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Winter ML, Olivia SG. Sex Work and Parenthood: The Experiences of Female Sex Workers Who Are also Parents or Caregivers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:852. [PMID: 39063429 PMCID: PMC11276712 DOI: 10.3390/ijerph21070852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024]
Abstract
Complex interactions exist between sex work and parenthood, impacting the lives of those in sex work who also provide care for others. This scoping review aims to review the experiences and challenges of female sex workers who are parents or caregivers, highlighting the socioeconomic, psychological, and legal dimensions of their dual roles. The rationale for this review stems from the recognition that sex workers who are also parents face unique and multifaceted challenges that significantly impact their wellbeing and that of their children. The five stages of a scoping review suggested by Arksey and O'Malley were followed in this study. A comprehensive literature search was conducted across electronic databases such as PubMed, PsycINFO, and Google Scholar. This study covered publications written in English from 2010 to 2023. Studies were selected based on their focus on sex workers who are parents or caregivers. Both qualitative and quantitative research articles were included. Thematic analysis was employed to synthesize findings across the selected studies. Studies published prior to 2013, studies that were not published in English, and studies that did not address the experiences of female sex workers who are parents or caregivers were excluded from this study. The review identified 14 studies meeting the inclusion criteria. Five key themes emerged from this study: (1) social stigma and healthcare discrimination; (2) legal challenges; (3) mental nexus; (4) risk behaviors and exposing children to a hazardous environment; and (5) social support. Sex workers who are also parents or caregivers navigate a multifaceted landscape of challenges and resilience. Policy reforms are needed to reduce stigma, provide financial support, and ensure legal protections for this key population.
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Affiliation(s)
- Mokhwelepa Leshata Winter
- School of Medicine, Faculty of Health Science, University of Limpopo, Private Bag X 1106, Sovenga, Polokwane 0727, South Africa;
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Reed E, West BS, Frost E, Salazar M, Silverman JG, McIntosh CT, Gómez MGR, Urada LA, Brouwer KC. Economic vulnerability, violence, and sexual risk factors for HIV among female sex workers in Tijuana, Mexico. AIDS Behav 2022; 26:3210-3219. [PMID: 35380288 PMCID: PMC8980205 DOI: 10.1007/s10461-022-03670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women's work, limiting women's negotiating power with clients and in turn, increasing their vulnerability for violence and HIV. This study assessed economic vulnerability in relation to violence and sexual risk behaviors for HIV among a sample of FSW in Tijuana, Mexico. FSW at least 18 years of age were recruited through venue-based sampling for a survey (n = 228) and in-depth interviews (n = 50) to investigate HIV risk factors in this region. Using crude and adjusted logistic regression models, we assessed lack of financial support from others as well as reports of financial hardship separately in relation to experiencing sexual violence (e.g. by clients, police, relationship partners, in the past 6 months), physical violence (past 6 months), STI diagnosis, and inconsistent condom use (past 30 days). Qualitative interviews (n = 50), conducted with a subsample of the survey participants, were also examined for related themes. FSW who reported no financial support were more likely to report sexual violence (OR = 2.1; 95% CI:1.1-4.2). FSW who reported financial hardship were more likely to experience sexual violence (OR = 1.9; 95% CI:1.1-3.6) and physical violence (OR = 1.9; 95% CI:1.1-3.6), as well as to report past 30-day inconsistent condom use (OR = 2.4; 95%CI: 1.3-4.6) and to test positive for an STI (OR = 1.9; 95% CI:1.1-3.4). Qualitative data substantiated these findings. Findings suggest that interventions to improve economic well-being may be useful to prevent the intersecting concerns of violence and HIV among FSW.
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Affiliation(s)
- Elizabeth Reed
- School of Public Health, San Diego State University, 5500 Campanile Drive, 92182-4162, San Diego, California, USA.
| | - Brooke S West
- School of Social Work, Columbia University, New York, NY, USA
| | - Elizabeth Frost
- School of Public Health, San Diego State University, 5500 Campanile Drive, 92182-4162, San Diego, California, USA
- School of Social Work, Columbia University, New York, NY, USA
| | - Marissa Salazar
- School of Public Health, San Diego State University, 5500 Campanile Drive, 92182-4162, San Diego, California, USA
| | - Jay G Silverman
- University of California, San Diego, La Jolla, California, USA
| | | | - María Gudelia Rangel Gómez
- US-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte (COLEF), Tijuana, Mexico
| | - Lianne A Urada
- University of California, San Diego, La Jolla, California, USA
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Amogne MD, Sanders EJ, Belihu WB, Sundewall J, Agardh A. Condom failure and pre-exposure prophylaxis use experience among female sex workers in Ethiopia: a qualitative study. BMC Public Health 2022; 22:1079. [PMID: 35641959 PMCID: PMC9158269 DOI: 10.1186/s12889-022-13468-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female sex workers (FSW) remain a highly exposed group for HIV/STIs due to different factors including condom failure. In Ethiopia, pre-exposure prophylaxis (PrEP) has recently been introduced as an intervention strategy to prevent new HIV infections, but knowledge about FSWs' experiences of condom failure and PrEP use remains scarce. Therefore, this study explores FSWs' experiences concerning condom failure and their attitudes towards, and experiences of, PrEP uptake. METHOD A qualitative study using in-depth interviews was conducted among FSWs in Addis Ababa. A manifest and latent content analysis method was applied to identify categories and emerging themes. RESULT Seventeen FSWs (10 who started on PrEP, 1 who discontinued, and 6 who didn't start) were interviewed. FSWs described the reasons behind condom failure, the mechanisms they used to minimize the harm, and their attitudes towards PrEP use. FSWs struggled with the continuous risk of condom failure due to factors related to clients' and their own behavior. PrEP was mentioned as one the strategies FSWs used to minimize the harm resulting from condom failure, but PrEP use was compounded with doubts that deterred FSWs from uptake. FSWs' misconceptions, their lack of confidence, and PrEP side effects were also mentioned as the main challenges to start taking PrEP and/or to maintain good adherence. CONCLUSION The demands and behavior of the clients and FSWs' own actions and poor awareness were factors that increased the exposure of FSWs to condom failure. In addition, the challenges associated with PrEP uptake suggest the need for user-friendly strategies to counteract these barriers and facilitate PrEP uptake.
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Affiliation(s)
- Minilik Demissie Amogne
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden. .,Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Eduard J Sanders
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Headington, UK.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Kenya Medical Research Institute, Kilifi, Kenya
| | - Wudinesh Belete Belihu
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden.,Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jesper Sundewall
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden.,HEARD, University of KwaZulu-Natal, Durban, South Africa
| | - Anette Agardh
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden
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Nestadt DF, Park JN, Galai N, Beckham SW, Decker MR, Zemlak J, Sherman SG. Sex workers as mothers: Correlates of engagement in sex work to support children. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 8:251-261. [PMID: 36935888 PMCID: PMC10019358 DOI: 10.1007/s40609-021-00213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Globally, most female sex workers (FSW) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSW who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSW in Baltimore, Maryland, United States (U.S.). METHODS The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell's theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers. RESULTS Our sample included 214 FSW with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p<0.001). 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p=0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR=2.62; 95% CI:1.18-5.82; p=0.018); less housing instability (aOR=0.42; 95% CI:0.20-0.89; p=0.024); initiating sex work at age <23 (aOR=2.59; 95% CI:1.23-5.46; p=0.012); less frequent intoxication during sex with clients (aOR=0.31; 95% CI:0.14-0.67; p=0.003); and reporting mental health as most important health concern (aOR=2.37; 95% CI:1.09-5.17; p=0.029). CONCLUSIONS FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSW as whole social beings and center their experiences and needs as mothers.
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Affiliation(s)
- Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Mount Carmel, Israel
| | - S. W. Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R. Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Zemlak
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ampt FH, Lim MSC, Agius PA, L'Engle K, Manguro G, Gichuki C, Gichangi P, Chersich MF, Jaoko W, Temmerman M, Stoové M, Hellard M, Luchters S. Effect of a mobile phone intervention for female sex workers on unintended pregnancy in Kenya (WHISPER or SHOUT): a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2020; 8:e1534-e1545. [PMID: 33220217 DOI: 10.1016/s2214-109x(20)30389-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Female sex workers in low-income and middle-income countries face high risks of unintended pregnancy. We developed a 12-month, multifaceted short messaging service intervention (WHISPER) for female sex workers in Kenya who had the potential to become pregnant, to improve their contraceptive knowledge and behaviours. The aim of this study was to assess the effectiveness of the intervention to reduce the incidence of unintended pregnancy among sex workers in Kenya compared with an equal-attention control group receiving nutrition-focused messages (SHOUT). METHODS Our two-arm, cluster-randomised controlled trial was done in sex-work venues in two subcounties of Mombasa, Kenya (Kisauni and Changamwe). Participants, aged 16-34 years, not pregnant or planning pregnancy, able to read text messages in English, residing in the study area, and who had a personal mobile phone with one of two phone networks, were recruited from 93 randomly selected sex-work venues (clusters). Random cluster allocation (1:1) to the intervention or control group was concealed from participants and researchers until the intervention started. Both groups received text messages in English delivered two to three times per week for 12 months (137 messages in total), as well as additional on-demand messages. Message content in the intervention group focused on promotion of contraception, particularly long-acting reversible contraception and dual method contraceptive use; message content in the control group focused on promotion of nutritional knowledge and practices, including food safety, preparation, and purchasing. The primary endpoint, analysed in all participants who were randomly assigned and attended at least one follow-up visit, compared unintended pregnancy incidence between groups using discrete-time survival analysis at 6 and 12 months. This trial is registered with Australian New Zealand Clinical Trials Registry, ACTRN12616000852459, and is closed to new participants. FINDINGS Between Sept 14, 2016, and May 16, 2017, 1728 individuals were approached to take part in the study. Of these, 1155 were eligible for full screening, 1035 were screened, and 882 were eligible, enrolled, and randomly assigned (451 participants from 47 venues in the intervention group; 431 participants from 46 venues in the control group). 401 participants from the intervention group and 385 participants from the control group were included in the primary analysis. Incidence of unintended pregnancy was 15·5 per 100 person-years in the intervention group and 14·7 per 100 person-years in the control group (hazard ratio 0·98, 95% CI 0·69-1·39). INTERPRETATION The intervention had no measurable effect on unintended pregnancy incidence. Mobile health interventions, even when acceptable and rigorously designed, are unlikely to have a sufficient effect on behaviour among female sex workers to change pregnancy incidence when used in isolation. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul A Agius
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kelly L'Engle
- Department of Health Professions, University of San Francisco, San Francisco, CA, USA
| | | | | | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya; Technical University of Mombasa, Mombasa, Kenya; Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Matthew F Chersich
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya; Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | - Stanley Luchters
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Department of Population Health, Aga Khan University, Nairobi, Kenya.
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Brody C, Reno R, Chhoun P, Kaplan K, Tuot S, Yi S. Female Entertainment Workers and Condom Use Negotiation in Post-100% Condom Use Era Cambodia. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:3065-3074. [PMID: 32211995 PMCID: PMC7641922 DOI: 10.1007/s10508-020-01649-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 05/23/2023]
Abstract
Beyond the monopoly environment of the early 100% Condom Use Program in Cambodia, less is known about how current female entertainment workers negotiate condom use on their own, and what factors impact that negotiation. This study aims to understand the experiences of current female entertainment workers in negotiating condom use with clients in Cambodia. Data collection occurred over a period of 3 weeks (August-September 2017) with concurrent data transcription and translation. A total of 27 focus group discussions (FGDs) were conducted in the following groups: pilot FGD (5), karaoke bar (5), massage parlor (5), beer garden (5), on-call sex workers (3), cross-venue groups exploring parenting issues (2), and street-based sex workers (2). Female entertainment workers experience a range of control over negotiating condom use with clients. Participants reported times when they were able to take direct action and successfully insist on condom use, times when they agreed to participate in condomless sex for money in the face of economic insecurity, and times when male clients sabotaged their attempts to negotiate condom use with tricks, verbal threats or threats of violence. These experiences are influenced by alcohol use, economic shocks, trust between partners, and experiences with side effects. Our findings support the development of policies that re-invigorate the structural-level condom promotion programs while also acknowledging the many individual-level factors that shape condom use such as alcohol consumption, economic insecurity, trust, and side effects.
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Affiliation(s)
- Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, 94592, USA.
| | - Rebecca Reno
- School of Public Health, University of California, Berkeley, CA, USA
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Kathryn Kaplan
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, 94592, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, 94592, USA
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Yang F, Ketende S, Jennings Mayo-Wilson L, Lyons CE, Liestman B, Diouf D, Drame FM, Coly K, Turpin G, Mboup S, Toure-Kane C, Castor D, Cheng A, Diop-Ndiaye H, Leye-Diouf N, Kennedy C, Baral S. Associations Between Economic Factors and Condom Use Behavior Among Female Sex Workers in Dakar and Mbour, Senegal. AIDS Behav 2020; 24:2829-2841. [PMID: 32180091 DOI: 10.1007/s10461-020-02832-2] [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] [Indexed: 11/29/2022]
Abstract
Condom use remains a mainstay of HIV prevention programs around the world. However, data characterizing economic determinants of condom use among female sex workers (FSW) are limited, including in Senegal. We recruited 718 FSWs via respondent-driven sampling. Bivariate and multivariable regressions were conducted to assess the associations between economic variables and condom use at last sex. Paying rent (aRR: 1.07, 95%CI 1.01-1.13) was positively associated with condom use at last sex with new clients. No statistically significant associations were found between condom use and financial responsibility for dependent children, having additional source of income, sharing sex work earnings, or the ability to borrow from other FSWs, regardless of sexual partner types. The relationship between economic marginalization and consistent condom use among sex workers is complex reinforcing the need for behavioral economic research and prevention to be integrated into HIV prevention and treatment research and programs.
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Affiliation(s)
- Fan Yang
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA.
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, USA.
- School of Medicine, University of North Carolina, Project-China, Guangzhou, China.
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | | | - Carrie E Lyons
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Benjamin Liestman
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | | | - Fatou M Drame
- Enda Santé, Dakar, Senegal
- Gaston Berger University, Saint-Louis, Senegal
| | - Karleen Coly
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance Epidemiologique Et de Formations, Dakar, Senegal
- Laboratoire de Bacteriologie-Virologie, CHU Aristide Le Dantec, Dakar, Senegal
| | - Coumba Toure-Kane
- Laboratoire de Bacteriologie-Virologie, CHU Aristide Le Dantec, Dakar, Senegal
| | - Delivette Castor
- USAID, Office of HIV/AIDS, Bureau for Global Health, Arlington, VA, USA
| | - Alison Cheng
- USAID, Office of HIV/AIDS, Bureau for Global Health, Arlington, VA, USA
| | | | - Nafissatou Leye-Diouf
- Institut de Recherche en Santé, de Surveillance Epidemiologique Et de Formations, Dakar, Senegal
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
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Kedia SK, Dillon PJ, Basu A. A Qualitative Exploration of "Mother First" Identity and Antiretroviral Adherence among African American Women Living with HIV in the Mid-South Region of the United States. HEALTH COMMUNICATION 2020; 35:1190-1199. [PMID: 31167571 DOI: 10.1080/10410236.2019.1623641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The majority of African American women living with HIV are of child-bearing age and large numbers of these women express a desire to have children. Extant research suggests that motherhood provides HIV-positive women with a sense of hope and normalcy and, in some cases, is associated with positive HIV-related health behaviors. Guided by the tenets of the culture-centered approach (CCA), this qualitative study sought to understand the relationship between motherhood identity and ART adherence among a sample of 50 African American women living with HIV in the Mid-South region of the United States. Our theoretically-informed thematic analysis of in-depth interviews with all 50 women produced three primary themes: (1) experiencing HIV through the lens of motherhood, (2) the physical and social realities of the "mother first" orientation while living with HIV, and (3) the impact of the "mother first" orientation on ART adherence and self-care. These findings identify how participants' "mother first" identity orientation interacts with their sociocultural environment to enable and constrain their attempts at ART adherence. The findings also provide empirical evidence to support the CCA's theorizing regarding the ways in which the materiality of structures interact with symbolic cultural meanings to (re)produce health inequalities.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis
| | | | - Ambar Basu
- Department of Communication, University of South Florida
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9
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Lyons CE, Schwartz SR, Murray SM, Shannon K, Diouf D, Mothopeng T, Kouanda S, Simplice A, Kouame A, Mnisi Z, Tamoufe U, Phaswana-Mafuya N, Cham B, Drame FM, Aliu Djaló M, Baral S. The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nat Commun 2020; 11:773. [PMID: 32071298 PMCID: PMC7028952 DOI: 10.1038/s41467-020-14593-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022] Open
Abstract
Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011-2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.
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Affiliation(s)
- Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Sheree R Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins School of Public Health, Hampton House 624 N. Broadway 8th Floor, Baltimore, MD, 21205, USA
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Daouda Diouf
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, Institut Africain de Santé Publique, 12 BP 199, Ouagadougou, Burkina Faso
| | | | - Abo Kouame
- Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Zandile Mnisi
- Health Research Department, Strategic Information Division, Ministry of Health, Cooper Centre Office 106, Mbabane, Eswatini
| | - Ubald Tamoufe
- Metabiota. Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, 15939, Yaoundé, Cameroon
| | - Nancy Phaswana-Mafuya
- DVC Research and Innovation Office, North-West University, Potchefstroom Campus, Private Bag X6001 Potchefstroom, 2520, Potchefstroom, South Africa
| | - Bai Cham
- Actionaid, Banjul The Gambia, MDI Road, Kanifing South PMB 450, Serrekunda PO Box 725, Banjul, The Gambia
| | - Fatou M Drame
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
- Gaston Berger University, Department of Geography, School of Social Sciences. BP: 234 - Saint-Louis, Nationale 2, route de Ngallèle, St. Louis, Senegal
| | - Mamadú Aliu Djaló
- Enda Santé, Guiné-Bissau. Bairro Santa Luzia, Rua s/n, CP 1041, Bissau, Guinea-Bissau
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Bowring AL, Ampt FH, Schwartz S, Stoové MA, Luchters S, Baral S, Hellard M. HIV pre-exposure prophylaxis for female sex workers: ensuring women's family planning needs are not left behind. J Int AIDS Soc 2020; 23:e25442. [PMID: 32064765 PMCID: PMC7025091 DOI: 10.1002/jia2.25442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. DISCUSSION FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. CONCLUSIONS As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights.
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Affiliation(s)
- Anna L Bowring
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
- Burnet InstituteMelbourneVictoriaAustralia
| | - Frances H Ampt
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Mark A Stoové
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stanley Luchters
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Population HealthAga Khan UniversityNairobiKenya
- International Centre for Reproductive HealthDepartment of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Stefan Baral
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Margaret Hellard
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneVictoriaAustralia
- Doherty Institute and Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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Kilembe W, Inambao M, Sharkey T, Wall KM, Parker R, Himukumbwa C, Tichacek A, Malama K, Visoiu AM, Price M, Chomba E, Allen S. Single Mothers and Female Sex Workers in Zambia Have Similar Risk Profiles. AIDS Res Hum Retroviruses 2019; 35:814-825. [PMID: 31204869 DOI: 10.1089/aid.2019.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to compare reproductive health and high-risk behaviors in female sex workers (FSWs) and single mothers (SMs) in Zambia's two largest cities, Lusaka and Ndola. FSWs were invited from known community hot spots, and sexually active HIV- SMs were referred from infant vaccination services for free and anonymous screening and treatment for HIV and other sexually transmitted infections (STIs) and long acting reversible contraception. A subset completed an interviewer-administered survey. From 2012 to 2016, 1,893 women (1,377 FSWs and 516 HIV- SMs) responded to referrals. HIV prevalence was 50% in Lusaka and 33% in Ndola FSWs. Positive syphilis serology (rapid plasmin reagin) was found in 29%-31% of HIV+ FSWs and 9%-12% of HIV- FSWs and SMs. Trichomonas was more common in Ndola (11%-12%), compared with Lusaka (3%-7%). Antiretroviral therapy (ART) use among HIV+ FSWs was 9%-15%. In all groups, consistent condom use (8%-11%) and modern contraceptive use (35%-65%) were low. Low literacy and reported coercion at first sexual intercourse were common in both FSWs and SMs, as was alcohol use during sex among FSWs. Zambian FSWs and SMs have low condom use and high HIV/STI and unplanned pregnancy risk. Many FSWs and half of SMs are ≥25 years of age, and thus too old for HIV prevention services targeting "adolescent girls and young women" (aged 15-24). Tailored and targeted reproductive health services are needed to reduce HIV, STI, and unplanned pregnancy in these vulnerable women.
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Affiliation(s)
| | | | | | - Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | | | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, New York
| | - Elwyn Chomba
- Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
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12
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Parmley L, Fielding-Miller R, Mnisi Z, Kennedy CE. Obligations of motherhood in shaping sex work, condom use, and HIV care among Swazi female sex workers living with HIV. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:254-257. [PMID: 31333060 DOI: 10.2989/16085906.2019.1639521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Parental obligations influence sexual behaviour among female sex workers (FSW) and may serve as a risk or protective factor for HIV acquisition. How these obligations affect behaviours beyond HIV prevention, including HIV care, is understudied. We analysed 25 interviews conducted with 11 mothers who sell sex and are living with HIV, and 4 key informants as part of a larger study examining the positive health, dignity, and prevention needs of FSW in eSwatini. Despite awareness of HIV reinfection, FSW initiated sex work and engaged in condomless sex due to financial pressures of providing for children. While women attributed having condomless sex to their obligations as a provider, motherhood also served as motivation to engage in HIV care. Further, FSW described children as a source of support in HIV care. Children reminded mothers to take their medications, prepared food to take with medications, and assisted with travel to the clinic.
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Affiliation(s)
- Lauren Parmley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Rebecca Fielding-Miller
- Center on Gender Equity and Health, Division of Global Public Health, University of California , San Diego , USA
| | - Zandile Mnisi
- Health Research Department, Strategic Information Division, Ministry of Health eSwatini , Mbabane , eSwatini
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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13
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Yam EA, Sultana N, Hossain T, Zieman B, Roy S, Yasmin R, Sadiq N, Hossain SMI. Reproductive health and desire for children among young female sex workers in Bangladesh brothels. Health Care Women Int 2019; 40:981-994. [PMID: 31161893 DOI: 10.1080/07399332.2019.1623801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Globally, reproductive health research among female sex workers (FSWs) often focuses on pregnancy prevention, but many women who sell sex aspire to have children in the future. In Bangladesh, where early marriage and parenthood is the norm, we examine reproductive histories and childbearing desires of young women who sell sex in brothels. We interviewed 1061 FSWs aged 18 to 24 in eight brothels in three Bangladesh divisions. Interviewers elicited information on sociodemographic characteristics, contraceptive use, pregnancy history, and childbearing desire. Bivariate and multivariate analyses were conducted to examine correlates of wanting to have a child within 24 months.
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Affiliation(s)
- Eileen A Yam
- Population Council , Washington , District of Columbia , USA
| | | | | | - Brady Zieman
- Population Council , Washington , District of Columbia , USA
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14
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Parmley L, Rao A, Kose Z, Lambert A, Max R, Phaswana-Mafuya N, Mcingana M, Hausler H, Baral S, Schwartz S. Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa. Reprod Health 2019; 16:63. [PMID: 31138313 PMCID: PMC6538548 DOI: 10.1186/s12978-019-0716-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Late presentation combined with limited engagement in antenatal care (ANC) increases risk of vertical transmission among mothers living with HIV. Female sex workers (FSW) have more than four times greater burden of HIV than other women of reproductive age in South Africa and the majority of FSW are mothers. For mothers who sell sex and are at increased HIV acquisition risk, timely and routine ANC seeking is especially vital for prevention of vertical transmission. This study represents a mixed-methods study with FSW in Port Elizabeth, South Africa, to characterize factors influencing ANC seeking behaviors in a high HIV prevalence context. METHODS FSW (n = 410) were recruited into a cross-sectional study through respondent-driven sampling between October 2014 and April 2015 and tested for HIV and pregnancy. A sub-sample of pregnant and postpartum women (n = 30) were invited to participate in in-depth interviews (IDIs) to explore their current or most recent pregnancy experiences. IDIs were coded using a modified grounded theory approach and descriptive analyses assessed the frequency of themes explored in the qualitative analysis among the quantitative sample. RESULTS In the quantitative survey, 77% of FSW were mothers (313/410); of these, two-thirds were living with HIV (212/313) and 40% reported being on antiretroviral therapy (ART) (84/212). FSW in the qualitative sub-sample reported unintended pregnancies with clients due to inconsistent contraceptive use; many reported discovering their unintended pregnancies between 4 and 7 months of gestation. FSW attributed delayed ANC seeking and ART initiation in the second or third trimesters to late pregnancy detection. Other factors limiting engagement in ANC included substance and alcohol use and discontent with previous healthcare-related experiences. CONCLUSIONS Late pregnancy discovery, primarily because pregnancies were unplanned, contributed to late ANC presentation and delayed ART initiation, increasing risks of vertical HIV transmission. Given limited ART coverage among participants, addressing the broader sexual and reproductive health and rights needs of mothers who sell sex has important implications for preventing vertical transmission of HIV. Integrating comprehensive family planning services into FSW programming, as well as providing active linkage to ANC services may reduce barriers to accessing timely ANC, decreasing risks of vertical transmission.
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Affiliation(s)
- Lauren Parmley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Zamakayise Kose
- Human Sciences Research Council, 1st Floor Office 103 Fairview Office Park Greenacres, Port Elizabeth, 6057 South Africa
| | - Andy Lambert
- TB/HIV Care, 25 St Georges Mall, Cape Town City Centre, Cape Town, 8000 South Africa
| | - Ryan Max
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Nancy Phaswana-Mafuya
- Human Sciences Research Council, 1st Floor Office 103 Fairview Office Park Greenacres, Port Elizabeth, 6057 South Africa
| | - Mfezi Mcingana
- TB/HIV Care, Office 207 A.A. House, Corner Rink & Park Drive, Central, Port Elizabeth, South Africa
| | - Harry Hausler
- TB/HIV Care, 25 St Georges Mall, Cape Town City Centre, Cape Town, 8000 South Africa
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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15
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Rao A, Schwartz S, Billong SC, Bowring A, Fouda G, Ndonko F, Njindam I, Levitt D, Bissek AC, Njoya O, Baral S. Predictors of early childhood HIV testing among children of sex workers living with HIV in Cameroon. BMC Public Health 2019; 19:602. [PMID: 31138289 PMCID: PMC6538542 DOI: 10.1186/s12889-019-6812-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite recent progress, there exist gaps in the prevention of vertical HIV transmission program access and uptake in Cameroon. Female sex workers (FSW), many of whom are mothers, are disproportionately affected by HIV and have specific barriers to HIV testing and treatment access. Testing for HIV-exposed infants is crucial in monitoring for incident infection and timely intervention. This study explores the level of early childhood testing and also associations between antenatal care (ANC) attendance and other factors and early childhood HIV testing among FSW in Cameroon. METHODS FSW were recruited to participate in an integrated biobehavioral survey in Cameroon between December 2015 and October 2016. Women were included in these analyses if they were living with HIV and had at least one living child. Both univariate and multivariable logistic regression were used to look at predictors of a child being tested for HIV before age five. RESULTS A total of 481/2255 FSW were eligible for these analyses as they were HIV seropositive and had at least one living child at the time of the study. Women included in these analyses had a median age of 35(IQR 30-41). Nearly 70% reported none of their children had been tested for HIV before age five (326/481), and 3.5%(17/481) reported one or more of their children had been diagnosed with HIV. ANC attendance (adjusted OR 2.12, 95% CI: [1.02, 4.55]), awareness of HIV status (aOR 3.70[2.30, 5.93]), pregnancy intentions (aOR 1.89[1.16, 3.08]), and higher education (aOR 2.17[1.01, 4.71]) were all independently associated with increased odds of women having a greater proportion of children tested for HIV before age five. Regional differences in early childhood testing were also observed. CONCLUSION Vertical transmission of HIV remains a challenge in Cameroon, and HIV testing among children of FSW living with HIV was very low. ANC attendance and promotion of the mother's health were associated with increased child HIV testing. For women at high risk of HIV and for whom engagement in the health system is low, strategies to promote and ensure ANC attendance are essential for their health and the health of their children.
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Affiliation(s)
- Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | | | - Anna Bowring
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | | | | | - Iliassou Njindam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | | | - Anne-C Bissek
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon.,Division of Operational Research in Health, Ministry of Public Health, Yaoundé, Cameroon
| | - Oudou Njoya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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16
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Choudhry V, Dayal R, Pillai D, Kalokhe AS, Beier K, Patel V. Child sexual abuse in India: A systematic review. PLoS One 2018; 13:e0205086. [PMID: 30300379 PMCID: PMC6177170 DOI: 10.1371/journal.pone.0205086] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 09/19/2018] [Indexed: 01/06/2023] Open
Abstract
Objective Child Sexual Abuse (CSA) is a pressing human right issue and public health concern. We conducted a systematic review of quantitative and qualitative studies published in the past decade on CSA in India to examine the distribution of the prevalence estimates for both genders, to improve understanding of the determinants and consequences of CSA and identify gaps in the current state of research. Methods For this systematic review, we searched electronic literature databases (PubMed, POPLINE, and PsycINFO) for articles published in English on Child Sexual Abuse in India between January 1, 2006 and January 1, 2016 using 55 search terms. Data were extracted from published articles only. Findings Fifty-one studies met inclusion criteria for the review. The review indicates that prevalence rates of CSA is high among both boys and girls in India. Due to heterogeneity of study designs and lack of standardised assessments, reported prevalence estimates varied greatly among both genders in different studies. There is a need to conduct representative studies using a validated instrument to obtain valid epidemiological estimates. Commercial sex workers, men who have sex with men, and women with psychiatric disorders were at higher risks for sexual abuse during childhood. In addition, the synthesis of qualitative data across studies included in the review suggests that exposure and perpetration of CSA is a multifaceted phenomenon grounded in the interplay between individual, family, community, and societal factors. The review indicates poor physical, behavioural, social, and mental health outcomes of CSA in India. We conclude with a research agenda calling for quantitative and qualitative studies to explore the determinants and perpetration of child sexual abuse in India from an ecological lens. This research agenda may be necessary to inform the development of a culturally tailored primary prevention and treatment strategy for CSA victims in India.
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Affiliation(s)
- Vikas Choudhry
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
- Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India
- * E-mail:
| | - Radhika Dayal
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
| | - Divya Pillai
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
| | - Ameeta S. Kalokhe
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße, Berlin, Germany
| | - Vikram Patel
- Public Health Foundation of India, Institutional Area, Gurugram, Haryana, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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17
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Dayal R, Kalokhe AS, Choudhry V, Pillai D, Beier K, Patel V. Ethical and definitional considerations in research on child sexual violence in India. BMC Public Health 2018; 18:1144. [PMID: 30261867 PMCID: PMC6161376 DOI: 10.1186/s12889-018-6036-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While critically important, child sexual violence (CSV) research poses numerous ethical and safety challenges. Recently, the studies dedicated to understanding and addressing CSV in India have been on the rise, but no published ethical guidelines to direct such research currently exist. To help inform ethical and safety recommendations for the design, conduct, and reporting of future CSV research in India and similar settings, we systematically reviewed the ethics and safety practices reported in recent Indian CSV literature. METHODS A multi-tiered approach was used to understand current ethical practices and gaps: 1) systematic review of Indian CSV studies published over the past decade, 2) examination of existing guidelines on related topics to develop an ethical framework, 3) development of an ethics checklist based on the recommendations from the surveyed guidelines, and 4) application of the checklist to each of the reviewed studies. RESULT Our search yielded 51 eligible studies. From each, data from 6 major thematic areas was extracted: informed consent, confidentiality, selection, training, and protection of study team members, validity of CSV measurement methods, measures to minimize participant harm, and participant compensation. Several gaps were noted: only two-thirds reported approval by ethics committees, obtaining informed consent, and assured participants of confidentiality. Only 25% (13/51) reported assessing ongoing CSV risk and providing necessary support services, none noted whether ongoing CSV was reported to authorities (required by Indian law), and none reported safeguards to protect staff from the effects of conducting CSV research. Further, 43% (22/51) limited surveillance of CSV to one form of abuse and/or used a "loaded term," increasing the potential for underreporting. CONCLUSIONS Through enhancing understanding of current ethical practices and gaps in CSV research in India, this systematic review informs reporting protocols and future guidelines for CSV research in India and other similar settings.
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Affiliation(s)
- Radhika Dayal
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
| | - Ameeta S. Kalokhe
- Emory University School of Medicine Division of Infectious Diseases and Rollins School of Public Health Department of Global Health, Atlanta, USA
| | - Vikas Choudhry
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
- Sambodhi Research and Communications Pvt. Ltd., C-126, Sector- 2, Noida, 201301 Uttar Pradesh India
| | - Divya Pillai
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße 57, 10117 Berlin, Germany
| | - Vikram Patel
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002 Haryana India
- Department of Global Health and Social Medicine, Harvard Medical School, MA Boston, 02115 USA
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18
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Ma PHX, Chan ZCY, Loke AY. Conflicting identities between sex workers and motherhood: A systematic review. Women Health 2018; 59:534-557. [PMID: 30040603 DOI: 10.1080/03630242.2018.1500417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Being a mother is a traditional and central role for women. However, due to criminalization, social stigma and marginalized lifestyles, female sex workers (FSWs) may encounter disadvantages and social inequality. The aim of this review was to synthesize the results of studies focused on the challenges that FSWs face in negotiating their maternal identity with their stigmatized identity as sex workers. A total of 21 studies published from 2002 to 2016 were included in this review. Textual narrative and a thematic synthesis approach were adopted to synthesize key themes. Two common themes across countries were identified: conflicting identities between the jobs as sex workers and motherhood and responses to social expectations of ideal motherhood. Given the challenges that FSWs face with motherhood, comprehensive services, including health, family, social, and legal services, are needed to support FSWs as individuals and as mothers. A more holistic approach is recommended to address their physical, emotional, financial, and social problems faced by FSWs. Services should be offered in a friendly and non-judgmental manner. Further, to advance the health and safety of FSWs and their children, prostitution law may need to move toward decriminalization of sex work and educate the general public about respecting FSWs.
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Affiliation(s)
- Polly H X Ma
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
| | - Zenobia C Y Chan
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
| | - Alice Yuen Loke
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
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19
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Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region. Sex Transm Dis 2018; 44:477-482. [PMID: 28703726 DOI: 10.1097/olq.0000000000000634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Globally, female sex workers (FSWs) have been identified as a high-risk group for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). However, as women of reproductive age, FSWs also have children. Few studies have investigated if financial responsibilities associated with motherhood increase women's vulnerability to HIV and STIs among FSWs. METHODS From March 2013 to March 2014, 603 FSWs aged ≥18 years were recruited from Tijuana and Ciudad Juarez (Mexico) to participate in a study assessing HIV/STI risk environments. RESULTS Findings from logistic regression models indicate that FSWs who reported motherhood were more likely to report (in the past 30 days): a higher client volume (>30 clients) (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 1.27-2.87) and always using alcohol right before or during sex with clients in the past 30 days (AOR, 1.77; 95% CI, 1.19-2.61). In contrast, they were more likely to report consistent condom use for vaginal or anal sex with clients (AOR, 1.68; 95% CI, 1.10-2.55), less likely to report using drugs right before or during sex with clients (AOR, 0.38; 95% CI, 0.26-0.56) and less likely to have tested positive for STIs at baseline (AOR, 0.63; 95% CI, 0.43-0.91). CONCLUSIONS These results provide a glimpse of the complex relationship between motherhood and women who are sex workers. Understanding the convergence of motherhood and sex work and how this can influence a woman's decision when engaging in sex work and affect her health is essential to designing effective programs addressing reduce risk for HIV and STIs among FSWs in this region and elsewhere.
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20
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Duff P, Birungi J, Dobrer S, Akello M, Muzaaya G, Shannon K. Social and structural factors increase inconsistent condom use by sex workers' one-time and regular clients in Northern Uganda. AIDS Care 2017; 30:751-759. [PMID: 29067831 DOI: 10.1080/09540121.2017.1394966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While sex workers (SWs) bear the brunt of the epidemic in Uganda, there remains a dearth of empirical research on the structural drivers of HIV prevention among SWs. This study examined the drivers of inconsistent condom use by one-time and regular clients of young women SWs in Gulu, Northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young SWs, aged 14 years and older (2011-2012). SWs were recruited using peer/SW-led outreach, in partnership with The AIDS Support Organization and other CBOs. Multivariable logistic regression was used to examine the correlates of inconsistent condom use by one-time and regular clients. In total, 84.5% of the 381 SWs servicing regular clients and 76.8% of the 393 SWs servicing one-time clients reported inconsistent client condom use. In multivariable analysis, physical/sexual violence by clients (AOR = 5.39; 95%CI 3.05-9.49), low sexual control by workers (measured by the validated Pulweritz scale) (AOR = 2.86; 95%CI 1.47-5.58), alcohol/drug use while working (AOR = 1.98; 95%CI 1.17-3.35) and migration to Gulu for sex work (AOR = 1.73; 95%CI 0.95-3.14) were positively correlated with inconsistent condom use by one-time clients. Correlates of inconsistent condom use by regular clients included: low sexual control by workers (AOR = 4.63; 95%CI 2.32-9.23); physical/sexual violence by clients (AOR = 3.48; 95%CI 1.85-6.53); police harassment (AOR = 2.57; 95%CI 1.17-5.65); and being a single mother (AOR = 2.07; 95%CI 1.09-3.93). Structural and interpersonal factors strongly influence inconsistent condom use by clients, with violence by clients and police, low sexual control by workers, migration and single-parenthood all linked to non-condom use. There is a need for peer-led structural interventions that improve access to occupational health and safety standards (e.g., violence prevention and alcohol/drug harm reduction policies/programming). Shifts away from the current punitive approaches towards SWs are integral to the success of such interventions, as they continue to undermine HIV prevention efforts.
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Affiliation(s)
- Putu Duff
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada
| | | | - Sabina Dobrer
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | | | | | - Kate Shannon
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada
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Yam EA, Kidanu A, Burnett-Zieman B, Pilgrim N, Okal J, Bekele A, Gudeta D, Caswell G. Pregnancy Experiences of Female Sex Workers in Adama City, Ethiopia: Complexity of Partner Relationships and Pregnancy Intentions. Stud Fam Plann 2017; 48:107-119. [PMID: 28263396 PMCID: PMC5516190 DOI: 10.1111/sifp.12019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Research and programs for female sex workers (FSWs) tend to focus exclusively on HIV prevention, with little attention paid to how pregnancy affects their lives. We examine the circumstances surrounding pregnancy and childbirth among women selling sex in Ethiopia. In Adama City, researchers asked 30 FSWs aged 18 and older who had ever been pregnant to participate in in-depth interviews. The women reported on pregnancies experienced both before and after they had begun selling sex. They identified some of the fathers as clients, former partners, and current partners, but they did not know the identities of the other fathers. Missed injections, skipped pills, and inconsistent condom use were causes of unintended pregnancy. Abortion was common, typically with a medication regimen at a facility. Comprehensive sexual and reproductive health services should be provided to women who sell sex, in recognition and support of their need for family planning and their desire to plan whether and when to have children.
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Affiliation(s)
- Eileen A Yam
- Associate, Brady Burnett-Zieman is Staff Associate, and Nanlesta Pilgrim is Associate, Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008
| | - Aklilu Kidanu
- Director, Miz-Hasab Research Center, Addis Ababa, Ethiopia
| | - Brady Burnett-Zieman
- Associate, Brady Burnett-Zieman is Staff Associate, and Nanlesta Pilgrim is Associate, Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008
| | - Nanlesta Pilgrim
- Associate, Brady Burnett-Zieman is Staff Associate, and Nanlesta Pilgrim is Associate, Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008
| | - Jerry Okal
- Associate, Population Council, Nairobi, Kenya
| | - Assefa Bekele
- Adama Branch Manager and Daniel Gudeta is Project Coordinator, Link Up, Organization for Social Services, Health and Development, Addis Ababa, Ethiopia
| | - Daniel Gudeta
- Link Up, Organization for Social Services, Health and Development, Addis Ababa, Ethiopia
| | - Georgina Caswell
- Regional Advisor, Link Up, International HIV/AIDS Alliance, Cape Town, South Africa
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Reed E, Erausquin JT, Biradavolu M, Servin AE, Blankenship KM. Non-barrier contraceptive use and relation to condom use behaviour by partner type among female sex workers in Andhra Pradesh, India. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:60-66. [PMID: 26699872 PMCID: PMC5284462 DOI: 10.1136/jfprhc-2014-100918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners. METHODS FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients. RESULTS Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) [adjusted odds ratio (AOR) 2.2, 95% confidence interval (CI) 1.2-4.0] and with an occasional client (past week) (AOR 2.6, 95% CI 1.6-5.3), as well as accepting more money for sex without a condom (past 30 days) (AOR 2.5, 95% CI 1.5-4.3). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners. CONCLUSIONS Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.
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Affiliation(s)
- Elizabeth Reed
- Assistant Professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA,USA
| | - Jennifer Toller Erausquin
- Assistant Professor, Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Monica Biradavolu
- Scholar in Residence, Department of Sociology, American University, Washington, DC, USA
| | - Argentina E Servin
- Postdoctoral Fellow, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA,USA
| | - Kim M Blankenship
- Professor and Chair, Department of Sociology, American University, Washington, DC, USA
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Factors Related to Pregnancy Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2016; 20:2346-2356. [PMID: 27146829 DOI: 10.1007/s10461-016-1422-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Female sex workers (FSWs) living with HIV are a vulnerable population for multiple health concerns and have been vastly understudied in public health literature. This study analyzes factors related to pregnancy among 268 FSWs living with HIV in the Dominican Republic. Results indicate that 34 % of participants had been pregnant since HIV diagnosis. Multivariate analysis revealed significant associations between pregnancy after HIV diagnosis and ART interruption (AOR 2.41; 95 % CI 1.19, 4.94), knowledge of mother-to-child transmission (AOR 2.12; 95 % CI 0.99, 4.55), serostatus disclosure to a sex partner (AOR 2.46; 95 % CI 1.31, 4.62), older age (AOR 0.91; 95 % CI 0.87, 0.95) and a more negative perception of their health provider (AOR 0.56; 95 % CI 0.34, 0.93). Results indicate noteworthy associations between having been pregnant and the health provider experience and ART interruption, indicating a significant need for further research on this population to ensure both maternal and child health.
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Semple SJ, Pitpitan EV, Chavarin CV, Strathdee SA, Mendoza DV, Aarons GA, Patterson TL. Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities. Glob Public Health 2016; 12:1538-1552. [PMID: 27416059 DOI: 10.1080/17441692.2016.1206603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.
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Affiliation(s)
- Shirley J Semple
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Eileen V Pitpitan
- b Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Claudia V Chavarin
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Steffanie A Strathdee
- b Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Doroteo V Mendoza
- c Evaluation and Research Department , Mexican Foundation for Family Planning (Mexfam) , Mexico City , Mexico
| | - Gregory A Aarons
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Thomas L Patterson
- a Department of Psychiatry , University of California , San Diego , CA , USA
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Willis B, Welch K, Onda S. Health of female sex workers and their children: a call for action. LANCET GLOBAL HEALTH 2016; 4:e438-9. [PMID: 27185469 DOI: 10.1016/s2214-109x(16)30071-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Saki Onda
- Global Health Promise, Portland, OR 97201, USA
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Reed E, Erausquin JT, Groves AK, Salazar M, Biradavolu M, Blankenship KM. Client-perpetrated and husband-perpetrated violence among female sex workers in Andhra Pradesh, India: HIV/STI risk across personal and work contexts. Sex Transm Infect 2016; 92:424-9. [PMID: 26905080 PMCID: PMC4992639 DOI: 10.1136/sextrans-2015-052162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 02/01/2016] [Indexed: 12/04/2022] Open
Abstract
Objectives This study examines violence experienced in work and personal contexts and relation to HIV risk factors in these contexts among female sex workers (FSW) in Andhra Pradesh, India. Methods FSW at least 18 years of age (n=2335) were recruited through three rounds of respondent-driven sampling between 2006 and 2010 for a survey on HIV risk. Using crude and adjusted logistic regression models, any sexual/physical violence (last 6 months) perpetrated by clients and husbands were separately assessed in association with accepting more money for sex without a condom (last 30 days), consistent condom use with clients and husbands (last 30 days), and sexually transmitted infection (STI) symptoms (last 6 months). Results The mean age among participants was 32, 22% reported being currently married, and 22% and 21% reported physical/sexual violence by clients and husbands, respectively. In adjusted logistic regression models, FSW who experienced client violence were more likely to report accepting more money for unprotected sex trades (adjusted OR (AOR)=1.7; 95% CI 1.4 to 2.2), less likely to report consistent condom use with clients (AOR=0.6; 95% CI 0.5 to 0.7) and more likely to report STI symptoms (AOR=3.5; 95% CI 2.6 to 4.6). Women who reported husband violence were more likely to report accepting more money for unprotected sex trades (AOR=2.1; 95% CI 1.2 to 3.7), less likely to report consistent condom use with clients (AOR=0.5; 95% CI 0.3 to 0.8) and more likely to report STI symptoms (AOR=2.6; 95% CI 1.6 to 4.1). Conclusions Among FSW, experiences of violence in work and personal contexts are associated with sexual HIV risk behaviours with clients as well as STI symptoms.
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Affiliation(s)
- Elizabeth Reed
- Division of Global Public Health, School of Medicine: La Jolla, University of California, San Diego, CA, USA
| | - J T Erausquin
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Allison K Groves
- Department of Sociology, American University, Washington DC, USA
| | - Marissa Salazar
- Division of Global Public Health, School of Medicine: La Jolla, University of California, San Diego, CA, USA
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Deering KN, Shaw SY, Thompson LH, Ramanaik S, Raghavendra T, Doddamane M, Bhattacharjee P, Moses S, Lorway R. Fertility intentions, power relations and condom use within intimate and other non-paying partnerships of women in sex work in Bagalkot District, South India. AIDS Care 2015; 27:1241-9. [PMID: 26295360 DOI: 10.1080/09540121.2015.1050981] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers' main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers (SWs); and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of SWs and their NPPs. Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by SWs. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by SWs whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of SWs and NPPs) were examined to assess sexual risk for HIV/STIs. Overall, this study included 257 SWs and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP (AOR = 3.71[1.44-9.58]); and having decisions about condom use made by their main NPP (AOR = 9.87[4.03-24.16]) or both equally (AOR = 3.18[1.39-7.80]) (versus by the SWs herself). Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and SWs, and between NPPs and their non-SWs wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for SWs in the context of their relationships with NPPs.
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Affiliation(s)
- Kathleen N Deering
- a Faculty of Medicine, Division of AIDS , University of British Columbia , Vancouver , Canada.,b BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Souradet Y Shaw
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Laura H Thompson
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | | | - T Raghavendra
- d Karnataka Health Promotion Trust , Bangalore , India
| | | | | | - Stephen Moses
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada.,e Faculty of Medicine, Medical Microbiology , University of Manitoba , Winnipeg , Canada
| | - Robert Lorway
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Mothers who sell sex: a potential paradigm for integrated HIV, sexual, and reproductive health interventions among women at high risk of HIV in Burkina Faso. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S154-61. [PMID: 25723980 DOI: 10.1097/qai.0000000000000454] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antenatal care is a point of entry into the health system for women across Africa and may facilitate the uptake of HIV services among female sex workers (FSWs). This study aimed to evaluate the determinants of motherhood among FSWs, their sexual risks, and their engagement in health care. METHODS A cross-sectional study was conducted from January to July 2013 among FSWs in Ouagadougou and Bobo-Dioulasso, Burkina Faso. The study used respondent-driven sampling for HIV testing and behavioral data collection. Predictors of motherhood and the association of motherhood and sex work dynamics were assessed separately using logistic regression. RESULTS Of the 696 women enrolled, the majority of participants (76.6%, n = 533) had at least 1 biological child. Mothers were more likely to have a nonpaying partner [adjusted odds ratio (aOR), 1.73; 95% confidence interval (CI): 1.20 to 2.49], and significantly less likely to currently desire to conceive (aOR, 0.21; 95% CI: 0.13 to 0.33). Motherhood was predictive of having reduced condomless vaginal or anal sex with a new client [age-adjusted odds ratio (aaOR), 0.80; 95% CI: 0.65 to 0.97] in the past 30 days, and increased condomless vaginal or anal sex with a nonpaying partner (aaOR, 1.49; 95% CI: 1.13 to 1.96). Motherhood was prognostic of a higher likelihood of ever being tested for HIV (aaOR, 1.89; 95% CI: 1.55 to 2.31). Motherhood was predictive of reporting limited difficulty when accessing health services (aaOR, 0.15; 95% CI: 0.67 to 0.34). CONCLUSIONS Motherhood is common among FSWs. The results indicate that FSWs who are mothers may have more exposure to health care because of seeking antenatal/perinatal services, presenting important opportunities for inclusion in the HIV continuum of care and to prevent vertical transmission.
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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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Beckham SW, Shembilu CR, Winch PJ, Beyrer C, Kerrigan DL. 'If you have children, you have responsibilities': motherhood, sex work and HIV in southern Tanzania. CULTURE, HEALTH & SEXUALITY 2014; 17:165-79. [PMID: 25270410 PMCID: PMC6472475 DOI: 10.1080/13691058.2014.961034] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/30/2014] [Indexed: 05/28/2023]
Abstract
Many female sex workers begin sex work as mothers, or because they are mothers, and others seek childbearing. Motherhood may influence women's livelihoods as sex workers and their subsequent HIV risks. We used qualitative research methods (30 in-depth interviews and three focus group discussions) and employed Connell's theory of Gender and Power to explore the intersections between motherhood, sex work, and HIV-related risk. Participants were adult women who self-reported exchanging sex for money within the past month and worked in entertainment venues in southern Tanzania. Participants had two children on average, and two-thirds had children at home. Women situated their socially stigmatised work within their respectable identities as mothers caring for their children. Being mothers affected sex workers' negotiating power in complex manners, which led to both reported increases in HIV-related risk behaviours (accepting more clients, accepting more money for no condom, anal sex), and decreases in risk behaviours (using condoms, demanding condom use, testing for HIV). Sex workers/mothers were aware of risks at work, but with children to support, their choices were constrained. Future policies and programming should consider sex workers' financial and practical needs as mothers, including those related to their children such as school fees and childcare.
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Affiliation(s)
- Sarah W. Beckham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deanna L. Kerrigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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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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HIV/STI risk among venue-based female sex workers across the globe: a look back and the way forward. Curr HIV/AIDS Rep 2013; 10:65-78. [PMID: 23160840 DOI: 10.1007/s11904-012-0142-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Female sex workers (FSWs) continue to represent a high-risk population in need of targeted HIV prevention interventions. Targeting environmental risk factors should result in more sustainable behavior change than individual-level interventions alone. There are many types of FSWs who operate in and through a variety of micro- (eg, brothels) and macro-level (eg, being sex-trafficked) contexts. Efforts to characterize FSWs and inform HIV prevention programs have often relied on sex work typologies or categorizations of FSWs by venue or type. We conducted a systematic search and qualitatively reviewed 37 published studies on venue-based FSWs to examine the appropriateness of sex work typologies, and the extent to which this research has systematically examined characteristics of different risk environments. We extracted information on study characteristics like venue comparisons, HIV/STI prevalence, and sampling strategies. We found mixed results with regards to the reliability of typologies in predicting HIV/STI infection; relying solely on categorization of FSWs by venue or type did not predict seroprevalence in a consistent manner. Only 65 % of the studies that allowed for venue comparisons on HIV/STI prevalence provided data on venue characteristics. The factors that were assessed were largely individual-level FSW factors (eg, demographics, number of clients per day), rather than social and structural characteristics of the risk environment. We outline a strategy for future research on venue-based FSWs that ultimately aims to inform structural-level HIV interventions for FSWs.
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