51
|
Malama K, Sagaon-Teyssier L, Parker R, Tichacek A, Sharkey T, Kilembe W, Inambao M, Price MA, Spire B, Allen S. Factors associated with alcohol use before sex among HIV-negative female sex workers in Zambia. Int J STD AIDS 2020; 31:119-126. [PMID: 31948340 DOI: 10.1177/0956462419886159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Female sex workers (FSWs) are at high risk of HIV infection. Alcohol use prior to sex can compound this risk. We investigated the factors associated with having sex under the influence of alcohol among Zambian FSWs. Community health workers and peer FSWs recruited 331 HIV-negative FSWs in Lusaka and Ndola. In a cross-sectional survey, we asked FSWs how often they had sex under the influence of alcohol in the previous month and categorised responses as ‘always’ and ‘not always’. The adjusted odds ratios (AORs) of always having sex under the influence of alcohol were higher among FSWs who charged clients medium (AOR: 2.20, 95% confidence interval [CI]: 1.04–4.68) and low fees (AOR: 2.65, 95% CI: 1.26–5.60) for sex versus high fees; received 9–19 (AOR: 2.37, 95% CI: 1.15–4.91) and 20 or more clients per month (AOR: 3.06, 95% CI: 1.47–6.37) versus up to 8 clients per month; and never used condoms versus always used condoms with clients (AOR: 4.21, 95% CI: 1.53–11.55). FSWs who always used alcohol before sex appeared more likely to engage in riskier sex and charge clients lower fees. Interventions for financial empowerment and alcohol risk reduction should complement existing HIV prevention interventions for FSWs.
Collapse
Affiliation(s)
- Kalonde Malama
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Tyronza Sharkey
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - William Kilembe
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - Mubiana Inambao
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Ndola, Zambia
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Bruno Spire
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
52
|
Brody C, Kaplan KC, Tuot S, Chhoun P, Farr C, Swendeman D, Yi S. "We Cannot Avoid Drinking": Alcohol Use among Female Entertainment Workers in Cambodia. Subst Use Misuse 2020; 55:602-612. [PMID: 31762369 PMCID: PMC9998118 DOI: 10.1080/10826084.2019.1691596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Female entertainment workers (FEWs) in Cambodia work in predominantly alcohol-based venues and therefore may face occupational risks. Studies have suggested that FEWs are pressured to consume alcohol while at the workplace, which may have adverse health outcomes. This study aims to explore the experiences of alcohol use among FEWs in Cambodia. Methods: Twenty-seven focus group discussions (FGDs) with FEWs were conducted across five sites in four provinces in Cambodia. FGD participants were FEWs who worked at entertainment venues, including karaoke TV bars, beer gardens, and massage parlors, as well as women who worked as on-call or street-based sex workers, and women across entertainment venues who were parenting. Results: The authors modified a conceptual model to create a framework based on the major themes identified within the FGDs on autonomy in alcohol use among FEWs. The framework and thematic components highlight the continuum of autonomy from pressured or coerced alcohol use to, economically or socially rational alcohol use to voluntary alcohol use. Factors that impacted alcohol use across the spectrum include experiencing an economic shock, needing to maintain a livelihood, experiencing psychological distress, having the desire to thrive in employment environment and drinking socially for personal enjoyment. Conclusion/Importance: Much of the motivation behind alcohol use is related to the need for economic security. For women who do not have other employment or income-generating options, individual behavior change programing is unlikely to be effective. Structural changes are needed to improve the health and safety of FEWs in Cambodia.
Collapse
Affiliation(s)
- Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
| | - Kathryn C Kaplan
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Caroline Farr
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| |
Collapse
|
53
|
Characterizing Unsafe Sexual Behavior among Factory Workers in the Context of Rapid Industrialization in Northern Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245085. [PMID: 31842473 PMCID: PMC6950032 DOI: 10.3390/ijerph16245085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 12/04/2022]
Abstract
Industrial workers or factory workers, especially migrant workers, have been found to be vulnerable populations at risk of sexually transmitted infections (STIs). However, there has been a gap in literature regarding health behaviors of migrant factory workers. We conducted a cross-sectional study among 230 factory workers in Hanoi and Bac Ninh cities in Northern Vietnam from July to September 2018 to identify sexual risk practices and related factors among migrant and nonmigrant factory workers. Information collected regarding sexual behavior included the number of sexual partners in the previous 12 months and whether they used condoms in their last sexual intercourse. Two-thirds of participants reported having no sexual activity in the last 12 months, and there was a low percentage of participants using condoms in their last sexual intercourse. Being female, living with spouses/partners, and being a nonimmigrant had a negative association with the lack of using condoms in the last sexual intercourse with casual partners/sex workers, as opposed to having mobility and self-care problems and identifying as a binge drinker. Therefore, workplace-based prevention programs focusing on providing tailored sexual health education and promoting condom use among industrial workers, especially those who are immigrant or migrant workers, in Vietnam should be emphasized.
Collapse
|
54
|
Kuteesa MO, Seeley J, Weiss HA, Cook S, Kamali A, Webb EL. Alcohol Misuse and Illicit Drug Use Among Occupational Groups at High Risk of HIV in Sub-Saharan Africa: A Systematic Review. AIDS Behav 2019; 23:3199-3225. [PMID: 30945031 DOI: 10.1007/s10461-019-02483-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Key occupational groups in sub-Saharan Africa (SSA) are at increased risk of HIV, and may be at increased risk of substance use. In January 2018, we systematically searched for studies reporting prevalence of, and risk factors for alcohol misuse or illicit drug use and their association with HIV incidence or prevalence among fisherfolk, uniformed personnel, truckers, miners, motorcycle taxi riders and sex workers in SSA. Seventy-one studies published between 1983 and 2017 were included: 35 reported on alcohol misuse (19 using AUDIT, 5 using CAGE) and 44 on illicit drug use (eight reported both). Median prevalence of alcohol misuse based on AUDIT/CAGE was 32.8% (IQR 20.8-48.5%). Prevalence of illicit drug use ranged from 0.1% (95% CI: 0.0-0.2%) for injection drug use to 97.1% (95% CI: 85.1-99.9%) for khat (among uniformed personnel). Among papers examining associations between substance use and HIV incidence (n = 3) or prevalence (n = 14), nine papers (53%) reported a significant positive association (2 with incidence, 7 with prevalence). Harm reduction interventions in occupational settings are urgently required to prevent new HIV infections.
Collapse
Affiliation(s)
- Monica O Kuteesa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anatoli Kamali
- International AIDS Vaccine Initiative (IAVI), Nairobi, Kenya
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
55
|
Kuteesa MO, Seeley J, Cook S, Webb EL. Multi-level experiences and determinants of alcohol misuse and illicit drug use among occupational groups at high-risk of HIV in sub-Saharan Africa: A thematic synthesis of qualitative findings. Glob Public Health 2019; 15:715-733. [PMID: 31640453 PMCID: PMC7175470 DOI: 10.1080/17441692.2019.1679216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk (n = 4) or sex workers (n = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings.
Collapse
Affiliation(s)
- Monica O Kuteesa
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
56
|
Jiwatram-Negrón T, El-Bassel N. Overlapping intimate partner violence and sex trading among high-risk women: Implications for practice. Women Health 2019; 59:672-686. [PMID: 30543494 PMCID: PMC6565517 DOI: 10.1080/03630242.2018.1544967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Despite research indicating higher than average rates of intimate partner violence (IPV) across groups of vulnerable women, less is known about the prevalence and types of IPV experienced by women who trade sex for money, drugs, shelter or food, a high risk group for poor health and psychosocial outcomes. Using a cross-sectional design and multivariate logistic regression analyses, this study examined the relationship between IPV and sex trading in a convenience sample of 346 HIV-negative, drug-involved women in relationships, recruited during 2005-2010 in New York City. About 41% and 36% of participants reported lifetime and recent IPV, respectively, by their main partner, with significant differences by recent engagement in sex trading (p < 0.01). Results of multivariate analyses indicated that sex trading was associated with recent severe physical or sexual IPV (OR = 3.07, p < 0.01) and that depression, having ever been married, child sexual abuse, and income were associated with IPV (p < 0.05). Women who reported childhood sexual abuse and recent sex trading had a 7.37 higher odds (p < 0.01) for reporting severe physical or sexual IPV compared to those who reported neither. Findings highlight the need to expand screening and interventions among women who trade sex.
Collapse
Affiliation(s)
- Tina Jiwatram-Negrón
- School of Social Work, Arizona State University, 411 N. Central Avenue, Suite 800, Phoenix, AZ 85004, , 602.496.0677
| | - Nabila El-Bassel
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8 Floor, New York, NY, USA, , 212.851.2391
| |
Collapse
|
57
|
Milner AN, Hearld KR, Abreau N, Budhwani H, Mayra Rodriguez-Lauzurique R, Paulino-Ramirez R. Sex work, social support, and stigma: Experiences of transgender women in the Dominican Republic. INT J TRANSGENDERISM 2019; 20:403-412. [PMID: 32999625 DOI: 10.1080/15532739.2019.1596862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291). Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one's life. Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.
Collapse
Affiliation(s)
| | | | - Nicole Abreau
- Universidad Iberoamericana-UNIBE, Santo Domingo, Dominican Republic
| | - Henna Budhwani
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | |
Collapse
|
58
|
Bazzi AR, Yotebieng K, Otticha S, Rota G, Agot K, Ohaga S, Syvertsen JL. PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya. J Int AIDS Soc 2019; 22:e25266. [PMID: 30983147 PMCID: PMC6462807 DOI: 10.1002/jia2.25266] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/05/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Female and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre-exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention. METHODS From 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences. RESULTS Among 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past-month alcohol use and 91% of women and 82% of men reported past-month drug use. Violence was pervasive, with most women and men reporting past-year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non-stigmatizing PrEP delivery initiatives designed with input from sex workers. CONCLUSIONS Through a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.
Collapse
Affiliation(s)
- Angela R Bazzi
- Department of Community Health SciencesBoston University School of Public HealthBostonMAUSA
| | - Kelly Yotebieng
- Department of AnthropologyOhio State UniversityColumbusOHUSA
| | | | - Grace Rota
- Kenya Medical Research InstituteKisumuKenya
| | - Kawango Agot
- Impact Research & Development OrganizationKisumuKenya
| | - Spala Ohaga
- Impact Research & Development OrganizationKisumuKenya
| | | |
Collapse
|
59
|
Syvertsen JL, Agot K, Ohaga S, Bazzi AR. You can't do this job when you are sober: Heroin use among female sex workers and the need for comprehensive drug treatment programming in Kenya. Drug Alcohol Depend 2019; 194:495-499. [PMID: 30529906 PMCID: PMC6334295 DOI: 10.1016/j.drugalcdep.2018.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 01/01/2023]
Abstract
AIMS Globally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services. METHODS In a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use. RESULTS Among 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks. CONCLUSIONS Drawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.
Collapse
Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA; Department of Anthropology, University of California, Riverside, 1320B Watkins Hall, Riverside, CA 92521, USA.
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
| | - Angela Robertson Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118, USA.
| |
Collapse
|
60
|
Hearld KR, Milner AN, Budhwani H, Abreau N, Rodriguez-Lauzurique RM, Charow R, Paulino-Ramirez R. Alcohol Use, High Risk Behaviors, and Experiences of Discrimination Among Transgender Women in the Dominican Republic. Subst Use Misuse 2019; 54:1725-1733. [PMID: 31046549 DOI: 10.1080/10826084.2019.1608253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study examines associations between alcohol use, high risk sexual behaviors, and experiences of stigma among transgender women across the Dominican Republic. Data from the 2015 Transgender Health Needs Study were analyzed using bivariate analyses (N = 291). Results: High rates of stigma, verbal abuse, alcohol use, and sex work are found and are associated with each other. Almost 45% of regular alcohol users are engaging in sex work (43.6%), compared with 31.1% of the non-regular alcohol users (χ2=4.82, p < .05). Having sex under the influence of alcohol is statistically associated with high risk behaviors, such as engaging in sex work, sometimes or never using a condom when receiving anal sex, and higher numbers of sexual partners. Furthermore, transgender women who have had sex under the influence of alcohol report statistically significantly higher levels of verbal abuse, discrimination, and levels of perceived transgender stigma. Conclusions/Importance: Findings suggest that although anti-discrimination laws exist, policies may not protect transgender women from experiencing stigma and discrimination at work, potentially forcing them to seek alternative careers and engage in behaviors that expose them to greater personal risk and harm. This intersection of factors may indicate a notable public health gap in transgender health in the Dominican Republic.
Collapse
Affiliation(s)
| | | | - Henna Budhwani
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Nicole Abreau
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Rosa Mayra Rodriguez-Lauzurique
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
| | - Rebecca Charow
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Robert Paulino-Ramirez
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
| |
Collapse
|
61
|
Salazar M, Brouwer KC, Rocha-Jimenez T, Boyce S, Staines-Orozco H, Silverman JG. Substance Use among Female Sex Workers in Two US-Mexico Border Cities: Associations with Age of Entry. Subst Use Misuse 2018; 54:868-871. [PMID: 30595074 PMCID: PMC6474790 DOI: 10.1080/10826084.2018.1517367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18. METHODS Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients. RESULTS Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17. CONCLUSIONS Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.
Collapse
Affiliation(s)
- Marissa Salazar
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
- Center for Innovative Public Health Research, 555 N. El Camino Real #A347 San Clemente, CA, USA
| | - Kimberly C. Brouwer
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Teresita Rocha-Jimenez
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
| | - Sabrina Boyce
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
| | - Hugo Staines-Orozco
- Universidad Autónoma de Ciudad Juárez, School of Medicine, Av. Plutarco Elías Calles 1210,Fovissste Chamizal, Ciudad Juárez, Chihuahua, México
| | - Jay G. Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
| |
Collapse
|
62
|
Lancaster KE, Hetrick A, Jaquet A, Adedimeji A, Atwoli L, Colby DJ, Mayor AM, Parcesepe A, Syvertsen J. Substance use and universal access to HIV testing and treatment in sub-Saharan Africa: implications and research priorities. J Virus Erad 2018; 4:26-32. [PMID: 30515311 PMCID: PMC6248849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
As universal testing and treatment for HIV, or 'treat all', expands across sub-Saharan Africa (SSA), substance use will likely have a negative impact on the success of scale-up efforts for antiretroviral treatment (ART). Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, as many countries in SSA expand ART, evidence of the extent of substance use, and its impact in the region, is more limited. Stigma, and the psychoactive effects of substance use, are barriers to seeking HIV treatment and adhering to ART regimens for persons with heavy alcohol use or substance use. As a result, we identified several implementation and operations research priorities and metrics for monitoring the impact of substance use and Treat All. Identifying barriers and facilitators to the integration of the prevention and treatment of substance use with HIV care, and assessing effects on HIV outcomes, through longitudinal studies are priorities that will determine the impacts of substance use on 'treat all' in SSA. Future research must use existing infrastructure, including large networks of HIV clinics, to enhance our understanding of the implementation and service delivery of substance use screening, referral and treatment. These networks will also inform robust and standardised substance use estimates and interventions within the 'treat all' era in SSA.
Collapse
Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, Ohio State University,
Columbus, OH,
USA
| | - Angela Hetrick
- Division of Epidemiology, College of Public Health, Ohio State University,
Columbus, OH,
USA
| | | | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine,
Bronx, NY,
USA
| | | | - Donn J Colby
- SEARCH, Thai Red Cross AIDS Research Center,
Bangkok,
Thailand
| | - Angel M Mayor
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón,
Puerto Rico
| | - Angela Parcesepe
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health,
Chapel Hill, NC,
USA
| | - Jennifer Syvertsen
- Department of Anthropology, University of California,
Riverside, CA,
USA
| |
Collapse
|
63
|
Lancaster KE, Hetrick A, Jaquet A, Adedimeji A, Atwoli L, Colby DJ, Mayor AM, Parcesepe A, Syvertsen J. Substance use and universal access to HIV testing and treatment in sub-Saharan Africa: implications and research priorities. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30342-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
64
|
Adapting the Risk Environment Framework to Understand Substance Use, Gender-Based Violence, and HIV Risk Behaviors Among Female Sex Workers in Tanzania. AIDS Behav 2018; 22:3296-3306. [PMID: 29767818 DOI: 10.1007/s10461-018-2156-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Female sex workers (FSWs) in sub-Saharan Africa are disproportionately affected by HIV and gender-based violence (GBV). Substance use overlaps with these co-occurring epidemics to further increase FSWs' risk for negative health outcomes. We explored the relationship between substance use, GBV, and consistent condom use utilizing baseline data from a cohort of 496 FSWs in Tanzania. Results demonstrate high levels of alcohol use and GBV, and low levels of consistent condom use. Frequent intoxication during sex work was associated with increased odds of recent GBV (aOR 1.64, 95% CI 1.07, 2.49; p value 0.02) and reduced odds of consistent condom use with clients (aOR 0.58, 95% CI 0.37, 0.92; p-value 0.02). We adapt the risk environment framework to contextualize our findings in the social and structural context and to gain insight into intervention approaches to address the intersecting challenges of substance use, GBV, and HIV among FSWs in Tanzania and similar settings.
Collapse
|
65
|
Richards SD, Stonbraker S, Halpern M, Amesty S. Cervical cancer screening among transactional female sex workers in the Dominican Republic. Int J STD AIDS 2018; 29:1204-1214. [PMID: 29966506 PMCID: PMC6089663 DOI: 10.1177/0956462418779662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18-54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8-14.5) or daily (AOR 4.9, 95% CI: 1.5-16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0-1.5) were significantly associated ( p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.
Collapse
Affiliation(s)
- Sheyla D Richards
- 1 Program for Global and Population Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Samantha Stonbraker
- 2 Columbia University School of Nursing, New York, NY, USA
- 3 Clínica de Familia, La Romana, Dominican Republic
| | - Mina Halpern
- 3 Clínica de Familia, La Romana, Dominican Republic
| | - Silvia Amesty
- 1 Program for Global and Population Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- 4 Heilbrunn Department of Population and Family Health, Columbia University, Mailman School of Public Health, New York, NY, USA
- 5 Center for Family and Community Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
66
|
Musyoki H, Bhattacharjee P, Blanchard AK, Kioko J, Kaosa S, Anthony J, Javalkar P, Musimbi J, Malaba SJ, Olwande C, Blanchard JF, Sirengo M, Isac S, Moses S. Changes in HIV prevention programme outcomes among key populations in Kenya: Data from periodic surveys. PLoS One 2018; 13:e0203784. [PMID: 30231072 PMCID: PMC6145580 DOI: 10.1371/journal.pone.0203784] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022] Open
Abstract
The Kenya National AIDS and STI Control Programme (NASCOP) conducted annual polling booth surveys (PBS) in 2014 and 2015 to measure outcomes from the national HIV prevention programme for key populations (KPs), comprising behavioural, biomedical and structural interventions. KPs included female sex workers (FSWs), men who have sex with men (MSM) and people who inject drugs (PWID). We compared survey results from the first and second rounds. Comparing the second to the first round, significantly more FSWs (93% vs. 88%, p<0.001) and MSM (77% vs. 58%, p<0.001) reported condom use at last sex with a paying client, and at last anal sex among MSM (80% vs. 77%, p<0.05) and PWID (48% vs. 27%, p<0.01). However, condom use with regular partners remained low, at less than 53% for FSWs and 69% for MSM. Among PWID, there was a significant increase in use of new needles and syringes at last injection (93% vs. 88%, p<0.001), and a significant decrease in reported non-availability of clean needles (23% vs. 36%, p<0.001). The number of overdoses in the past six months reduced significantly but remained high (40% vs. 51%, p<0.001). FSWs and MSM reported significantly higher HIV testing, and in all KP groups, over 93% reported ever having been tested for HIV. Among the respondents self-reporting to have tested HIV positive (24% of FSW, 22% of MSM and 19% of PWID), 80% of FSWs, 70% of MSM, and 73% of PWID reported currently taking antiretroviral therapy (ART). While the experience of forced intercourse by partners declined among FSWs (18% vs. 22%, p<0.01) and MSM (13% vs. 17%, p<0.01), more FSWs reported violence by law enforcement personnel (49% vs. 44%, p<0.001). These findings provide valuable information on the programme's progress, and a signpost for the integrated behavioural, biomedical and structural interventions to achieve their HIV prevention targets.
Collapse
Affiliation(s)
- Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Parinita Bhattacharjee
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Andrea K. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Shem Kaosa
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - John Anthony
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Carol Olwande
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - James F. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Martin Sirengo
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Shajy Isac
- 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
| |
Collapse
|
67
|
Workplace violence among female sex workers who use drugs in Vancouver, Canada: does client-targeted policing increase safety? J Public Health Policy 2018; 39:86-99. [PMID: 29109517 DOI: 10.1057/s41271-017-0098-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Workplace violence, by clients or predators, poses serious negative health consequences for sex workers. In 2013, the Vancouver (British Columbia), Canada Police Department changed their guidelines with the goal of increasing safety for sex workers by focusing law enforcement on clients and third parties, but not sex workers. We sought to examine the trends and correlates of workplace violence among female sex workers (FSW) before and after the guideline change, using data collected from prospective cohorts of persons who use illicit drugs in Vancouver, Canada. Among 259 FSW, 21.0% reported workplace violence at least once during the study period between 2008 and 2014. There was no statistically significant change in rates of workplace violence after the guideline change. In our multivariable analysis, daily heroin use was independently associated with workplace violence. The 2013 policing guideline change did not appear to have resulted in decreased reports of workplace violence. Increased access to opioid agonist therapies may reduce workplace violence among drug-using FSW.
Collapse
|
68
|
Beksinska A, Prakash R, Isac S, Mohan HL, Platt L, Blanchard J, Moses S, Beattie TS. Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open 2018; 8:e021389. [PMID: 30206080 PMCID: PMC6144389 DOI: 10.1136/bmjopen-2017-021389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence. METHODS An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk. RESULTS 1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only. CONCLUSION HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.
Collapse
Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - H L Mohan
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Lucy Platt
- Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
69
|
Heylen E, Shamban E, Steward WT, Krishnan G, Solomon R, Srikrishnan AK, Ekstrand ML. Alcohol Use and Experiences of Partner Violence Among Female Sex Workers in Coastal Andhra Pradesh, India. Violence Against Women 2018; 25:251-273. [PMID: 29953335 DOI: 10.1177/1077801218778384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cross-sectional study describes the prevalence and context of violence by sexual partners against female sex workers (FSWs, N = 589) in Andhra Pradesh and its association with alcohol use by FSWs and abusive partners. In all, 84% of FSWs reported alcohol use; 65% reported lifetime physical abuse by a sexual partner. Most abused women suffered abuse from multiple partners, often triggered by inebriation or FSW's defiance. In multivariate logistic regressions, frequency of FSW's alcohol use was associated with abuse by clients and primary partner, whereas partner's alcohol use was only significant for abuse by primary partner, not clients.
Collapse
Affiliation(s)
- Elsa Heylen
- 1 University of California, San Francisco, USA
| | | | | | | | | | - A K Srikrishnan
- 4 Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Maria L Ekstrand
- 1 University of California, San Francisco, USA.,5 St. John's Research Institute, Bangalore, India
| |
Collapse
|
70
|
Jiwatram-Negrón T, Michalopoulos LM, El-Bassel N. The syndemic effect of injection drug use, intimate partner violence, and HIV on mental health among drug-involved women in Kazakhstan. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2018; 5:71-81. [PMID: 30364672 PMCID: PMC6197815 DOI: 10.1007/s40609-018-0112-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined the synergistic effect of substance use (injection drug use), intimate partner violence, and HIV (dubbed the "SAVA syndemic") on depression and suicidal thoughts among a sample of high-risk women in Kazakhstan, a country with a notably high prevalence of suicide and violence against women, and concentrated epidemics of HIV and injection drug use. Using baseline data from an intervention study conducted in Almaty, Kazakhstan among 364 drug-involved couples, multivariate logistic regression analyses were used to examine the relationship between the SAVA syndemic continuum and mental health. Compared to women reporting none of the SAVA conditions, women who experienced the full range of the SAVA syndemic continuum had a 15.5-fold odds (p < .05) of reporting depression and a 6-fold odds (p < .05) in reporting suicidal thought disturbances. Findings suggest the need for integrated screening assessments among practitioners and interventions designed to address multiple, commonly co-occurring conditions in Central Asia.
Collapse
Affiliation(s)
- Tina Jiwatram-Negrón
- 1080 S. University Avenue, #B646, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Nabila El-Bassel
- 1255 Amsterdam Avenue, 8 Floor, School of Social Work, Columbia University, New York City, NY, USA
| |
Collapse
|
71
|
Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region. Sex Transm Dis 2018; 44:477-482. [PMID: 28703726 DOI: 10.1097/olq.0000000000000634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Globally, female sex workers (FSWs) have been identified as a high-risk group for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). However, as women of reproductive age, FSWs also have children. Few studies have investigated if financial responsibilities associated with motherhood increase women's vulnerability to HIV and STIs among FSWs. METHODS From March 2013 to March 2014, 603 FSWs aged ≥18 years were recruited from Tijuana and Ciudad Juarez (Mexico) to participate in a study assessing HIV/STI risk environments. RESULTS Findings from logistic regression models indicate that FSWs who reported motherhood were more likely to report (in the past 30 days): a higher client volume (>30 clients) (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 1.27-2.87) and always using alcohol right before or during sex with clients in the past 30 days (AOR, 1.77; 95% CI, 1.19-2.61). In contrast, they were more likely to report consistent condom use for vaginal or anal sex with clients (AOR, 1.68; 95% CI, 1.10-2.55), less likely to report using drugs right before or during sex with clients (AOR, 0.38; 95% CI, 0.26-0.56) and less likely to have tested positive for STIs at baseline (AOR, 0.63; 95% CI, 0.43-0.91). CONCLUSIONS These results provide a glimpse of the complex relationship between motherhood and women who are sex workers. Understanding the convergence of motherhood and sex work and how this can influence a woman's decision when engaging in sex work and affect her health is essential to designing effective programs addressing reduce risk for HIV and STIs among FSWs in this region and elsewhere.
Collapse
|
72
|
Lancaster KE, MacLean SA, Lungu T, Mmodzi P, Hosseinipour MC, Hershow RB, Powers KA, Pence BW, Hoffman IF, Miller WC, Go VF. Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study. Subst Use Misuse 2018; 53:782-791. [PMID: 29020505 PMCID: PMC5884720 DOI: 10.1080/10826084.2017.1365088] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. OBJECTIVE To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. METHODS In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. RESULTS Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. CONCLUSIONS Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work.
Collapse
Affiliation(s)
- Kathryn E. Lancaster
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Sarah A. MacLean
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Lilongwe, Malawi
| | - Thandie Lungu
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pearson Mmodzi
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Lilongwe, Malawi
| | - Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly A. Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Irving F. Hoffman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - William C. Miller
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
73
|
Jiwatram-Negrón T, El-Bassel N, Primbetova S, Terlikbayeva A. Gender-Based Violence Among HIV-Positive Women in Kazakhstan: Prevalence, Types, and Associated Risk and Protective Factors. Violence Against Women 2017; 24:1570-1590. [PMID: 29332520 DOI: 10.1177/1077801217741218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines the prevalence and associated multilevel risk and protective factors of intimate and nonintimate partner violence among a sample of 249 HIV-positive women in Kazakhstan. We found high prevalence of both lifetime intimate partner violence (52%) and nonintimate partner violence (30%). Together, nearly 60% experienced at least one incident of violence by either an intimate or nonintimate partner (gender-based violence [GBV]). In the multivariate analyses, we found associations between several individual, interpersonal, and socio-structural risk factors and GBV. Findings provide direction for practice, policy, and future research to address the intersection of GBV and HIV in Kazakhstan.
Collapse
Affiliation(s)
| | - Nabila El-Bassel
- 2 Columbia University, New York City, USA.,3 Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | |
Collapse
|
74
|
Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya. Sex Transm Dis 2017; 43:642-7. [PMID: 27631360 DOI: 10.1097/olq.0000000000000502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies of alcohol use and sexual behavior in African populations have primarily been cross-sectional, used nonvalidated measures of alcohol use, or relied on self-reported sexual risk endpoints. Few have focused on human immunodeficiency virus (HIV)-positive women. METHODS Longitudinal data were collected from a cohort of HIV-positive Kenyan female sex workers. At enrollment and annual visits, participants were asked about past-year alcohol use using the Alcohol Use Disorders Identification Test (AUDIT). The primary endpoint was detection of prostate-specific antigen (PSA) in vaginal secretions at quarterly examinations. Associations between hazardous/harmful alcohol use (AUDIT score ≥7), PSA detection, and secondary measures of sexual risk were evaluated using generalized estimating equations with a log binomial regression model. RESULTS A total of 405 women contributed 2750 vaginal samples over 606 person-years of follow-up. Hazardous/harmful alcohol use was reported at 16.6% of AUDIT assessments and was associated with higher risk of PSA detection (relative risk 1.50; 95% confidence interval, 1.11-2.01) relative to no alcohol use. This association was attenuated and no longer statistically significant, after adjusting for age, work venue, intimate partner violence, depression, and partnership status (adjusted relative risk, 1.13; 95% confidence interval, 0.82-1.56). In exploratory analyses, alcohol use was associated with self-report of unprotected sex and with sexually transmitted infection acquisition. CONCLUSIONS Although hazardous/harmful alcohol use was not associated with detection of PSA in adjusted analysis, associations with secondary outcomes suggest that alcohol use is at least a marker of sexual risk behavior.
Collapse
|
75
|
Offringa R, Tsai LC, Aira T, Riedel M, Witte SS. Personal and Financial Risk Typologies Among Women Who Engage in Sex Work in Mongolia: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1857-1866. [PMID: 27473070 PMCID: PMC5276798 DOI: 10.1007/s10508-016-0824-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 04/12/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
Women engaged in sex work bear a disproportionate burden of HIV infection worldwide, particularly in low- to middle-income countries. Stakeholders interested in promoting prevention and treatment programs are challenged to efficiently and effectively target heterogeneous groups of women. This problem is particularly difficult because it is nearly impossible to know how those groups are composed a priori. Although grouping based on individual variables (e.g., age or place of solicitation) can describe a sample of women engaged in sex work, selecting these variables requires a strong intuitive understanding of the population. Furthermore, this approach is difficult to quantify and has the potential to reinforce preconceived notions, rather than generate new information. We aimed to investigate groupings of women engaged in sex work. The data were collected from a sample of 204 women who were referred to an HIV prevention intervention in Ulaanbaatar, Mongolia. Latent class analysis was used to create subgroups of women engaged in sex work, based on personal and financial risk factors. This analysis found three latent classes, representing unique response pattern profiles of personal and financial risk. The current study approached typology research in a novel, more empirical way and provided a description of different subgroups, which may respond differently to HIV risk interventions.
Collapse
Affiliation(s)
- Reid Offringa
- Columbia University School of Social Work, New York, NY, USA
| | - Laura Cordisco Tsai
- Department of Social Work, George Mason University, 10340 Democracy Lane, Fairfax, VA, 22030, USA.
| | | | - Marion Riedel
- Columbia University School of Social Work, New York, NY, USA
| | - Susan S Witte
- Columbia University School of Social Work, New York, NY, USA
| |
Collapse
|
76
|
Carlson CE, Witte SS, Pala AN, Tsai LC, Wainberg M, Aira T. The impact of violence, perceived stigma, and other work-related stressors on depressive symptoms among women engaged in sex work. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2017; 4:51-57. [PMID: 29577014 PMCID: PMC5860680 DOI: 10.1007/s40609-017-0085-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While the physical health risks of sex work have been well documented, fewer studies have explored mental health risks associated with sex work. This study examined rates of depressive symptoms and associated risk factors among women engaged in sex work in Mongolia (n=222), a country experiencing significant economic and social development and where mental health infrastructure is in its infancy. A linear regression analysis indicated that significant risk factors for depressive symptoms included paying partner sexual violence, perceived occupational stigma, less social support, and higher harmful alcohol use. As one of the first studies to examine depression among sex workers, this study holds important social welfare implications for this marginalized population in Mongolia and other low-resource settings globally.
Collapse
Affiliation(s)
| | | | | | | | - Milton Wainberg
- Columbia University, New York State Psychiatric Institute New York, NY
| | | |
Collapse
|
77
|
Davis A, Jiwatram-Negrón T, Primbetova S, Terlikbayeva A, Bilokon Y, Chubukova L, El-Bassel N. Multi-level risk factors associated with sex trading among women living with HIV in Kazakhstan: A neglected key population. Int J STD AIDS 2017; 28:1397-1404. [PMID: 28492343 DOI: 10.1177/0956462417708678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Little is known about the prevalence and risk factors associated with sex trading among HIV-positive women. A total of 242 HIV-positive women were recruited in five regions in Kazakhstan. These women completed a survey containing items on socio-demographics, HIV stigma, intimate partner violence, and partner risk behaviors. Multivariate regression was used to examine associations between risk factors and sex trading after controlling for socio-demographic factors. Fifty-six (23.1%) women reported trading sex in the past 90 days. Women who reported recent sex trading were more likely than women who did not trade sex in the past 90 days to experience intimate partner violence (adjusted odds ratio [AOR]: 2.25; 95% confidence interval [CI]: 1.08-4.73), to have been homeless in the past 90 days (AOR: 4.12; 95% CI: 1.19-14.29), and to know or suspect a male partner had a sexually transmitted infection (AOR: 2.20; 95% CI: 1.07-4.53), had sex with another partner (AOR: 4.53; 95% CI: 2.25-9.14), or injected drugs in the past year (AOR: 3.31; 95% CI: 1.64-6.65). These findings underscore the need for comprehensive HIV prevention and intervention programs that address the multi-level risk factors associated with sex trading for women infected with HIV.
Collapse
Affiliation(s)
- Alissa Davis
- 1 HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, & Health, Columbia University, New York City, NY, USA.,2 New York State Psychiatric Institute, New York City, NY, USA.,3 Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Tina Jiwatram-Negrón
- 3 Global Health Research Center of Central Asia, Almaty, Kazakhstan.,4 School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Yelena Bilokon
- 5 Kazakhstan Network of Women Living with HIV, Almaty, Kazakhstan
| | - Lyubov Chubukova
- 5 Kazakhstan Network of Women Living with HIV, Almaty, Kazakhstan
| | - Nabila El-Bassel
- 3 Global Health Research Center of Central Asia, Almaty, Kazakhstan.,6 School of Social Work, Columbia University, New York City, NY, USA
| |
Collapse
|
78
|
Karamouzian M, Mirzazadeh A, Rawat A, Shokoohi M, Haghdoost AA, Sedaghat A, Shahesmaeili A, Sharifi H. Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:86-91. [PMID: 28478309 DOI: 10.1016/j.drugpo.2017.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Globally, one in three women who inject drugs is involved in sex work which increases their vulnerability to sexually transmitted infections including HIV. This study was conducted to improve our understanding of injection drug use practices among Iranian female sex workers (FSWs) and shed light on the high-risk profile of FSWs who inject drugs (FSW-IDUs). METHODS This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews and lifetime injection drug use was assessed through the responses to the question "Have you ever injected any illicit drugs?". Independent variables included a range of socio-demographic and risk characteristics. Logistic regression models were applied to investigate the correlates of lifetime history of injection drug use. RESULTS Median (Q1, Q3) age of the participants was 30 (25, 37) and a total of 127 (14.6%, 95% confidence interval (CI): 12.3-17.1) had ever injected drugs. In the multivariable logistic regression model, older age (adjusted odds ratio (AOR)=AOR25-34 vs. <18=3.37, 95% CI: 1.64, 7.70; AOR≥35 vs. <18=2.80, 95% CI: 1.11, 7.10), longer duration (>5 years) of involvement in sex work (AOR=1.06, 95% CI: 1.02, 1.10), and history of drinking alcohol (AOR=4.42, 95% CI: 2.67, 7.32) were positively associated with lifetime history of drug injection and younger age at sex work debut (AOR=0.52, 95% CI: 0.28, 0.96) was negatively associated with lifetime history of illicit drug injection among FSWs. CONCLUSION The prevalence of injection drug use among FSWs in Iran is concerning. Given the potential of this sub-population in bridging HIV into the general population, gender-sensitive and peer-led harm reduction programs should be further scaled up to meet the special needs of this vulnerable population.
Collapse
Affiliation(s)
- Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Angeli Rawat
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mostafa Shokoohi
- Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali A Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sedaghat
- Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
79
|
Bowring AL, Pasomsouk N, Hughes C, van Gemert C, Higgs P, Sychareun V, Hellard M, Power R. "We Might Get Some Free Beers": Experience and Motivation for Transactional Sex Among Behaviorally Bisexual Men in Vientiane, Laos. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1047-1059. [PMID: 27007470 DOI: 10.1007/s10508-016-0705-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 05/10/2023]
Abstract
People engaging in transactional sex are considered a key population for HIV prevention. Prior quantitative surveys demonstrated that behaviorally bisexual men in Vientiane, Laos commonly transact sex. In 2013, we conducted a qualitative study to explore behaviorally bisexual men's experience, motivations, and perceptions related to transactional sex in Vientiane. Behaviorally bisexual men were recruited from bars, nightclubs, and dormitories for five focus group discussions (FGDs) and 11 in-depth interviews (n = 31). Additionally, young women were recruited from a university, garment factory, and nightclub for four FGDs (n = 22). Transcripts were translated and thematically coded. Bisexual male participants most commonly described being paid for sex by male-to-female transgender people and buying sex from women. Both male and female participants reported that older, single women pay younger men for sex. Negotiation and direction of sexual transactions are influenced by age, attraction, and wealth. Common motivations for selling sex included the need for money to support family or fund school fees, material gain, or physical pleasure. Transactional sex was often opportunistic. Some behaviorally bisexual men reported selling sex in order to pay another more desirable sex partner or to buy gifts for their regular sex partner. Participants perceived high risk associated with intercourse with female sex workers but not with other transactional sex partners. Health interventions are needed to improve knowledge, risk perception, and health behaviors, but must recognize the diversity of transactional sex in Vientiane. Both physical and virtual settings may be appropriate for reaching behaviorally bisexual men and their partners.
Collapse
Affiliation(s)
- Anna L Bowring
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Chad Hughes
- Centre for International Health, Burnet Institute, Melbourne, Australia
| | - Caroline van Gemert
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Higgs
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Fitzroy, Melbourne, Australia
| | - Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert Power
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for International Health, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
80
|
Carvajal B, Stuardo V, Manríquez JM, Belmar J, Folch C. [Survey adaptation for bio-behavioural surveillance of HIV in Chilean female sex workers]. GACETA SANITARIA 2017; 31:478-484. [PMID: 28411873 DOI: 10.1016/j.gaceta.2016.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To adapt a behavioural questionnaire for second-generation HIV/AIDS surveillance in female sex workers (FSWs) in the Metropolitan Region, Chile. METHODS Qualitative study of instruments validation. A Spanish instrument adapted in Catalonia was validated through a translation and back-translation of the original version. The content validity was determined through a modified Delphi method, via FSW and HIV experts representing community, political and institutional levels. Applicability aspects were determined by the application of the questionnaire to FSW in the Metropolitan Region. RESULTS The questionnaire, drafted in Spain, was successfully adapted to Chilean Spanish. The content validity process enabled sections to be created that address HIV in FSWs. The adapted questionnaire takes less than 15minutes to complete, which makes it usable in fieldwork. The 61 women surveyed came from different countries (all were Latin Americans) and had different educational levels; all this enabled potential applicability problems to be detected. DISCUSSION The adapted questionnaire for Chile contains all the UNAIDS indicators for FSWs, as well as the recommended indicators of Family Health International for bio-behavioural surveillance. Said questionnaire serves as a tool for second-generation HIV/other STD surveillance and further contributes to preventive policies in Chilean FSWs.
Collapse
Affiliation(s)
- Bielka Carvajal
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Universidad de Chile, Santiago, Chile
| | - Valeria Stuardo
- Programa de Epidemiología, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | - José Manuel Manríquez
- Programa de Epidemiología, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Julieta Belmar
- Programa de Epidemiología, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa de Doctorado en Metodología de la Investigación Biomédica y Salud Pública, Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Universidad Autónoma de Barcelona, Barcelona, España
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les ITS i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| |
Collapse
|
81
|
Mukumbang FC. Actions of female sex workers who experience male condom failure during penetrative sexual encounters with clients in Cape Town: Implications for HIV prevention strategies. South Afr J HIV Med 2017; 18:698. [PMID: 29568633 PMCID: PMC5843032 DOI: 10.4102/sajhivmed.v18i1.698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/05/2017] [Indexed: 01/22/2023] Open
Abstract
Background Condom failure has always been found to coexist with condom usage, especially among sex workers. Objective To describe the actions of female sex workers when they are faced with situations of condom failure. Methods Using the survey design, the participants were selected through the snowball sampling method. Their responses were obtained using a structured questionnaire. A total of 100 questionnaires were analysed. Results With respect to the immediate actions of sex workers after condom failure, 36% of the respondents continued with the sexual encounter after noticing that the condom was broken. Another 36% stopped immediately when they noticed that the condom had failed, but replaced the condom; 13% of the participants stopped the sexual encounter completely; 3% applied vaginal spermicidal foam; and 5% of the respondents stopped immediately and took a douche when they had the chance. For the actions within the next 24 hours of experiencing condom failure with a client, 53% of the participants did nothing; 4% sought counsel from a professional; 3% of the respondents took alcohol or drugs to forget the incident, 25% went to the clinic for assistance and 8% offered other responses. Conclusion While continuing the sexual encounter without replacing the condom, taking alcohol and drugs or doing nothing could increase the risk of contracting HIV; however, actions like stopping the sexual encounter completely and visiting a clinic or a professional could make a difference between staying HIV negative or seroconverting. There is a need for targeted intervention to address issues of inappropriate behaviours after experiencing condom failure.
Collapse
Affiliation(s)
- Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, South Africa.,Department of Public Health, Institute of Tropical Medicine, Belgium
| |
Collapse
|
82
|
Roth EA, Benoit C, Jansson M, Hallsgrimdottir H. PUBLIC DRINKING VENUES AS RISK ENVIRONMENTS: COMMERCIAL SEX, ALCOHOL AND VIOLENCE IN A LARGE INFORMAL SETTLEMENT IN NAIROBI, KENYA. HUMAN ECOLOGY 2017; 45:277-283. [PMID: 28983133 PMCID: PMC5624530 DOI: 10.1007/s10745-017-9897-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Cecilia Benoit
- Department of Sociology, Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Mikael Jansson
- Department of Sociology, Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Helga Hallsgrimdottir
- Department of Sociology, Centre for Global Studies, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
83
|
Delgado JR, Segura ER, Lake JE, Sanchez J, Lama JR, Clark JL. Event-level analysis of alcohol consumption and condom use in partnership contexts among men who have sex with men and transgender women in Lima, Peru. Drug Alcohol Depend 2017; 170:17-24. [PMID: 27865150 PMCID: PMC5183551 DOI: 10.1016/j.drugalcdep.2016.10.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND We explored the association between alcohol use and condomless receptive (CRAI) and insertive (CIAI) anal intercourse within partnership contexts of men who have sex with men (MSM) and transgender women (TGW) in Lima, Peru. METHODS From 2012-2014, we surveyed men and TGW (n=1607) who reported anal intercourse with ≥1 male or TGW. Alcohol use with up to 3 sexual partners during the prior 90days was evaluated. Bivariate and multivariate analyses used generalized estimating equations to assess event-level associations between alcohol use, CRAI, CIAI, and partnership characteristics while adjusting for participant clustering from multiple partners. RESULTS Of 4774 sexual partnerships reported, 48% were casual, 34% primary, 10% anonymous, and 8% commercial. Alcohol use preceding sex was significantly (p<0.05) associated with CRAI (PR=1.26) and CIAI (PR=1.37). Partnership characteristics significantly associated with alcohol use included commercial sex work (PR=2.21) and trended (p<0.10) towards alcohol use with casual (PR=1.16), transgender (PR=1.48), and moderno ("versatile"; PR=1.17) partners. CRAI and CIAI were more common among participants who reported knowing they (PR=1.52; PR=1.41, respectively) or their partner (PR=1.47; PR=1.44, respectively) was HIV-uninfected. Yet, only CIAI (PR=1.42) was more commonly reported with known HIV-infected partners. Participants who drank alcohol prior to sex were less likely to know their partner's HIV serostatus. CONCLUSIONS Alcohol use prior to intercourse was associated with CRAI and CIAI, varied by partnership type, and may impair knowledge of partner HIV serostatus. Detailed knowledge of alcohol use within partner-specific contexts is essential for informing condom-based and alternative HIV prevention strategies for MSM and TGW in Peru.
Collapse
Affiliation(s)
- Jeanne R. Delgado
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA,The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, Rhode Island, 02912, USA
| | - Eddy R. Segura
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA
| | - Jordan E. Lake
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Avenida Almirante Miguel Grau 1010, Barranco (Lima 4) Peru
| | - Javier R. Lama
- Asociación Civil Impacta Salud y Educación, Avenida Almirante Miguel Grau 1010, Barranco (Lima 4) Peru
| | - Jesse L. Clark
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA
| |
Collapse
|
84
|
Lancaster KE, Cernigliaro D, Zulliger R, Fleming PF. HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: A systematic review. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2016; 15:377-386. [PMID: 27974017 PMCID: PMC5541376 DOI: 10.2989/16085906.2016.1255652] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Female sex workers (FSW) living with HIV in sub-Saharan Africa have poor engagement to HIV care and treatment. Understanding the HIV care and treatment engagement experiences of FSW has important implications for interventions to enhance care and treatment outcomes. We conducted a systematic review to examine the HIV care experiences and determinants of linkage and retention in care, antiretroviral therapy (ART) initiation, and ART adherence and viral suppression among FSW living with HIV in sub-Saharan Africa. The databases PubMed, Embase, Web of Science, SCOPUS, CINAHL, Global Health, Psycinfo, Sociological Abstracts, and Popline were searched for variations of search terms related to sex work and HIV care and treatment among sub-Saharan African populations. Ten peer-reviewed articles published between January 2000 and August 2015 met inclusion criteria and were included in this review. Despite expanded ART access, FSW in sub-Saharan Africa have sub-optimal HIV care and treatment engagement outcomes. Stigma, discrimination, poor nutrition, food insecurity, and substance use were commonly reported and associated with poor linkage to care, retention in care, and ART initiation. Included studies suggest that interventions with FSW should focus on multilevel barriers to engagement in HIV care and treatment and explore the involvement of social support from intimate male partners. Our results emphasise several critical points of intervention for FSW living with HIV, which are urgently needed to enhance linkage to HIV care, retention in care, and treatment initiation, particularly where the HIV prevalence among FSW is greatest.
Collapse
Affiliation(s)
- Kathryn E. Lancaster
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dana Cernigliaro
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rose Zulliger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul F. Fleming
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
85
|
Scheim AI, Bauer GR, Shokoohi M. Heavy episodic drinking among transgender persons: Disparities and predictors. Drug Alcohol Depend 2016; 167:156-62. [PMID: 27542688 DOI: 10.1016/j.drugalcdep.2016.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/06/2016] [Accepted: 08/07/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Drawing on a survey of transgender people in Canada's most populous province, we estimate the frequency of heavy episodic drinking (HED), compare HED prevalence to the age-standardized background population, and examine associations with socio-demographics, gender transition, and social exclusion. METHODS 433 transgender persons aged 16+ completed a respondent-driven sampling survey in 2009-2010. Analyses were weighted using RDS II methods, including frequencies and prevalence ratios. Overall and sex-specific estimates of HED among Ontario residents in the 2009-2010 Canadian Community Health Survey (n=39,980) were standardized to the overall and gender-specific transgender age distributions. RESULTS Estimated prevalence of HED at least monthly among transgender Ontarians was 33.2% (95% CI: 26.3, 40.1), 1.5 times greater than expected based on the age-standardized Ontario population. Transmasculine (female-to-male spectrum) persons were more likely than transfeminine persons to report HED (42.2% versus 22.7%), an effect robust to covariate adjustment. Current sex work was associated with greater HED, but gender transition and social exclusion factors were not. CONCLUSION Gendered pathways to alcohol misuse, particularly among transmasculine persons, warrant further research and intervention development.
Collapse
Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada.
| | - Greta R Bauer
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada.
| | - Mostafa Shokoohi
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada.
| |
Collapse
|
86
|
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.
Collapse
|
87
|
Ślęzak I. Causes and strategies of limiting psychoactive substance use by female escort agency sex workers. ALCOHOLISM AND DRUG ADDICTION 2016. [DOI: 10.1016/j.alkona.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
88
|
Couture MC, Page K, Sansothy N, Stein E, Vun MC, Hahn JA. High prevalence of unhealthy alcohol use and comparison of self-reported alcohol consumption to phosphatidylethanol among women engaged in sex work and their male clients in Cambodia. Drug Alcohol Depend 2016; 165:29-37. [PMID: 27251102 PMCID: PMC5565395 DOI: 10.1016/j.drugalcdep.2016.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/07/2016] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Cambodia, most of the female sex workers (FSW) work in venues where unhealthy alcohol use is ubiquitous and potentially contributing to the HIV epidemic. However, no accurate data exists. We compare self-reported unhealthy alcohol consumption to a biomarker of alcohol intake in Cambodian FSW and male clients, and determine factors associated with unhealthy alcohol use. METHODS A cross-sectional study was conducted among FSW (n=100) and male clients (n=100) in entertainment and sex work venues in Cambodia. Self-reported unhealthy alcohol use (AUDIT-C) was compared to phosphatidylethanol (PEth) positive (≥50ng/ml), a biomarker of alcohol intake. Sociodemographics data was collected. Correlates of self-reported unhealthy alcohol use and PEth positive were determined. RESULTS The prevalence of PEth positive in FSW was 60.0%. Self-reported unhealthy alcohol consumption was reported by 85.0% of the women. Almost all women (95.0%) testing PEth positive also reported unhealthy alcohol use. Prevalence of unhealthy alcohol consumption (self-report and PEth positive) was higher in FSW working in entertainment establishments compared to other sex work venues (p<0.01). Among male clients, 47.0% reported unhealthy alcohol consumption and 42.0% had a PEth positive. However, only 57.1% of male clients with PEth positive reported unhealthy alcohol use. CONCLUSIONS Unhealthy alcohol consumption is prevalent in Cambodian sex work settings. Self-reported unhealthy alcohol use is well reported by FSW, but less by male clients. These findings highlight the urgency of using accurate measures of unhealthy alcohol consumption and integrating this health issue into HIV prevention interventions.
Collapse
Affiliation(s)
- Marie-Claude Couture
- Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, United States.
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Dept. of Internal Medicine MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Neth Sansothy
- National Center for HIV, AIDS, Dermatology and STDs, #245H, street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia,University of Health Sciences-Cambodia, #73 Monivong Boulevard, Srah Chak, Phnom Penh, Cambodia
| | - Ellen Stein
- Global Health Sciences / Prevention and Public Health Group, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States
| | - Mean Chhi Vun
- National Center for HIV, AIDS, Dermatology and STDs, #245H, street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States
| |
Collapse
|
89
|
Atchison C, Burnett PJ. The social dynamics of safe sex practices among Canadian sex industry clients. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:939-956. [PMID: 27018404 DOI: 10.1111/1467-9566.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Much of what we know about the safe sex practices of people who pay for sexual services (clients) remains firmly grounded in empirical and interpretive tendencies to overemphasise the causal link between social, cultural or individual characteristics and sexual decision-making. In this study we apply Adam Green's Bourdieu-inspired sexual fields theory to examine the ways in which safe sex practices are interdependently shaped by social, personal and interpersonal forces. Using data from 697 questionnaires and 24 semi-structured interviews with Canadian clients, we implemented a series of six additive logistic regression models and contextualised the results with the interview data to reveal the relational interdependencies of intra-psychic, macro, meso and micro-level factors related to safe sex practices. The questionnaire responses and interview data used in the study were gathered from a diverse sample of clients who were over the age of 19, had paid money for sexual services on one or more occasions during their lifetime and who resided in Canada at the time of participation. Our results illustrate the ways in which factors related to the venue where sexual acts take place, clients' relationships with commercial and non-commercial partners and personal choices related to substance use interdependently inform safe sex practices.
Collapse
Affiliation(s)
- Chris Atchison
- Department of Sociology, University of Victoria, Victoria, Canada
| | | |
Collapse
|
90
|
Yu YJ, Li X, Tam CC, Zhou Y, Chen Y, Shen Z. Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China. AIDS Care 2016; 28:1455-60. [PMID: 27240573 DOI: 10.1080/09540121.2016.1189500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs - a rapidly increasing, vulnerable population in southwest China. The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14-66) recruited over five years (2010-2014) from 35 National Sentinel Surveillance sites in Guangxi. Analyses included Fisher's exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.
Collapse
Affiliation(s)
- Yeon Jung Yu
- a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA
| | - Xiaoming Li
- a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA
| | - Cheuk Chi Tam
- b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Yuejiao Zhou
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| | - Yi Chen
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| | - Zhiyong Shen
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| |
Collapse
|
91
|
Parcesepe AM, L Engle KL, Martin SL, Green S, Sinkele W, Suchindran C, Speizer IS, Mwarogo P, Kingola N. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial. Drug Alcohol Depend 2016; 161:21-8. [PMID: 26872880 PMCID: PMC4936780 DOI: 10.1016/j.drugalcdep.2015.12.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. DESIGN Randomized controlled trial. SETTING HIV prevention drop-in centers in Mombasa, Kenya. PARTICIPANTS 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). INTERVENTION 6 session alcohol harm reduction intervention. COMPARATOR 6 session non-alcohol related nutrition intervention. MEASUREMENTS In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. FINDINGS The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. CONCLUSIONS The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.
Collapse
Affiliation(s)
- Angela M Parcesepe
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States.
| | - Kelly L L Engle
- FHI 360, 359 Blackwell St., Durham, NC 27701, United States; Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, United States
| | - Sandra L Martin
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Sherri Green
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), PO Box 21761 Ngong Road, 00505 Nairobi, Kenya
| | - Chirayath Suchindran
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Rosenau Hall, Chapel Hill, NC, United States
| | - Ilene S Speizer
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Peter Mwarogo
- FHI 360, The Chancery 2nd and 3rd Floor Valley Road, PO Box 38835-00623, Nairobi, Kenya
| | - Nzioki Kingola
- International Center for Reproductive Health, PO Box 91109, Mombasa, Kenya
| |
Collapse
|
92
|
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.
Collapse
|
93
|
HIV-Alcohol Risk Reduction Interventions in Sub-Saharan Africa: A Systematic Review of the Literature and Recommendations for a Way Forward. AIDS Behav 2016; 20:484-503. [PMID: 26511865 DOI: 10.1007/s10461-015-1233-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sub-Saharan Africa bears 69 % of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and synthesize the findings of HIV-alcohol risk reduction interventions implemented in the region and reported in peer-reviewed journals. Of 644 citations screened, 19 met the inclusion criteria for this review. A discussion of methodological challenges, research gaps, and recommendations for future interventions is included. Relatively few interventions were found, and evidence is mixed about the efficacy of HIV-alcohol risk reduction interventions. There is a need to further integrate HIV-alcohol risk reduction components into HIV prevention programming and to document results from such integration. Additionally, research on larger scale, multi-level interventions is needed to identify effective HIV-alcohol risk reduction strategies.
Collapse
|
94
|
Yuen WWY, Tran L, Wong CKH, Holroyd E, Tang CSK, Wong WCW. Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis. AIDS Care 2016; 28:816-24. [PMID: 26837316 DOI: 10.1080/09540121.2016.1139038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Current HIV prevention interventions for female sex workers (FSWs) have tended to target the cognitive factors in changing their behaviors, yet little attention has been paid to the psychological factors that influence the behavior of women in sex work. This review aimed to explore the associations between the psychological health of FSWs and HIV risk. A total of eight studies published in English before July 2013 were identified and reviewed. FSWs had reported psychological issues, including depression, suicidal thoughts as well as lower quality of life, and the pooled prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections. Among the five studies which measured symptoms of depression, four documented that higher depression scores were significantly associated with inconsistent condom use among FSWs with their clients and/or partners. Meta-analysis using a fixed-effects model was performed to examine the association between depression and inconsistent condom use and found that higher scores in depression were significantly associated with inconsistent condom use (odds ratio = 2.57, p < .001). This review contends that future HIV preventive interventions should take psychological health of FSWs into consideration.
Collapse
Affiliation(s)
- Winnie Wing-Yan Yuen
- a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong
| | - Lynn Tran
- a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong
| | - Carlos King-Ho Wong
- a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong
| | - Eleanor Holroyd
- b School of Health Sciences , RMIT University , Melbourne , Victoria , Australia
| | - Catherine So-Kum Tang
- c Department of Psychology, Faculty of Arts and Social Sciences , National University of Singapore , Singapore
| | - William Chi-Wai Wong
- a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong
| |
Collapse
|
95
|
High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:153. [PMID: 26805868 PMCID: PMC4772173 DOI: 10.3390/ijerph13020153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/30/2015] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.
Collapse
|
96
|
Freeman RC. Toward Development of Enhanced Preventive Interventions for HIV Sexual Risk among Alcohol-Using Populations: Confronting the 'Mere Pause from Thinking'. AIDS Behav 2016; 20 Suppl 1:S1-18. [PMID: 26362168 DOI: 10.1007/s10461-015-1179-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The papers in this issue detail state-of-the science knowledge regarding the role of alcohol use in HIV/AIDS risk, as well as offer suggestions for ways forward for behavioral HIV prevention for at-risk alcohol-using populations. In light of recent evidence suggesting that the anticipated uptake of the newer biomedical HIV prevention approaches, prominently including pre-exposure prophylaxis, has been stalled owing to a host of barriers, it has become ever more clear that behavioral prevention avenues must continue to receive due consideration as a viable HIV/AIDS prevention approach. The papers collected here make a valuable contribution to "combination prevention" efforts to curb HIV spread.
Collapse
Affiliation(s)
- Robert C Freeman
- Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 2073 MSC 9304, Bethesda, MD, 20892-9304, USA.
| |
Collapse
|
97
|
Thapa S, Bista N, Hannes K, Buve A, Vermandere M, Mathei C. Vulnerability of wives of Nepalese labor migrants to HIV infection: Integrating quantitative and qualitative evidence. Women Health 2015; 56:745-66. [PMID: 26630366 DOI: 10.1080/03630242.2015.1118726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV risk is determined by the interaction between social and individual risk factors, but information about such factors among Nepalese women is not yet understood. Therefore, to assess the risk factors and vulnerability of the wives of Nepalese labor migrants to HIV infection, the authors conducted a mixed-methods study in which a descriptive qualitative study was embedded within a case-control study. Two hundred twenty-four wives of labor migrants were interviewed in the case-control study, and two focus group discussions (n = 8 and 9) were conducted in the qualitative study. The authors found that illiteracy, low socio-economic status, and gender inequality contributed to poor knowledge and poor sexual negotiation among the wives of labor migrants and increased their risk of HIV through unprotected sex. Among male labor migrants, illiteracy, low socio-economic status, migration to India before marriage, and alcohol consumption contributed to liaisons with female sex workers, increasing the risk of HIV to the men and their wives through unprotected sex. Both labor migrants and their wives feared disclosure of positive HIV status due to HIV stigma and thus were less likely to be tested for HIV. HIV prevention programs should consider the interaction among these risk factors when targeting labor migrants and their wives.
Collapse
Affiliation(s)
- Subash Thapa
- a Department of Public Health and Primary Care , Katholieke Universiteit Leuven , Leuven , Belgium.,b Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium
| | - Nirmala Bista
- c Department of Public Health , Nobel College Pokhara University , Kathmandu , Nepal.,d Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven , Leuven , Belgium
| | - Karin Hannes
- e Centre for Sociology Research , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Anne Buve
- b Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium
| | - Mieke Vermandere
- a Department of Public Health and Primary Care , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Catharina Mathei
- a Department of Public Health and Primary Care , Katholieke Universiteit Leuven , Leuven , Belgium
| |
Collapse
|
98
|
Semple SJ, Pitpitan EV, Chavarin CV, Strathdee SA, Zavala RI, Aarons GA, Patterson TL. Prevalence and Correlates of Hazardous Drinking among Female Sex Workers in 13 Mexican Cities. Alcohol Alcohol 2015; 51:450-6. [PMID: 26546017 PMCID: PMC4922383 DOI: 10.1093/alcalc/agv124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/16/2015] [Indexed: 01/18/2023] Open
Abstract
AIMS To describe the prevalence and correlates of hazardous drinking among female sex workers (FSWs) at 13 sites throughout Mexico. METHODS FSWs (N = 1089) who were enrolled in a brief sexual risk reduction intervention (Mujer Segura) were queried about their sexual risk and substance use practices and their work contexts. Participants were classified as hazardous or non-hazardous drinkers based on the Alcohol Use Disorders test (AUDIT-C). Logistic regression models were used to examine individual, contextual, and community-level factors as correlates of hazardous drinking. RESULTS Ninety-two percent of participants reported alcohol consumption in the past month. Among drinkers (N = 1001), 83% met AUDIT-C criteria for hazardous drinking. Factors that were independently associated with hazardous drinking included: drug use in the past month (adjusted odds ratio (AOR) = 3.31; 95% CI 1.29-8.45), being a cigarette smoker (AOR = 1.71; 95% CI 1.13-2.58), being a barmaid or dance hostess (AOR = 3.40; 95% CI 1.95-5.91), alcohol use before or during sex with clients (AOR = 7.78; 95% CI 4.84-12.52), and working in a city with a higher marginalization index (AOR = 1.07; 95% CI 1.04-1.11). CONCLUSIONS Findings support the high prioritization by public health authorities of alcohol prevention and treatment programs for FSWs.
Collapse
Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Claudia V Chavarin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Rosa Icela Zavala
- Evaluation and Research Department, Mexican Foundation for Family Planning (Mexfam), Juárez 208, Tlalpan, Mexico, D.F. 14000, Mexico
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
99
|
Schonbrun YC, Johnson J, Anderson BJ, Stein MD. Sex Trading Among Hazardously Drinking Jailed Women. WOMEN & CRIMINAL JUSTICE 2015; 26:165-179. [PMID: 28190917 PMCID: PMC5300066 DOI: 10.1080/08974454.2015.1083931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For women involved in sex trading, both alcohol problems and passage through the criminal justice system are highly prevalent. This study is the first to conduct a focused examination of factors associated with sex trading among hazardously drinking, pretrial, jailed women. Cocaine use, social support for alcohol abstinence, and more days incarcerated in the 90 days leading up to the index incarceration were significantly associated with sex trading involvement among alcoholic women. Helping incarcerated alcoholic women reduce cocaine use and improve sober support networks during and following an incarceration may minimize sex trading after release.
Collapse
|
100
|
Pedersen PV, Arnfred A, Algren MH, Juel K. Comparison of health behaviors among women brothel workers to those of the general population of women in Denmark. Women Health 2015; 56:376-94. [DOI: 10.1080/03630242.2015.1101734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|