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Xie Y, Xiong M, Qi Z, Shen J, Xu X, Luo X, Wang C, Tang W. Client-Perpetrated Violence Experience Among Female Sex Worker in Guangdong, South China: Results from a Cross-Sectional Study. AIDS Behav 2023; 27:806-815. [PMID: 36044124 DOI: 10.1007/s10461-022-03813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Client-perpetrated violence (CPV) can lead to worse health consequences. However, little attention is paid to the CPV experience among Chinese female sex workers. Our study aimed to assess the association between CPV experience and health risk behaviors among FSWs in China. Data used in this study was from the baseline interviewer-administered questionnaire of a cluster randomized controlled trial conducted in June-October 2020. The collected information included sociodemographic characteristics, HIV/STI symptoms, number of clients, quality of the workplace, and past CPV experience. The association between violence experience and potential HIV/STI risk factors was explored using multivariable regression. Among 480 FSWs who participated in this study, 13.5% experienced CPV in the past. Compared to those who had never experienced CPV, FSWs who experienced CPV were more likely to report previous STI-related symptoms (aOR 4.29, 95% CI 1.73-10.64), more than 15 clients in the past month (aOR 2.56, 95% CI 1.18-5.52), a history of HIV testing (aOR 2.99, 95% CI 1.64-5.46), and work at low-tier workplaces (aOR 2.09, 95% CI 1.18-3.70). Overall, CPV prevalence is not low among Chinese FSWs, and there are some associations with HIV/STI risk factors; a future intervention targeting CPV in HIV/STI prevention programs is needed.
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Affiliation(s)
- Yewei Xie
- Duke Global Health Institute, Duke University, Durham, NC, USA.,University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Mingzhou Xiong
- Dermatology Hospital of South Medical University, Guangzhou, China
| | - Zhidong Qi
- Yunfu Chronic Disease Prevention Center, Yunfu, China
| | - Jingwen Shen
- Maoming Chronic Disease Prevention Center, Maoming, China
| | - Xiaojuan Xu
- Yangjiang Public Health Hospital, Yangjiang, China
| | - Xinyi Luo
- Yingde Chronic Disease Control Hospital, Yingde, China
| | - Cheng Wang
- Dermatology Hospital of South Medical University, Guangzhou, China.
| | - Weiming Tang
- Dermatology Hospital of South Medical University, Guangzhou, China. .,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road 7030, Chapel Hill, NC, 27599, USA.
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Twizelimana D, Muula AS. Actions taken by female sex workers (FSWs) after condom failure in semi urban Blantyre, Malawi. BMC WOMENS HEALTH 2020; 20:273. [PMID: 33298055 PMCID: PMC7727183 DOI: 10.1186/s12905-020-01142-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/02/2020] [Indexed: 12/03/2022]
Abstract
Background Little is known about actions taken by female sex workers (FSWs) after male condom failure during male–female sexual intercourse. The objective of this study was to investigate the actions taken by FSWs after condom failure among FSWs in semi-urban, Blantyre in Malawi. Methods A cross sectional, qualitative study was conducted among FSWs in Blantyre, Malawi between May and July 2019. Snowballing technique was used to recruit study participants in four purposively selected study sites. Focus group discussions and in-depth interviews were conducted by trained research assistants among 40 FSWs. Data were analyzed using thematic content analysis. Results Study participants reported having taken different actions after condom failure. Out of 18 FSWs who experienced condom failure, 10 reported to have stopped sex immediately and changed the condom and then resumed afterwards. They reported to have douched, urinated, and/or squatted to prevent pregnancy, sexually transmitted infections (STIs) and HIV acquisition. Five study participants reported to have asked for extra pay from the client; 10 FSWs didn’t seek medical care. They thought the actions taken were enough for HIV and pregnancy prevention. Out of the 18 FSWs, only 3 stopped sexual intercourse completely and sought medical care which included post-exposure prophylaxis for HIV, STI treatment, and emergency contraceptives. Another 3 reported that they did not stop the sexual intercourse but only squatted and/or douched after sexual intercourse. The remaining 2 FSWs reported not to have stopped sexual intercourse and no any other actions were taken after the condom failure. Conclusion We report some inadequate behaviors among FSWs after condom failure. Health programs should develop interventions and support the performance of safer sex and actions after condom failure among FSWs to prevent STIs including HIV, and unplanned pregnancies. Interpersonal, structural and policy factors hindering FSWs’ access to perform effective interventions need to be addressed.
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Affiliation(s)
- Donatien Twizelimana
- Ekwendeni Mission Hospital, P.O. Box 19, Ekwendeni, Mzimba North, Malawi. .,Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Chichiri, Private Bag 360, Blantyre, Malawi. .,The Africa Center of Excellence in Public Health and Herbal Medicine (ACEPHEM), University of Malawi, Blantyre, Malawi.
| | - Adamson S Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Chichiri, Private Bag 360, Blantyre, Malawi.,The Africa Center of Excellence in Public Health and Herbal Medicine (ACEPHEM), University of Malawi, Blantyre, Malawi
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3
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Owen BN, Baggaley RF, Elmes J, Harvey A, Shubber Z, Butler AR, Silhol R, Anton P, Shacklett B, van der Straten A, Boily MC. What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis. AIDS Behav 2020; 24:697-713. [PMID: 30953304 PMCID: PMC6778486 DOI: 10.1007/s10461-019-02477-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers' (FSW) high HIV burden. We aim to determine how common and frequent AI is among FSW globally. We searched PubMed, Embase and PsycINFO for studies reporting the proportion of FSW practising AI (prevalence) and/or the number of AI acts (frequency) worldwide from 01/1980 to 10/2018. We assessed the influence of participant and study characteristics on AI prevalence (e.g. continent, study year and interview method) through sub-group analysis. Of 15,830 identified studies, 131 were included. Nearly all (N = 128) reported AI prevalence and few frequency (N = 13), over various recall periods. Most studies used face-to-face interviews (N = 111). Pooled prevalences varied little by recall period (lifetime: 15.7% 95%CI 12.2-19.3%, N = 30, I2 = 99%; past month: 16.2% 95%CI 10.8-21.6%, N = 18, I2 = 99%). The pooled proportion of FSW reporting < 100% condom use tended to be non-significantly higher during AI compared to during VI (e.g. any unprotected VI: 19.1% 95%CI 1.7-36.4, N = 5 and any unprotected AI: 46.4% 95%CI 9.1-83.6, N = 5 in the past week). Across all study participants, between 2.4 and 15.9% (N = 6) of all intercourse acts (AI and VI) were anal. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics. Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.
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Affiliation(s)
- Branwen Nia Owen
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK.
| | - Rebecca F Baggaley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Harvey
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Zara Shubber
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Ailsa R Butler
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Peter Anton
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, University of California, Davis, USA
| | - Ariane van der Straten
- Women's Global Health Imperative Program, RTI International, San Francisco, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, USA
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK
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Probandari A, Setyani RA, Pamungkasari EP, Widyaningsih V, Demartoto A. Improving knowledge, acceptance, and utilization of female condoms among sex workers through a peer education: a mixed methods study in Surakarta Municipality, Central Java Province, Indonesia. Health Care Women Int 2019; 41:600-618. [PMID: 31385750 DOI: 10.1080/07399332.2019.1639710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Female sex workers (FSW) are high-risk for HIV infection. The authors conducted a quasi-experimental study by providing peer education on 110 FSWs, and routine HIV education on 120 controls, in Surakarta Indonesia. An additional qualitative study was performed to explain the contextual factors contributing to the effectiveness of peer education. The difference in difference approach showed that peer education improved knowledge, acceptance, and utilization of female condom. The improvements were related to the clients' perceptions, access, and available interactive communication with the peer educator. The peer education program should be enhanced to support the prevention of HIV/AIDS.
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Affiliation(s)
- Ari Probandari
- Research Group of Disease Control, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Rizka Ayu Setyani
- School of Midwifery, Respati University, Yogyakarta, Indonesia.,Master of Public Health Program, Graduate School, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Eti Poncorini Pamungkasari
- Research Group of Disease Control, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Vitri Widyaningsih
- Research Group of Disease Control, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Argyo Demartoto
- Department of Sociology, Faculty of Politics and Social Science, Universitas Sebelas Maret, Surakarta, Indonesia
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Beksinska A, Prakash R, Isac S, Mohan HL, Platt L, Blanchard J, Moses S, Beattie TS. Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open 2018; 8:e021389. [PMID: 30206080 PMCID: PMC6144389 DOI: 10.1136/bmjopen-2017-021389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence. METHODS An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk. RESULTS 1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only. CONCLUSION HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - H L Mohan
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Lucy Platt
- Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Masvawure TB, Mantell JE, Tocco JU, Gichangi P, Restar A, Chabeda SV, Lafort Y, Sandfort TGM. Intentional and Unintentional Condom Breakage and Slippage in the Sexual Interactions of Female and Male Sex Workers and Clients in Mombasa, Kenya. AIDS Behav 2018; 22:637-648. [PMID: 28975484 DOI: 10.1007/s10461-017-1922-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to the direct actions of clients. Breakages and slippages fell into two main groups: those that were intentionally caused by clients and unintentional ones caused by inebriation, forceful thrusting during sex and incorrect or non-lubricant use. Participant responses included: stopping sex and replacing the damaged condoms, doing nothing, getting tested for HIV, using post-exposure prophylaxis and washing. Some sex workers also employed strategies to prevent the occurrence of condom breakages. Innovative client-oriented HIV prevention and risk-reduction interventions are therefore urgently needed. Additionally, sex workers should be equipped with skills to recognize and manage breakages.
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Affiliation(s)
- Tsitsi B Masvawure
- Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA.
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jack Ume Tocco
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya
- International Centre for Reproductive Health-Ghent University, Ghent, Belgium
- Department of Anatomy, University of Nairobi, Nairobi, Kenya
| | - Arjee Restar
- Brown School of Public Health, Brown University, Providence, RI, USA
| | | | - Yves Lafort
- International Centre for Reproductive Health-Ghent University, Ghent, Belgium
| | - Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Owen BN, Elmes J, Silhol R, Dang Q, McGowan I, Shacklett B, Swann EM, van der Straten A, Baggaley RF, Boily MC. How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta-analysis. J Int AIDS Soc 2017; 19:21162. [PMID: 28364565 PMCID: PMC5461120 DOI: 10.7448/ias.20.1.21162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 12/15/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. METHODS We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by sub-groups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. RESULTS Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4-27.5%], three-month = 20.3% [6.1-34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0-47.4%], recall period not stated = 40.1% [36.2-44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0% and 0.7-21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. CONCLUSION Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic.
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Affiliation(s)
- Branwen N. Owen
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Que Dang
- Vaccine Clinical Research Branch, Division of AIDS, National Institutes of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, UK
| | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA
| | - Edith M. Swann
- Vaccine Clinical Research Branch, Division of AIDS, National Institutes of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | | | - Rebecca F. Baggaley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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HIV burden in men who have sex with men: a prospective cohort study 2007-2012. Sci Rep 2015; 5:11205. [PMID: 26135810 PMCID: PMC5393284 DOI: 10.1038/srep11205] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 04/09/2015] [Indexed: 11/14/2022] Open
Abstract
We conducted a prospective cohort study among HIV-negative MSM aged 18 years or older between 2007 and 2012 in Beijing, China to measure the rates of incident HIV and identify risk factors for infection. Among 5,800 participants evaluated at enrollment, we identified 486 prevalent cases of HIV (8.4%). Among the 3,625 enrollees who were HIV-negative at enrollment and completed at least one follow-up interview, we identified 440 incident cases of HIV in the follow up period: this constituted an HIV incidence rate of 7.1 per 100 person-years (95% CI: 6.4–7.7). Early treatment of syphilis may have significantly reduced risk of HIV infection (RR: 1.45, 95% CI: 1.11–1.93), while MSM presenting perfect compliance in the cohort did not show reduction in HIV infection. Our study suggested that HIV incidence has been remained high in this sample of Chinese MSM during the intensive preventive intervention, suggesting that we need to find new strategies to prevent HIV infection in this population.
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Semple SJ, Strathdee SA, Pitpitan EV, Chavarin C, Patterson TL. Behavioral and psychosocial correlates of anal sex among male clients of female sex workers in Tijuana, Mexico. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1025-1033. [PMID: 25795530 DOI: 10.1007/s10508-015-0514-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
Most studies of heterosexual sex risk practices have focused on condomless vaginal sex despite evidence that condomless anal sex has a significantly higher risk of HIV transmission. The present study focused on male clients' anal sex practices with female sex workers (FSWs) in Tijuana, Mexico, where an HIV epidemic is growing among high-risk groups. Logistic regression analyses were used to identify psychosocial and behavioral correlates of anal sex among male clients. Our sample of HIV-negative men (N = 400) was predominantly Latino (87.5 %), born in Mexico (78.8 %), never married (36.8 %) or in a regular or common-law marriage (31.5 %), and employed (62.8 %), with an average age and education of 37.8 and 9.2 years, respectively. Eighty-nine percent identified as heterosexual and 11 % as bisexual. By design, 50 % of the sample resided in Tijuana and the other 50 % in San Diego County. Nearly half (49 %) reported at least one incident of anal sex with a FSW in Tijuana in the past 4 months; of those participants, 85 % reported that one or more of their anal sex acts with FSWs had been without a condom. In a multivariate model, anal sex with a FSW in the past 4 months was associated with bisexual identification, methamphetamine use with FSWs, repeat visits to the same FSW, higher scores on perceived stigma about being a client of FSWs, and sexual compulsivity. Prevention programs are needed that address the behavioral and psychosocial correlates of heterosexual anal sex in order to reduce HIV/STI transmission risk among male clients, FSWs, and their sexual network members.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 0680, La Jolla, CA, 92093-0680, USA
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10
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Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, Reza-Paul S, Lau J, Deering K, Pickles MR, Boily MC. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet 2015; 385:55-71. [PMID: 25059947 PMCID: PMC4297548 DOI: 10.1016/s0140-6736(14)60931-4] [Citation(s) in RCA: 516] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1-31) and 20% in Canada (95% UI 3-39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25-42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8-36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33-46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.
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Affiliation(s)
- Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.
| | | | - Shira M Goldenberg
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - Putu Duff
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - Peninah Mwangi
- Bar Hostesses Empowerment and Support Program, African Sex Workers Alliance, Nairobi, Kenya
| | | | | | | | - Kathleen Deering
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
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11
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Ramanathan S, Nagarajan K, Ramakrishnan L, Mainkar MK, Goswami P, Yadav D, Sen S, George B, Rachakulla H, Subramanian T, Paranjape RS. Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India. BMJ Open 2014; 4:e005166. [PMID: 25410604 PMCID: PMC4244455 DOI: 10.1136/bmjopen-2014-005166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009-2010), we examined prevalence of anal intercourse, male clients' self-reported inconsistent condom use during anal intercourse with FSWs, and correlates of this behaviour in India's high HIV prevalence southern states (Andhra Pradesh, Maharashtra and Tamil Nadu combined). METHODS Using two-stage time location cluster sampling, we recruited 4803 clients of FSWs, ages 18-60 years, who had purchased sex from an FSW in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and sexually transmitted infections (syphilis, gonorrhoea and chlamydia). Logistic regression analysis was used to identify the factors associated with inconsistent condom use during anal intercourse (in the past 6 months) with FSWs. RESULTS Overall, 12.3% clients reported anal intercourse in the past 6 months, of whom 48.4% used condoms inconsistently. Clients of FSWs who were ages 26 years or older (AOR 2.68, p=0.032); employed as manual labourers (AOR 2.43, p=0.013); consumed alcohol (AOR 2.63, p=0.001); reported five or more sex acts with FSWs in the past month (AOR 2.53, p=0.031); and perceived themselves to be at higher risk for HIV (AOR 4.82, p=0.001) were more likely to inconsistently use condoms during anal intercourse. CONCLUSIONS The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes.
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Affiliation(s)
| | | | | | - Mandar K Mainkar
- National AIDS Research Institute (NARI), Pune, Maharashtra, India
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Gurav K, Bradley J, Chandrashekhar Gowda G, Alary M. Perspectives on condom breakage: a qualitative study of female sex workers in Bangalore, India. CULTURE, HEALTH & SEXUALITY 2014; 16:575-586. [PMID: 24588078 DOI: 10.1080/13691058.2014.883642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A qualitative study was conducted to obtain a detailed understanding of two key determinants of condom breakage - 'rough sex' and poor condom fit - identified in a recent telephone survey of female sex workers, in Bangalore, India. Transcripts from six focus-group discussions involving 35 female sex workers who reported condom breakage during the telephone survey were analysed. Rough sex in different forms, from over-exuberance to violence, was often described by sex workers as a result of clients' inebriation and use of sexual stimulants, which, they report, cause tumescence, excessive thrusting and sex that lasts longer than usual, thereby increasing the risk of condom breakage. Condom breakage in this setting is the result of a complex set of social situations involving client behaviours and power dynamics that has the potential to put the health and personal lives of sex workers at risk. These findings and their implications for programme development are discussed.
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Affiliation(s)
- Kaveri Gurav
- a Karnataka Health Promotion Trust , Bangalore , India
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