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Nattabi J, Bahar OS, Nabayinda J, Nabunya P, Kiyingi J, Kizito S, Namuwonge F, Nsubuga E, Witte SS, Ssewamala FM. Crossroads of Choice: A qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda. RESEARCH SQUARE 2024:rs.3.rs-4468785. [PMID: 38883774 PMCID: PMC11177997 DOI: 10.21203/rs.3.rs-4468785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Women Engaged in commercial Sex Work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk to HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs. Methods Semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within a larger study-Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 HIV hotspots in the Southern region of Uganda. Participants were selected based on their intervention attendance (high/medium/low attendance). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to from transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?". All interviews were audio-recorded, transcribed verbatim and translated into English. Thematic analysis in Dedoose software was used to analyze the data. Results Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and continuing sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to leave sex work. Individual level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the structural level, factors which include interpersonal stigma and discrimination (from immediate family and community members), physical and sexual violence and income related factors were identified as facilitators and barriers to leaving sex work. Conclusion Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.
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Gnaim-Mwassi N, Avieli H, Band-Winterstein T. Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences. J Elder Abuse Negl 2024; 36:117-147. [PMID: 38566491 DOI: 10.1080/08946566.2024.2331503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.
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Affiliation(s)
- Nora Gnaim-Mwassi
- Minerva Center on Intersectionality in Aging, Department of Gerontology, University of Haifa, Haifa, Israel
| | - Hila Avieli
- Department of Criminology, Ariel University, Ariel, Israel
| | - Tova Band-Winterstein
- Minerva Center on Intersectionality in Aging, Department of Gerontology, University of Haifa, Haifa, Israel
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Shah P, Kabuti R, Beksinska A, Nyariki E, Babu H, Kungu M, Jama Z, Ngurukiri P, Kaul R, Kyegombe N, Medley GF, Devries K, Seeley J, Weiss HA, Beattie TS, Kimani J. Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya. BMJ Open 2023; 13:e078618. [PMID: 38114279 DOI: 10.1136/bmjopen-2023-078618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya. BACKGROUND Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation. DESIGN Building on previous qualitative research with this cohort, analysis of behavioural-biological cross-sectional data using hierarchical logistic regression. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural-biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling. RESULTS Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66). CONCLUSIONS Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karen Devries
- Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Helen Anne Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Shah P, Beattie TS, Kabuti R, Liku J, Kung'u M, Babu H, Jama Z, Kaul R, Weiss HA, Kyegombe N, Medley GF, Devries K, Gafos M, Nyariki E, Kimani J, Seeley J. Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya. BMJ Open 2023; 13:e068886. [PMID: 37045579 PMCID: PMC10106030 DOI: 10.1136/bmjopen-2022-068886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya. DESIGN Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi and participated in baseline behavioural-biological surveys. Participants in this qualitative study were randomly selected from the Maisha Fiti study cohort and were interviewed between October 2019 and July 2020. Women described their lives from childhood, covering topics including sex work, violence and financial management. RESULTS 48 out of 1003 Maisha Fiti participants participated in the in-depth qualitative interviews. FSWs described how physical and sexual violence, poverty and incomplete education in their childhood and adolescence intertwined with early pregnancy, marriage, intimate partner violence and relationship breakdown in their adolescence and early adulthood. The data analysis found clear syndemic relationships between these risk factors, particularly childhood violence, poverty and incomplete education and highlighted pathways leading to financial desperation and caring for dependents, and subsequent entry into sex work. Women perceived sex work as risky and most would prefer alternative work if possible, but it provided them with some financial independence and agency. CONCLUSIONS This is the first study in Kenya to qualitatively explore the early lives of sex workers from a syndemic perspective. This method identified the pivotal points of (1) leaving school early due to poverty or pregnancy, (2) breakdown of early intimate relationships and (3) women caring for dependents on their own. Complex, multi-component structural interventions before these points could help increase school retention, reduce teenage pregnancy, tackle violence, support young mothers and reduce entry into sex work and the risk that it entails by expanding livelihood options.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Jennifer Liku
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Mary Kung'u
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Anne Weiss
- MRC International and Statistics Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Nambusi Kyegombe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Graham F Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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Nabayinda J, Kizito S, Witte S, Nabunnya P, Kiyingi J, Namuwonge F, Nsubuga E, Bahar OS, Mayo-Wilson LJ, Yang LS, Nattabi J, Magorokosho N, Ssewamala FM. Factors Associated with Consistent Condom Use Among Women Engaged in Sex Work: Lessons From the Kyaterekera Study in Southwestern Uganda. AIDS Behav 2023; 27:969-977. [PMID: 36112259 PMCID: PMC9974574 DOI: 10.1007/s10461-022-03833-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
We examined the factors associated with consistent condom use among women engaged in sex work in the Southern parts of Uganda. We used baseline data from a longitudinal study involving WESW from 19 hotspots in Southern Uganda. We conducted hierarchical models to determine the individual, economic, behavioral, and health-related factors associated with consistent condom use. We found that, alcohol use (b=-0.48, 95% CI=-0.77, -0.19), accepting money for condomless sex (b=-0.33, 95% CI=-0.38, -0.28), multiple customers (b=-0.01, 95% CI=-0.01, -0.005), being married (b = 0.50, 95% CI = 0.01, 0.99), owning more assets (b = 0.08, 95% CI = 0.05, 0.13), having another income earner in the household (b = 0.55, 95% CI = 0.27, 0.83), condom use self-efficacy (b = 0.11, 95% CI = 0.03, 0.19), condom use communication (b = 0.06, 95% CI = 0.001, 0.12), and being knowledgeable about HIV/STIs transmission (b = 0.08, 95% CI = 0.01, 0.15) were associated with consistent condom use. Additionally, 29% of the women were consistent condom users. Hence, there is need to implement interventions that promote consistent condom use among WESW.
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Affiliation(s)
- Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Susan Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Proscovia Nabunnya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB7400, 27599, Chapel Hill, NC, USA
| | - Lyla Sunyoung Yang
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
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Visser RM, Arntz A. A faulty compass: Why do some people choose situations that are not good for them? J Behav Ther Exp Psychiatry 2023; 78:101793. [PMID: 36435553 DOI: 10.1016/j.jbtep.2022.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/12/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
Why do some people seem to be drawn to situations that are not good for them? While we all regularly end up in situations that we would have preferred to avoid, we tend to not choose situations or other people that are not good for us, and with time most of us get better at recognizing and avoiding these situations. However, it is a well-known clinical phenomenon that some people have a faulty compass when it comes to these situations, increasing the likelihood of repeated exposure to negative experiences and even trauma. In this paper, we reflect on the relationship between adverse experiences early in development and dysfunctional choices in adulthood, with the aim to reinvigorate interest in this clinically important phenomenon, which is in need of rigorous empirical study. Based on the literature and clinical observations, we distill four categories of hypotheses: people make dysfunctional choices 1) to process or master previous trauma, 2) out of habit and because of preferences for what is familiar, 3) to maintain a coherent view of themselves and the world, and 4) to avoid difficult emotions. We end with concrete questions that can help narrow down the heterogenous set of observations and explanations, providing a first step towards a better conceptualisation and systematic documentation of (factors contributing to) maladaptive situation selection. We dedicate this essay to Jack Rachman, who was a great inspirator for the field of experimental psychopathology with his essays highlighting phenomena that were overlooked and drawing attention to fresh ideas.
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Affiliation(s)
- Renée M Visser
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
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Nabayinda J, Kiyingi J, Kizito S, Nsubuga E, Nabunya P, Bahar OS, Magorokosho N, Nattabi J, Witte S, Fred MS. Does asset ownership influence sexual risk-taking behaviors among women engaged in sex work in Southern Uganda? A mediation analysis. BMC Womens Health 2022; 22:537. [PMID: 36550547 PMCID: PMC9773531 DOI: 10.1186/s12905-022-02129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Economic vulnerability influences women engaged in commercial sex work (WESW) to further engage in sexual risk behaviors, as they often have multiple customers and engage in unprotected sex for financial gains. This study examined asset ownership's direct and indirect impact on sexual risk-taking behaviors among WESW in Southern Uganda, a very vulnerable group of women at high risk for contracting HIV and other STIs. METHODOLOGY We used baseline data from the Kyaterekera study, an NIH-funded study among WESW aged 18-55 across 19 HIV hotspots in Southern Uganda. Structural equation modeling was used to examine the direct, indirect, and total effects of assets-defined as ownership of physical and financial resources-on sexual risk-taking behaviors among WESW. RESULTS Results showed that asset ownership was associated with a decrease in depression (β = - 0.096 [95% CI - 0.191, - 0.001], p = 0.050) and increased access to medical care (β = 0.174 [95% CI 0.072, 0.275], p = 0.001).We also found that an increase in access to medical care was associated with decreased sexual risk-taking behaviors (β = - 0.107 [95% CI - 0.210, - 0.004], p = 0.041). We observed a specific indirect effect between assets and sexual risk-taking behaviors through access to medical care (β = - 0.019 [95% CI - 0.040, - 0.002], p = 0.05). Mediation contributed 31% of the total effects of asset ownership on sexual risk-taking behaviors. CONCLUSION To our knowledge, this is among the few studies to examine the impact of asset ownership on sexual risk-taking behaviors among WESW in Southern Uganda. Findings from this study indicate that increasing access to economic resources may reduce the risk of WESW engaging in unprotected sex for higher income, which limits the spread of HIV among this population. The results also indicate that asset ownership may allow women to access healthcare services.
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Affiliation(s)
- Josephine Nabayinda
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Joshua Kiyingi
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Samuel Kizito
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Edward Nsubuga
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Proscovia Nabunya
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Ozge Sensoy Bahar
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Natasja Magorokosho
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Jennifer Nattabi
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Susan Witte
- grid.21729.3f0000000419368729Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027 USA
| | - M. Ssewamala Fred
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
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8
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Halkett A, O’Grady SM, Hinshaw SP. An Exploratory Investigation of Childhood Sexual Abuse and Other Theory-Driven Predictors of Sex Work Among Women with and without Childhood ADHD. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:949-962. [PMID: 36439670 PMCID: PMC9684379 DOI: 10.1007/s40653-022-00467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
Limited research has identified prospective risk factors for young-adult sex work or examined overlapping predictors concurrently. We investigated childhood sexual abuse (CSA), along with other theory-driven predictors of sex work, among a well-characterized sample of girls with and without childhood diagnoses of attention/deficit-hyperactivity disorder (ADHD). METHODS Participants were a racially and socioeconomically diverse sample of 140 girls with rigorously diagnosed ADHD (47 Inattentive [ADHD-I], 93 Combined [ADHD-C]), and 88 age- and ethnicity-matched comparison girls, all followed longitudinally into adulthood. Self-report data on young-adult occupations revealed a subsample of 7 participants reporting engagement in "sex work" or "prostitution." Logistic regressions tested whether CSA, measured both dichotomously and by discrete age ranges, predicted later sex work, accounting for other risk factors. RESULTS A lifetime history of CSA was positively associated with sex work in initial analyses (β = 1.51, p = .045), but not after adjusting for additional risk factors. When examined by age ranges, only CSA occurring between ages 9-15 significantly predicted sex work (β = 2.84, p = .043), even after adjusting for additional risk factors. Childhood ADHD-C also emerged as a significant predictor (β = 4.94, p = .015). ADHD-related medication and years of education were protective factors only when CSA was considered dichotomously. CONCLUSIONS Findings from this exploratory study underscore the need for longitudinal research that (a) considers the developmental timing of CSA and (b) accounts for impulsivity and inattention as risk factors for sex work among young-adult women. Implications for clinical practice are briefly discussed.
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Affiliation(s)
- Ashley Halkett
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704 USA
| | - Sinclaire M. O’Grady
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704 USA
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704 USA
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143 USA
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9
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Panneh M, Gafos M, Nyariki E, Liku J, Shah P, Wanjiru R, Wanjiru M, Beksinska A, Pollock J, Jama Z, Babu H, Kaul R, Seeley J, Bradley J, Kimani J, Beattie T. Mental health challenges and perceived risks among female sex Workers in Nairobi, Kenya. BMC Public Health 2022; 22:2158. [PMID: 36418973 PMCID: PMC9685887 DOI: 10.1186/s12889-022-14527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) in Kenya are at an increased risk of violence, poverty, police arrest, and problematic alcohol and other substance use, all of which are linked to poor mental health and suicidal ideation. Despite the psychological stressors experienced by FSWs, there is no published qualitative methods research investigating their mental health experiences in Kenya. In this paper, we draw on data from in-depth interviews to examine FSWs' lifetime mental health experiences and perceived risk factors. METHODS We used baseline in-depth interviews of the Maisha Fiti longitudinal study of FSWs in Nairobi. We randomly selected 40 FSWs from 1003 FSWs who attended a baseline behavioural-biological interview as part of the Maisha Fiti study. The interview guide was semi-structured, and participants were asked to detail their life stories, including narrating specific events such as entry into sex work, experiences of violence, mental health experiences, and use of alcohol and other substances. Interviews were recorded in Kiswahili/ English and transcribed in English. Data were coded and thematically analysed in Nvivo (v.12). RESULTS Results indicated that the majority of participants understood 'mental health' as 'insanity', 'stress', 'depression', and 'suicide'; nevertheless, a number described mental health symptomatically, while a few believed that mental health problems were caused by witchcraft. Interestingly, poverty, low levels of education, poor job opportunities, a lack of family support, harmful gender norms, intimate partner violence and subsequent relationship breakdowns, and family bereavement all contributed to poor mental health and subsequent entry into sex work. In addition, the consequences of sex work such as sexual risks, and ongoing violence from police and clients, further exacerbated poor mental health. CONCLUSIONS There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy.
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Affiliation(s)
- Mamtuti Panneh
- LSHTM, Department for Global Health and Development, London, UK.
| | - Mitzy Gafos
- LSHTM, Department for Global Health and Development, London, UK
| | - Emily Nyariki
- LSHTM, Department for Global Health and Development, London, UK
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Pooja Shah
- LSHTM, Department for Global Health and Development, London, UK
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | | | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- LSHTM, Department for Global Health and Development, London, UK
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Janet Seeley
- LSHTM, Department for Global Health and Development, London, UK
| | - John Bradley
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tara Beattie
- LSHTM, Department for Global Health and Development, London, UK
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10
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Kennedy L. The silent majority: The typical Canadian sex worker may not be who we think. PLoS One 2022; 17:e0277550. [PMID: 36378670 PMCID: PMC9665380 DOI: 10.1371/journal.pone.0277550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most sex worker population studies measure population at discrete points in time and very few studies have been done in industrialized democracies. The purpose of this study is to consider how time affects the population dynamics of contact sex workers in Canada using publicly available internet advertising data collected over multiple years. METHODS 3.6 million web pages were collected from advertising sites used by contact sex workers between November, 2014 and December, 2016 inclusive. Contacts were extracted from ads and used to identify advertisers. First names were used to estimate the number of workers represented by an advertiser. Counts of advertisers and names were adjusted for missing data and overcounting. Two approaches for correcting overcounts are compared. Population estimates were generated weekly, monthly and for the two year period. The length of time advertisers were active was also estimated. Estimates are also compared with related research. RESULTS Canadian sex workers typically advertised individually or in small collectives (median name count 1, IQR 1-2, average 1.8, SD 4.4). Advertisers were active for a mean of 73.3 days (SD 151.8, median 14, IQR 1-58). Advertisers were at least 83.5% female. Respectively the scaled weekly, monthly, and biannual estimates for female sex workers represented 0.2%, 0.3% and 2% of the 2016 Canadian female 20-49 population. White advertisers were the most predominant ethnic group (53%). CONCLUSIONS Sex work in Canada is a more pervasive phenomenon than indicated by spot estimates and the length of the data collection period is an important variable. Non-random samples used in qualitative research in Canada likely do not reflect the larger sex worker population represented in advertising. The overall brevity of advertising activity suggests that workers typically exercise agency, reflecting the findings of other Canadian research.
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11
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Jansson M, Smith M, Benoit C, Magnuson D, Healey P. Challenges and Benefits of Disclosure of Sex Work to Intimate Partners. JOURNAL OF SEX RESEARCH 2022:1-13. [PMID: 35877549 DOI: 10.1080/00224499.2022.2092587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex workers' noncommercial intimate partnerships are marginalized on two counts - they are non-monogamous and at least one partner is in sex work, an occupation with much stigma. We asked a heterogeneous sample of Canadian sex workers (N = 218) about their decisions to reveal/not reveal their sex work to intimate partners, and the resulting challenges and benefits. A minority (58/183) of participants who had been or were currently involved in an intimate relationship kept their work secret from at least one partner or disclosed limited information, shielding them from stigma but resulting in a burden of secrecy. The majority of participants (151/183) who had been/were currently involved in an intimate relationship chose to disclose their sex work to at least one partner, which for most, had one or more negative consequences. A small group of participants related that disclosure resulted in acceptance, support, and understanding from their intimate partner. Some participants avoided the disclosure dilemma by forming intimate relationships from social connections where sex work status was already known. These relationships were generally supportive. We conclude that intimate relationships provide positive experiences for many people who sell sexual services and that these relationships could be stronger if societal stigma was reduced.
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Affiliation(s)
- Mikael Jansson
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria
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12
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Job Attributes and Mental Health: A Comparative Study of Sex Work and Hairstyling. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A growing literature advocates for using a labor perspective to study sex work. According to this approach, sex work involves many of the costs, benefits, and possibilities for exploitation that are common to many jobs. We add to the field with an examination of job attributes and mental health. Our analysis is comparative and uses data from a panel study of people in sex work and hairstyling. We examined job attributes that may differ across these occupations, such as stigma and customer hostility, as well as those that may be more comparable, such as job insecurity, income, and self-employment. Our analysis used mixed-effects regression and included an array of time-varying and time-invariant variables. Our results showed negative associations between mental health and job insecurity and stigma, for both hairstyling and sex work. We also found two occupation-specific relationships: for sex work, limited discretion to make decisions while at work was negatively related to mental health, whereas for hairstyling, mental health was positively associated with self-employment. Our results highlight the usefulness of an inter-occupational labor perspective for understanding the mental health consequences of being in sex work compared to hairstyling.
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13
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Kim SJ, Peterson C. The health effects of gendered and devalued work: health outcomes of incarcerated women engaging in sex work and care/service work. HEALTH & JUSTICE 2020; 8:23. [PMID: 33206239 PMCID: PMC7677821 DOI: 10.1186/s40352-020-00124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Women with a history of incarceration are often engaged in highly gendered work, either sex work or low-wage care/service work jobs. While employment is an important element of reentry plans, low-wage jobs may not necessarily help women leave illicit activities, including commercial sex work. Incarcerated women often move between care/service work and sex work to supplement income, putting them at greater risk for negative health outcomes. RESULTS Using survey data from 400 women detained in a large urban jail, we examined how incarcerated women's experience with sex work and low-wage care/service work affects four health-related outcomes: overall health concerns, clinical depression, regular drug use, and self-esteem. Of the survey participants, 24% engaged exclusively in sex work and 34% in care/service work. However, 41% of women held both sex work and care/service work jobs, prior to incarceration. Compared to women engaged in care/service work, a greater proportion of women engaged in sex work reported overall health concerns, clinical depression, and regular drug use. On the other hand, women in care/service work jobs exclusively reported lower levels of self-esteem than women engaging in sex work. CONCLUSIONS Many reentry programs emphasize the importance of employment for former inmates, and yet, job options for women detained in jail are often limited to low-wage care/service jobs, which do not necessarily provide adequate security to lift women's economic burdens. Consequently, many women with a history of incarceration may supplement their income with sex work to meet their basic economic needs. However, both of these highly gendered and devalued jobs may negatively affect health and wellbeing of women.
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Affiliation(s)
- Sage J. Kim
- Division of Health Policy & Administration, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor St. #781, Chicago, IL USA
| | - Caryn Peterson
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL USA
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14
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Sharma R, Pooyak S, Jongbloed K, Zamar D, Pearce ME, Mazzuca A, Schechter MT, Spittal PM. The Cedar Project: Historical, structural and interpersonal determinants of involvement in survival sex work over time among Indigenous women who have used drugs in two Canadian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:103012. [PMID: 33166826 DOI: 10.1016/j.drugpo.2020.103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. METHODS The Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016 . Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. RESULTS Among 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50-2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36-2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22-2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18-2.28), used crack daily (ARR: 2.85; 95% CI: 2.36-3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98-3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15-2.05) were more likely to be involved in sex work. CONCLUSION Indigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.
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Affiliation(s)
- Richa Sharma
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Sherri Pooyak
- AHA Centre/ Canadian Aboriginal AIDS Network, 6520 Salish Dr, Vancouver, BC, V6N 2C7
| | - Kate Jongbloed
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - David Zamar
- BC Children's Hospital Research Institute, 950 W28th Ave, Vancouver, BC, V5Z 4H4
| | - Margo E Pearce
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4
| | - April Mazzuca
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Martin T Schechter
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Patricia M Spittal
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3.
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15
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Quaife M, Lépine A, Deering K, Terris-Prestholt F, Beattie T, Isac S, Paranjape RS, Vickerman P. The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India. Health Policy Plan 2020; 34:784-791. [PMID: 31603470 PMCID: PMC6913694 DOI: 10.1093/heapol/czz100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/26/2022] Open
Abstract
There is some evidence that female sex workers (FSWs) receive greater earnings for providing unprotected sex. In 2003, the landscape of the fight against HIV/AIDS dramatically changed in India with the introduction of Avahan, the largest HIV prevention programme implemented globally. Using a unique, cross-sectional bio-behavioural dataset from 3591 FSWs located in the four Indian states where Avahan was implemented, we estimate the economic loss faced by FSWs who always use condoms. We estimate the causal effect of condom use on the price charged during the last paid sexual intercourse using the random targeting of Avahan as an instrumental variable. Results indicate that FSWs who always use condoms face an income loss of 65% (INR125, US$2.60) per sex act compared to peers providing unprotected sex, consistent with our expectations. The main finding confirms that clients have a preference for unprotected sex and that policies aiming at changing clients’ preferences and at improving the bargaining power of FSWs are required to limit the spread of HIV.
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Affiliation(s)
- Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurélia Lépine
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Deering
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Shajy Isac
- Monitoring and Evaluation, Research and Special Studies, Karnataka Health Promotion Trust, Rajajinagar, Bangalore, India.,Department of Community Health Sciences, Center for Global Public Health, University of Manitoba, Canada
| | | | - Peter Vickerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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16
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Kingston S, Smith N. Sex counts: An examination of sexual service advertisements in a UK online directory. THE BRITISH JOURNAL OF SOCIOLOGY 2020; 71:328-348. [PMID: 31903606 DOI: 10.1111/1468-4446.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 04/01/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
Internationally, sex work research, public opinion, policy, laws, and practice are predicated on the assumption that commercial sex is a priori sold by women and bought by men. Scarce attention has been devoted to lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) sex working as well as women who pay for sex. This is as much an empirical absence as it is a theoretical one, for the ideological claim that women comprise the "vast majority" of sex workers is rarely, if ever, exposed to empirical scrutiny. Focusing on the UK, we address this major gap in evidence in order to challenge the gendered and heterosexist logics that underpin contemporary debates. We do so by presenting large-scale data gained from the quantitative analysis of 25,511 registered member profiles of an online escort directory. Our findings point to heterogeneity rather than homogeneity in the contemporary sex industry including in terms of gender identity, sexual orientation, and advertised client base. For example, while two-thirds of advertisements self-identify as "Female," one in four are listed as "Male;" less than half list their sexual orientation as "Straight;" and nearly two-thirds advertise to women clients. Our study thus challenges prevailing heteronormative assumptions about commercial sex, which erase LGBTQ sex workers and other non-normative identities and practices, and which we argue have important political, practical, and theoretical consequences.
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Affiliation(s)
- Sarah Kingston
- School of Forensic and Applied Sciences, The University of Central Lancashire, Preston, United Kingdom
| | - Nicola Smith
- Department of Political Science and International Studies, University of Birmingham, Birmingham, United Kingdom
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17
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Benoit C, Maurice R, Abel G, Smith M, Jansson M, Healey P, Magnuson D. 'I dodged the stigma bullet': Canadian sex workers' situated responses to occupational stigma. CULTURE, HEALTH & SEXUALITY 2020; 22:81-95. [PMID: 30794087 DOI: 10.1080/13691058.2019.1576226] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Stigma attached to sex workers' occupation, sometimes disparagingly referred to as 'prostitution' or 'whore' stigma, is a fundamental challenge for people in sex work. Yet sex workers are not powerless when confronting occupational stigma. We employed thematic analysis with data from in-person interviews conducted in 2012-13 with a diverse sample of 218 adult sex workers in Canada. Our participants perceived a high degree of occupational stigma, which they responded to and managed using four main strategies. First, some participants internalised negative discourses about their sex work and accepted their discredited status. Second, many controlled access to information about themselves, consciously keeping knowledge of their occupation from most people while sharing it with trusted others. Third, some participants rejected society's negative view of their occupation. Finally, some attempted to reduce the personal impact of stigma by reframing sex work to emphasise its positive and empowering elements. Participants often strategically responded to stigma contingent on the situated contexts of their work and personal life. We discuss these findings in relation to the existing knowledge base about stigma attached to sex workers' occupation as well as how these findings may direct future research on stigma strategies.
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Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Renay Maurice
- Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Gillian Abel
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Michaela Smith
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Priscilla Healey
- School of Child and Youth Care, University of Victoria University of Victoria, Victoria, BC, Canada
| | - Douglas Magnuson
- School of Child and Youth Care, University of Victoria University of Victoria, Victoria, BC, Canada
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18
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Berg RC, Molin SB, Nanavati J. Women Who Trade Sexual Services from Men: A Systematic Mapping Review. JOURNAL OF SEX RESEARCH 2020; 57:104-118. [PMID: 31264896 DOI: 10.1080/00224499.2019.1624680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a - possibly growing and diversifying - female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.
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Affiliation(s)
- Rigmor C Berg
- Division of Health Services, Norwegian Institute of Public Health and Department of Community Medicine, University of Tromso
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19
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Curtis MG, D’Aniello C, Twist MLC, Brents BG, Eddy B. ‘We are naked waitresses who deliver sex’: a phenomenological study of circumstantial sex workers’ lives. SEXUAL AND RELATIONSHIP THERAPY 2019. [DOI: 10.1080/14681994.2019.1689386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael G. Curtis
- Department of Human Development and Family Studies, University of Georgia, Athens, GA, USA
| | - Carissa D’Aniello
- Department of Community, Family and Addiction Sciences, Texas Tech University, Lubbock, TX, USA
| | - Markie L. C. Twist
- Department of Human Development and Family Studies, University of Wisconsin-Stout, Menomonie, WI, USA
| | - Barbara G. Brents
- Department of Sociology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Brandon Eddy
- Department of Psychiatry and Behavioral Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
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20
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Shaver FM. "The Prostitution Problem": Why Isn't Evidence Used to Inform Policy Initiatives? ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1955-1959. [PMID: 30560344 DOI: 10.1007/s10508-018-1374-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Frances M Shaver
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, H3G 1M8, Canada.
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21
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Benoit C, Smith M, Jansson M, Healey P, Magnuson D. "The Prostitution Problem": Claims, Evidence, and Policy Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1905-1923. [PMID: 30498916 DOI: 10.1007/s10508-018-1276-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 05/12/2023]
Abstract
Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.
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Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada.
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Priscilla Healey
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
| | - Doug Magnuson
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
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22
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Bond KT, Yoon IS, Houang ST, Downing MJ, Grov C, Hirshfield S. Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based U.S. Sample of Men Who Have Sex with Men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:255-267. [PMID: 31814855 PMCID: PMC6897531 DOI: 10.1007/s13178-018-0366-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Demographic, behavioral, and structural factors among four mutually exclusive transactional sex categories were assessed in an online sample of 7217 sexually active US men who have sex with men (MSM): (1) No Trade Sex group (87%); (2) Sellers, accepting money or drugs for sex (5%); (3) Buyers, giving money or drugs for sex (6%); and (4) Sellers and Buyers, accepting and giving money or drugs for sex (2%). Separate multivariable logistic regressions compared men who did not report past 60-day transactional sex with men in the three transactional sex groups. Sellers were more likely to report being black or Asian (versus white), low income, a recent STI diagnosis, six or more recent male anal sex partners, and polydrug use. Buyers were more likely to report being older, higher income, urban residence, incarceration history, a recent STI diagnosis, and having non-main sex partners. Sellers and Buyers were more likely to report a higher income, incarceration history, six or more recent male anal sex partners, and polydrug use. Findings suggest that public health policy and HIV prevention harm reduction strategies should address the distinct sexual and behavioral risk patterns among MSM who engage in transactional sex based on payment direction.
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Affiliation(s)
- Keosha T. Bond
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | - Irene S. Yoon
- L2 Gartner, Research and Strategy Team, New York, NY, USA
| | - Steven T. Houang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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23
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Orchard T, Murie A, Elash HL, Bunch M, Middleton C, Sadakhom D, Oiamo T, Benoit C. "People like us": spatialised notions of health, stigma, power and subjectivity among women in street sex work. CULTURE, HEALTH & SEXUALITY 2019; 21:478-494. [PMID: 30378467 DOI: 10.1080/13691058.2018.1490455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
Most spatially-oriented studies about health, safety and service provision among women in street sex work have taken place in large urban cities and document how the socio-legal and moral surveillance of geographical spaces constrain their daily movements and compromise their ability to care for themselves. Designed to contribute new knowledge about the broader socio-cultural and environmental landscape of sex work in smaller urban centres, we conducted qualitative interviews and social mapping activities with thirty-three women working in a medium-sized Canadian city. Our findings demonstrate a socio-spatial convergence regarding service provision, violence, and stigma, which is common in sex trading spaces that double as service landscapes for poor populations. Women in this study employ unique agential strategies to navigate these competing forces, many of which draw upon the multivalent uses of different urban spaces to optimise service access, reduce the propensity for violence, and manage their health with dignity. Their use of the spatialised term 'everywhere' as an idiom of distress regarding issues of power, agency and their desire to take part in wider civic discourse are also explored. These data contribute new insights about spatialised notions of health, stigma, agency, and subjectivity among women in sex work and how they manage 'risky' environments.
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Affiliation(s)
- Treena Orchard
- a School of Health Studies , University of Western Ontario , London , Ontario , Canada
| | - Angela Murie
- b Department of Social Work , University of Windsor , Windsor , Ontario , Canada
| | | | - Mary Bunch
- d Institute for Gender, Sexuality and Feminist Studies , McGill University , Montreal , Quebec , Canada
| | | | - Danielle Sadakhom
- f Environmental Applied Science and Management , Toronto , Ontario , Canada
| | - Tor Oiamo
- g Department of Geography and Environmental Studies , Ryerson University , Toronto , Ontario , Canada
| | - Cecilia Benoit
- h Canadian Institute for Substance Use Research & Department of Sociology , University of Victoria , Victoria , British Columbia , Canada
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24
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Sawicki DA, Meffert BN, Read K, Heinz AJ. Culturally Competent Health Care for Sex Workers: An Examination of Myths That Stigmatize Sex-Work and Hinder Access to Care. SEXUAL AND RELATIONSHIP THERAPY 2019; 34:355-371. [PMID: 30899197 DOI: 10.1080/14681994.2019.1574970] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sex workers are individuals who offer sexual services in exchange for compensation (i.e., money, goods, or other services). Within the United States the full-service sex work (FSSW) industry generates 14 billion dollars annually there are estimated to be 1-2 million FSSWers, though experts believe this number to be an underestimate. Many FSSWers face the possibility of violence, legal involvement, and social stigmatization. As a result, this population experiences increased risk for mental health disorders. Given these risks and vulnerabilities, FSSWers stand to benefit from receiving mental health care however a constellation of individual, organizational, and systemic barriers limit care utilization. Destigmatization of FSSW and offering of culturally competent mental health care can help empower this traditionally marginalized population. The objective of the current review is to (1) educate clinicians on sex work and describe the unique struggles faced by FSSW and vulnerability factors clinicians must consider, (2) address 5 common myths about FSSW that perpetuate stigma, and (3) advance a research and culturally competent clinical training agenda that can optimize mental health care engagement and utilization within the sex work community.
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Affiliation(s)
- Danielle A Sawicki
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Healthcare System
| | - Brienna N Meffert
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Healthcare System
| | - Kate Read
- Black Dot Writing LLC, Veterans Affairs Palo Alto Healthcare System
| | - Adrienne J Heinz
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Healthcare System.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System
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Benoit C, Jansson SM, Smith M, Flagg J. Prostitution Stigma and Its Effect on the Working Conditions, Personal Lives, and Health of Sex Workers. JOURNAL OF SEX RESEARCH 2018; 55:457-471. [PMID: 29148837 DOI: 10.1080/00224499.2017.1393652] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Researchers have shown that stigma is a fundamental determinant of behavior, well-being, and health for many marginalized groups, but sex workers are notably absent from their analyses. This article aims to fill the empirical research gap on sex workers by reviewing the mounting evidence of stigmatization attached to sex workers' occupation, often referred to as "prostitution" or "whore" stigma. We give special attention to its negative effect on the working conditions, personal lives, and health of sex workers. The article first draws attention to the problem of terminology related to the subject area and makes the case for consideration of prostitution stigmatization as a fundamental cause of social inequality. We then examined the sources of prostitution stigma at macro, meso, and micro levels. The third section focuses on tactics sex workers employ to manage, reframe, or resist occupational stigma. We conclude with a call for more comparative studies of stigma related to sex work to contribute to the general stigma literature, as well as social policy and law reform.
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Affiliation(s)
- Cecilia Benoit
- a Centre for Addictions Research of British Columbia , University of Victoria
| | - S Mikael Jansson
- a Centre for Addictions Research of British Columbia , University of Victoria
| | - Michaela Smith
- a Centre for Addictions Research of British Columbia , University of Victoria
| | - Jackson Flagg
- a Centre for Addictions Research of British Columbia , University of Victoria
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26
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Benoit C, Smith M, Jansson M, Magnus S, Flagg J, Maurice R. Sex work and three dimensions of self-esteem: self-worth, authenticity and self-efficacy. CULTURE, HEALTH & SEXUALITY 2018; 20:69-83. [PMID: 28548011 DOI: 10.1080/13691058.2017.1328075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sex work is assumed to have a negative effect on self-esteem, nearly exclusively expressed as low self-worth, due to its social unacceptability and despite the diversity of persons, positions and roles within the sex industry. In this study, we asked a heterogeneous sample of 218 Canadian sex workers delivering services in various venues about how their work affected their sense of self. Using thematic analysis based on a three-dimensional conception of self-esteem - self-worth (viewing oneself in a favourable light), authenticity (being one's true self) and self-efficacy (competency) - we shed light on the relationship between involvement in sex work and self-esteem. Findings demonstrate that the relationship between sex work and self-esteem is complex: the majority of participants discussed multiple dimensions of self-esteem and often spoke of how sex work had both positive and negative effects on their sense of self. Social background factors, work location and life events and experiences also had an effect on self-esteem. Future research should take a more complex approach to understanding these issues by considering elements beyond self-worth, such as authenticity and self-efficacy, and examining how sex workers' backgrounds and individual motivations intersect with these three dimensions.
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Affiliation(s)
- Cecilia Benoit
- a Centre for Addictions Research , University of Victoria , Victoria , Canada
- b Department of Sociology , University of Victoria , Victoria , Canada
| | - Michaela Smith
- a Centre for Addictions Research , University of Victoria , Victoria , Canada
| | - Mikael Jansson
- a Centre for Addictions Research , University of Victoria , Victoria , Canada
- b Department of Sociology , University of Victoria , Victoria , Canada
| | - Samantha Magnus
- a Centre for Addictions Research , University of Victoria , Victoria , Canada
| | - Jackson Flagg
- a Centre for Addictions Research , University of Victoria , Victoria , Canada
| | - Renay Maurice
- a Centre for Addictions Research , University of Victoria , Victoria , Canada
- b Department of Sociology , University of Victoria , Victoria , Canada
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27
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Andreatos N, Grigoras C, Shehadeh F, Pliakos EE, Stoukides G, Port J, Flokas ME, Mylonakis E. The impact of HIV infection and socioeconomic factors on the incidence of gonorrhea: A county-level, US-wide analysis. PLoS One 2017; 12:e0183938. [PMID: 28863154 PMCID: PMC5580927 DOI: 10.1371/journal.pone.0183938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Gonorrhea is the second most commonly reported identifiable disease in the United States (U.S.). Importantly, more than 25% of gonorrheal infections demonstrate antibiotic resistance, leading the Centers for Disease Control and Prevention (CDC) to classify gonorrhea as an “urgent threat”. Methods We examined the association of gonorrhea infection rates with the incidence of HIV and socioeconomic factors. A county-level multivariable model was then constructed. Results Multivariable analysis demonstrated that HIV incidence [Coefficient (Coeff): 1.26, 95% Confidence Interval (CI): 0.86, 1.66, P<0.001] exhibited the most powerful independent association with the incidence of gonorrhea and predicted 40% of the observed variation in gonorrhea infection rates. Sociodemographic factors like county urban ranking (Coeff: 0.12, 95% CI: 0.03, 0.20, P = 0.005), percentage of women (Coeff: 0.41, 95% CI: 0.28, 0.53, P<0.001) and percentage of individuals under the poverty line (Coeff: 0.45, 95% CI: 0.32, 0.57, P<0.001) exerted a secondary impact. A regression model that incorporated these variables predicted 56% of the observed variation in gonorrhea incidence (Pmodel<0.001, R2 model = 0.56). Conclusions Gonorrhea and HIV infection exhibited a powerful correlation thus emphasizing the benefits of comprehensive screening for sexually transmitted infections (STIs) and the value of pre-exposure prophylaxis for HIV among patients visiting an STI clinic. Furthermore, sociodemographic factors also impacted gonorrhea incidence, thus suggesting another possible focus for public health initiatives.
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Affiliation(s)
- Nikolaos Andreatos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Christos Grigoras
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Elina Eleftheria Pliakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Georgianna Stoukides
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Jenna Port
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Myrto Eleni Flokas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
- * E-mail:
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Offringa R, Tsai LC, Aira T, Riedel M, Witte SS. Personal and Financial Risk Typologies Among Women Who Engage in Sex Work in Mongolia: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1857-1866. [PMID: 27473070 PMCID: PMC5276798 DOI: 10.1007/s10508-016-0824-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 04/12/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
Women engaged in sex work bear a disproportionate burden of HIV infection worldwide, particularly in low- to middle-income countries. Stakeholders interested in promoting prevention and treatment programs are challenged to efficiently and effectively target heterogeneous groups of women. This problem is particularly difficult because it is nearly impossible to know how those groups are composed a priori. Although grouping based on individual variables (e.g., age or place of solicitation) can describe a sample of women engaged in sex work, selecting these variables requires a strong intuitive understanding of the population. Furthermore, this approach is difficult to quantify and has the potential to reinforce preconceived notions, rather than generate new information. We aimed to investigate groupings of women engaged in sex work. The data were collected from a sample of 204 women who were referred to an HIV prevention intervention in Ulaanbaatar, Mongolia. Latent class analysis was used to create subgroups of women engaged in sex work, based on personal and financial risk factors. This analysis found three latent classes, representing unique response pattern profiles of personal and financial risk. The current study approached typology research in a novel, more empirical way and provided a description of different subgroups, which may respond differently to HIV risk interventions.
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Affiliation(s)
- Reid Offringa
- Columbia University School of Social Work, New York, NY, USA
| | - Laura Cordisco Tsai
- Department of Social Work, George Mason University, 10340 Democracy Lane, Fairfax, VA, 22030, USA.
| | | | - Marion Riedel
- Columbia University School of Social Work, New York, NY, USA
| | - Susan S Witte
- Columbia University School of Social Work, New York, NY, USA
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29
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Krumrei-Mancuso EJ. Sex Work and Mental Health: A Study of Women in the Netherlands. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1843-1856. [PMID: 27439600 DOI: 10.1007/s10508-016-0785-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 03/20/2016] [Accepted: 05/29/2016] [Indexed: 06/06/2023]
Abstract
This study examined how characteristics of prostitution and quality-of-life factors related to symptoms of depression and post-traumatic stress among 88 women engaged in prostitution in the Netherlands. Numerous factors were associated with elevated mental health concerns, including the experience of violence in prostitution, engaging in street prostitution, being motivated to engage in prostitution for financial reasons, having less confidence in one's ability to find alternative work, desiring to leave prostitution, and sense of self-transcendence. In contrast, focusing on achievement, having a sense of fair treatment from others and society, and self-acceptance were associated with better mental health outcomes. Finally, mediation analyses indicated that post-traumatic stress associated with engaging in prostitution against one's deeper desire to exit prostitution was, in part, the result of a lack of self-acceptance. The analyses controlled for relevant demographic factors, including age and level of education. The effect sizes for each of the findings ranged from medium to large. Implications for mental health care and public policy are included.
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Affiliation(s)
- Elizabeth J Krumrei-Mancuso
- Social Science Division, Department of Psychology, Pepperdine University, 24255 Pacific Coast Hwy, Malibu, CA, 90263, USA.
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30
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Parcesepe AM, L'Engle KL, Martin SL, Green S, Suchindran C, Mwarogo P. Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya. J Urban Health 2016; 93:1010-1026. [PMID: 27714491 PMCID: PMC5126017 DOI: 10.1007/s11524-016-0073-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1501 Riverside Drive, New York, NY, USA.
| | - Kelly L L'Engle
- Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sherri Green
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Benoit C, McCarthy B, Jansson M. Stigma, sex work, and substance use: a comparative analysis. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:437-451. [PMID: 25688450 DOI: 10.1111/1467-9566.12201] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Stigma is a widely used concept in social science research and an extensive literature claims that stigmatisation contributes to numerous negative health outcomes. However, few studies compare groups that vary in the extent to which they are stigmatised and even fewer studies examine stigma's independent and mediating effects. This article addresses these gaps in a comparative study of perceived stigma and drug use among three low-income feminised service occupations: sex work, food and alcoholic beverage serving, and barbering and hairstyling. An analysis of longitudinal data shows positive associations between sex work, perceived stigma, and socially less acceptable drug use (for example, heroin and cocaine), and that stigma mediates part of the link between sex work and the use of these drugs. Our overall findings suggest that perceived stigma is pronounced among those who work in the sex industry and negatively affects health independently of sex work involvement.
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Affiliation(s)
- Cecilia Benoit
- Centre for Addictions Research of BC, Department of Sociology, University of Victoria, BC, Canada
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