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Grosso A, Bowring AL, Njindam IM, Decker MR, Lyons C, Rao A, Tamoufe U, Fako GH, Fouda G, Levitt D, Turpin G, Billong SC, Zoung-Kanyi Bissek AC, Njoya O, Baral S. Sexually Transmitted Infection Risks and Symptoms Heightened Among Female Sex Workers who Started Selling Sex Before the Age of 18 in Five Cities in Cameroon. AIDS Behav 2024; 28:898-906. [PMID: 37843686 PMCID: PMC10896857 DOI: 10.1007/s10461-023-04196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
Many adolescents under 18 years old who sell sex are at elevated risk for sexually transmitted infection (STI) acquisition, which may persist into adulthood. There has been limited study of the burden of the risks and vulnerabilities among women who started selling sex as adolescents across Sub-Saharan Africa. In this study, a Adult female sex workers (FSW) recruited through respondent-driven sampling in five cities in Cameroon from December 2015 to October 2016 completed a questionnaire and human immunodeficiency virus (HIV) and syphilis testing. Multivariable logistic regression analysis controlling for age was used to identify factors associated with reporting selling sex before age 18. Selling sex before age 18 was reported by 11.5% (256/2,220) of FSW. Initiation of selling sex as an adolescent was positively associated with experiencing dysuria (adjusted odds ratio [aOR]:1.50, 95% confidence interval [CI]:1.08-2.10) or genital warts (aOR:1.78, 95% CI:1.08-2.94) and negatively associated with prior recent testing for HIV (aOR:0.71, 95% CI:0.53-0.96) or STIs (aOR:0.65, 95% CI:0.44-0.96). Consistent condom use with clients was negatively associated with early initiation of selling sex (aOR:0.58, 95% CI:0.42-0.80), while experience of recent sexual violence was positively associated with early initiation (aOR:1.74, 95% CI:1.15-2.63). There were no independent significant differences in HIV (24.5%) or syphilis (8.3%) prevalence. Given the limited use of HIV and STI testing services by women who sold sex as adolescents, the prevalence of forced sex, condomless sex, and STI symptoms were high. Programs serving FSW should more vigorously aim to serve adolescents and adults who began selling sex early.
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Affiliation(s)
- Ashley Grosso
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Anna L Bowring
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | | | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, 615 N Wolfe St Baltimore, MD, Baltimore, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Ubald Tamoufe
- Metabiota, Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, Yaoundé, 15939, Cameroon
| | - Guy H Fako
- Care and Health Program, Yaoundé, Cameroon
| | - Ghislaine Fouda
- CARE Cameroon, Villa La Rose (3è étage, Av. Churchill, Yaoundé, Cameroon
| | - Daniel Levitt
- CARE USA, 115 Broadway, 5th floor, New York, NY, 10006, USA
- FHI 360, New York, United States
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Serge C Billong
- Groupe Technique Central, CNLS, Rue Henri Dunant, Yaoundé, Cameroon
| | | | - Oudou Njoya
- Department of Internal Medicine, Yaoundé University Hospital Center, Joseph Tchooungui Akoa, Yaoundé, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
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Shah P, Kabuti R, Beksinska A, Nyariki E, Babu H, Kungu M, Jama Z, Ngurukiri P, Kaul R, Kyegombe N, Medley GF, Devries K, Seeley J, Weiss HA, Beattie TS, Kimani J. Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya. BMJ Open 2023; 13:e078618. [PMID: 38114279 DOI: 10.1136/bmjopen-2023-078618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya. BACKGROUND Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation. DESIGN Building on previous qualitative research with this cohort, analysis of behavioural-biological cross-sectional data using hierarchical logistic regression. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural-biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling. RESULTS Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66). CONCLUSIONS Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karen Devries
- Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Helen Anne Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Longo JDD, Woromogo SH, Diemer HSC, Tekpa G, Nambei WS, Grésenguet G. Young women who sell sex in Bangui, Central African Republic: a neglected group highly vulnerable to HIV. J Public Health (Oxf) 2023; 45:e630-e638. [PMID: 37477242 DOI: 10.1093/pubmed/fdad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The objectives of this study were to determine the association between the vulnerability factors linked to human immunodeficiency virus (HIV) and other sexually transmitted infection among the young women who sell sex (YWSS) group (15-24 years) and adult sex workers, engaged in consensual sex for money (AFSW). METHODS A cross-sectional study was conducted among AFSW involved in commercial sex transactions. Prevalence ratios (PR) analysis was carried out using log-binomial regression model. RESULTS The prevalence of HIV-1 was 29.4% among YWSS compared to 19.6% among female sex worker (PR = 1.43 [1.07-1.91]). Consistent condoms use last 3 months were very low at 22.3% and 41.2%, respectively (PR = 0.52 [0.37-0.74]), the low education level among YWSS versus AFSW (PR = 0.55 [0.40-0.76]); YWSS having been a victim of sexual violence in the last 12 months (PR = 2.00 [1.52-2.63]), were also more likely to be HIV positive. CONCLUSIONS The YWSS had a high prevalence of HIV, experienced other socioeconomic vulnerabilities and remain a key population for comprehensive HIV programs. To reach all YWSS, programs need to consider many outreach programs and address the shared determinants of HIV risk.
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Affiliation(s)
- Jean de Dieu Longo
- National Reference Centre for Sexually Transmitted Diseases and Antiretroviral Therapy, Bangui, Central African Republic
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
| | - Sylvain Honoré Woromogo
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
- Communicable Diseases Unit, Inter-State Centre for Higher Education in Public Health of Central Africa, Brazzaville, Republic of Congo
| | - Henri Saint-Calvaire Diemer
- National Reference Centre for Sexually Transmitted Diseases and Antiretroviral Therapy, Bangui, Central African Republic
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
| | - Gaspard Tekpa
- Department of Infectious and Tropical Diseases, University Hospital of Friendship, Bangui, Central African Republic
| | | | - Gérard Grésenguet
- National Reference Centre for Sexually Transmitted Diseases and Antiretroviral Therapy, Bangui, Central African Republic
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
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Grosso A, Fielding-Miller R, Matse S, Sithole B, Baral S. The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini. Front Psychiatry 2023; 14:1048703. [PMID: 37435406 PMCID: PMC10331471 DOI: 10.3389/fpsyt.2023.1048703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
Background Minors who sell sex are likely to have complex mental health needs that may persist into adulthood. This topic is understudied in sub-Saharan Africa. This study hypothesized that adult female sex workers in Eswatini who started selling sex as minors have a higher prevalence of depression than those who started as adults. We also examined correlates of depression and underage initiation of selling sex, including stigma and condom-related behaviors. Methods From October-December 2014, women aged 18 or older who sold sex in the past 12 months in Eswatini were recruited through venue-based sampling. Participants completed a survey including the 9-item Patient Health Questionnaire (PHQ-9) and a question about the age at which they first sold sex for money. T-tests, χ2 tests and multivariable logistic regression were used to assess associations. Results Overall, 43.1% of participants (332/770) had probable depression, and 16.6% (128/770) started selling sex as minors under the age of 18. Over half (55.5%, 71/128) of those who started selling sex as minors had depression. This was significantly higher than the 40.7% (261/642) prevalence of depression among participants who started selling sex as adults (p = 0.002). After adjusting for confounders, female sex workers who started selling sex as minors had higher odds of depression than those who started as adults (adjusted odds ratio [aOR] 1.70, 95% confidence interval 1.11-2.60). Conclusion Results highlight the need for trauma-informed and adolescent-friendly mental health services in settings free of stigma toward female sex workers in Eswatini.
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Affiliation(s)
- Ashley Grosso
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, United States
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | | | - Bhekie Sithole
- Health Communication Capacity Collaborative, Mbabane, Eswatini
| | - Stefan Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Beksinska A, Karlsen O, Gafos M, Beattie TS. Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001216. [PMID: 37310993 DOI: 10.1371/journal.pgph.0001216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/08/2022] [Indexed: 06/15/2023]
Abstract
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Studies were selected for inclusion that reported any measure of prevalence or incidence of alcohol use among FSWs aged 18 or older from countries defined as LMIC in accordance with the World Bank income groups 2019. The following study designs were included: cross-sectional survey, case-control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Study quality was assessed with the Center for Evidence-Based Management (CEBMa) Critical Appraisal Tool. Pooled prevalence estimates were calculated for (i) any hazardous/harmful/dependent alcohol use, (ii) harmful/dependent alcohol use only, both overall and by region and (iii) daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31-51%), and of daily alcohol use was 26% (95% CI: 17-36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01-2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15-1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24-4.80), but not with HIV, violence or mental health problems. We found a high prevalence of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with important HIV risk factors such as inconsistent condom use, STIs and other drug use. Major limitations included heterogeneity in tools and cut-off scores to measure alcohol use and other common risk factors, and a paucity of longitudinal studies. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oda Karlsen
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chingono R, Kasese C, Miles S, Busza J. 'I was in need of somewhere to release my hurt:' Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups. Glob Health Action 2022; 15:2040151. [PMID: 35322767 PMCID: PMC8956306 DOI: 10.1080/16549716.2022.2040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.
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Affiliation(s)
- Rudo Chingono
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Institute of Global Health, University College London, UK
| | - Constance Kasese
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Sam Miles
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
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Stoner MCD, Rucinski KB, Lyons C, Napierala S. Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta-analysis. J Int AIDS Soc 2022; 25:e26028. [PMID: 36302078 PMCID: PMC9612831 DOI: 10.1002/jia2.26028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Young women who sell sex (YWSS) are at heightened risk of HIV acquisition and transmission and are among the least engaged in HIV services. There is insufficient epidemiologic evidence characterizing the burden of HIV among YWSS, particularly as compared to older WSS. These data are needed to design and tailor effective HIV prevention and treatment programmes for this population. METHODS We conducted two parallel systematic reviews and meta-analyses to define both the immediate and long-term HIV risks for YWSS, including among women engaged in sex work, survival sex and transactional sex. In the first review, we identified and synthesized published studies of HIV incidence comparing estimates for cisgender women ≤24 years of age versus >24. In the second review, we identified and synthesized studies of HIV prevalence, comparing estimates for cisgender women who initiated selling sex <18 versus ≥18 years. In both reviews, we completed a search of four databases for articles in any language and any geographic area published from 1 January 1980 until 12 February 2021. Included articles were assessed for quality and a random effects model was used to calculate pooled effect estimates for each review. RESULTS AND DISCUSSION We identified 12 studies for the HIV incidence review and 18 studies for the HIV prevalence review. In a meta-analysis, HIV incidence was elevated in younger (5.3 per 100 person-years [PY]; 95% confidence interval [CI]: 3.5, 7.1) compared to older women (2.8 per 100 PY; 95% CI: 1.7, 3.9), although CIs overlapped. HIV prevalence among those who initiated selling sex <18 years of age (28.8; 95% CI: 18.9, 38.7) was higher than those who initiated later (20.5; 95% CI: 12.4, 28.6). CONCLUSIONS These companion reviews offer an important perspective on the relative HIV risk of engaging in selling sex at a younger age. Our findings highlight the unique and intersectional challenges YWSS face, and the importance of ensuring that health services are tailored to meet their specific needs. Research and programming should routinely stratify data into meaningful age bands to differentiate and intervene within this population.
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Affiliation(s)
| | - Katherine B. Rucinski
- Social and Behavioral Interventions Program, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Carrie Lyons
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Sue Napierala
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
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Gore MN, Patwardhan AR. Disparities in the Cost of Living Adjusted Earnings of Female Sex Workers in India, Thailand, and the USA: A Need to Create an Equitable Economic Survival of Female Sex Workers. J Prim Care Community Health 2022; 13:21501319221101857. [PMID: 35603562 PMCID: PMC9130802 DOI: 10.1177/21501319221101857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Financial necessity and desperation is the primary reason for females to enter
into sex work. The health and well-being of female sex workers (FSWs) depend on
the balance between their earnings and the cost of living in their local
environment. Therefore it would be of value to examine the comparative cost of
living adjusted earnings of FSWs in different countries to gauge equity or its
absence in their financial state. Data about per client per encounter earnings
for FSWs in Pune, India was taken from primary research conducted by the first
author. Equivalent secondary data was acquired for the US and Thailand from an
online literature review. Earnings after converting to US dollar values were
adjusted against the cost of living in the respective environments of the FSWs
and then compared. An FSW in India, (Pune) earned on the average US $4.40 after
adjusting for the cost of living locally, while in Thailand (Bangkok) the
equivalent earning was US $18.77 and in the US (Washington DC region) it was
$101.79. These results suggest that an FSW in the US earns 23 times more, and a
Thai FSW earns 4 times more than an FSW in India. There are numerous variables
that affect the earnings of an FSW and the limited defined scope of this paper
based on available data does not permit detailed analyses of causal or
intermediate influencing factors. Nonetheless, it can be said with reasonable
confidence that much needs to be done and can be done to mitigate the earning
disparity, particularly in an emerging economy like India as shown in this small
study, and that can perhaps be done best under the umbrella domain of a “harm
reduction approach.”
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Affiliation(s)
- Manisha N Gore
- Symbiosis International (Deemed University), Pune, Maharashtra, India
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Silverman JG, Boyce SC, Fonseka RW, Triplett D, Chiang LF, Caslin SS, Raj A. The relationship between commercial sexual exploitation of children (CSEC) and childhood sexual abuse (CSA) among boys and girls in Haiti. Int J Inj Contr Saf Promot 2021; 29:86-92. [PMID: 34923923 DOI: 10.1080/17457300.2021.2004430] [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] [Indexed: 10/19/2022]
Abstract
To test the hypothesis that childhood sexual abuse (CSA) is a risk factor for commercial sexual exploitation of children (CSEC), we analysed data from the Haiti Violence Against Children Survey (VACS), a population-based sample of adolescents and young adults ages 13-24 (1459 males and 1457 females). Twenty-one percent of males and 25% of females reported CSA; 6% of males and 4% of females reported CSEC. The adjusted odds ratios (AORs) for CSEC based on exposure to CSA were 5.6 (95% confidence interval/CI: 3.1-10.2) for males and 5.9 (CI: 2.6-13.0) for females. For each year earlier that males first experienced CSA, the odds of CSEC increased 60% (AOR 1.6, CI 1.2-2.0). In this first nationally-representative study of lifetime CSEC, both boys and girls victimised by CSA in Haiti were more likely to have also experienced CSEC than other youth, with children who experienced CSA at younger ages at the greatest risk.
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Affiliation(s)
- Jay G Silverman
- Center on Gender Equity and Health, University of California San Diego (UCSD), San Diego, CA, USA
| | - Sabrina C Boyce
- Center on Gender Equity and Health, University of California San Diego (UCSD), San Diego, CA, USA
| | - Ruvani W Fonseka
- Center on Gender Equity and Health, University of California San Diego (UCSD), San Diego, CA, USA
| | - Daniel Triplett
- Center on Gender Equity and Health, University of California San Diego (UCSD), San Diego, CA, USA
| | - Laura F Chiang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sharon S Caslin
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego (UCSD), San Diego, CA, USA
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Peitzmeier SM, Wirtz AL, Beyrer C, Peryshkina A, Sherman SG, Colantuoni E, Decker MR. Polyvictimization Among Russian Sex Workers: Intimate Partner, Police, and Pimp Violence Cluster With Client Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8056-NP8081. [PMID: 30966847 PMCID: PMC9476162 DOI: 10.1177/0886260519839431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Female sex workers (FSW) are a key population in the HIV epidemic and face high levels of violence. While women globally are predominantly at risk of intimate partner violence (IPV), FSW are additionally vulnerable to violence from clients, police, and pimps associated with their occupation. FSW are therefore at risk of cumulative trauma from polyvictimization, or violence from multiple types of perpetrators. Polyvictimization is a driver of morbidity and mortality in numerous populations, but there has been little research on how multiple types of victimization are related to one another in FSW. A cross-sectional survey was conducted among 754 FSW from three cities in the Russian Federation. Surveys assessed lifetime experiences of client, police, intimate partner, and pimp violence. Multivariate log-binomial and Poisson regression were used to test associations between these types of violence. Forty-five percent experienced any type of violence, including 31.7% from clients, 16.0% from police, 15.7% from intimate partners, and 11.4% from pimps. One fifth (20.4%) experienced polyvictimization. Client violence was central to polyvictimization: Only 5.9% of polyvictimization occurs without client violence. When client violence was not present, police, pimp, or IPV co-occurred significantly less than would be expected under an assumption that these types of violence occur independently (p < .001). However, they co-occurred more than would be expected when client violence is present. After adjusting for other types of violence experienced and demographic factors, experiencing client violence was independently associated with police violence (adjusted relative risk [ARR] = 2.77, 95% confidence interval [CI] [1.67, 4.59]), IPV (ARR = 3.67, 95% CI [1.95, 6.89]), and pimp violence (ARR = 5.26, 95% CI [2.80, 9.86]). Client violence may drive exposure to other types of violence and enable polyvictimization in a way that other types of violence do not in this setting. Violence prevention interventions may achieve maximal effect in reducing multiple types of violence by focusing on client violence.
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Affiliation(s)
- Sarah M Peitzmeier
- University of Michigan, Ann Arbor, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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King R, Muhanguzi E, Nakitto M, Mirembe M, Kasujja FX, Bagiire D, Seeley J. Mobility study of young women who exchange sex for money or commodities using Google Maps and qualitative methods in Kampala, Uganda. BMJ Open 2021; 11:e043078. [PMID: 34011583 PMCID: PMC8137195 DOI: 10.1136/bmjopen-2020-043078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES We aimed to assess mobility patterns and reasons for high mobility among young women engaged in sex work within a randomised controlled trial to gauge how mobility may hinder access to health services and enhance HIV risk in a highly vulnerable population. SETTING Participants were recruited from a clinic in Kampala, Uganda set up for women at high risk of HIV infection. PARTICIPANTS Adolescent girls and young women engaged in sex for money and/or commodities are at particular risk in countries with high HIV prevalence and high fertility rates. High mobility increases exposure to HIV risk. Women participants were eligible for the parent study if aged 15-24 years, HIV negative and engaged in sex work. For this substudy, 34 qualitative interviews were held with 14 sex workers (6 HIV positive, 8 HIV negative), 6 health worker/policy makers, 3 peer educators, 5 'queen mothers' and 6 male partners MEASURES: Participants used Google Maps to identify work venues at 12-month and 18-month study visits. We also conducted 34 interviews on mobility with: high-risk women, male partners, health workers and sex-worker managers. Topics included: distance, frequency and reasons for mobility. We used Python software to analyse mapping data. RESULTS Interviews found in depth narratives describing lack of education and employment opportunities, violence, lack of agency, social, sexual and familial support networks and poverty as a complex web of reasons for high mobility among young sex workers. CONCLUSIONS Young women at high risk are highly mobile. Reasons for mobility impact access and retention to health services and research activities. Strategies to improve retention in care should be cognisant and tailored to suit mobility patterns. TRIAL REGISTRATION NUMBER NCT03203200.
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Affiliation(s)
- Rachel King
- Institute for Global Health Sciences, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Eva Muhanguzi
- Institute for Global Health Sciences, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Miriam Nakitto
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Miriam Mirembe
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Francis Xavier Kasujja
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Daniel Bagiire
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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12
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Sa M, C R, Ml M, Lr S, J TM, S J, X S, Rs G, Sa S, K D, K H, R M, Mj M, M O, A G, D W, Ai S. Examining the gender composition of drug injecting initiation events: A mixed methods investigation of three North American contexts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103056. [PMID: 33310638 PMCID: PMC8046711 DOI: 10.1016/j.drugpo.2020.103056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gender influences the health and social risks faced by individuals initiating drug injecting. Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred. METHODS The PReventing Injecting by Modifying Existing Responses (PRIMER) study pooled data from three prospective community-recruited cohorts of people who inject drugs (PWID) in San Diego, USA, Vancouver, Canada, and Tijuana, Mexico. A qualitative subsample provided narrative data on their experiences of, and the contexts for, injection initiation events. Guided by Rhodes' risk environment framework, we examined the gender composition of initiation events stratified by city, and analyzed qualitative data using abductive thematic analyses. RESULTS Among 2,622 PWID (Tijuana: n = 531; San Diego: n = 352; Vancouver: n = 1,739), 112 (4.3%) reported providing initiation assistance to injection-naïve individuals in the previous six months. The proportion of gender concordant (e.g., male-male) initiation pairs varied, (χ2 = 10.32, p <0.001) with greater than expected concordance among pairs in Tijuana compared with those in Vancouver or San Diego. Sixty-one interviews provided context for the discrepancy across sites by highlighting the gendered injection initiation risk environments of prison/jail detention in Tijuana, intimate partnerships in San Diego, and overdose risk in Vancouver. CONCLUSIONS These results highlight how gender influences injection initiation events within spatial, social, and economic risk environments, and how this influence varies across settings. These findings can inform interventions to reduce the risk of injection initiation and related harms.
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Affiliation(s)
- Meyers Sa
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Rafful C
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
| | - Mittal Ml
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, Mexico
| | - Smith Lr
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Tirado-Muñoz J
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jain S
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Sun X
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Garfein Rs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Strathdee Sa
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - DeBeck K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - Hayashi K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - McNeil R
- School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, United States
| | - Milloy Mj
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9 Canada
| | - Olding M
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada
| | - Guise A
- Addison House, Guy's Hospital, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Werb D
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - Scheim Ai
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
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13
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Wang M, Lim SH, Gibson BA, Azwa I, Guadamuz TE, Altice FL, Kamarulzaman A, Wickersham JA. Correlates of newly diagnosed HIV infection among cisgender women sex workers and transgender women sex workers in Greater Kuala Lumpur, Malaysia. Int J STD AIDS 2021; 32:609-619. [PMID: 33752518 DOI: 10.1177/0956462420970417] [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: 11/17/2022]
Abstract
Globally, cisgender women sex workers (CWSWs) and transgender women sex workers (TWSWs) experience increased vulnerabilities to HIV infection. Unfortunately, there is limited data on the drivers of HIV infection in these two understudied populations, particularly in Southeast Asia. To better understand factors associated with HIV infection, we evaluated correlates of newly diagnosed HIV infection in these two populations in Greater Kuala Lumpur, Malaysia. A total of 469 women (CWSW: n = 283; TWSW: n = 186) were included in this study. Most participants who tested HIV+ were unaware of their infection (59.6%; n = 34/57). Separate binary and multivariable logistic regressions were conducted to identify correlates of newly diagnosed HIV in CWSWs and TWSWs. Among CWSWs, Chlamydia trachomatis (aOR = 5.66; p = 0.007) and lifetime use of ecstasy/MDMA (aOR = 5.34; p = 0.03) were associated with newly diagnosed HIV, while condomless vaginal sex with clients was associated with lower likelihood of HIV infection (aOR = 0.98; p = 0.01). Among TWSWs, being single (aOR = 6.76; p = 0.03), using mobile application to solicit clients (aOR = 25.33; p = 0.006), and having C. trachomatis infection (aOR = 88.22, p = 0.02) were associated with newly diagnosed HIV. Expansion of HIV/sexually transmitted infection screening is needed to increase detection of HIV and linkage to care for sex workers. Interventions to reduce HIV infection among CWSWs and TWSWs should be tailored to these populations' unique vulnerabilities.
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Affiliation(s)
- Melinda Wang
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Sin How Lim
- Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia.,Faculty of Medicine, Department of Social and Preventive Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Britton A Gibson
- Frank H. Netter MD School of Medicine, 472529Quinnipiac University, North Haven, CT, USA
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Thomas E Guadamuz
- Department of Society and Health, Faculty of Social Sciences and Humanities, 26685Mahidol University, Nakhon Pathom, Thailand
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia.,Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
| | - Adeeba Kamarulzaman
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia
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14
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Malama K, Sagaon-Teyssier L, Gosset A, Parker R, Wall KM, Tichacek A, Sharkey T, Kilembe W, Inambao M, Price MA, Spire B, Allen S. Loss to follow-up among female sex workers in Zambia: findings from a five-year HIV-incidence cohort. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 19:296-303. [PMID: 33337978 DOI: 10.2989/16085906.2020.1836005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
HIV-incidence studies are used to identify at-risk populations for HIV-prevention trials and interventions, but loss to follow-up (LTFU) can bias results if participants who remain differ from those who drop out. We investigated the incidence of and factors associated with LTFU among Zambian female sex workers (FSWs) in an HIV-incidence cohort from 2012 to 2017. Enrolled participants returned at month one, month three and quarterly thereafter. FSWs were considered LTFU if they missed six consecutive months, or if their last visit was six months before the study end date. Of 420 FSWs, 139 (33%) were LTFU at a rate of 15.7 per 100 person years. In multivariable analysis, LTFU was greater for FSWs who never used alcohol, began sex work above the age of consent, and had a lower volume of new clients. Our study appeared to retain FSWs in most need of HIV-prevention services offered at follow-up.
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Affiliation(s)
- Kalonde Malama
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,ORS PACA, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,ORS PACA, Marseille, France
| | - Andréa Gosset
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, USA
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, USA
| | - Tyronza Sharkey
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - William Kilembe
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - Mubiana Inambao
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Ndola, Zambia
| | - Matt A Price
- IAVI, New York, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,ORS PACA, Marseille, France
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Emory University, School of Medicine, Atlanta, USA
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15
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Age Matters: Determinants of sexual and reproductive health vulnerabilities amongst young women who sell sex (16-24 years) in Zimbabwe. Soc Sci Med 2020; 270:113597. [PMID: 33360151 DOI: 10.1016/j.socscimed.2020.113597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/29/2020] [Accepted: 12/06/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16-24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design. OBJECTIVE This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16-24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16-24 year age band. METHODS In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories. RESULTS Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16-19 years) and older YWSS (20-24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a "sex worker" identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks. CONCLUSIONS We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes.
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16
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Khezri M, Shokoohi M, Mirzazadeh A, Karamouzian M, Sharifi H, Haghdoost A, Baral SD. Early sex work initiation and its association with condomless sex and sexually transmitted infections among female sex workers in Iran. Int J STD AIDS 2020; 31:671-679. [PMID: 32538329 DOI: 10.1177/0956462420913431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Early sex work initiation among female sex workers (FSWs) increases their vulnerabilities to high-risk sexual practices and sexually transmitted infections (STIs). We examined the association of early sex work with condomless sex indicators, HIV, and other STIs, including human papillomavirus, chlamydia, trichomoniasis, syphilis, and gonorrhea, among FSWs in Iran. We recruited 1347 FSWs from 13 cities in 2015, with 1296 participants (94.2%) reporting information about their age of sex work initiation. Early sex work was defined as the initiation of selling sex before 18 years of age. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported using multivariable logistic regression. Overall, 10.1% of FSWs reported early sex work initiation. FSWs who initiated sex work earlier were more likely to report last-month inconsistent condom use (aOR = 3.31, 95% CI: 1.82, 6.02) and condomless sex with last client (aOR = 1.72, 95% CI: 1.15, 2.56). There was no statistically significant association between early sex work and HIV (aOR = 1.40, 95% CI: 0.43, 4.53) and any other STIs (aOR = 1.01, 95% CI: 0.69, 1.48), except for chlamydia (aOR = 2.09, 95% CI: 1.08, 4.04). These findings suggest that FSWs with early sexual debut would benefit from differentiated interventions including screening for STIs and enhanced counseling for condom use.
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Affiliation(s)
- Mehrdad Khezri
- 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
| | - 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.,Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - 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, San Francisco, CA, USA
| | - 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.,Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - 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
| | - AliAkbar Haghdoost
- 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
| | - Stefan D Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Rocha-Jiménez T, Morales-Miranda S, Fernández-Casanueva C, Brouwer KC. The influence of migration in substance use practices and HIV/STI-related risks of female sex workers at a dynamic border crossing. J Ethn Subst Abuse 2020; 19:503-520. [PMID: 30795721 PMCID: PMC8638352 DOI: 10.1080/15332640.2018.1556763] [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: 01/13/2023]
Abstract
We explored the association of international migration with substance use and HIV/STI risk factors among female sex workers (FSW). Using modified time-location sampling, we recruited 266 FSW at the Mexico-Guatemala border. Crude and adjusted logistic regression models were used to evaluate the relationships. HIV risks, such as frequent hard drug use and drug use in another country, were greater for migrant compared to nonmigrant FSW. However, more migrant versus nonmigrant FSW reported consistent condom use with clients and having a health card. Our study highlights regional patterns of substance use among FSW and risk or protective behaviors related to migration status.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
- Graduate School of Public Health, San Diego State University, Center for U.S.-Mexican Studies, University of California, San Diego, California
| | | | - Carmen Fernández-Casanueva
- Centro de Investigaciones y Estudios Superiores en Antropología Social CIESAS, San Cristóbal de las Casas, Chiapas, México
| | - Kimberly C Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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18
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Farahmand M, Moghoofei M, Dorost A, Abbasi S, Monavari SH, Kiani SJ, Tavakoli A. Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis. BMC Public Health 2020; 20:1455. [PMID: 32977797 PMCID: PMC7519561 DOI: 10.1186/s12889-020-09570-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and the distribution of HPV types among FSWs across the world. METHODS Five computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable sources of heterogeneity. The meta-analysis was performed using the "Metaprop" function in the R package Meta. RESULTS Sixty-two studies involving 21,402 FSWs from 33 countries were included in this meta-analysis, and the pooled HPV prevalence was 42.6% (95% confidence interval (CI): 38.5-46.7%). HPV-16 (10.1, 95% CI: 8.2-12.5%), HPV-52 (7.9, 95% CI: 5.9-10.7%), and HPV-53 (6.0, 95% CI: 4.4-8.1%) were the most common high-risk HPV types identified among FSWs. The pooled estimated prevalence of HPV infection among FSWs before and after 2010 were slightly different, 43.6% (95% CI: 36.1-51.4%) and 41.9% (95% CI: 37.2-46.8%), respectively. CONCLUSION Due to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and the incidence of HPV-associated malignancies among the general population.
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Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Moghoofei
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abolfazl Dorost
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Abbasi
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamidreza Monavari
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jalal Kiani
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
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Rashti R, Sharafi H, Alavian SM, Moradi Y, Mohamadi Bolbanabad A, Moradi G. Systematic Review and Meta-Analysis of Global Prevalence of HBsAg and HIV and HCV Antibodies among People Who Inject Drugs and Female Sex Workers. Pathogens 2020; 9:pathogens9060432. [PMID: 32486342 PMCID: PMC7350380 DOI: 10.3390/pathogens9060432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
The main objective of this study was to evaluate the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C virus (HCV) and hepatitis B virus (HBV) and their co-infections among people who inject drugs (PWID) and female sex workers (FSWs). Data sources were searched from January 2008 to October 2018 in different databases. Data were analyzed in Stata 16 software using the Metaprop command. The results showed that the prevalence of HIV, HCV and HBV among PWID was 15%, 60% and 6%, respectively. The prevalence of HIV, HCV and HBV among FSWs was 5%, 1% and 3%, respectively. The prevalence of HIV/HCV, HIV/HBV, HCV/HBV and HIV/HCV/HBV co-infections among PWID was 13%, 2%, 3% and 2%, respectively. The prevalence of HIV/HCV and HIV/HBV co-infections among FSWs was 3% and 1%, respectively. The results show that the prevalence of HCV and HIV infections in PWID and the prevalence of HIV in FSWs is higher than their prevalence in the general population. Interventions for the prevention of HIV and HCV in PWID appear to be poor, and may not be sufficient to effectively prevent HIV and HCV transmission.
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Affiliation(s)
- Roya Rashti
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Heidar Sharafi
- Middle East Liver Diseases Center, Tehran 1598976513, Iran;
| | - Seyed Moayed Alavian
- Professor of Gastroenterology and Hepatology, Middle East Liver Disease Center, Tehran 1598976513, Iran;
| | - Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
- Correspondence:
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20
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Associations Between Violence and HIV Risk Behaviors Differ by Perpetrator Among Russian Sex Workers. AIDS Behav 2020; 24:812-822. [PMID: 31531737 DOI: 10.1007/s10461-019-02668-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Violence is associated with HIV and HIV risk behaviors among female sex workers (FSW). However, few studies assess multiple forms of violence and multiple HIV risk behaviors to build a comprehensive picture of how violence is implicated in HIV risk. Using respondent-driven sampling, 754 FSW were recruited in the Russian Federation. Surveys collected data on lifetime exposure to client, police, intimate partner, and pimp violence, as well as recent HIV risk behavior in the forms of injecting drug use (IDU), and inconsistent condom use with intimate partners and clients. Multivariable log-binomial and Poisson regression were used to assess associations between violence and HIV risk behavior outcomes. Lifetime client (31.7%), police (16.0%), intimate partner (15.7%), and pimp (11.4%) violence were prevalent. IDU (10.7%) and inconsistent condom use with intimate partners (45.1%) and clients (22.5%) were common. Intimate partner violence (IPV) and client violence were associated with IDU (ARRIPV 2.12, 95% CI 1.10, 4.10; ARRClient 2.75, 95% CI 1.19, 6.32), IPV and police violence were associated with inconsistent condom use with intimate partners (ARRIPV 1.10, 95% CI 1.01, 1.19; ARRPolice 1.11, 95% CI 1.01, 1.21), and IPV and police violence were associated with inconsistent condom use with clients (ARRIPV 1.49, 95% CI 1.02, 2.17; ARRPolice 1.65, 95% CI 1.19, 2.29). Each perpetrator-specific type of violence was associated with a unique set of HIV risk behaviors. Comprehensive violence prevention programming that addresses multiple perpetrators of violence against FSW, including clients, intimate partners and police, is critical for reducing sexual and drug-related HIV risk in FSW.
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21
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Zhang Y, Liang B, Liu D, Wei G, Mo S, Nong A, Ning C, Liao Y, Jiang J, Pan P, Yang Y, Zang N, Vanphu D, Van N, Ye L, Liang H, Huang J. Migrant female sex workers working at the Sino-Vietnamese border for a short time have a higher risk of HIV transmission: a consecutive cross-sectional study. AIDS Res Ther 2020; 17:4. [PMID: 32033564 PMCID: PMC7006200 DOI: 10.1186/s12981-020-0260-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES For migrant female sex workers (FSWs) at the Sino-Vietnamese border, the impact of work time in their current location on the spread of HIV/AIDS is not clear. METHODS Data were collected from the Sino-Vietnamese border cities of Guangxi, China. Migrant FSWs working in these cities were studied. FSWs who worked less than 6 months in their current location were assigned to the short-term work group (ST FSWs), and FSWs who worked equal to or longer than 6 months in their current location were assigned to the long-term work group (LT FSWs). Logistic regression was performed to examine the impact of work time in the current location and factors associated with HIV infection. RESULTS Among the 1667 migrant FSWs, 586 (35.2%) and 1081 (64.9%) were assigned to the ST FSW and LT FSW groups, respectively. Compared to LT FSWs, ST FSWs were more likely to be of Vietnamese nationality, be less than 18 years old when they first engaged in commercial sex work, and have a low-level of HIV-related knowledge and had higher odds of using condoms inconsistently, having more male clients, having no regular male clients, and having a history of male clients who used aphrodisiacs but lower odds of receiving free condoms distribution and education/HIV counselling and testing programme. The analysis of factors associated with HIV infection revealed that Vietnamese FSWs, less than 18 years old when they first engaged in commercial sex work, having no regular male clients, and having lower average charge per sex transaction were correlated with HIV infection. CONCLUSION FSWs with short-term work at the Sino-Vietnamese border had a higher risk of risky sex and were correlated with HIV risk factors. Vietnamese FSWs were at higher risk of HIV infection, and they were more likely to have short-term work. More targeted HIV prevention should be designed for new FSWs who recently began working in a locality to further control the spread of HIV, particularly cross-border FSWs.
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22
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Grosso A, Busch S, Mothopeng T, Sweitzer S, Nkonyana J, Mpooa N, Taruberekera N, Baral S. HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho. J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485709 PMCID: PMC5978702 DOI: 10.1002/jia2.25042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Sustainable Development Goals (SDGs) about gender equality; decent work; and peace, justice, and strong institutions include a focus on eradicating trafficking and sexual exploitation of and violence against women and children. In Lesotho, 86% of women have experienced gender‐based violence. In addition, overall HIV prevalence is among the highest globally, and higher among adolescent girls than boys. Moreover, nearly three quarters of female sex workers (FSW) are estimated to be living with HIV in Lesotho. In this context, sexually exploited children may be particularly vulnerable to violence and HIV acquisition risks. This study's objective is to examine the prevalence and correlates of experiencing sexual exploitation as a child among FSW in Lesotho. Methods FSW (≥18 years) recruited through respondent‐driven sampling in Maseru and Maputsoe from February to September 2014 completed HIV and syphilis testing and an interviewer‐administered survey, including a question about the age at which they started providing sex for money. This study examined correlates of experiencing sexual exploitation as a child (<18 years) through multivariable logistic regression analyses for each city, controlling for current age. Results Across both cities, 20.0% (142/710) of participants were sexually exploited as children. Among them, 65.5% (93/142) tested positive for HIV and 31.0% (44/142) for syphilis, which was similar to those who started selling sex as adults, after adjusting for current age. Participants who experienced child sexual exploitation were more likely to have been forced to have sex before age 18 than those who started selling sex as adults (Maseru‐adjusted odds ratio (aOR): 3.52, 95% Confidence Interval (CI): 1.61 to 7.66, p = 0.002; Maputsoe‐aOR: 4.39, 95% CI: 1.22 to 15.75, p = 0.023). In Maseru, participants who were sexually exploited as children were more likely to avoid carrying condoms to prevent trouble with police (aOR: 3.18, 95% CI: 1.50 to 6.75, p = 0.003). Conclusions Risk determinants for HIV and violence among sexually exploited children can be studied retrospectively through research with adult FSW. Further research working directly with sexually exploited children will improve understanding of their needs. Preventing commercial sexual exploitation of children and addressing the social and healthcare needs of those who are exploited are necessary to fully achieve SDGs 5, 8 and 16 and an AIDS‐Free Generation.
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Affiliation(s)
- Ashley Grosso
- Public Health Solutions, Research and Evaluation Unit, New York, NY, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
| | - Shianne Busch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
| | | | - Stephanie Sweitzer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
| | | | - Nkomile Mpooa
- Care for Basotho, Maseru, Lesotho.,Care-Lesotho, Maseru, Lesotho
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
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Murillo-Zamora E, Mendoza-Cano O, Guzmán-Esquivel J, Trujillo-Hernández B, Higareda-Almaraz MA, Ahumada-López LA, Higareda-Almaraz E, García-López NA. Trends in Teen Births in Mexico Spanning 25 Years: A Need for Regionally-directed Preventive Strategies. Arch Med Res 2019; 50:142-150. [PMID: 31495391 DOI: 10.1016/j.arcmed.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/19/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016. METHODS A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models. RESULTS The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94). CONCLUSIONS Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.
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Affiliation(s)
- Efrén Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico
| | - Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Coquimatlán, Colima, Mexico.
| | - José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico; Facultad de Medicina, Universidad de Colima, Colima, Colima, Mexico
| | | | | | - Luz Angélica Ahumada-López
- Dirección, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico
| | | | - Nallely A García-López
- Departamento Clínico, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico
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Bristow CC, Brown B, Marg L, Iñiguez RI, Meckel-Parker K, Silverman JG, Magis-Rodriguez C, Gaines TL, Brouwer KC. Prevalence and correlates of cervical abnormalities among female sex workers in Tijuana, Mexico. Int J STD AIDS 2019; 30:861-867. [PMID: 31159713 PMCID: PMC6901098 DOI: 10.1177/0956462419841464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: In Tijuana, Mexico, sex work is regulated by the municipal health department and includes regular testing for HIV and other sexually transmitted infections (STIs) for registered female sex workers (FSWs). However, Pap testing is missing from current sexual health assessments. We aimed to answer the following research questions: 1.) What is the prevalence of cervical abnormalities among a sample of FSWs in Tijuana, Mexico? 2.) What are the correlates of cervical abnormalities among a sample of FSWs in Tijuana, Mexico? Study design: From 2013-2014, a cohort of 300 FSWs in Tijuana, Mexico were recruited using modified time-location sampling. Participants were given Pap, HIV, and STI tests. Results: The prevalence of an abnormal Pap was 11.7% (35/300). FSWs ever registered with municipal health services were less likely to have an abnormal Pap result (4.8% vs 14.4%, p=0.03), were more likely to report a previous Pap test (88.1% vs 70.4%, p=.001), and were more likely to report a sexual health checkup in the last year (60.7% vs 37.0%, p<0.001) than those who had never been registered. Conclusions: FSWs remain at risk for cervical abnormalities, including those registered with the municipality. We conducted Pap testing for female sex workers in Tijuana, Mexico and found that over 11% had abnormal Pap test results.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Brandon Brown
- Department of Social Medicine and Population Health, University of California Riverside School of Medicine
| | - Logan Marg
- Department of Sociology, University of California Riverside
| | | | - Kristen Meckel-Parker
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Jay G. Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Carlos Magis-Rodriguez
- Centro Nacional para la prevención y el Control del VIH/SIDA (CENSIDA), Mexico City, Mexico
| | - Tommi L. Gaines
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Kimberly C. Brouwer
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
- Department of Family Medicine and Public Health, University of California San Diego
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Park JN, Footer KH, Decker MR, Tomko C, Allen ST, Galai N, Sherman SG. Interpersonal and structural factors associated with receptive syringe-sharing among a prospective cohort of female sex workers who inject drugs. Addiction 2019; 114:1204-1213. [PMID: 30694587 PMCID: PMC6548574 DOI: 10.1111/add.14567] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/20/2018] [Accepted: 01/21/2019] [Indexed: 02/02/2023]
Abstract
AIMS To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. DESIGN Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. SETTING Baltimore, MD, USA PARTICIPANTS: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1% white and 62.9% in a relationship/married. MEASUREMENTS Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. FINDINGS Nearly all FSW-IDU used heroin (97.1%) or crack cocaine (89.7%). Recent RSS was reported by 18.3%. Syringes were accessed from needle exchange programs (64.6%), pharmacies (29.7%), street sellers (30.3%) or personal networks (29.1%). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9%, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95% confidence interval (CI) = 1.09-4.33], having an intimate partner who injected drugs (aOR = 2.18, 95% CI = 0.98-4.85), being injected by others (aOR = 4.95, 95% CI = 2.42-10.10) and obtaining syringes from a street seller (aOR = 1.88, 95% CI = 0.94-3.78) or from a member of their personal network (aOR = 4.43, 95% CI = 2.21-8.90). CONCLUSIONS Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.
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Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA,Corresponding author
| | - Katherine H.A. Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA,Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA
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Salazar M, Brouwer KC, Rocha-Jimenez T, Boyce S, Staines-Orozco H, Silverman JG. Substance Use among Female Sex Workers in Two US-Mexico Border Cities: Associations with Age of Entry. Subst Use Misuse 2018; 54:868-871. [PMID: 30595074 PMCID: PMC6474790 DOI: 10.1080/10826084.2018.1517367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18. METHODS Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients. RESULTS Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17. CONCLUSIONS Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.
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Affiliation(s)
- Marissa Salazar
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
- Center for Innovative Public Health Research, 555 N. El Camino Real #A347 San Clemente, CA, USA
| | - Kimberly C. Brouwer
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Teresita Rocha-Jimenez
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
| | - Sabrina Boyce
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
| | - Hugo Staines-Orozco
- Universidad Autónoma de Ciudad Juárez, School of Medicine, Av. Plutarco Elías Calles 1210,Fovissste Chamizal, Ciudad Juárez, Chihuahua, México
| | - Jay G. Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
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Keshavarzi S, Khani Jeihooni A, Yazdanpanah A. Effect of Educational Program Based on the Theory of Planned Behavior on Increasing the Safe Sexual Behaviors among Addicts Covered by Addiction Treatment Centers in Shiraz. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2018. [DOI: 10.21859/jech.5.2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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MacLean SA, Lancaster KE, Lungu T, Mmodzi P, Hosseinipour MC, Pence BW, Gaynes BN, Hoffman IF, Miller WC. Prevalence and correlates of probable depression and post-traumatic stress disorder among female sex workers in Lilongwe, Malawi. Int J Ment Health Addict 2017; 16:150-163. [PMID: 29556159 DOI: 10.1007/s11469-017-9829-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Globally, female sex workers (FSW) experience a high prevalence of mental health disorders, but in sub-Saharan Africa these are rarely identified. If left untreated, mental health disorders may place FSW and their partners at risk for HIV/sexually transmitted infections (STIs). We assessed the prevalence and correlates of probable depression, post-traumatic stress disorder (PTSD), and suicidal ideation (SI) in a cohort of 200 FSW in Lilongwe, Malawi. FSW completed the Patient Health Questionnaire-9 and the PTSD Check List-Civilian Version. The prevalence of depression was 8%, as was the prevalence of PTSD. Nearly half (49%) of FSW were experiencing mild depression. FSW were more likely to have probable depression if they completed primary school or initiated sex work before 18 years. They were more likely to have probable PTSD if they had ≥ 20 clients per week or initiated sex work before 18 years. Interventions are needed to diagnose mental health disorders among FSW at great risk for HIV/STIs.
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Affiliation(s)
- Sarah A MacLean
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Kathryn E Lancaster
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd Chapel Hill, North Carolina 27599 USA
| | - Thandie Lungu
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Pearson Mmodzi
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Mina C Hosseinipour
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd Chapel Hill, North Carolina 27599 USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599 USA
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, North Carolina 27599 USA
| | - Irving F Hoffman
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, 302 Cunz Hall, 1841 Neil Avenue, Columbus, Ohio 43210 USA
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Hemmati Sabet A, Navabi Nejad S, Khalatbari J. Effectiveness of Schema Therapy and Group Cognitive Therapy on Anxiety in Women with High-Risk Sexual Behavior. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2017. [DOI: 10.29252/jgbfnm.14.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Rocha-Jiménez T, Brouwer KC, Silverman JG, Morales-Miranda S, Goldenberg SM. Exploring the Context and Implementation of Public Health Regulations Governing Sex Work: A Qualitative Study with Migrant Sex Workers in Guatemala. J Immigr Minor Health 2017; 19:1235-1244. [PMID: 27015834 PMCID: PMC7176102 DOI: 10.1007/s10903-016-0399-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Public health regulations practices surrounding sex work and their enforcement can have unintended consequences for HIV and sexually transmitted infection (STI) prevention and care among sex workers. This analysis was based on qualitative in-depth (n = 33) and focus groups interviews (n = 20) conducted with migrant female sex workers in Tecún Umán and Quetzaltenango, Guatemala, and explored the implementation of sex work regulations and related consequences for HIV prevention and care among migrant sex workers. Sex work regulations were found to have health-related benefits (e.g., access to HIV/STI testing) as well as negative impacts, such as abuse by police and harassment, detention/deportation of migrant sex workers. Whereas public health regulations may improve access to HIV/STI testing, their implementation may inadvertently jeopardize sex workers' health through unintended negative consequences. Non-coercive, evidence-based public health and sex work policies and programs are needed to expand access to HIV/STI prevention and care among migrant sex workers, while protecting their dignity and human rights.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Global Public Health, University of California, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Kimberly C Brouwer
- Division of Global Public Health, University of California, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Jay G Silverman
- Division of Global Public Health, University of California, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Sonia Morales-Miranda
- Unidad de VIH/SIDA, Universidad del Valle de Guatemala, 18 Avenida 11-42, Zona 15 Vista Hermosa III, Guatemala, Guatemala
| | - Shira M Goldenberg
- Division of Global Public Health, University of California, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
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Rocha-Jimenez T, Brouwer KC, Salazar M, Boyce SC, Servin AE, Goldenberg SM, Staines-Orozco H, Vera-Monroy RB, Silverman JG. "He invited me and didn't ask anything in return" Migration and Mobility as Vulnerabilities for Sexual Exploitation among Female Adolescents in Mexico. INTERNATIONAL MIGRATION 2017; 56:5-17. [PMID: 33293733 DOI: 10.1111/imig.12333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although human trafficking is recognized as a major human rights violation, there is limited evidence regarding the vulnerabilities that contribute to female adolescents' risk of being forced or coerced into the sex trade. Vulnerabilities such as gender-based violence, economic and social inequalities have been shown to shape the risk of sexual exploitation among adolescents. In-depth interviews (n=18) with current sex workers who reported being deceived or forced into the sex trade as adolescents (<17 years old) were analysed to explore their experiences of migration and mobility in Mexico. Driven by socio-economic and vulnerabilities in home communities, adolescents often engaged in internal migration and mobility to other Mexican communities and states. Migration and mobility further predisposed them to social isolation, economic hardship and abuse, which were used as tools to trick them into the sex trade. Policies that support safer migration for adolescents in origin, transit, and destination communities are needed.
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Affiliation(s)
- Teresita Rocha-Jimenez
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | | | - Marissa Salazar
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | - Sabrina C Boyce
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | - Argentina E Servin
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | | | | | - Ricardo B Vera-Monroy
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | - Jay G Silverman
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
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Van Bavel H. Beyond exploitation: towards a nuanced understanding of agency for adolescent female sex workers - evidence from Zanzibar and Morogoro. CULTURE, HEALTH & SEXUALITY 2017; 19:76-90. [PMID: 27426679 DOI: 10.1080/13691058.2016.1207253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study examines how young women sex workers exercise agency when entering prostitution, coping with occupational health problems and accessing healthcare services. It was conducted at two sites in Tanzania: Morogoro on Tanzania's mainland and Stone Town on Zanzibar Island. A total of 19 in-depth interviews were conducted with female sex workers who were 18-years old or younger at the time of entry into prostitution and 12 key informant interviews with sex workers who were 19 or older at the time of entry into prostitution. Eight key informant interviews were held with the peer educators and staff of ZAYEDESA, a sex worker organization on Zanzibar. The findings show that agency is more constrained for adolescent sex workers compared to adult sex workers. However, younger sex workers find coping strategies to navigate within the constraints that compromise their agency, reflecting different positions on the agency spectrum, ranging from reconciliation, via negotiation, to actual individual or collective agency. Adolescent sex worker agency is often severely compromised; however, it is still present and should not be ignored. Rather, it should inspire the design and implementation of harm reduction and rehabilitative interventions that address the needs of young sex workers in their particular situation.
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Parcesepe AM, L'Engle KL, Martin SL, Green S, Suchindran C, Mwarogo P. Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya. J Urban Health 2016; 93:1010-1026. [PMID: 27714491 PMCID: PMC5126017 DOI: 10.1007/s11524-016-0073-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1501 Riverside Drive, New York, NY, USA.
| | - Kelly L L'Engle
- Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sherri Green
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Policing practices as a structural determinant for HIV among sex workers: a systematic review of empirical findings. J Int AIDS Soc 2016; 19:20883. [PMID: 27435716 PMCID: PMC4951541 DOI: 10.7448/ias.19.4.20883] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/13/2016] [Accepted: 04/24/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Sex workers are disproportionately infected with HIV worldwide. Significant focus has been placed on understanding the structural determinants of HIV and designing related interventions. Although there is growing international evidence that policing is an important structural HIV determinant among sex workers, the evidence has not been systematically reviewed. Methods We conducted a systematic review of quantitative studies to examine the effects of policing on HIV and STI infection and HIV-related outcomes (condom use; syringe use; number of clients; HIV/STI testing and access) among cis and trans women sex workers. Databases included PubMed, Embase, Scopus, Sociological Abstracts, Popline, Global Health (OVID), Web of Science, IBSS, IndMed and WHOLIS. We searched for studies that included police practices as an exposure for HIV or STI infection or HIV-related outcomes. Results Of the 137 peer-reviewed articles identified for full text review, 14 were included, representing sex workers' experiences with police across five settings. Arrest was the most commonly explored measure with between 6 and 45% of sex workers reporting having ever been arrested. Sexual coercion was observed between 3 and 37% of the time and police extortion between 12 and 28% across studies. Half the studies used a single measure to capture police behaviours. Studies predominantly focused on “extra-legal policing practices,” with insufficient attention to the role of “legal enforcement activities”. All studies found an association between police behaviours and HIV or STI infection, or a related risk behaviour. Conclusions The review points to a small body of evidence that confirms policing practices as an important structural HIV determinant for sex workers, but studies lack generalizability with respect to identifying those police behaviours most relevant to women's HIV risk environment.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Parcesepe AM, L'Engle KL, Martin SL, Green S, Suchindran C, Mwarogo P. Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis. Sex Transm Infect 2016; 92:593-598. [PMID: 27217378 DOI: 10.1136/sextrans-2016-052549] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/28/2016] [Accepted: 04/23/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya. METHODS In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status. RESULTS FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early. CONCLUSIONS Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Kelly L L'Engle
- FHI 360, Durham, North Carolina, USA.,Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Sandra L Martin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sherri Green
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Chirayath Suchindran
- Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Busza J, Mtetwa S, Mapfumo R, Hanisch D, Wong-Gruenwald R, Cowan F. Underage and underserved: reaching young women who sell sex in Zimbabwe. AIDS Care 2016; 28 Suppl 2:14-20. [PMID: 27391994 PMCID: PMC4991229 DOI: 10.1080/09540121.2016.1176673] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/23/2016] [Indexed: 11/21/2022]
Abstract
Young women who sell sex (YWSS) in Southern Africa are highly vulnerable to HIV, as the risks of being young and female in a high prevalence setting coalesce with those of commercial sex. YWSS are less able to negotiate safe sex, more likely to have higher risk partners, and less likely to use available health services compared to older sex workers. In Zimbabwe's national HIV programme for sex workers, fewer than 1% of clients were 15-29. We developed monthly interactive workshops for YWSS based on an Activity Pack consisting of 21 sessions organised into six modules. The aim was to encourage YWSS' interaction with each other, build their trust, confidence and skills, and encourage uptake of clinical services. We conducted a process evaluation to assess programme strengths, identify challenges, and recommend changes. This paper presents findings synthesising programme records with qualitative data and discusses feasibility, acceptability, and outputs during the pilot phase. In total, 143 YWSS attended meetings and most were from the target 15-19-year-old age group. Participants enjoyed the sessions and reported improved cooperation, willingness to negotiate with clients, and self-reflection about their futures. Staff found facilitating sessions easy and activities clear and appropriate. Challenges included identifying appropriate referrals, initial recruitment of women in some sites, and managing participants' requests for financial compensation. The number of clients aged 15-19 increased at sex worker clinics in all sites. This programme is the first to target YWSS in Zimbabwe to address their disproportionately low service use. It proved feasible to staff and acceptable to participants over a one-year period. Given enhanced vulnerability of YWSS, this programme provides one workable model for reaching this underserved group.
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Affiliation(s)
- Joanna Busza
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sibongile Mtetwa
- Centre for Sexual Health, HIV and AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Rumbidzo Mapfumo
- Centre for Sexual Health, HIV and AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Dagmar Hanisch
- United Nations Population Fund (UNFPA), 605 3rd Avenue, New York, NY, United States
| | | | - Frances Cowan
- Centre for Sexual Health, HIV and AIDS Research (CeSHHAR), Harare, Zimbabwe
- Department of Infection & Population Health, University College London (UCL), London, UK
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Silverman JG, Servin A, Goldenberg SM, Magis-Rodriguez C, Ritter J, Raj A, Brouwer KC. Sexual Violence and HIV Infection Associated With Adolescent vs Adult Entry Into the Sex Trade in Mexico. JAMA 2015; 314:516-8. [PMID: 26241604 PMCID: PMC4890562 DOI: 10.1001/jama.2015.7376] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jay G Silverman
- San Diego School of Medicine, University of California-San Diego, La Jolla, California
| | - Argentina Servin
- San Diego School of Medicine, University of California-San Diego, La Jolla, California
| | | | - Carlos Magis-Rodriguez
- National Center for the Prevention and Control of HIV/AIDS, Ministry of Health of Mexico, Mexico City
| | - Julie Ritter
- San Diego School of Medicine, University of California-San Diego, La Jolla, California
| | - Anita Raj
- San Diego School of Medicine, University of California-San Diego, La Jolla, California
| | - Kimberly C Brouwer
- San Diego School of Medicine, University of California-San Diego, La Jolla, California
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Servin AE, Brouwer KC, Gordon L, Rocha-Jimenez T, Staines H, Vera-Monroy RB, Strathdee SA, Silverman JG. Vulnerability Factors and Pathways Leading to Underage Entry into Sex Work in two Mexican-US Border Cities. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2015; 6:3. [PMID: 25932343 PMCID: PMC4412591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Structural determinants of health among women who started selling sex as minors in Burkina Faso. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S162-70. [PMID: 25723981 DOI: 10.1097/qai.0000000000000447] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the prevalence of and factors associated with initiation of selling sex as a minor. DESIGN Data were drawn from cross-sectional studies of adult female sex workers (FSW) recruited through respondent-driven sampling in Ouagadougou and Bobo-Dioulasso, Burkina Faso. METHODS FSW completed a questionnaire that included a retrospective question regarding the age at which they started selling sex. Separate multivariate logistic regression analyses were conducted for each city to examine associations with initiation of selling sex as a minor (<18 year old), controlling for current age. RESULTS Of study participants, 27.8% (194/698) reported selling sex as a minor, ranging from 24.4% (85/349) in Bobo-Dioulasso to 31.2% (85/349) in Ouagadougou. In Ouagadougou, early initiates were more than twice as likely to report someone ever forced them to have sex [age-adjusted odds ratio (aaOR): 2.54, 95% confidence interval (CI): 1.53 to 4.23]. In Bobo-Dioulasso, those who started as minors were more likely to report someone ever tortured them (aaOR: 2.29, 95% CI: 1.28 to 4.10). In both cities, early initiates were more likely to not use a condom with a client if offered more money (Ouagadougou aaOR: 2.34, 95% CI: 1.23 to 4.47; Bobo-Dioulasso aaOR: 2.37, 95% CI: 1.29 to 4.36). In Ouagadougou, women who had started selling sex at a young age were half as likely to have been tested for HIV more than once ever (aaOR: 0.50, 95% CI: 0.26 to 0.94). In Bobo-Dioulasso, early initiates were less likely to attend HIV-related talks or meetings (aaOR: 0.56, 95% CI: 0.33 to 0.97). CONCLUSIONS A substantial proportion of FSW in Burkina Faso started selling sex as minors. The findings show that there are heightened vulnerabilities associated with selling sex below age 18 years, including physical and sexual violence, client-related barriers to condom use, and lower access to HIV-related services.
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Goldenberg SM, Silverman JG, Engstrom D, Bojorquez-Chapela I, Usita P, Rolón ML, Strathdee SA. Exploring the context of trafficking and adolescent sex industry involvement in Tijuana, Mexico: consequences for HIV risk and prevention. Violence Against Women 2015; 21:478-99. [PMID: 25648946 DOI: 10.1177/1077801215569079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coerced and adolescent sex industry involvement are linked to serious health and social consequences, including enhanced risk of HIV infection. Using ethnographic fieldwork, including interviews with 30 female sex workers with a history of coerced or adolescent sex industry involvement, we describe contextual factors influencing vulnerability to coerced and adolescent sex industry entry and their impacts on HIV risk and prevention. Early gender-based violence and economic vulnerability perpetuated vulnerability to coercion and adolescent sex exchange, while HIV risk mitigation capacities improved with increased age, control over working conditions, and experience. Structural interventions addressing gender-based violence, economic factors, and HIV prevention among all females who exchange sex are needed.
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Affiliation(s)
- Shira M Goldenberg
- University of British Columbia, Vancouver, Canada Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | | | | | | | - María Luisa Rolón
- University of California, San Diego, USA Universidad Xochicalco, Tijuana, Mexico
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Affiliation(s)
- Maia Rusakova
- NGO Stellit, St Petersburg, Russian Federation, Budapest, Hungary
| | | | - Steffanie A Strathdee
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA.
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Decker MR, Crago AL, Chu SKH, Sherman SG, Seshu MS, Buthelezi K, Dhaliwal M, Beyrer C. Human rights violations against sex workers: burden and effect on HIV. Lancet 2015; 385:186-99. [PMID: 25059943 PMCID: PMC4454473 DOI: 10.1016/s0140-6736(14)60800-x] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We reviewed evidence from more than 800 studies and reports on the burden and HIV implications of human rights violations against sex workers. Published research documents widespread abuses of human rights perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts. Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing. Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law. Protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing. Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Susan G Sherman
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meena S Seshu
- Sampada Grameen Mahila Sanstha (SANGRAM), Sangli, India
| | - Kholi Buthelezi
- Sisonke Sex Workers Movement, Sex Workers Education and Advocacy Taskforce (SWEAT), Cape Town, South Africa
| | - Mandeep Dhaliwal
- Division of HIV, Health & Development Practice UNDP, New York, NY, USA
| | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Examining negative effects of early life experiences on reproductive and sexual health among female sex workers in Tijuana, Mexico. Int J Gynaecol Obstet 2014; 128:169-73. [PMID: 25458416 DOI: 10.1016/j.ijgo.2014.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 08/05/2014] [Accepted: 10/02/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore experiences during childhood and adolescence that influenced reproductive and sexual health among women who had entered the sex industry in adolescence. METHODS A qualitative study was conducted using information provided by 25 female sex workers (FSWs) from Tijuana, Mexico, who reported entering the sex industry when younger than 18 years. In-depth, semi-structured interviews were conducted with all participants between January 31, 2011, and July 8, 2011. RESULTS Four interrelated themes that shaped health experiences-early sexual abuse, early illicit drug use, ongoing violence, and limited access to reproductive and sexual health care-were identified. Participants reporting these experiences were at risk of unintended teenaged pregnancy, spontaneous abortion or stillbirth, and untreated sexually transmitted infections. CONCLUSION Programs and policies that address social, structural, and individual vulnerabilities during adolescence and adulthood are required to promote reproductive and sexual health among FSWs in Tijuana, Mexico.
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HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed. Curr Opin HIV AIDS 2014; 9:174-82. [PMID: 24464089 DOI: 10.1097/coh.0000000000000042] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors. RECENT FINDINGS Our review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work. SUMMARY Future research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally.
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Abstract
PURPOSE OF REVIEW The aim of the present review is to update HIV/AIDS Epidemiology in Latin America and the Caribbean highlighting the concentrated aspect of epidemic in the region. RECENT FINDINGS Among general population, HIV prevalence in Latin America is at stable levels (0.2-0.7%). The Caribbean still has one of the highest HIV prevalence rates in the world (<0.1-3%), but incidences have declined around 49%. This is not the current situation for high-risk key populations; most incident cases occur among MSM. Available data on transgender women suggest that they are the most-at-risk group. Female sex workers still have a 12-fold the chance of being HIV positive compared with other women. IDU prevalence was revised to 0.45%, but non-IDU has been suggested as a mediator between sexual risk and HIV. SUMMARY The increase in treatment coverage (mean is at 63%) resulted in modifications of HIV/AIDS epidemiology. New strategies to seek, test and link key populations to care are urgently needed and targeted interventions to prevent HIV expansion among them must be adopted. These strategies should consider the particular situation regarding social inequalities, discrimination and violence that pervade the HIV epidemic among key populations.
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Triple jeopardy: Adolescent experiences of sex work and migration in Zimbabwe. Health Place 2014; 28:85-91. [DOI: 10.1016/j.healthplace.2014.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/31/2014] [Accepted: 04/02/2014] [Indexed: 11/16/2022]
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Early sex work initiation independently elevates odds of HIV infection and police arrest among adult sex workers in a Canadian setting. J Acquir Immune Defic Syndr 2014; 65:122-8. [PMID: 23982660 DOI: 10.1097/qai.0b013e3182a98ee6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To explore factors associated with early sex work initiation and model the independent effect of early initiation on HIV infection and prostitution arrests among adult sex workers (SWs). DESIGN Baseline data (2010-2011) were drawn from a cohort of SWs who exchanged sex for money within the last month and were recruited through time location sampling in Vancouver, Canada. Analyses were restricted to adults ≥18 years old. METHODS SWs completed a questionnaire and HIV/sexually transmitted infection testing. Using multivariate logistic regression, we identified associations with early sex work initiation (<18 years old) and constructed confounder models examining the independent effect of early initiation on HIV and prostitution arrests among adult SWs. RESULTS Of 508 SWs, 193 (38.0%) reported early sex work initiation, with 78.53% primarily street-involved SWs and 21.46% off-street SWs. HIV prevalence was 11.22%, which was 19.69% among early initiates. Early initiates were more likely to be Canadian born [adjusted odds ratio (AOR): 6.8, 95% confidence interval (CI): 2.42 to 19.02], inject drugs (AOR: 1.6, 95% CI: 1.0 to 2.5), and to have worked for a manager (AOR: 2.22, 95% CI: 1.3 to 3.6) or been coerced into sex work (AOR: 2.3, 95% CI: 1.14 to 4.44). Early initiation retained an independent effect on increased risk of HIV infection (AOR: 2.5, 95% CI: 1.3 to 3.2) and prostitution arrests (AOR: 2.0, 95% CI: 1.3 to 3.2). CONCLUSIONS Adolescent sex work initiation is concentrated among marginalized, drug, and street-involved SWs. Early initiation holds an independent increased effect on HIV infection and criminalization of adult SWs. Findings suggest the need for evidence-based approaches to reduce harm among adult and youth SWs.
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Sex workers perspectives on strategies to reduce sexual exploitation and HIV risk: a qualitative study in Tijuana, Mexico. PLoS One 2013; 8:e72982. [PMID: 24023661 PMCID: PMC3758274 DOI: 10.1371/journal.pone.0072982] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022] Open
Abstract
Globally, female sex workers are a population at greatly elevated risk of HIV infection, and the reasons for and context of sex industry involvement have key implications for HIV risk and prevention. Evidence suggests that experiences of sexual exploitation (i.e., forced/coerced sex exchange) contribute to health-related harms. However, public health interventions that address HIV vulnerability and sexual exploitation are lacking. Therefore, the objective of this study was to elicit recommendations for interventions to prevent sexual exploitation and reduce HIV risk from current female sex workers with a history of sexual exploitation or youth sex work. From 2010-2011, we conducted in-depth interviews with sex workers (n = 31) in Tijuana, Mexico who reported having previously experienced sexual exploitation or youth sex work. Participants recommended that interventions aim to (1) reduce susceptibility to sexual exploitation by providing social support and peer-based education; (2) mitigate harms by improving access to HIV prevention resources and psychological support, and reducing gender-based violence; and (3) provide opportunities to exit the sex industry via vocational supports and improved access to effective drug treatment. Structural interventions incorporating these strategies are recommended to reduce susceptibility to sexual exploitation and enhance capacities to prevent HIV infection among marginalized women and girls in Mexico and across international settings.
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