduction in treatment seeking (10%, p<0.05). CONCLUSIONS This study demonstrates a significant effect of physical violence on reporting of any STI symptom and treatment seeking. Findings call for the immediate inclusion of strategies aimed to address violence related challenges in HIV prevention program currently being provided at Thane district. Such strategies would further help in enhancing the access to tailored STI prevention and care services among FSWs in the district.
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Affiliation(s)
- Ravi Prakash
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
- * E-mail: ;
| | - Suneedh Manthri
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Shaikh Tayyaba
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Anna Joy
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Sunil Saksena Raj
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Devender Singh
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Ashok Agarwal
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
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491
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Levi-Minzi MA, Surratt HL, O'Grady CL, Kurtz SP. Finding what works: Predicting health or social service linkage in drug using, African American, female sex workers in Miami, FL. Health Care Women Int 2016; 37:744-59. [PMID: 26933839 DOI: 10.1080/07399332.2016.1158262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Female sex workers (FSWs) encounter numerous challenges in accessing health and social services. In this study of drug using, African American FSWs, the authors examine specific factors associated with health or social service linkage among participants in a randomized intervention trial. Respondent linkage was significantly associated with individual factors (living alone, severe internal mental distress, and traumatic victimization) and project-related variables (attending five case management sessions and client engagement rating). In the multivariate model, higher client engagement and session attendance remained significant. The researchers conclude by discussing the importance of intervention attendance and engagement as key contributors to health and social service linkage among FSWs.
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Affiliation(s)
- Maria A Levi-Minzi
- a Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University , Miami , Florida , USA
| | - Hilary L Surratt
- a Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University , Miami , Florida , USA
| | - Catherine L O'Grady
- a Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University , Miami , Florida , USA
| | - Steven P Kurtz
- a Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University , Miami , Florida , USA
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492
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Abstract
OBJECTIVE Although the global burden of HIV infection among sex workers (SW) has been well recognized, HIV-related risks among sex workers who inject drugs (SW-IDU) have received less attention. We investigated the relationship between sex work and HIV incidence among people who inject drugs (IDU) in a Canadian setting. DESIGN Prospective cohort study. METHODS Using Kaplan-Meier methods and the extended Cox regression, we compared HIV incidence among SW-IDU and non-SW-IDU in Vancouver, Canada, after adjusting for potential confounders. RESULTS Between 1996 and 2012, 1647 participants were included in the study, including 512 (31.1%) IDU engaged in sex work. At 5 years the HIV cumulative incidence was higher among SW-IDU in comparison to other IDU (12 vs. 7%, P = 0.001). In unadjusted Cox regression analyses, HIV incidence among SW-IDU was also elevated [relative hazard: 1.69; 95% confidence interval (CI): 1.13-2.53]. However, in a multivariable analysis, sex work did not remain associated with HIV infection (adjusted relative hazard: 0.74; 95% CI: 0.45-1.20), with cocaine injection appearing to account for the elevated risk for HIV infection among SW-IDU. CONCLUSION These data suggest that local SW-IDU have elevated rates of HIV infection. However, our exploration of risk factors among SW-IDU demonstrated that drug use patterns and environmental factors, rather than sexual risks, may explain the elevated HIV incidence among SW-IDU locally. Our findings highlight the need for social and structural interventions, including increased access to harm reduction programs and addiction treatment.
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493
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Duff P, Ogilvie G, Shoveller J, Amram O, Chettiar J, Nguyen P, Dobrer S, Montaner J, Shannon K. Barriers to Cervical Screening Among Sex Workers in Vancouver. Am J Public Health 2016; 106:366-73. [PMID: 26562102 PMCID: PMC4724251 DOI: 10.2105/ajph.2015.302863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We longitudinally examined the social, structural, and geographic correlates of cervical screening among sex workers in Metropolitan Vancouver, British Columbia, to determine the roles that physical and social geography play in routine reproductive health care access. METHODS Analysis drew on (2010-2013) data from an open prospective cohort of sex workers (An Evaluation of Sex Workers' Health Access). We used multivariable logistic regression with generalized estimating equations (GEE) to model correlates of regular cervical screening. RESULTS At baseline, 236 (38.6%) of 611 sex workers in our sample had received cervical screening, and 63 (10.3%) were HIV-seropositive. In multivariable GEE analysis, HIV-seropositivity (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.06, 2.58) and accessing outreach services (AOR = 1.35; 95% CI = 1.09, 1.66) were correlated with regular cervical screening. Experiencing barriers to health care access (e.g., poor treatment by health care staff, limited hours of operation, and language barriers) reduced odds of regular Papanicolaou testing (AOR = 0.81; 95% CI = 0.65, 1.00). CONCLUSIONS Sex workers in Metropolitan Vancouver had suboptimal levels of cervical screening. Innovative mobile outreach service delivery models offering cervical screening as one component of sex worker-targeted comprehensive sexual and reproductive health services may hold promise.
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Affiliation(s)
- Putu Duff
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Gina Ogilvie
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Jean Shoveller
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Ofer Amram
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Jill Chettiar
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Paul Nguyen
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Sabina Dobrer
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Julio Montaner
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Kate Shannon
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
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494
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Seidman D, Rusch M, Abramovitz D, Stockman JK, Martinez G, Rangel G, Vera A, Ulibarri MD, Strathdee SA. Intravaginal practices among HIV-negative female sex workers along the US-Mexico border and their implications for emerging HIV prevention interventions. Int J Gynaecol Obstet 2016; 133:212-6. [PMID: 26874868 DOI: 10.1016/j.ijgo.2015.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/08/2015] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities-Tijuana and Ciudad Juarez-on the border between the USA and Mexico. METHODS Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs. RESULTS Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6months (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1-3.1; P=0.03), three or more pregnancies (aOR 1.9, 95% CI 1.1-3.2; P=0.02), and having clients who became violent when proposing condom use (aOR 5.8, 95% CI 1.0-34.3; P=0.05), which are all factors related to inconsistent condom use. CONCLUSION Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.
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Affiliation(s)
- Dominika Seidman
- Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Melanie Rusch
- Population Health and Epidemiology, Island Health, Victoria, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Daniela Abramovitz
- Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Jamila K Stockman
- Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Gustavo Martinez
- Community Health and Development of Ciudad Juarez and the Mexican Federation of Private Associations, Ciudad Juarez, Mexico
| | | | - Alicia Vera
- Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
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495
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Comment on "Hepatitis C and the Sex Trade". Can J Gastroenterol Hepatol 2016; 2016:1253208. [PMID: 27444114 PMCID: PMC4904654 DOI: 10.1155/2016/1253208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
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496
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Burman CJ, Aphane M, Delobelle P. Weak signal detection: A discrete window of opportunity for achieving 'Vision 90:90:90'? SAHARA J 2016; 13:17-34. [PMID: 26821952 PMCID: PMC5642432 DOI: 10.1080/17290376.2015.1123642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION UNAIDS' Vision 90:90:90 is a call to 'end AIDS'. Developing predictive foresight of the unpredictable changes that this journey will entail could contribute to the ambition of 'ending AIDS'. There are few opportunities for managing unpredictable changes. We introduce 'weak signal detection' as a potential opportunity to fill this void. METHOD Combining futures and complexity theory, we reflect on two pilot case studies that involved the Archetype Extraction technique and the SenseMaker(®) Collector(™) tool. RESULTS Both the piloted techniques have the potentials to surface weak signals--but there is room for improvement. DISCUSSION A management response to a complex weak signal requires pattern management, rather than an exclusive focus on behaviour management. CONCLUSION Weak signal detection is a window of opportunity to improve resilience to unpredictable changes in the HIV/AIDS landscape that can both reduce the risk that emerges from the changes and increase the visibility of opportunities to exploit the unpredictable changes that could contribute to 'ending AIDS'.
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Affiliation(s)
- Christopher J. Burman
- PhD, is affiliated to Rural Development and Innovation Hub, University of Limpopo, Turfloop Campus, Polokwane, South Africa
| | - Marota Aphane
- Masters in Development, is affiliated to Rural Development and Innovation Hub, University of Limpopo, Turfloop Campus, Polokwane, South Africa
| | - Peter Delobelle
- MD, PhD is affiliated to School of Public Health, University of the Western Cape, Robert Sobukwe Road, Belville, Cape Town 7535, South Africa
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497
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Goldenberg SM, Duff P, Krusi A. Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives. BMC Public Health 2015; 15:1241. [PMID: 26672756 PMCID: PMC4681074 DOI: 10.1186/s12889-015-2491-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022] Open
Abstract
Background Sex workers (SWs) experience a disproportionately high burden of HIV, with evidence indicating that complex and dynamic factors within work environments play a critical role in mitigating or producing HIV risks in sex work. In light of sweeping policy efforts to further criminalize sex work globally, coupled with emerging calls for structural responses situated in labour and human-rights frameworks, this meta-synthesis of the qualitative and ethnographic literature sought to examine SWs’ narratives to elucidate the ways in which physical, social and policy features of diverse work environments influence SWs’ agency to engage in HIV prevention. Methods We conducted a meta-synthesis of qualitative and ethnographic studies published from 2008 to 2014 to elucidate SWs’ narratives and lived experiences of the complex and nuanced ways in which physical, social, and policy features of indoor and outdoor work environments shape HIV prevention in the sex industry. Results Twenty-four qualitative and/or ethnographic studies were included in this meta-synthesis. SWs’ narratives revealed the nuanced ways that physical, social, and policy features of work environments shaped HIV risk and interacted with macrostructural constraints (e.g., criminalization, stigma) and community determinants (e.g., sex worker empowerment initiatives) to shape SWs’ agency in negotiating condom use. SWs’ narratives revealed the ways in which the existence of occupational health and safety standards in indoor establishments, as well as protective practices of third parties (e.g., condom promotion) and other SWs/peers were critical ways of enhancing safety and sexual risk negotiation within indoor work environments. Additionally, working in settings where negative interactions with law enforcement were minimized (e.g., working in decriminalized contexts or environments in which peers/managers successfully deterred unjust policing practices) was critical for supporting SWs’ agency to negotiate HIV prevention. Conclusions Policy reforms to remove punitive approaches to sex work, ensure supportive workplace standards and policies, and foster SWs’ ability to work collectively are recommended to foster the realization of SWs’ health and human rights across diverse settings. Future qualitative and mixed-methods research is recommended to ensure that HIV policies and programmes are grounded in SWs’ voices and realities, particularly in more under-represented regions such as Eastern Europe and Sub-Saharan Africa. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2491-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shira M Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Krusi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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498
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Muldoon KA. A systematic review of the clinical and social epidemiological research among sex workers in Uganda. BMC Public Health 2015; 15:1226. [PMID: 26652160 PMCID: PMC4674940 DOI: 10.1186/s12889-015-2553-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to the high burden of disease among sex workers and their position as a population heavily affected by the HIV epidemic, there has been a growing body of literature investigating the prevalence and risk factors associated with HIV risk among sex workers. To contextualize and summarize the existing research evidence base, a systematic review was conducted to synthesize the epidemiological literature on sex workers in Uganda. METHODS Database selection and search strategy development followed the Cochrane Collaboration's standards for conducting systematic review searches. All studies that included sex workers as the primary research participants were included in the review. The search was then geographically restricted to the country of Uganda. Items were identified from 18 databases (grey and peer-review) on March 10-11, 2015. RESULTS A total of 484 articles were retrieved from the database search. After removal of duplicates, a total of 353 articles were screened for eligibility and 64 full-text articles were assessed. The final review included 24 studies with quantitative methodology conducted among sex workers in Uganda. The HIV prevalence among female sex workers ranged from 32.4-52.0 % and between 8.2-9.0 % had multiple HIV infections. Both multi-drug resistance to antiretroviral therapy (2.6 %) and antibiotics (83.1 %) were observed. Between 33.3-55.1 % reported inconsistent condom use in the past month. In the previous 6 months, over 80 % of sex workers experienced client-perpetrated violence and 18 % experienced intimate partner violence. Over 30 % had a history of extreme war-related trauma. CONCLUSIONS There was limited information on socio-structural factors that affect sex workers' commercial working environments in Uganda, including the role of policing and criminalization, as well as the prevalence and factors associated with violence. The majority of the existing evidence is based in Kampala, highlighting a need for information on sex work in other regions of Uganda. Additionally, there is limited information on features of the non-commercial components of sex workers' lives as well as the services needed to reduce risks outside of the sex industry.
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Affiliation(s)
- Katherine A Muldoon
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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499
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Micheni M, Rogers S, Wahome E, Darwinkel M, van der Elst E, Gichuru E, Graham SM, Sanders EJ, Smith AD. Risk of sexual, physical and verbal assaults on men who have sex with men and female sex workers in coastal Kenya. AIDS 2015; 29 Suppl 3:S231-6. [PMID: 26562812 PMCID: PMC4706373 DOI: 10.1097/qad.0000000000000912] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Violence toward MSM and female sex workers (FSW) is associated with HIV risk, and its prevention is prioritized in international HIV/AIDS policy. METHODS Sociodemographic and behavioural data derived from HIV risk and follow-up cohorts including MSM and FSW in coastal Kenya between 2005 and 2014 was used to estimate the risk of rape, physical assault and verbal abuse, and to assess associations between first occurrence of assault with individual and recent behavioural factors. RESULTS Incidence of first reported rape was similar for MSM [3.9, confidence interval (CI) 3.1-5.0 per 100 person-years (pyrs)] and FSW (4.8 CI 3.5-6.4 per 100 pyrs), P = 0.22. Incidence of first reported physical and verbal assault was higher for FSW than MSM (21.1 versus 12.9 per 100 pyrs, P = 0.14 and 51.3 versus 30.9 per 100 pyrs, P = 0.03 respectively). Recent alcohol use was associated with reporting of all forms of assault by MSM [adjusted odds ratio (AOR) 1.8, CI 0.9-3.5] and FSW (AOR 4.4, CI 1.41-14.0), as was recent sale of sex for MSM (AOR 2.0, CI 1.1-3.8). Exclusive sex with men, active sex work, and group sex were also specifically associated with reporting rape for MSM. Perpetrators of sexual and verbal assault were usually unknown, whilst perpetrators of physical violence toward FSW were usually regular sexual partners. CONCLUSION MSM and FSW experienced a similarly high incidence of sexual assault in coastal Kenya, in addition to physical and verbal assault. Current national policies focus heavily on gender-based violence against women and young girls, but need to be inclusive of MSM and FSW.
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Affiliation(s)
- Murugi Micheni
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Sam Rogers
- Nuffield Department of Population Health, University of Oxford, Headington, UK
| | - Elizabeth Wahome
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Marianne Darwinkel
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Elise van der Elst
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Evans Gichuru
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Susan M. Graham
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, Washington, USA
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, UK
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Adrian D. Smith
- Nuffield Department of Population Health, University of Oxford, Headington, UK
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500
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Argento E, Shannon K, Nguyen P, Dobrer S, Chettiar J, Deering KN. The role of dyad-level factors in shaping sexual and drug-related HIV/STI risks among sex workers with intimate partners. Drug Alcohol Depend 2015; 157:166-73. [PMID: 26585612 PMCID: PMC4678956 DOI: 10.1016/j.drugalcdep.2015.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/30/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite high HIV burden among sex workers (SWs) globally, and relatively high prevalence of client condom use, research on potential HIV/STI risk pathways of intimate partnerships is limited. This study investigated partner/dyad-level factors associated with inconsistent condom use among SWs with intimate partners in Vancouver, Canada. METHODS Baseline data (2010-2013) were drawn from a community-based prospective cohort of women SWs. Multivariable generalized estimating equations logistic regression examined dyad-level factors associated with inconsistent condom use (<100% in last six months) with up to three male intimate partners per SW. Adjusted odds ratios and 95% confidence intervals were reported (AOR[95%CI]). RESULTS Overall, 369 SWs reported having at least one intimate partner, with 70.1% reporting inconsistent condom use. Median length of partnerships was 1.8 years, with longer duration linked to inconsistent condom use. In multivariable analysis, dyad factors significantly associated with increased odds of inconsistent condom use included: having a cohabiting (5.43[2.53-11.66]) or non-cohabiting intimate partner (2.15[1.11-4.19]) (versus casual partner), providing drugs (3.04[1.47-6.30]) or financial support to an intimate partner (2.46[1.05-5.74]), physical intimate partner violence (2.20[1.17-4.12]), and an intimate partner providing physical safety (2.08[1.11-3.91]); non-injection drug use was associated with a 68% reduced odds (0.32[0.17-0.60]). CONCLUSIONS Our study highlights the complex role of dyad-level factors in shaping sexual and drug-related HIV/STI risk pathways for SWs from intimate partners. Couple and gender-focused interventions efforts are needed to reduce HIV/STI risks to SWs through intimate partnerships. This research supports further calls for integrated violence and HIV prevention within broader sexual/reproductive health efforts for SWs.
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Affiliation(s)
- Elena Argento
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kate Shannon
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Paul Nguyen
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Sabina Dobrer
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Jill Chettiar
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Kathleen N Deering
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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