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Beattie TS, Smilenova B, Krishnaratne S, Mazzuca A. Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003297. [PMID: 32931504 PMCID: PMC7491736 DOI: 10.1371/journal.pmed.1003297] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Shari Krishnaratne
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Canada
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Dayton R, Alvarez B, Morales GJ, Rojas Almonte J, Faccini M, Gomes B, Wolf RC, Wilcher R. Assessing an inclusive model to increase access to comprehensive gender-based violence response services and improve HIV outcomes in Puerto Plata, Dominican Republic. CULTURE, HEALTH & SEXUALITY 2020; 22:1001-1017. [PMID: 31429671 DOI: 10.1080/13691058.2019.1647556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
Experiences of gender-based violence (GBV) are associated with increased vulnerability to HIV and difficulty accessing HIV services; at the same time, people living with HIV are at an increased risk of GBV. Key populations most affected by HIV - gay and other men who have sex with men, female sex workers and transgender women - also experience a disproportionate burden of GBV. In Puerto Plata, Dominican Republic, a local civil society organisation has led efforts to improve and integrate GBV and HIV services while making them welcoming to key population members and people living with HIV. According to interviews with service providers and service users and an analysis of service statistics, the intervention improved service quality and coordination, increased disclosures of violence and increased GBV response service uptake among the general population, key population members and people living with HIV. Findings also suggest that the intervention increased the uptake of HIV services, including HIV testing and post-exposure prophylaxis, and improved mental health among those receiving GBV response services. This case study of integrated GBV and HIV services describes a new model for simultaneously, synergistically and inclusively addressing two major epidemics negatively affecting health and well-being in affected communities today.
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Affiliation(s)
- Robyn Dayton
- FHI 360, Global Health, Population and Nutrition, Durham, NC, USA
| | - Betty Alvarez
- Center for Promotion and Human Solidarity (CEPROSH), Puerto Plata, Dominican Republic
| | | | | | - Monica Faccini
- Center for Promotion and Human Solidarity (CEPROSH), Puerto Plata, Dominican Republic
| | - Bayardo Gomes
- Center for Promotion and Human Solidarity (CEPROSH), Puerto Plata, Dominican Republic
| | - R Cameron Wolf
- United States Agency for International Development (USAID), Office of HIV/AIDS, Global Health Bureau, Washington, DC, USA
| | - Rose Wilcher
- FHI 360, Global Health, Population and Nutrition, Durham, NC, USA
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Passos TS, Almeida-Santos MA. [Sex Work during the COVID-19 Pandemic Period in the Ibero-American Context: analysis of advertisements on websites]. CIENCIA & SAUDE COLETIVA 2020; 25:4237-4248. [PMID: 33175033 DOI: 10.1590/1413-812320202511.26622020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
Sex workers become increasingly economically vulnerable due to the restrictive measures implemented to combat the coronavirus pandemic. In this respect, the scope of this study is to analyze the content of prostitution websites and advertisements regarding measures related to the COVID-19 pandemic. It involved a description of the visits and analysis of content of communications on websites that advertise commercial sex transactions. The percentage change in the number of visits for three periods from 02/2019 to 04/2020 was calculated. Subsequently, ads with the terms "corona," "pandemic" and "quarantine" on websites that offer search engines were extracted. The Bardin method was then used for content analysis. There was an increase in the number of visits to prostitution websites between 2019 and 2020, followed by a decrease with the advent of the coronavirus pandemic crisis. With regard to the protection measures during the pandemic, health recommendations and the incentive to engage in virtual sex are highlighted. Of the 1,991,014 advertisements, 0.51% mention the COVID-19 crisis regarding noncompliance with social distancing, protection measures and the offer of online sex.
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Affiliation(s)
- Taciana Silveira Passos
- Pós-Graduação em Saúde e Ambiente, Universidade Tiradentes. Av. Murilo Dantas 300, Farolândia. 49032-490 Aracaju SE Brasil.
| | - Marcos Antonio Almeida-Santos
- Pós-Graduação em Saúde e Ambiente, Universidade Tiradentes. Av. Murilo Dantas 300, Farolândia. 49032-490 Aracaju SE Brasil.
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Beaujolais B, Dillard RL. Court-Affiliated Diversion Programs for Prostitution-Related Crimes: A Comprehensive Review of Program Components and Impact. VIOLENCE AND VICTIMS 2020; 35:562-588. [PMID: 32788336 DOI: 10.1891/vv-d-19-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Court diversion programs offer alternative treatment interventions in lieu of punitive sanctions. Programs have recently been developed for women arrested for prostitution, with a recognition that many of these individuals frequently experience multiple forms of violence and experience multiple barriers to exiting sex work. This review aims to (a) examine programmatic components used across programs, and (b) identify the diversionary programs' impact on participants. METHODS Studies were identified by entering key search words into three electronic databases and by conducting a citation search. RESULTS Nine articles were included in the review. Although programs varied in structure, services, and length of time, studies indicated a range of positive outcomes for participants. CONCLUSIONS Results help to illuminate future directions for criminal justice practice, policy, and research.
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White RH, Park JN, Galai N, Decker MR, Allen ST, Footer KHA, Sherman SG. Short-term interruptions to sex work among a prospective cohort of street-based cisgender female sex workers in Baltimore. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102858. [PMID: 32726687 DOI: 10.1016/j.drugpo.2020.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Street-based female sex workers (FSW) often cycle in and out of sex work engagement. For many FSW, substance use plays a critical role in sex work entry, continuation, and interruptions. We examined individual, interpersonal, and structural correlates of short-term interruptions of sex work among street-based FSW in an urban environment. METHODS Data were from 205 FSW in Baltimore, MD, USA followed as part of an observational prospective cohort study between April 2016-Februrary 2018. The primary outcome was short-term interruptions of sex work (stopping sex work) over the past 3 months, asked every 3 months over a 12-month follow-up. We assessed the relationship between individual, structural, and interpersonal factors for each woman's prior visit and current visit with short-term sex work interruptions. We employed modified Poisson regression with Generalized Estimating Equations to identify correlates of short-term interruptions of sex work. RESULTS Eighty-two women (40%) reported stopping sex work over the past 3 months at least once during follow-up. Past drug treatment (adjusted incidence rate ratio [aIRR] 1.40; 95% CI: 1.06-1.86) and not having used drugs in the past 3 months (aIRR 2.70; 95% CI: 1.96-3.71) were positively associated with short-term interruption to sex work. Past intimate partner violence (IPV) (aIRR 0.52; 95% CI: 0.31-0.86) and current homelessness (aIRR 0.61; 95% CI: 0.41-0.91) were negatively associated with short-term interruption. Results were inconclusive for the association between recent prostitution arrest and short-term interruptions to sex work (IRR 0.86; 95% CI: 0.40-1.86). CONCLUSION The study suggests that similar to other professions, women leave sex work for numerous reasons. Substance use cessation and participation in drug treatment programs may contribute to short-term interruptions of sex work by reducing reliance on sex work for income among street-based FSW. Structural vulnerabilities including homelessness and IPV are driving continued street-based sex work, speaking to the need for holistic structural interventions.
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Affiliation(s)
- Rebecca Hamilton White
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E6608, Baltimore, MD 21205, USA; Department of Statistics, University of Haifa, 199 Aba Khushi Street, Mount Carmel, Haifa 3498838, Israel.
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4142, Baltimore, MD 21205, USA.
| | - Sean T Allen
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Katherine H A Footer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
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Nelson EUE. Structural inequities, HIV vulnerability and women’s agency: Street-based sex workers in Nigeria. Glob Public Health 2020; 15:1800-1809. [DOI: 10.1080/17441692.2020.1791211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fehrenbacher AE, Park JN, Footer KHA, Silberzahn BE, Allen ST, Sherman SG. Exposure to Police and Client Violence Among Incarcerated Female Sex Workers in Baltimore City, Maryland. Am J Public Health 2020; 110:S152-S159. [PMID: 31967867 DOI: 10.2105/ajph.2019.305451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the rate and correlates of incarceration among street-based female sex workers (FSWs).Methods. From April 2016 to January 2017, FSWs (n = 250) in Baltimore City, Maryland, were enrolled in a 12-month prospective cohort study. We analyzed baseline data and used zero-inflated negative binomial regression to model the incarceration rate.Results. Overall, 70% of FSWs had ever been incarcerated (mean = 15 times). In the multivariable analysis, incarceration rate was higher for FSWs exposed to police violence, non-Hispanic White FSWs, and women who used injection drugs daily. Risk for ever being incarcerated was higher for FSWs exposed to police or client violence, non-Hispanic Black FSWs, women who used injection or noninjection drugs daily, and those with longer time in sex work.Conclusions. Incarceration was associated with exposure to violence from both police and clients. Daily drug use and time in sex work appeared to amplify these risks. Although non-Hispanic Black women were at greater risk for ever being incarcerated, non-Hispanic White women were incarcerated more frequently.Public Health Implications. Decriminalization of sex work and drug use should be prioritized to reduce violence against FSWs.
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Affiliation(s)
- Anne E Fehrenbacher
- At the time of the study, Anne E. Fehrenbacher was with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), and the University of California Global Health Institute (UCGHI) at the University of California, San Francisco (UCSF). Ju Nyeong Park, Katherine H. A. Footer, Bradley E. Silberzahn, Sean T. Allen, and Susan G. Sherman were with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Katherine H. A. Footer and Susan G. Sherman were also with the Department of Epidemiology, and Susan G. Sherman was also with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Ju Nyeong Park
- At the time of the study, Anne E. Fehrenbacher was with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), and the University of California Global Health Institute (UCGHI) at the University of California, San Francisco (UCSF). Ju Nyeong Park, Katherine H. A. Footer, Bradley E. Silberzahn, Sean T. Allen, and Susan G. Sherman were with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Katherine H. A. Footer and Susan G. Sherman were also with the Department of Epidemiology, and Susan G. Sherman was also with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Katherine H A Footer
- At the time of the study, Anne E. Fehrenbacher was with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), and the University of California Global Health Institute (UCGHI) at the University of California, San Francisco (UCSF). Ju Nyeong Park, Katherine H. A. Footer, Bradley E. Silberzahn, Sean T. Allen, and Susan G. Sherman were with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Katherine H. A. Footer and Susan G. Sherman were also with the Department of Epidemiology, and Susan G. Sherman was also with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Bradley E Silberzahn
- At the time of the study, Anne E. Fehrenbacher was with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), and the University of California Global Health Institute (UCGHI) at the University of California, San Francisco (UCSF). Ju Nyeong Park, Katherine H. A. Footer, Bradley E. Silberzahn, Sean T. Allen, and Susan G. Sherman were with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Katherine H. A. Footer and Susan G. Sherman were also with the Department of Epidemiology, and Susan G. Sherman was also with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Sean T Allen
- At the time of the study, Anne E. Fehrenbacher was with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), and the University of California Global Health Institute (UCGHI) at the University of California, San Francisco (UCSF). Ju Nyeong Park, Katherine H. A. Footer, Bradley E. Silberzahn, Sean T. Allen, and Susan G. Sherman were with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Katherine H. A. Footer and Susan G. Sherman were also with the Department of Epidemiology, and Susan G. Sherman was also with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Susan G Sherman
- At the time of the study, Anne E. Fehrenbacher was with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), and the University of California Global Health Institute (UCGHI) at the University of California, San Francisco (UCSF). Ju Nyeong Park, Katherine H. A. Footer, Bradley E. Silberzahn, Sean T. Allen, and Susan G. Sherman were with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Katherine H. A. Footer and Susan G. Sherman were also with the Department of Epidemiology, and Susan G. Sherman was also with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Glick JL, Lim S, Beckham SW, Tomko C, Park JN, Sherman SG. Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD. Harm Reduct J 2020; 17:43. [PMID: 32539784 PMCID: PMC7296724 DOI: 10.1186/s12954-020-00383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Structural vulnerabilities reflect societal level factors (e.g., sexism, homophobia, racism) that constrain an individual's agency, particularly related to health outcomes. This study examines the association between SM status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based FSW. METHODS The current study utilizes baseline data from the SAPPHIRE study, a prospective cohort of cis gender and transgender FSW in Baltimore, MD, recruited through targeted time-location sampling from April 2016 to January 2017. The current analysis focuses on cisgender women. The baseline survey ascertained demographics, substance use, intimate partner violence (IPV), and sex work characteristics. Multivariable models were constructed using self-identity and behaviorally defined SM status as independent variables with vulnerability outcomes (e.g., injection drug use, injection speedball, binge drinking, homelessness, physical IPV, ever had a pimp, and being a minor at sex work entry (age < 18)) as dependent variables. RESULTS Of the participants (n = 247), 25.5% (n = 63) self-identified as a SM by identity (e.g., gay or bisexual), and 8.5% (n = 21) reported SM behavior (e.g., same-gender sexual behavior) in the past 3 months. In multivariable logistic regression models, SM status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical IPV, and being a minor at sex work entry. SM status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry. CONCLUSION The study indicates disproportionate structural vulnerability and heightened HIV risk among SM-FSW, as compared to their heterosexual counterparts, with differences in their profile by sexual identity and behavior. Findings suggest a need for nuanced interventions tailored to these populations.
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Affiliation(s)
- Jennifer L Glick
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Sahnah Lim
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - S Wilson Beckham
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Catherine Tomko
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ju Nyeong Park
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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159
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Shokoohi M, Karamouzian M, Dolan K, Sharifi H, Mirzazadeh A. Social and structural determinants of health associated with drug use patterns among female sex workers in Iran: A latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 91:102798. [PMID: 32505433 DOI: 10.1016/j.drugpo.2020.102798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Female sex workers (FSWs) experience adversities regarding social determinants of health (SDH) and behavioural factors including illicit drug use. This study aimed to assess the clustered impact of SDH on illicit drug use among FSWs in Iran. METHODS We surveyed 1,347 FSWs in 13 major cities in 2015. Latent class analysis was conducted to identify distinct classes of five measured SDH including low education, unemployment, unstable housing, last-year incarceration and sexual violence. We examined the association of these classes with five illicit drug use patterns using multivariable generalized linear model with Poisson family and log link, and reported adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI). RESULTS We identified five SDH classes: Class 1: no SDH adversities; Class 2: mainly unemployment; Class 3: low education and unemployment; Class 4: sexual violence and unemployment; and Class 5: multiple SDH adversities. The prevalence of last-month drug use ranged from 7.0% in Class 1 to 53.3% in Class 5. Compared to FSWs in Class 1, those in Class 2 (aPR: 2.47, 95% CI: 1.15, 5.27), Class 3 (aPR: 3.69, 95% CI: 1.62, 8.36), Class 4 (aPR: 4.49, 95% CI: 1.71, 11.78) and Class 5 (aPR: 6.35, 95% CI: 2.42, 16.69) were more likely to report last-month drug use. The same patterns were observed for specific drugs of opium use, crystal methamphetamine use, and heroin-crack use, as well as poly-drug use. CONCLUSION Socio-structural determinants are clustered together and elevate the likelihood of illicit drug use among FSWs. Our findings highlighted the significance of assessing and addressing such key determinants of health in drug use harm reduction programs targeting FSWs.
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Affiliation(s)
- Mostafa Shokoohi
- 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; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - 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, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - 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; Department of Biostatistics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- 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; Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, California, United States.
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Murphy EC, Segura ER, Lake JE, Huerta L, Perez-Brumer AG, Mayer KH, Reisner SL, Lama JR, Clark JL. Intimate Partner Violence Against Transgender Women: Prevalence and Correlates in Lima, Peru (2016-2018). AIDS Behav 2020; 24:1743-1751. [PMID: 31720954 PMCID: PMC7214207 DOI: 10.1007/s10461-019-02728-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17-10.25, aPR 2.46, 95% CI 1.14-5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19-4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56-12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63-14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission.
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Affiliation(s)
- Ellen C Murphy
- Wayne State University School of Medicine, Detroit, MI, USA
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | | | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Health and Department of Medicine, Harvard Medical School, The Fenway Institute, Boston, MA, USA
| | - Sari L Reisner
- Fenway Health and Department of Medicine, Harvard Medical School, The Fenway Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Division of Infectious Diseases, Department of Medicine, UCLA Geffen School of Medicine, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
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161
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Missed Study Visits and Subsequent HIV Incidence Among Women in a Predominantly Sex Worker Cohort Attending a Dedicated Clinic Service in Kampala, Uganda. J Acquir Immune Defic Syndr 2020; 82:343-354. [PMID: 31658178 DOI: 10.1097/qai.0000000000002143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited evidence on the relationship between sustained exposure of female sex workers (FSWs) to targeted HIV programmes and HIV incidence. We investigate the relationship between the number of missed study visits (MSVs) within each episode of 2 consecutively attended visits (MSVs) and subsequent HIV risk in a predominantly FSW cohort. METHODS Women at high risk of HIV are invited to attend an ongoing dedicated clinic offering a combination HIV prevention intervention in Kampala, Uganda. Study visits are scheduled once every 3 months. The analysis included HIV-seronegative women with ≥1 follow-up visit from enrollment (between April 2008 and May 2017) to August 2017. Cox regression models were fitted adjusted for characteristics on sociodemographic, reproductive, behavioral, and sexually transmitted infections (through clinical examination and serological testing for syphilis). FINDINGS Among 2206 participants, HIV incidence was 3.1/100 (170/5540) person-years [95% confidence interval (CI): 2.6 to 3.5]. Incidence increased from 2.6/100 person-years (95% CI: 2.1 to 3.2) in episodes without a MSV to 3.0/100 (95% CI: 2.2 to 4.1) for 1-2 MSVs and 4.3/100 (95% CI: 3.3 to 5.6) for ≥3 MSVs. Relative to episodes without a MSV, the hazard ratios (adjusted for confounding variables) were 1.40 (95% CI: 0.93 to 2.12) for 1-2 MSVs and 2.00 (95% CI: 1.35 to 2.95) for ≥3 MSVs (P-trend = 0.001). CONCLUSION Missing study visits was associated with increased subsequent HIV risk. Although several factors may underlie this association, the finding suggests effectiveness of targeted combination HIV prevention. But exposure to targeted interventions needs to be monitored, facilitated, and sustained in FSWs.
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Footer KHA, Silberzahn BE, Lim S, Huettner S, Kumar VA, Loeffler D, Peitzmeier SM, Sherman SG. "An ethnographic exploration of factors that drive policing of street-based female sex workers in a U.S. setting - identifying opportunities for intervention". BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:12. [PMID: 32410616 PMCID: PMC7227297 DOI: 10.1186/s12914-020-00232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
Background Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health and human rights evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape harmful policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods Drawing on ethnographic methods, 280 h of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health and human rights goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which harmful police practices towards sex work operate. Conclusions A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the rights and health of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
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Affiliation(s)
- Katherine H A Footer
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Bradley E Silberzahn
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sahnah Lim
- New York University School of Medicine, Department of Population Health and Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Steven Huettner
- Johns Hopkins School of Medicine, Department of Pediatrics, 5200 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victor A Kumar
- Johns Hopkins Krieger School of Arts and Sciences, Department of Anthropology, 466 Mergenthaler Hall, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Derek Loeffler
- Baltimore City Police Department, Northwestern District, 5271 Reistertown Road, Baltimore, MD, 21215, USA
| | - Sarah M Peitzmeier
- Johns Hopkins Bloomberg School of Publissc Health, Department of Population, Family, and Reproductive Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
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Barriers and facilitators to retaining a cohort of street-based cisgender female sex workers recruited in Baltimore, Maryland, USA: results from the SAPPHIRE study. BMC Public Health 2020; 20:585. [PMID: 32349728 PMCID: PMC7191822 DOI: 10.1186/s12889-020-08723-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/16/2020] [Indexed: 01/11/2023] Open
Abstract
Background Despite experiencing HIV/STIs, violence, and other morbidities at higher rates than the general public, street-based female sex workers are often absent from public health research and surveillance due to the difficulty and high costs associated with engagement and retention. The current study builds on existing literature by examining barriers and facilitators of retaining a street-based cohort of cisgender female sex workers recruited in a mobile setting in Baltimore, Maryland who participated in the SAPPHIRE study. Participants completed interviews and sexual health testing at baseline, 3-, 6-, 9-, and 12-months. Methods Retention strategies are described and discussed in light of their benefits and challenges. Strategies included collecting several forms of participant contact information, maintaining an extensive field presence by data collectors, conducting social media outreach and public record searches, and providing cash and non-cash incentives. We also calculated raw and adjusted retention proportions at each follow-up period. Lastly, baseline sample characteristics were compared by number of completed visits across demographic, structural vulnerabilities, work environment, and substance use variables using F-tests and Pearson’s chi-square tests. Results Although there were drawbacks to each retention strategy, each method was useful in tandem in achieving a successful follow-up rate. While direct forms of contact such as phone calls, social media outreach, and email were useful for retaining more stable participants, less stable participants required extensive field-based efforts such as home and site visits that increase the likelihood of random encounters. Overall, adjusted retention exceeded 70% for the duration of the 12-month study. Participants who were younger, recently experienced homelessness, and injected drugs daily were less likely to have completed all or most follow-up visits. Conclusion Retention of street-based female sex workers required the simultaneous use of diverse retention strategies that were tailored to participant characteristics. With familiarity of the dynamic nature of the study population characteristics, resources can be appropriately allocated to strategies most likely to result in successful retention.
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Project Shikamana: Community Empowerment-Based Combination HIV Prevention Significantly Impacts HIV Incidence and Care Continuum Outcomes Among Female Sex Workers in Iringa, Tanzania. J Acquir Immune Defic Syndr 2020; 82:141-148. [PMID: 31513552 DOI: 10.1097/qai.0000000000002123] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the impact of a community empowerment model of combination HIV prevention (Project Shikamana) among female sex workers (FSW) in Iringa, Tanzania. METHODS We conducted a 2-community randomized trial. Intervention elements included the following: (1) Community-led drop-in center and mobilization activities; (2) venue-based peer education, condom distribution, and HIV testing; (3) peer service navigation; (4) provider sensitivity trainings; and (5) SMS reminders. We used time-location sampling to enroll 496 FSW and conducted a survey and blood draws to screen for HIV and assess viral load at 0 and 18 months. We conducted an intent-to-treat analysis using logistic and Poisson regression and inverse probability weighting for primary outcomes. RESULTS The analysis included 171 HIV-positive and 216 HIV-negative FSW who completed baseline and 18-month study visits. Participants in the intervention were significantly less likely to become infected with HIV at 18-month follow-up (RR 0.38; P = 0.047), with an HIV incidence of 5.0% in the intervention vs. 10.4% control. Decreases in inconsistent condom use over time were significantly greater in the intervention (72.0%-43.6%) vs. control (68.8%-54.0%; RR 0.81, P = 0.042). At follow-up, we observed significant differences in behavioral HIV care continuum outcomes, and positive, but nonsignificant, increases in viral suppression (40.0%-50.6%) in the intervention vs. control (35.9%-47.4%). There was a strong association of between higher intervention exposure and HIV outcomes including viral suppression. CONCLUSIONS Project Shikamana is the first trial of community empowerment-based combination prevention among FSW in Africa to show a significant reduction in HIV incidence warranting its broader implementation and evaluation.
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Goldenberg SM, Amram O, Braschel M, Moreheart S, Shannon K. Urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort. Health Place 2020; 62:102288. [PMID: 32479365 PMCID: PMC7574814 DOI: 10.1016/j.healthplace.2020.102288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 01/07/2023]
Abstract
Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers' work/living environments in relation to gentrification exposure in Metro Vancouver (2010-2014), and modeled independent effects of gentrification exposure on reduced utilization of HIV/STI testing, sexual health, and sex worker support services. These decreases occurred despite efforts to scale-up HIV services for marginalized populations. Planning of healthcare, housing, and other support services should be responsive to shifting urban landscapes for marginalized women.
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Affiliation(s)
- Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888, University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
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Davey C, Dirawo J, Hargreaves JR, Cowan FM. Exploring the Association Between Mobility and Access to HIV Services Among Female Sex Workers in Zimbabwe. AIDS Behav 2020; 24:746-761. [PMID: 31256270 DOI: 10.1007/s10461-019-02559-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Female sex workers (FSW) face structural barriers to HIV-service access, however the effect of their mobility is uncertain. Using cross-sectional data from 2839 FSW in 14 sites in Zimbabwe, we explored the association between mobility (number of trips, distance, duration) in the past 12 months and five HIV-service-access outcomes: exposure to community mobilisation, clinic attendance, HIV testing, antiretroviral treatment initiation, and viral suppression (< 1000 copies per mL). We used modified-Poisson regression, and natural-effects models to estimate how the effect of trip frequency was mediated by distance and duration away. Each additional trip in 12 months was associated with increased community-mobilisation-event attendance (adjusted RR 1.08, 95% CI 1.04-1.12) and attending clinic two-or-more times (adjusted RR 1.02, 95% CI 1.00-1.05). There was little evidence of any other associations, or of mediation. Our findings are consistent with literature that found the effects of mobility to vary by context and outcome. This is the first study to consider many FSW-mobility and HIV-service-access measures together. Future research on mobility and health-related behaviour should use a spectrum of measures.
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Affiliation(s)
- Calum Davey
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK.
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, 5 Avondale West, Harare, Zimbabwe
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, 5 Avondale West, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Shepp V, O’Callaghan E, Kirkner A, Lorenz K, Ullman S. Sexual Assault Survivors Who Exchange Sex: Identity, Stigma, and Informal Responses from Support Providers. AFFILIA 2020; 35:105-128. [PMID: 34219914 PMCID: PMC8248476 DOI: 10.1177/0886109919866161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
It is well established in the literature that individuals who engage in sex work are more likely to experience sexual trauma/violence, but little research has examined experiences of sexual assault survivors who exchange sex from the survivor's perspective. Sexual assault survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about disclosure, social reactions, and help-seeking following assault. Sixteen survivors mentioned experiences exchanging sex, which comprises the sample for the current study, as well as comments from twelve SPs. Qualitative analysis revealed several themes including violence experienced engaging in sex work, navigating stigma and the identity of both sexual assault survivor and sex worker, and how survivors' social supports impact their recovery. Survivors endorsed their sex worker identities at varying levels, and others used their identity as a sexual assault survivor to explain why they engaged in sex work. Social work implications regarding service provision and advocacy work are discussed.
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Hall J, Donelle L, Laliberte Rudman D, Baumann J, Weaver H, Jones R, Moulton-Sauve M, Jenkins K, Trudell A. "It Is Important for Everyone as Humans to Feel Important, Right?" Findings from a Community-Based Participatory Needs Assessment with Street-level Sex Workers. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:33-46. [PMID: 32156199 DOI: 10.1080/19371918.2020.1733163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A community-based participatory research design informed the development and conduct of a needs assessment with street-level sex workers within a mid-sized city in Ontario, Canada. The research question was: What would help street-level sex workers to live with enhanced safety and dignity within their community? Twenty-four women who accessed a peer-driven drop-in center (SafeSpace) participated in in-depth interviews. Observational data of items requested by women who accessed SafeSpace were also documented over a 6-month time period. The overarching theme of relationships was identified as vital to participants' ability to live and work with enhanced safety and dignity in their community. Subthemes included: Informal/formal surveillance: Relationships to public space(s); Nowhere to go for us: Relationships with/in community services; and You're given the time you need: Relationships in a peer-driven drop-in center for/with/by sex workers. Our findings demonstrate how central relationships are, particularly peer, to enhancing or diminishing sex workers' sense of dignity, self-worth, safety, and enhanced their access to services.
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Affiliation(s)
- Jodi Hall
- School of Nursing, Faculty of Health, Community Studies and Public Safety, London, ON, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, School of Health Studies, Faculty of Health Sciences, FIMS/Nursing Building (FNB), Western University, London, ON, Canada
| | - Debbie Laliberte Rudman
- School of Occupational Therapy & Occupational Science Field, Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
| | | | | | | | | | - Karen Jenkins
- School of Nursing, Western-Fanshawe Collaborative BScN Program, Faculty of Health Science, Human Services and Nursing, London, ON, Canada
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Rosen JG, Park JN, Opper N, Lim S, Sherman SG. Patterns and Correlates of New Drug Initiation among Female Exotic Dancers: The Contribution of Occupational and Structural Risks. Subst Use Misuse 2020; 55:1122-1128. [PMID: 32107953 PMCID: PMC7180119 DOI: 10.1080/10826084.2020.1729199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Exotic dance clubs (EDCs) can play pivotal roles in the production of drug-related risks for female exotic dancers (FED). We aimed to characterize the structural and occupational factors associated with new drug initiation post-EDC entry among new FED (N = 117) in Baltimore, Maryland. Materials and Methods: Logistic regression models tested the associations of new drug uptake, measured as initiating any illicit drug (including non-prescribed and diverted prescription narcotics) not used prior to EDC employment, with structural (e.g. debt sources, housing instability) and occupational (e.g. sex work, dancing as sole income source) vulnerabilities. Results: Most FED were younger than 24 years-old (60%), identified as Black/African American (61%), and did not complete high school (56%). Twenty-nine (25%) reported using any new drug post-EDC entry, with cocaine (34%) cited most frequently among newly initiated substances. In multivariable analysis, drug initiation was significantly associated with cumulative debt sources (Adjusted Odds Ratio [AOR] = 1.82, 95% Confidence Interval [CI]: 1.19-2.77), dancing as only income source (AOR = 4.21, CI: 1.29-13.71), and sex work (AOR = 9.26, CI: 2.74-31.32). Conclusions: Our findings implicate co-occurring structural and occupational factors in FED's initiation of illicit drugs proceeding EDC employment. Results demonstrate the coping role of drug use for FED in stressful working environments and the multiple vulnerabilities associated with illicit drug uptake. The study reinforces a need for harm reduction interventions (i.e. debt relief, employment connections, increased hourly pay) that consider the contribution of overlapping financial insecurities to the production of occupational risks motivating drug uptake.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neisha Opper
- Department of Population, Family, and Reproductive Health, Baltimore, Maryland, USA
| | - Sahnah Lim
- Department of Population, Family, and Reproductive Health, Baltimore, Maryland, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Javalkar P, Platt L, Prakash R, Beattie TS, Collumbien M, Gafos M, Ramanaik S, Davey C, Jewkes R, Watts C, Bhattacharjee P, Thalinja R, Dl K, Isac S, Heise L. Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India. BMJ Glob Health 2019; 4:e001546. [PMID: 31798984 PMCID: PMC6861099 DOI: 10.1136/bmjgh-2019-001546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction Samvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers in Northern Karnataka, India. Methods A cluster randomised controlled trial in 47 villages. Female sex workers with IPs in the last 6 months were eligible for baseline (2014), midline (2016) and endline (2017) surveys. 24 villages were randomised to Samvedana Plus and 23 to a wait-list control. Primary outcomes among sex workers included experience of physical and/or sexual IPV or severe physical/sexual IPV in the last 6 months and consistent condom use with their IP in past 30 days. Analyses adjusted for clustering and baseline cluster-level means of outcomes. Result Baseline (n=620) imbalance was observed with respect to age (33.9 vs 35.2) and IPV (31.4% vs 45.0%). No differences in physical/sexual IPV (8.1% vs 9.0%), severe physical/sexual IPV (6.9% vs 8.7%) or consistent condom use with IPs (62.5% vs 57.3%) were observed by trial arm at end line (n=547). Samvedana Plus was associated with decreased acceptance of IPV (adjusted OR (AOR)=0.62, 95% CI 0.40 to 0.94, p=0.025), increased awareness of self-protection strategies (AOR=1.73, 95% CI=1.04-2.89, p=0.035) and solidarity of sex workers around issues of IPV (AOR=1.69, 95% CI=1.02-2.82, p=0.042). We observed an increase in IPV between baseline (25.9%) and midline (63.5%) among women in Samvedana Plus villages but lower in comparison villages (41.8%-44.3%) and a sharp decrease at end line in both arms (~8%). Conclusion We found no evidence that Samvedana Plus reduced IPV or increased condom use, but it may impact acceptance of IPV, increase knowledge of self-protection strategies and increase sex worker solidarity. Inconsistencies in reported IPV undermined the ability of the trial to assess effectiveness. Trial registration number NCT02807259.
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Affiliation(s)
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bengalaru, India
| | - Tara S Beattie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Martine Collumbien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Calum Davey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Jewkes
- Gender and Health Division, South African Medical Research Council, Pretoria, South Africa
| | - Charlotte Watts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Kavitha Dl
- Karnataka Health Promotion Trust, Bengalaru, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bengalaru, India
| | - Lori Heise
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Grimstad F. From Suffrage to the Senate: Expanding Inclusion in Women's Rights to Achieve Women's Health Equality. MISSOURI MEDICINE 2019; 116:472-475. [PMID: 31911723 PMCID: PMC6913852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Frances Grimstad
- Frances Grimstad, MD, is a Clinical Instructor at Boston Children's Hospital in Pediatric and Adolescent Gynecology for Harvard University. She was formerly a Fellow at university of Missouri Kansas City/Children's Mercy Hospital, Kansas City, Missouri
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Benoit C, Smith M, Jansson M, Healey P, Magnuson D. "The Prostitution Problem": Claims, Evidence, and Policy Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1905-1923. [PMID: 30498916 DOI: 10.1007/s10508-018-1276-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 05/12/2023]
Abstract
Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.
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Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada.
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Priscilla Healey
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
| | - Doug Magnuson
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
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Moran R, Farley M. Consent, Coercion, and Culpability: Is Prostitution Stigmatized Work or an Exploitive and Violent Practice Rooted in Sex, Race, and Class Inequality? ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1947-1953. [PMID: 30723878 DOI: 10.1007/s10508-018-1371-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Rachel Moran
- Survivors of Prostitution Abuse Calling for Enlightenment (SPACE International), Dublin, Republic of Ireland
| | - Melissa Farley
- Prostitution Research and Education, P.O. Box 16254, San Francisco, CA, 94116-0254, USA.
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Campbell R, Sanders T, Scoular J, Pitcher J, Cunningham S. Risking safety and rights: online sex work, crimes and 'blended safety repertoires'. THE BRITISH JOURNAL OF SOCIOLOGY 2019; 70:1539-1560. [PMID: 30318604 DOI: 10.1111/1468-4446.12493] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
It has been well established that those working in the sex industry are at various risks of violence and crime depending on where they sell sex and the environments in which they work. What sociological research has failed to address is how crime and safety have been affected by the dynamic changing nature of sex work given the dominance of the internet and digital technologies, including the development of new markets such as webcamming. This paper reports the most comprehensive findings on the internet-based sex market in the UK demonstrating types of crimes experienced by internet-based sex workers and the strategies of risk management that sex workers adopt, building on our article in the British Journal of Sociology in 2007. We present the concept of 'blended safety repertoires' to explain how sex workers, particularly independent escorts, are using a range of traditional techniques alongside digitally enabled strategies to keep themselves safe. We contribute a deeper understanding of why sex workers who work indoors rarely report crimes to the police, reflecting the dilemmas experienced. Our findings highlight how legal and policy changes which seek to ban online adult services advertising and sex work related content within online spaces would have direct impact on the safety strategies online sex workers employ and would further undermine their safety. These findings occur in a context where aspects of sex work are quasi-criminalized through the brothel keeping legislation. We conclude that the legal and policy failure to recognize sex work as a form of employment, contributes to the stigmatization of sex work and prevents individuals working together. Current UK policy disallows a framework for employment laws and health and safety standards to regulate sex work, leaving sex workers in the shadow economy, their safety at risk in a quasi-legal system. In light of the strong evidence that the internet makes sex work safer, we argue that decriminalisation as a rights based model of regulation is most appropriate.
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Abelson A, Lyons C, Decker M, Ketende S, Mfochive Njindam I, Fouda G, Ndonko F, Levitt D, Tamoufe U, Billong S, Bissek ACZK, Baral SD. Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. Int J Soc Psychiatry 2019; 65:445-457. [PMID: 31234685 DOI: 10.1177/0020764019858646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs' experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. METHODS In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. RESULTS Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2-1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3-2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2-2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. CONCLUSION Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.
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Affiliation(s)
- Anna Abelson
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele Decker
- 2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Serge Billong
- 6 Groupe Technique Central du Comité National de Lutte contre le SIDA, Yaoundc, Cameroon
| | | | - Stefan D Baral
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ssewamala FM, Sensoy Bahar O, Tozan Y, Nabunya P, Mayo-Wilson LJ, Kiyingi J, Kagaayi J, Bellamy S, McKay MM, Witte SS. A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial. BMC Womens Health 2019; 19:111. [PMID: 31419968 PMCID: PMC6697981 DOI: 10.1186/s12905-019-0807-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda. METHODS This three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences. DISCUSSION When WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention's efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT03583541 .
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Affiliation(s)
- Fred M Ssewamala
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Yesim Tozan
- College of Global Public Health, New York University, New York City, NY, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | | | - Joshua Kiyingi
- International Center for Child Health and Development, Masaka, Uganda
| | | | | | - Mary M McKay
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Susan S Witte
- Columbia University School of Social Work, New York City, NY, USA
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178
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Khan S, Nair S, Huynh A, Chevrier C, Thalinja R, Prakash R, Javalkar P, Ramanaik S, Isac S, Bhattacharjee P, Lorway R. Media, nationalism, and the body: Exploring masculinities, male partner violence, and HIV vulnerability among female sex workers in northern Karnataka, India. Glob Public Health 2019; 15:64-82. [PMID: 31405327 DOI: 10.1080/17441692.2019.1650948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Public health and media discourses on men and HIV prevention in India have largely focused on changing knowledge, attitudes and risk behaviour pertaining to condom use and safe sex. Little attempt has been made towards intervening in areas such as masculinity, dominant gender norms and intimate partner violence (IPV) that have been shown to have a direct link to HIV prevalence. In this paper, drawing on findings from an ethnographic study in northern Karnataka (India), we show how socio-political and communicative contexts influence and perpetuate violent behaviours by men in intimate relationships with female sex workers (FSW). We argue that constructions of masculinity, the stereotypes of which are reinforced through contemporary media, and movies, are intricately linked with processes of nationalism and play out in forms of chauvinism among working-class men. Violence, celebrated through various patriarchal discourses, legitimises and reinforces gender ideals that govern the private lives of men and their female intimate partners. This study provides a complex and nuanced understanding of structural factors that lead to IPV against FSWs and offers implications for HIV intervention planning in the region and beyond.
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Affiliation(s)
- Shamshad Khan
- Department of Communication, University of Texas at San Antonio, San Antonio, TX, USA
| | - Sapna Nair
- Karnataka Health Promotion Trust, Bangalore, India
| | - Anthony Huynh
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Claudyne Chevrier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, India
| | | | | | - Shajy Isac
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Robert Lorway
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Barreto D, Shoveller J, Braschel M, Duff P, Shannon K. The Effect of Violence and Intersecting Structural Inequities on High Rates of Food Insecurity among Marginalized Sex Workers in a Canadian Setting. J Urban Health 2019; 96:605-615. [PMID: 30039301 PMCID: PMC6890872 DOI: 10.1007/s11524-018-0281-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food security is both a basic human right and a public health necessity. Despite known gendered contexts of food insecurity, there is a dearth of research on prevalence and factors driving increased food insecurity for sex workers in a criminalized setting. The current study longitudinally examines the prevalence and structural and individual factors associated with increased odds of food insecurity among street and off-street sex workers in a Canadian urban setting. Prospective analyses drew on data from a community-based longitudinal cohort of cis and trans women in street and off-street sex work in An Evaluation of Sex Workers Health Access (2010-2014). The primary outcome was a time-updated measure of food insecurity, using the Radimer-Cornell scale. We used bivariable and multivariable logistic regression using generalized estimating equations to prospectively model correlates of food insecurity over a five-year period. Of 761 cis and trans women sex workers, 72.4% (n = 551) were food insecure over the study period. Over a third (35.2%, n = 268) identified as Indigenous and a quarter, 25.6% (n = 195) were of a gender/sexual minority. Within the 11.0% (n = 84) of women living with HIV, 96.4% (n = 81) were food insecure over the follow-up period. In multivariable analysis, Indigenous ancestry (AOR = 1.58 [95% CI 1.18, 2.10]), unstable housing (AOR = 1.27 [95% CI 1.03, 1.57]), stimulant use (AOR = 1.97 [95% CI 1.57, 2.45]), heroin use (AOR = 1.72 [95% CI 1.36, 2.19]), mental health diagnosis (AOR = 2.38 [95% CI 1.85, 3.05]), recent violence (AOR = 1.54 [95% CI 1.24, 1.91]), means of food access: reliant on food services only vs. self-sufficient (AOR = 1.78 [95% CI 1.38, 2.29]), and means of food access: both vs. self-sufficient (AOR = 2.29 [95% CI 1.84, 2.86]) were associated with food insecurity. In separate multivariable models, both recent and lifetime physical and/or sexual violence remained independently associated with food insecurity (AOR 1.54 [95% CI 1.24, 1.91]; AOR 4.62 [95% CI 2.99, 7.14], respectively). Almost all study participants living with HIV reported being food insecure. These intersecting risks demonstrate the negative impacts associated with living with HIV, experiencing food insecurity and/or physical or sexual violence. This study also highlights the potential for interventions that address structural inequities (e.g., decriminalizing sex work) to have crosscutting impacts to reduce barriers to accessing necessities (including food) or health and social services (e.g., methadone; primary care).
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Affiliation(s)
- Daniella Barreto
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jeannie Shoveller
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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180
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Ngale K, Cummings B, Horth R. Unseen, unheard and unprotected: prevalence and correlates of violence among female sex workers in Mozambique. CULTURE, HEALTH & SEXUALITY 2019; 21:898-913. [PMID: 30451098 DOI: 10.1080/13691058.2018.1524512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 06/09/2023]
Abstract
Violence against women, including female sex workers, is a public health concern worldwide. This is the first study in Mozambique to estimate the prevalence of and factors associated with physical and sexual violence against female sex workers. We used data collected from 1,250 women recruited using respondent-driven sampling in the cities of Maputo, Beira and Nampula in 2011-12. Participants were 15 years of age and reported having had sex for money in the preceding six months. Prevalence of physical or sexual violence (defined as being hit or battered or raped or forced to have sex within the last 6 months) ranged from 10.0% to 25.6%. Strangers (37.0%) and acquaintances (31.2%) were reported to be the most frequent perpetrators of sexual violence. Among participants who experienced sexual violence, 65.9% and 87.0% did not seek medical care and police assistance, respectively. Physical or sexual violence was associated with city (adjusted odds ratio [AOR] 2.6 and 2.0 Nampula and Beira vs Maputo), age (AOR 1.9, aged 15-24 years vs aged 25 and older), unprotected sex with last client (AOR 1.6) and self-reported sexually transmitted infections (AOR 2.1). The high prevalence of violence found confirms the need for interventions to mitigate this problem.
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Affiliation(s)
- Kátia Ngale
- a Pathfinder International , Maputo , Mozambique
| | - Beverley Cummings
- b US Centers for Disease Control and Prevention , Maputo , Mozambique
| | - Roberta Horth
- c Global Health Sciences , University of California San Francisco , Maputo , Mozambique
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181
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Leddy AM, Weiss E, Yam E, Pulerwitz J. Gender-based violence and engagement in biomedical HIV prevention, care and treatment: a scoping review. BMC Public Health 2019; 19:897. [PMID: 31286914 PMCID: PMC6615289 DOI: 10.1186/s12889-019-7192-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background While gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear. Clarifying how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP) - will not only provide insights into how to best meet individual women’s HIV care needs, but also inform public health oriented HIV epidemic control strategies. Methods Through a comprehensive scoping review, we synthesized and analyzed existing evidence regarding the influence of GBV on engagement in PrEP and the HIV care continuum among women living with HIV, including members of key populations (female sex workers, transgender women and women who use drugs). We explored PubMed, Scopus and Web of Science for peer-reviewed studies published in 2003–2017. Of the 279 sources identified, a subset of 51 sources met the criteria and were included in the scoping review. Results Studies were identified from 17 countries. The majority of studies utilized quantitative cross-sectional designs (n = 33), with the rest using longitudinal (n = 4), qualitative (n = 10) or mixed methods (n = 4) designs. Taken together, findings suggest that GBV impedes women’s uptake of HIV testing, care, and treatment, yet this can vary across different geographic and epidemic settings. Substantial gaps in the literature do still exist, including studies on the impact of GBV on engagement in PrEP, and research among key populations. Conclusions This scoping review contributes to our knowledge regarding the role GBV plays in women’s engagement in PrEP and the HIV care continuum. Findings reveal the need for more longitudinal research to provide insights into the causal pathways linking GBV and HIV care and treatment outcomes. Research is also needed to illuminate the impact of GBV on PrEP use and adherence as well as the impact of GBV on engagement along the HIV care continuum among key populations. It is critical that programs and research keep pace with these findings in order to reduce the global burden of GBV and HIV among women.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA, 94158, USA.
| | - Ellen Weiss
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
| | - Eileen Yam
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
| | - Julie Pulerwitz
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
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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.
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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
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Karamouzian M, Shokoohi M, Kaplan RL, Noroozi A, Sharifi H, Baral SD, Mirzazadeh A. Characterizing the relationship between incarceration and structural risks among female sex workers in Iran: findings of a nationwide biobehavioral surveillance survey. Ann Epidemiol 2019; 35:29-34. [DOI: 10.1016/j.annepidem.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
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Fagbamigbe A, Abi R, Akinwumi T, Ogunsuji O, Odigwe A, Olowolafe T. Survival analysis and prognostic factors associated with the timing of first forced sexual act among women in Kenya, Zimbabwe and Cote d‘Ivoire. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fearon E, Phillips A, Mtetwa S, Chabata ST, Mushati P, Cambiano V, Busza J, Napierala S, Hensen B, Baral S, Weir SS, Rice B, Cowan FM, Hargreaves JR. How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis. J Acquir Immune Defic Syndr 2019; 81:24-35. [PMID: 30964804 PMCID: PMC6467580 DOI: 10.1097/qai.0000000000001980] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND "HIV prevention cascades" have been proposed to support programs by identifying gaps in demand for, access to, and capability to adhere to HIV prevention tools, but there are few empirical examples to guide development. We apply a prevention cascade framework to examine prevention coverage and factors associated with condoms and/or PrEP adherence among female sex workers. SETTING Seven sites across Zimbabwe. METHODS Seven respondent-driven sampling surveys from the intervention sites of a pragmatic cluster-randomized trial in Zimbabwe in 2016 were analyzed, and 611/1439 women testing HIV-negative included. We operationalized key components of an HIV prevention cascade including demand, supply, and capability to adhere to 2 tools for HIV prevention: condoms and pre-exposure prophylaxis (PrEP). We used adjusted logistic regression to identify determinants of adherence to condoms and PrEP in turn, examining the effect of adherence to one tool on adherence to the other. RESULTS There were 343/611, 54.7%, women reporting adherence to condoms and/or PrEP, leaving almost half uncovered. Although women were aware that condoms prevented HIV and reported good access to them, only 45·5% reported full adherence to condom use. For PrEP, a new technology, there were gaps along all 3 domains of demand, supply, and adherence. Alcohol use decreased adherence to PrEP and condoms. Younger and newer entrants to sex work were less likely to take PrEP every day. CONCLUSIONS HIV prevention programming among female sex workers in Zimbabwe could consider increasing awareness of PrEP alongside supply, alcohol use interventions, and approaches to engaging younger women.
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Affiliation(s)
- Elizabeth Fearon
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Phillips
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Sibongile Mtetwa
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Sungai T. Chabata
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Valentina Cambiano
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Joanna Busza
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sue Napierala
- Women's Global Health Imperative, RTI International, San Francisco, CA
| | - Bernadette Hensen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sharon S. Weir
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Brian Rice
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Frances M. Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - James R. Hargreaves
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Parmley L, Rao A, Young K, Kose Z, Phaswana-Mafuya N, Mcingana M, Lambert A, Hausler H, Baral S, Schwartz S. Female Sex Workers' Experiences Selling Sex during Pregnancy and Post-Delivery in South Africa. Stud Fam Plann 2019; 50:201-217. [PMID: 30997677 DOI: 10.1111/sifp.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nearly 75 percent of female sex workers (FSWs) in Port Elizabeth, South Africa are mothers, many of whom engage in sex work during pregnancy or after delivery. We conducted in-depth interviews with 22 postpartum and 8 pregnant FSWs in Port Elizabeth. Interview guides were used to probe women's experiences, challenges, and concerns about selling sex during pregnancy and post-delivery in a high-HIV-prevalence context. Interviews were transcribed, translated, and coded using thematic analysis. FSWs experienced and feared violence by clients during pregnancy, highlighting the need for safe work environments. Further, FSWs expressed concerns about HIV acquisition and vertical transmission during the perinatal period. Physical challenges related to pregnancy affected women's ability to work. Returning to work post-delivery presented barriers to initiating and practicing exclusive breastfeeding. As a result, many FSWs practiced mixed feeding. Interventions, tailored to respond to FSW's challenges and experiences, may offer improved health outcomes in this context.
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Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE, Decker MR, Poteat TC, Footer KHA. Drivers of HIV Infection Among Cisgender and Transgender Female Sex Worker Populations in Baltimore City: Results From the SAPPHIRE Study. J Acquir Immune Defic Syndr 2019; 80:513-521. [PMID: 30649029 DOI: 10.1097/qai.0000000000001959] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine and compare risk factors for HIV infection among cisgender female sex workers (CFSWs) and transgender female sex workers (TFSWs). DESIGN Baseline data from a cohort study (SAPPHIRE) of street-based CFSW and TFSW in Baltimore, MD. METHODS Women were queried about individual (eg, drug use), interpersonal (eg, sexual abuse), and structural (eg, housing) risk factors and questioned on their sex work risk environment. Women were tested for HIV/sexually transmitted infections. We used logistic regression to identify key risk factors for prevalent HIV in each population. RESULTS We recruited 262 CFSW and 62 TFSW between 2016 and 2017. Compared with TFSW, CFSW were more likely to be white (66% vs. 0%), recently homeless (62% vs. 23%, P < 0.001), regularly gone to sleep hungry (54% vs. 16%, P < 0.001), and to inject drugs (71% vs. 4%, P < 0.001). HIV prevalence was 8 times greater in TFSW than in CFSW (40% vs. 5%, P < 0.001). All participants reported high rates of lifetime physical and sexual violence. Cocaine injection [adjusted odds ratio (aOR) = 3.65, 95% confidence interval (CI): 1.12 to 11.88], food insecurity (aOR = 1.92, 95% CI: 1.22 to 3.04), and >5 years in sex work (aOR = 5.40, 95% CI: 2.10 to 13.90) were independently associated with HIV among CFSW. Childhood sexual abuse (aOR = 4.56, 95% CI: 1.20 to 17.32), being in sex work due to lack of opportunities (aOR = 4.81, 95% CI: 1.29 to 17.90), and >5 years in sex work (aOR = 5.62, 95% CI: 1.44 to 21.85) were independently associated with HIV among TFSW. CONCLUSIONS Although distinct, both populations share a history of extensive childhood abuse and later life structural vulnerability, which drive their engagement in street-based sex work and their HIV risk profiles.
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Affiliation(s)
- Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, University of Haifa, Haifa, Israel
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Steve S Huettner
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Bradley E Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michele R Decker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tonia C Poteat
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine H A Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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188
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Eakle R, Bothma R, Bourne A, Gumede S, Motsosi K, Rees H. "I am still negative": Female sex workers' perspectives on uptake and use of daily pre-exposure prophylaxis for HIV prevention in South Africa. PLoS One 2019; 14:e0212271. [PMID: 30964874 PMCID: PMC6456175 DOI: 10.1371/journal.pone.0212271] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/30/2019] [Indexed: 12/13/2022] Open
Abstract
Women remain highly vulnerable to HIV infection in sub-Saharan Africa, with female sex workers (FSWs) facing some of the highest rates of HIV. Oral pre-exposure prophylaxis (PrEP) has the potential to reduce new infections among populations at highest risk and end-user perspectives of actual use in ‘real-world’ settings are critical to informing PrEP implementation. This paper presents findings from serial in-depth interviews (IDIs) conducted with FSW participants during the course of the Treatment And Prevention for Sex workers (TAPS) Demonstration Project in South Africa, exploring the lived experiences and perceptions of taking up and using PrEP. This research provides insight into risks and responsibilities facing FSWs perceived as prominent drivers in taking up and using PrEP, how PrEP was adopted to mitigate risk or ameliorate realities, and the characteristics of PrEP most valued, all of which are critical to consider in scale-up. Overall, distrust in the existence and/or efficacy of PrEP affected the motivation of women to come to the clinic and to maintain use. As one of the first reports of PrEP use among FSWs outside of a clinical trial setting, this research shows that it will be important to ensure accurate, relevant, and widespread messaging in communities to generate demand and support for PrEP.
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Affiliation(s)
- Robyn Eakle
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: ,
| | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Sanele Gumede
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keneilwe Motsosi
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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189
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Javalkar P, Platt L, Prakash R, Beattie T, Bhattacharjee P, Thalinja R, L KD, Sangha CATM, Ramanaik S, Collumbien M, Davey C, Moses S, Jewkes R, Isac S, Heise L. What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India. BMC Public Health 2019; 19:350. [PMID: 30922283 PMCID: PMC6440026 DOI: 10.1186/s12889-019-6673-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background Like other women in India, female sex workers (FSWs) frequently experience violence from their intimate partners (IPs)-a reality that increases their risk of acquiring HIV or other sexually transmitted infections. Less is known about the nature of these intimate relationships or what aspect of the relationship increases the risk of IP violence (IPV). We measured the prevalence and determinants of IPV on FSWs in the context of north Karnataka, India, characterized by high HIV-prevalence and extreme poverty. Methods Overall 620 FSWs with an IP participated in a baseline survey conducted for an on-going cluster-randomised controlled trial aiming to evaluate the impact of a multi-level intervention on IPV reduction. We characterize the nature of intimate relationships and explored determinants of severe physical and/or sexual IP violence using univariable and multivariable analyses. Results The median age of participants was 35 years with 10 years of duration in an intimate relationship. Though most relationships originated from a sex work encounter, 84% stated that IPs did not know they were currently practicing sex work. In past 6 months, the experience of emotional violence was 49% (95%CI:45.2–53.2), physical 33% (95%CI:29.5–37.1) and sexual violence 7% (95%CI:4.8–8.9), while 24% (95%CI:21.0–27.9) FSWs experienced recent severe physical and/or sexual violence from IPs. Factors associated with recent IPV included experience of physical and/or sexual violence from their clients in last 6 months (AOR 2.20; 95%CI: 1.29–3.75), sexual intercourse in the past 1 month when their IP was under the influence of alcohol (AOR 2.30; 95%CI: 1.47–3.59) and providing financial support to their IP (AOR 2.07; 95%CI: 1.28–3.34). Conclusions The association between increased risk of violence and provision of financial support to an IP is indicative of gendered power dynamics as men remain dominant irrespective of their financial dependency on FSWs. Interventions are needed that address inequitable gender norms which makes FSWs tolerate violence even though she is not financially dependent on IP. Higher likelihood of violence in presence of alcohol use and FSWs’ previous experience of workplace violence linked to IPV call for strengthening the crisis management systems within community-based organisations that can address all forms of violence and associated risk factors. Trial registration Clinical Trials NCT02807259
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Affiliation(s)
- Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Tara Beattie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.,Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Raghavendra Thalinja
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Kavitha D L
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | | | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Martine Collumbien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Calum Davey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Stephen Moses
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Rachel Jewkes
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.,Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Lori Heise
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, USA
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190
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McBride B, Goldenberg SM, Murphy A, Wu S, Braschel M, Krüsi A, Shannon K. Third Parties (Venue Owners, Managers, Security, etc.) and Access to Occupational Health and Safety Among Sex Workers in a Canadian Setting: 2010-2016. Am J Public Health 2019; 109:792-798. [PMID: 30897001 DOI: 10.2105/ajph.2019.304994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the impact of engagement with third parties (i.e., managers, receptionists, or owners of in-call venues; advertisers; security; spotters; and others) on sex workers' occupational health access. METHODS We drew longitudinal data from An Evaluation of Sex Workers' Health Access, a community-based cohort of more than 900 women sex workers. We used multivariable logistic regression and generalized estimating equations to (1) examine factors correlated with accessing third-party administrative or security services and (2) evaluate the impact of third-party services on access to mobile condom distribution and sex worker and community-led services (2010-2016). Finally, we evaluated changes in accessing third-party services pre-post end-demand criminalization (2010-2017). RESULTS Im/migrant sex workers (persons with any type of legal status who were born in another country; adjusted odds ratio [AOR] = 2.32; 95% confidence interval [CI] = 1.35, 3.98) had higher odds of accessing third-party services. In confounder models, third-party services were independently correlated with increased access to mobile condom distribution (AOR = 1.84; 95% CI = 1.47, 2.31) and sex worker and community-led services (AOR = 1.61; 95% CI = 1.15, 2.24). End-demand criminalization was linked to a decrease in access to third-party services (AOR = 0.79; 95% CI = 0.63, 0.99). CONCLUSIONS This research suggests that access to administrative and security services from third parties increases sex workers' occupational health and safety. Policy reforms to ensure sex workers' labor rights, including access to hiring third parties, are recommended.
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Affiliation(s)
- Bronwyn McBride
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Shira M Goldenberg
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Alka Murphy
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Sherry Wu
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Melissa Braschel
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Andrea Krüsi
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Kate Shannon
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
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191
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Putnis N, Burr J. Evidence or stereotype? Health inequalities and representations of sex workers in health publications in England. Health (London) 2019; 24:665-683. [PMID: 30854902 DOI: 10.1177/1363459319833242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The health of sex workers is considerably influenced by their position in society and by the marginalisation and stigmatisation they face worldwide. They are frequently criminalised and labelled as deviant, disordered or 'vulnerable': stereotypes that simplify and misrepresent their realities. Sex work policies create social and structural barriers, creating dangerous work environments and exacerbating significant health inequalities. Health organisations and their policies play an important role in highlighting inequalities and guiding health systems in reducing them. In this article, we use a document analysis design to analyse how and when sex workers are depicted in policies and publications by English national health organisations: National Health Service (NHS) England, Public Health England and the National Institute for Health and Care Excellence, along with the UK Department of Health. We find that sex workers are largely absent in these documents and, when present, are depicted not using evidence, but simplistically with moralistic undertones. The dichotomous constructions found in these texts: vulnerable yet also criminal 'prostitute' reflect wider political and social constructions of sex working women. This not only obscures their realities but also homogenises, blames and stigmatises, ultimately doing the opposite of what these organisations purport to do: it damages their health and well-being.
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192
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Beaujolais B, Kaloga M, Karandikar S, Gezinski LB, Kadambari P, Maskey K. Client-Perpetrated Violence Toward Female Sex Workers in Kathmandu. Violence Against Women 2019; 26:249-267. [PMID: 30843761 DOI: 10.1177/1077801219832117] [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
This qualitative study explores the experiences of client-perpetrated violence toward female sex workers in Kathmandu, Nepal. Individual interviews were conducted with 30 female sex workers. Data were analyzed using qualitative coding methods and thematic development. Two main themes emerged. Contexts in which client-perpetrated violence corresponded with (a) conditions associated with exchange of services, and (b) alcohol use. The first theme involved five factors: negotiating condom use, number of clients, requesting payment, length of service time, and negotiating sex acts. Alcohol use by clients and/or sex workers exacerbated violence. Implications for practice and research are discussed.
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Affiliation(s)
| | - Marissa Kaloga
- The Economic and Community Development Institute, Columbus, OH, USA
| | | | | | | | - Kipa Maskey
- Nepal School of Social Work, Kathmandu, Nepal
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193
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Tucker JD, Meier BM, Devoto C, Szunyogova E, Baral S. Sexual health and human rights: protecting rights to promote health. BMC Infect Dis 2019; 19:226. [PMID: 30836936 PMCID: PMC6402151 DOI: 10.1186/s12879-019-3860-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Joseph D Tucker
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building, Chapel Hill, NC, USA. .,Social Entrepreneurship to Spur Health (SESH), Guangzhou, China. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Benjamin M Meier
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,O'Neill Institute for National and Global Health Law, Georgetown Law Center, Washington, DC, USA
| | | | - Eva Szunyogova
- BMC International Health and Human Rights, BMC, London, UK
| | - Stefan Baral
- Departments of Epidemiology, International Health, and Health Policy and Management, Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
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194
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Evens E, Lanham M, Santi K, Cooke J, Ridgeway K, Morales G, Parker C, Brennan C, de Bruin M, Desrosiers PC, Diaz X, Drago M, McLean R, Mendizabal M, Davis D, Hershow RB, Dayton R. Experiences of gender-based violence among female sex workers, men who have sex with men, and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:9. [PMID: 30832664 PMCID: PMC6399914 DOI: 10.1186/s12914-019-0187-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Female sex workers, MSM, and transgender women-collectively referred to as key populations (KPs)-are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs' human rights. METHODS Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. RESULTS Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and-for transgender women and MSM-religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. CONCLUSIONS Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations' human rights.
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Affiliation(s)
- Emily Evens
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | | | - Karin Santi
- United Nations Development Programme, Panama City, Panama
| | - Juana Cooke
- United Nations Development Programme, Panama City, Panama
| | | | | | - Caleb Parker
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | | | - Marjan de Bruin
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | | | - Xenia Diaz
- United Nations Development Programme, San Salvador, El Salvador
| | - Marta Drago
- United Nations Development Programme, San Salvador, El Salvador
| | - Roger McLean
- Centre for Health Economics, The University of the West Indies St. Augustine Campus, St Augustine, Trinidad and Tobago
| | - Modesto Mendizabal
- Asociación Diké de Hombres y Mujeres Transgénero y LGBTI+, San Salvador, El Salvador
| | - Dirk Davis
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | - Rebecca B. Hershow
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Robyn Dayton
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
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195
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Argento E, Goldenberg S, Shannon K. Preventing sexually transmitted and blood borne infections (STBBIs) among sex workers: a critical review of the evidence on determinants and interventions in high-income countries. BMC Infect Dis 2019; 19:212. [PMID: 30832596 PMCID: PMC6399876 DOI: 10.1186/s12879-019-3694-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
Background Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries. Methods We searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited. Results Research demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted. Conclusions The high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.
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196
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Sawicki DA, Meffert BN, Read K, Heinz AJ. Culturally Competent Health Care for Sex Workers: An Examination of Myths That Stigmatize Sex-Work and Hinder Access to Care. SEXUAL AND RELATIONSHIP THERAPY 2019; 34:355-371. [PMID: 30899197 DOI: 10.1080/14681994.2019.1574970] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sex workers are individuals who offer sexual services in exchange for compensation (i.e., money, goods, or other services). Within the United States the full-service sex work (FSSW) industry generates 14 billion dollars annually there are estimated to be 1-2 million FSSWers, though experts believe this number to be an underestimate. Many FSSWers face the possibility of violence, legal involvement, and social stigmatization. As a result, this population experiences increased risk for mental health disorders. Given these risks and vulnerabilities, FSSWers stand to benefit from receiving mental health care however a constellation of individual, organizational, and systemic barriers limit care utilization. Destigmatization of FSSW and offering of culturally competent mental health care can help empower this traditionally marginalized population. The objective of the current review is to (1) educate clinicians on sex work and describe the unique struggles faced by FSSW and vulnerability factors clinicians must consider, (2) address 5 common myths about FSSW that perpetuate stigma, and (3) advance a research and culturally competent clinical training agenda that can optimize mental health care engagement and utilization within the sex work community.
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Affiliation(s)
- Danielle A Sawicki
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Healthcare System
| | - Brienna N Meffert
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Healthcare System
| | - Kate Read
- Black Dot Writing LLC, Veterans Affairs Palo Alto Healthcare System
| | - Adrienne J Heinz
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Healthcare System.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System
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197
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Affiliation(s)
- Jennifer Toller Erausquin
- Jennifer Toller Erausquin is with the Department of Public Health Education, University of North Carolina at Greensboro
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198
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Footer KHA, Park JN, Allen ST, Decker MR, Silberzahn BE, Huettner S, Galai N, Sherman SG. Police-Related Correlates of Client-Perpetrated Violence Among Female Sex Workers in Baltimore City, Maryland. Am J Public Health 2018; 109:289-295. [PMID: 30571295 DOI: 10.2105/ajph.2018.304809] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterize interactions that female sex workers (FSWs) have with the police and explore associations with client-perpetrated violence. METHODS Baseline data were collected April 2016 to January 2017 from 250 FSWs from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study based in Baltimore, Maryland. Interviewer-administered questionnaires captured different patrol or enforcement and abusive police encounters, experiences of client-perpetrated violence, and other risk factors, including drug use. We conducted bivariate and multivariable analysis in Stata/SE version 14.2 (StataCorp LP, College Station, TX). RESULTS Of participants, 78% reported lifetime abusive police encounters, 41% reported daily or weekly encounters of any type. In the previous 3 months, 22% experienced client-perpetrated violence. Heroin users (70% of participants) reported more abusive encounters (2.5 vs 1.6; P < .001) and more client-perpetrated violence (26% vs 12%; P = .02) than others. In multivariable analysis, each additional type of abusive interaction was associated with 1.3 times (95% confidence interval [CI] = 1.1, 1.5) increased odds of client-perpetrated violence. For patrol or enforcement encounters, this value was 1.3 (95% CI = 1.0, 1.7). CONCLUSIONS Frequent exposures to abusive police practices appear to contribute to an environment where client-perpetrated violence is regularly experienced. For FSWs who inject drugs, police exposure and client-perpetrated violence appear amplified. Public Health Implications. Structural interventions that address police-FSW interactions will help alleviate police's negative impact on FSWs' work environment.
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Affiliation(s)
- Katherine H A Footer
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Ju Nyeong Park
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sean T Allen
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michele R Decker
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Bradley E Silberzahn
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Steve Huettner
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Noya Galai
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Susan G Sherman
- Katherine H. A. Footer is with the Department of Health, Behavior, and Society, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ju Nyeong Park, Sean T. Allen, and Bradley E. Silberzahn are with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health. Michele R. Decker is with Johns Hopkins Bloomberg School of Public Health; Population, Family, and Reproductive Health; and School of Nursing. Steve Huettner is with Johns Hopkins School of Medicine. Noya Galai is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Susan G. Sherman is with the Departments of Health, Behavior, and Society; Population, Family, and Reproductive Health; and Epidemiology, Johns Hopkins Bloomberg School of Public Health
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199
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Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med 2018; 15:e1002680. [PMID: 30532209 PMCID: PMC6289426 DOI: 10.1371/journal.pmed.1002680] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur. METHODS AND FINDINGS We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. CONCLUSIONS Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.
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Argento E, Braschel M, Walsh Z, Socias ME, Shannon K. The moderating effect of psychedelics on the prospective relationship between prescription opioid use and suicide risk among marginalized women. J Psychopharmacol 2018; 32:1385-1391. [PMID: 30255717 PMCID: PMC6355147 DOI: 10.1177/0269881118798610] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Given high rates of depression and suicide among marginalized women, and increasing calls to integrate trauma-informed biomedical and community-led structural interventions, this study longitudinally examines the potential moderating effect of psychedelic use on the relationship between other illicit drug use and suicide risk. METHODS Data (2010-2017) were drawn from a community-based, prospective open cohort of marginalized women in Vancouver, Canada. Extended Cox regression analyses examined the moderating effect of psychedelic use on the association between other illicit drug use and incidence of suicidal ideation or attempt over follow-up. RESULTS Of 340 women without suicidal ideation or attempt at baseline, 16% ( n=53) reported a first suicidal episode during follow-up, with an incidence density of 4.63 per 100 person-years (95% confidence interval 3.53-6.07). In unadjusted analysis, psychedelic use moderated the relationship between prescription opioid use and suicide risk: among women who did not use psychedelics, prescription opioid use increased the hazard of suicide (hazard ratio 2.91; 95% confidence interval 1.40-6.03) whereas prescription opioid use was not associated with increased suicidal ideation or attempt among those who used psychedelics (hazard ratio 0.69; 95% confidence interval 0.27-1.73) (interaction term p-value: 0.016). The moderating effect of psychedelics remained significant when adjusted for confounders (interaction term p-value: 0.036). CONCLUSIONS Psychedelic use had a protective moderating effect on the relationship between prescription opioid use and suicide risk. In the context of a severe public health crisis around prescription opioids and lack of addiction services tailored to marginalized women, this study supports calls for innovative, evidence-based and trauma-informed interventions, including further research on the potential benefits of psychedelics.
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Affiliation(s)
- Elena Argento
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - M. Eugenia Socias
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,BC Centre on Substance Use, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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