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Salazar M, Silverman JG, Rangel Gómez MG, Urada LA, Brouwer KC, Reed E. Substance use, economic vulnerability, and HIV/STI risk among female sex workers in Mexico. Int J STD AIDS 2024; 35:147-154. [PMID: 37934459 DOI: 10.1177/09564624231214287] [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: 11/08/2023]
Abstract
BACKGROUND Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. METHODS Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). RESULTS Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). CONCLUSIONS Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.
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Affiliation(s)
- Marissa Salazar
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - María Gudelia Rangel Gómez
- US-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte (COLEF), Tijuana, Mexico
| | - Lianne A Urada
- School of Social Work, San Diego State University, San Diego, CA, USA
| | | | - Elizabeth Reed
- School of Public Health, San Diego State University, San Diego, CA, USA
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2
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West BS, Henry BF, Agah N, Vera A, Beletsky L, Rangel MG, Staines H, Patterson TL, Strathdee SA. Typologies and Correlates of Police Violence Against Female Sex Workers Who Inject Drugs at the México-United States Border: Limits of De Jure Decriminalization in Advancing Health and Human Rights. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8297-NP8324. [PMID: 33261533 PMCID: PMC8166925 DOI: 10.1177/0886260520975820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Decriminalization of sex work is increasingly promoted as a structural measure to improve the health of vulnerable groups. In México, sex work is not illegal, but knowledge of policies' street-level impact is limited. This study describes typologies of police violence against female sex workers who inject drugs (FSWID), identifying risk and protective factors for violence exposure to inform policy responses. Survey data were collected during 2008-2010 among HIV-negative FSWID in a behavioral intervention in Tijuana and Ciudad Juarez (N = 584). Latent class analysis identified typologies of police violence in the past 6 months: asked for money, money taken, syringes taken, asked for sex, and sexually assaulted. Structural equation modeling (SEM) predicted latent class membership using sociodemographic, behavioral and risk environment factors, controlling for age, education, marital status, and city. Recent police violence was reported by 68% of FSWID, with three typologies emerging: Low (36.6%); Material (47.8%): having money/syringes taken or being asked for money; and Material/Sexual (15.7%): material violence and being asked for sex or sexually assaulted. In multivariable SEM, Material Violence was associated with: being jailed [adjusted Odds Ratio (aOR) = 4.34], HIV testing (aOR = 2.18), and trading sex indoors (aOR = 1.66). Factors associated with Material/Sexual Violence included: being jailed (aOR = 41.18), injecting with clients (aOR = 3.12), earning more money for sex without a condom (aOR = 2.88), being raped by a client (aOR = 2.13), drinking with clients (aOR = 2.03), receiving substance use treatment (aOR = 1.95), being <18 when first trading sex (aOR = .43), trading sex outdoors (aOR = .53), and poor working conditions (aOR = .56). Despite de jure decriminalization of sex work, police violence against FSWID at the México-United States border is pervasive with implications for sex- and drug-related harms. Closing gaps in policy implementation and mitigating material/sexual violence from police is imperative to decreasing economic vulnerability, risk of overdose and HIV, and improving engagement in HIV and harm reduction services.
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Affiliation(s)
| | | | - Niloufar Agah
- University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- University of California San Diego, La Jolla, CA, USA
| | - Leo Beletsky
- University of California San Diego, La Jolla, CA, USA
| | | | - Hugo Staines
- Universidad Autónoma de Ciudad Juárez, Chihuahua, México
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3
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Rocha-Jiménez T, Morales-Miranda S, Fernández-Casanueva C, Silverman JG, Zúñiga ML, Goldenberg SM, Crespo N, Brouwer KC. Migration and Mobility: Correlates of Recent HIV Testing Among Substance Using Female Sex Workers at the Mexico-Guatemala Border. AIDS Behav 2022; 26:1467-1476. [PMID: 34982320 PMCID: PMC9001206 DOI: 10.1007/s10461-021-03501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/04/2022]
Abstract
The goal of this paper is to determine the association between traveling to engage in sex work in another country and recent access to HIV testing among substance-using female sex workers (FSWs) in the Mexico-Guatemala border region. From 2012 to 2015, through modified time-location sampling and peer referral, 255 FSWs were recruited at Mexico's southern border. Participants completed questionnaires on sociodemographics, migration and mobility experiences, work environment factors, and substance use. A conceptual framework, as depicted by a directed acyclic graph (DAG), guided our analysis. Crude and adjusted logistic regression models were used to evaluate the relationships between mobility experiences and HIV testing in the past year. Overall HIV testing was low (41%); after considering relevant covariates (i.e., interaction with health services and organizations, and sex work characteristics) traveling to engage in sex work in another country was found to be positively associated with HIV testing in the past year. Future efforts need to consider voluntary and non-stigmatizing prevention HIV services and focus on reaching out to less mobile women.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- Society and Health Research Center, Faculty of Humanities, Universidad Mayor, Santiago, Chile
| | | | - Carmen Fernández-Casanueva
- Centro de Investigaciones y Estudios Superiores en Antropología Social CIESAS, San Cristóbal de las Casas, Chiapas Mexico
| | - Jay G. Silverman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | | | - Shira M. Goldenberg
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- Division of Epidemiology and Biostatistics, San Diego State, San Diego, CA USA
| | - Noe Crespo
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Kimberly C. Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA USA
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4
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Nabunya P, Byansi W, Damulira C, Bahar OS, Jennings Mayo-Wilson L, Tozan Y, Kiyingi J, Nabayinda J, Braithwaite R, Witte SS, Ssewamala FM. Predictors of Depressive Symptoms and Post Traumatic Stress Disorder Among Women Engaged in Commercial Sex Work in Southern Uganda. Psychiatry Res 2021; 298:113817. [PMID: 33636517 PMCID: PMC8005481 DOI: 10.1016/j.psychres.2021.113817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023]
Abstract
This study examined the factors associated with depressive symptoms and post traumatic depressive disorder (PTSD) among economically vulnerable women engaged in commercial sex work (WESW) in southern Uganda. Baseline data from a longitudinal cluster randomized study involving 542 self-identified WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. Hierarchical linear regression modelling was utilized to estimate individual, family-level and economic-level predictors of depressive symptoms and PTSD. Family cohesion, sex work stigma, HIV status, financial distress, household assets, number of children and number of household income earners, were associated with PTSD. Similarly, family cohesion, number of people in the household, HIV status, sex work stigma, financial distress, and household assets, were associated with depressive symptoms. Women engaged in commercial sex work are at a higher risk of HIV and poor mental health outcomes. Sex work stigma and financial distress elevate levels of depressive symptoms and PTSD, over and above an individual's HIV status. Family and economic-level factors have the potential to mitigate the risk of poor mental health outcomes. As such, integrating stigma reduction and economic strengthening components in the programming targeting WESW-a key population, may be critical to address their mental health outcomes.
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Affiliation(s)
- Proscovia Nabunya
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - William Byansi
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Christopher Damulira
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Ozge Sensoy Bahar
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Science, 1025 E. 7(TH) Street, Bloomington, IN 47405, USA.
| | - Yesim Tozan
- New York University College of Global Public Health, 14 East 4(th) street, 3(rd) floor. New York, NY 10003, USA.
| | - Joshua Kiyingi
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Josephine Nabayinda
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Rachel Braithwaite
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Susan S Witte
- Columbia University School of Social Work1255 Amsterdam Avenue, New York, NY 10027, USA.
| | - Fred M Ssewamala
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
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5
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Rocha-Jiménez T, Morales-Miranda S, Fernández-Casanueva C, Brouwer KC. The influence of migration in substance use practices and HIV/STI-related risks of female sex workers at a dynamic border crossing. J Ethn Subst Abuse 2020; 19:503-520. [PMID: 30795721 PMCID: PMC8638352 DOI: 10.1080/15332640.2018.1556763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We explored the association of international migration with substance use and HIV/STI risk factors among female sex workers (FSW). Using modified time-location sampling, we recruited 266 FSW at the Mexico-Guatemala border. Crude and adjusted logistic regression models were used to evaluate the relationships. HIV risks, such as frequent hard drug use and drug use in another country, were greater for migrant compared to nonmigrant FSW. However, more migrant versus nonmigrant FSW reported consistent condom use with clients and having a health card. Our study highlights regional patterns of substance use among FSW and risk or protective behaviors related to migration status.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
- Graduate School of Public Health, San Diego State University, Center for U.S.-Mexican Studies, University of California, San Diego, California
| | | | - Carmen Fernández-Casanueva
- Centro de Investigaciones y Estudios Superiores en Antropología Social CIESAS, San Cristóbal de las Casas, Chiapas, México
| | - Kimberly C Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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6
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Farahmand M, Moghoofei M, Dorost A, Abbasi S, Monavari SH, Kiani SJ, Tavakoli A. Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis. BMC Public Health 2020; 20:1455. [PMID: 32977797 PMCID: PMC7519561 DOI: 10.1186/s12889-020-09570-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and the distribution of HPV types among FSWs across the world. METHODS Five computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable sources of heterogeneity. The meta-analysis was performed using the "Metaprop" function in the R package Meta. RESULTS Sixty-two studies involving 21,402 FSWs from 33 countries were included in this meta-analysis, and the pooled HPV prevalence was 42.6% (95% confidence interval (CI): 38.5-46.7%). HPV-16 (10.1, 95% CI: 8.2-12.5%), HPV-52 (7.9, 95% CI: 5.9-10.7%), and HPV-53 (6.0, 95% CI: 4.4-8.1%) were the most common high-risk HPV types identified among FSWs. The pooled estimated prevalence of HPV infection among FSWs before and after 2010 were slightly different, 43.6% (95% CI: 36.1-51.4%) and 41.9% (95% CI: 37.2-46.8%), respectively. CONCLUSION Due to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and the incidence of HPV-associated malignancies among the general population.
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Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Moghoofei
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abolfazl Dorost
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Abbasi
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamidreza Monavari
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jalal Kiani
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
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7
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West BS, Becerra Ramirez M, Bristow CC, Abramovitz DA, Vera A, Staines H, Gudelia Rangel M, Patterson TL, Strathdee SA. Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities. Int J STD AIDS 2020; 31:866-875. [PMID: 32623979 DOI: 10.1177/0956462420929463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Milagros Becerra Ramirez
- Department of Family Medicine, University of California Los Angeles International Medical Graduate Program, Los Angeles, CA, USA
| | - Claire C Bristow
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela A Abramovitz
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
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8
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Andrade EA, Leyva R, Kwan MP, Magis C, Stainez-Orozco H, Brouwer K. Women in Sex Work and the Risk Environment: Agency, Risk Perception, and Management in the Sex Work Environments of Two Mexico-U.S. Border Cities. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:317-328. [PMID: 31379977 PMCID: PMC6677136 DOI: 10.1007/s13178-018-0318-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sex work around the world takes place under conditions of structural violence and vulnerability. The México-U.S. border region is characterized by the presence of factors that increase the risk for health harms among female sex workers (FSW); located in this context, the risk environments of Tijuana and Ciudad Juárez have similar yet distinct characteristics that influence how risk is produced and experienced among FSWs. Exploring the ways in which FSWs enact agency in risk environments can illustrate how environmental characteristics shape perceived risks and the strategies that FSWs develop to manage them. This approach also identifies the limits that are placed by environmental characteristics over the capacity for harm reduction and prevention practices among FSWs. We analyzed the role of agency in the work environments of female sex workers and its relationship with risk perception and management in the cities of Tijuana and Cd. Juárez.
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Affiliation(s)
- Elí A Andrade
- Division of Global Public Health, University of California San Diego, La Jolla, USA
| | - René Leyva
- Centro de Investigación en Sistemas de Salud, Instuto Nacional de Salud Pública, Cuernavaca, México
| | - Mei-Po Kwan
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, USA
| | - Carlos Magis
- Centro Nacional para la Prevención y control del Sida, Secretaria de Salud, Mexico City, Mexico
| | - Hugo Stainez-Orozco
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | - Kimberly Brouwer
- Division of Global Public Health, University of California San Diego, La Jolla, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
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9
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Rocha-Jiménez T, Mittal ML, Artamonova I, Baker P, Cepeda J, Morales M, Abramovitz D, Clairgue E, Bañuelos A, Patterson T, Strathdee S, Beletsky L. The Role of Gender in the Health and Human Rights Practices of Police: The SHIELD Study in Tijuana, Mexico. Health Hum Rights 2019; 21:227-238. [PMID: 31239629 PMCID: PMC6586956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Globally, punitive drug law enforcement drives human rights violations. Drug control tactics, such as syringe confiscation and drug-related arrests, also cascade into health harms among people who use drugs. The role of police officer characteristics in shaping such enforcement and measures to reform police practices remains underexamined. We evaluated gender differences in syringe confiscation and syringe-related arrest behaviors among municipal police officers in Tijuana, Mexico, where syringe possession is legal. In the context of the SHIELD Study focusing on aligning policing with harm reduction measures, our baseline sample covered municipal police officers who reported having occupational contact with syringes. We used multivariable logistic regression with robust variance estimation via a generalized estimating equation to identify correlates of syringe-related policing behaviors. Among respondent officers (n=1,555), 12% were female. After considering possible confounding variables, such as district of service and work experience, female officers were significantly less likely to report confiscating syringes or arresting individuals for syringe possession. Consideration of officer gender is important in the design of interventions to improve the health and human rights of people who inject drugs and other highly policed groups, as well as measures to safeguard officer occupational safety. The feminization of law enforcement deserves special consideration as an imperative in reducing the public health harms of policing.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Research associate at the University of California San Diego’s Division of Infectious Diseases and Global Public Health and a fellow at the Center for U.S.-Mexican Studies, University of California San Diego, USA
| | - Maria Luisa Mittal
- Project scientist at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | | | - Pieter Baker
- PhD student and research associate at the University of California San Diego and San Diego State University, USA
| | - Javier Cepeda
- Assistant professor at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Mario Morales
- Research assistant at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Daniela Abramovitz
- Principal statistician at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Erika Clairgue
- Research program manager at the University of California San Diego, USA
| | - Arnulfo Bañuelos
- Research liaison at the Secretaría de Seguridad Pública Municipal, department of special planning and projects, Tijuana, Mexico
| | - Thomas Patterson
- Distinguished professor of psychiatry at the University of California San Diego, USA
| | - Steffanie Strathdee
- Associate dean of global health sciences, Harold Simon Professor at the University of California San Diego Department of Medicine, and principal investigator at Project ESCUDO
| | - Leo Beletsky
- Professor at the School of Law and Bouvé College of�Health Sciences, Northeastern University, and an associate adjunct professor at the University of California San Diego, USA
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10
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The relationship between health policy and public health interventions: a case study of the DRIVE project to "end" the HIV epidemic among people who inject drugs in Haiphong, Vietnam. J Public Health Policy 2019. [PMID: 29531303 DOI: 10.1057/s41271-017-0115-7] [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: 01/01/2023]
Abstract
We present a case study of the effects of health policies on the implementation and potential outcomes of a public health intervention, using the DRIVE project, that aims to 'end' the HIV epidemic among people who inject drugs in Haiphong, Vietnam. DRIVE's success depends on two policy transitions: (1) integration of donor-funded HIV outpatient clinics into public health clinics and expansion of social health insurance; (2) implementation of a "Renovation Plan" for substance use treatment. Interviews and focus group discussions with key informants and review of policy documents and clinic data reveal that both policy transitions are underway but face challenges. DRIVE promises to show how evolving policy affects health interventions and how advocacy based on project data can improve policy. Broad lessons include the importance of clear and consistent policies, vigorous enforcement, and adequate funding of promulgated policies.
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11
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Salazar M, Brouwer KC, Rocha-Jimenez T, Boyce S, Staines-Orozco H, Silverman JG. Substance Use among Female Sex Workers in Two US-Mexico Border Cities: Associations with Age of Entry. Subst Use Misuse 2018; 54:868-871. [PMID: 30595074 PMCID: PMC6474790 DOI: 10.1080/10826084.2018.1517367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18. METHODS Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients. RESULTS Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17. CONCLUSIONS Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.
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Affiliation(s)
- Marissa Salazar
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
- Center for Innovative Public Health Research, 555 N. El Camino Real #A347 San Clemente, CA, USA
| | - Kimberly C. Brouwer
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Teresita Rocha-Jimenez
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
| | - Sabrina Boyce
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
| | - Hugo Staines-Orozco
- Universidad Autónoma de Ciudad Juárez, School of Medicine, Av. Plutarco Elías Calles 1210,Fovissste Chamizal, Ciudad Juárez, Chihuahua, México
| | - Jay G. Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
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12
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Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med 2018; 15:e1002680. [PMID: 30532209 PMCID: PMC6289426 DOI: 10.1371/journal.pmed.1002680] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur. METHODS AND FINDINGS We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. CONCLUSIONS Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.
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Abstract
One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC's HIV/AIDS Prevention Research Synthesis Project's database for relevant interventions during 1988-2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.
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14
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Nowotny KM, Cepeda A, Perdue T, Negi N, Valdez A. Risk Environments and Substance Use Among Mexican Female Sex Work on the U.S.-Mexico Border. JOURNAL OF DRUG ISSUES 2017; 47:528-542. [PMID: 38529041 PMCID: PMC10963065 DOI: 10.1177/0022042616678609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
We use a risk environment framework to qualitatively examine pathways into substance use and abuse among Mexican female sex workers on the U.S.-Mexico border. Life history interviews and ethnographic observations were conducted with female sex workers to uncover how the border context shapes patterns of substance use. The findings illustrate that, for many women, initiation into sex work is contextualized within immigration, the global economy, and demands and desire for financial autonomy. Paradoxically, many find autonomy within sex work as they increase their ability to support their families and themselves. As women become more entrenched in sex work, however, they are put on a path toward substance abuse beginning with alcohol then cocaine and heroin. This identification of specific substance use pathways and trajectories has important implications for the development of prevention and intervention programs that can help curtail problematic drug use that can lead to negative health consequences.
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Affiliation(s)
| | - Alice Cepeda
- University of Southern California, Los Angeles, CA, USA
| | - Tasha Perdue
- University of Southern California, Los Angeles, CA, USA
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15
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Rocha-Jimenez T, Brouwer KC, Salazar M, Boyce SC, Servin AE, Goldenberg SM, Staines-Orozco H, Vera-Monroy RB, Silverman JG. "He invited me and didn't ask anything in return" Migration and Mobility as Vulnerabilities for Sexual Exploitation among Female Adolescents in Mexico. INTERNATIONAL MIGRATION 2017; 56:5-17. [PMID: 33293733 DOI: 10.1111/imig.12333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although human trafficking is recognized as a major human rights violation, there is limited evidence regarding the vulnerabilities that contribute to female adolescents' risk of being forced or coerced into the sex trade. Vulnerabilities such as gender-based violence, economic and social inequalities have been shown to shape the risk of sexual exploitation among adolescents. In-depth interviews (n=18) with current sex workers who reported being deceived or forced into the sex trade as adolescents (<17 years old) were analysed to explore their experiences of migration and mobility in Mexico. Driven by socio-economic and vulnerabilities in home communities, adolescents often engaged in internal migration and mobility to other Mexican communities and states. Migration and mobility further predisposed them to social isolation, economic hardship and abuse, which were used as tools to trick them into the sex trade. Policies that support safer migration for adolescents in origin, transit, and destination communities are needed.
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Affiliation(s)
- Teresita Rocha-Jimenez
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | | | - Marissa Salazar
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | - Sabrina C Boyce
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | - Argentina E Servin
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | | | | | - Ricardo B Vera-Monroy
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
| | - Jay G Silverman
- University of California, San Diego.,Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego
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16
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O'Reilly KR, d'Aquila E, Fonner V, Kennedy C, Sweat M. Can Policy Interventions Affect HIV-Related Behaviors? A Systematic Review of the Evidence from Low- and Middle-Income Countries. AIDS Behav 2017; 21:626-642. [PMID: 27864626 PMCID: PMC5303549 DOI: 10.1007/s10461-016-1615-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In their response to HIV, many countries have adopted and enacted policies to reduce transmission and increase HIV-related service use. Theoretically, policy-level interventions for HIV prevention have the potential to improve health behavior outcomes. These policy interventions vary in their scale, from relatively minor changes in clinical policy to major national legal initiatives. Assessing the effectiveness of HIV policy interventions is a challenging undertaking. While many policies exist and guide HIV programmes, relatively few have specifically been evaluated for their effects on reducing HIV risk taking or increasing HIV health-seeking behaviors. Thus, questions on the effectiveness of policy interventions to prevent HIV and change HIV-related risk behaviors remain largely unanswered. To address this current gap in the literature, we systematically reviewed the existing evidence on the effect of HIV policy interventions on changing HIV-related behaviors in low-and middle-income countries.
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Affiliation(s)
- Kevin R O'Reilly
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- , Rue de Grand Pre 26B, 1299, Crans-pres-Celigny, Switzerland.
| | - Erica d'Aquila
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Sweat
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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17
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Goldenberg SM, Brouwer KC, Jimenez TR, Miranda SM, Mindt MR. Enhancing the Ethical Conduct of HIV Research with Migrant Sex Workers: Human Rights, Policy, and Social Contextual Influences. PLoS One 2016; 11:e0155048. [PMID: 27159157 PMCID: PMC4861265 DOI: 10.1371/journal.pone.0155048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Migrant sex workers are often highly marginalized and disproportionately experience health and social inequities, including high prevalence of HIV, sexually transmitted infections, and human rights violations. In recent years, research involving migrant sex workers has increased, yet many knowledge gaps remain regarding how best to protect research participant rights and welfare. Our objective was to identify key challenges and opportunities related to the responsible conduct of HIV research with migrant sex workers. METHODS Focus groups and interviews conducted with 33 female sex workers ≥18 years old at the Guatemala-Mexico border from June 2013-February 2014 were analyzed. Participants were recruited through community outreach by a local HIV prevention organization to sex work establishments such as bars, hotels, street corners, and truck stops. RESULTS Key themes influencing research engagement for migrant sex workers included researcher mistrust and fear related to research participation, rooted in the social isolation frequently faced by recent migrants; intersecting concerns related to immigration status, fear of criminalization, and compliance with sex work regulations; and perceived benefits and risks of HIV/STI testing for migrants (e.g., immigration implications, stigma) represent potential barriers and opportunities for the responsible conduct of research involving migrant sex workers. CONCLUSIONS Results highlight the intersection between the human rights vulnerabilities of migrant sex workers and barriers to research participation, including social isolation of migrants and policy/legal barriers related to immigration and sex work. Findings illustrate the need for researchers to develop population-tailored procedures to address fears related to immigration and criminalization, and to reinforce positive and non-stigmatizing relationships with migrant sex workers. Community-led efforts to reduce stigma and foster community organization and supports for migrant sex workers are recommended, as are broader policy shifts that move away from punitive legal approaches towards approaches that safeguard and prioritize the human rights of migrant sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, 608–1081 Burrard Street (St. Paul's Hospital), Vancouver, BC, V6Z 1Y6, Canada
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | - Teresita Rocha Jimenez
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | | | - Monica Rivera Mindt
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
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18
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Kohler PK, Campos PE, Garcia PJ, Carcamo CP, Buendia C, Hughes JP, Mejia C, Garnett GP, Holmes KK. Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru. Int J STD AIDS 2016; 27:402-10. [PMID: 25941053 PMCID: PMC4742423 DOI: 10.1177/0956462415584488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.
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Affiliation(s)
- Pamela K Kohler
- Departments of Global Health, Psychosocial & Community Health, University of Washington, Seattle, WA, USA
| | | | - Patricia J Garcia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Clara Buendia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Carolina Mejia
- Department of Health Services, University of Washington, Seattle, USA
| | - Geoff P Garnett
- HIV/AIDS and TB, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - King K Holmes
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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Zhang X, Martinez-Donate AP, Simon NJE, Hovell MF, Rangel MG, Magis-Rodriguez C, Sipan CL. Risk behaviours for HIV infection among travelling Mexican migrants: The Mexico-US border as a contextual risk factor. Glob Public Health 2016; 12:65-83. [PMID: 26878494 DOI: 10.1080/17441692.2016.1142591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Mexico-US border region is a transit point in the trajectory of Mexican migrants travelling to and from the USA and a final destination for domestic migrants from other regions in Mexico. This region also represents a high-risk environment that may increase risk for HIV among migrants and the communities they connect. We conducted a cross-sectional, population-based survey, in Tijuana, Mexico, and compared Mexican migrants with a recent stay on the Mexico-US border region (Border, n = 553) with migrants arriving at the border from Mexican sending communities (Northbound, n = 1077). After controlling for demographics and migration history, border migrants were more likely to perceive their risk for HIV infection as high in this region and regard this area as a liberal place for sexual behaviours compared to Northbound migrants reporting on their perceptions of the sending communities (p < .05). Male border migrants were more likely to engage in sex, and have unprotected sex, with female sex workers during their recent stay on the border compared to other contexts (rate ratio = 3.0 and 6.6, respectively, p < .05). Binational and intensified interventions targeting Mexican migrants should be deployed in the Mexican border region to address migration related HIV transmission in Mexico and the USA.
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Affiliation(s)
- Xiao Zhang
- a Department of Population Health Sciences , University of Wisconsin-Madison , Madison , USA
| | - Ana P Martinez-Donate
- b Department of Community Health and Prevention , Drexel University , Philadelphia , USA
| | - Norma-Jean E Simon
- a Department of Population Health Sciences , University of Wisconsin-Madison , Madison , USA
| | - Melbourne F Hovell
- c Graduate School of Public Health , San Diego State University , San Diego , USA
| | | | - Carlos Magis-Rodriguez
- e Sexually Transmitted Infections Research Center, HIV/AIDS Program , Mexico City , Mexico
| | - Carol L Sipan
- f Department of Health Sciences , University of California-Merced , Merced , USA
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20
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Pitpitan EV, Kalichman SC. Reducing HIV Risks in the Places Where People Drink: Prevention Interventions in Alcohol Venues. AIDS Behav 2016; 20 Suppl 1:S119-33. [PMID: 26099244 DOI: 10.1007/s10461-015-1116-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Apart from individual alcohol drinking behavior, the context or places where people drink play a significant role in HIV transmission risk. In this paper, we review the research that has been conducted on alcohol venues to identify the social and structural factors (e.g., social norms, sexual behavior) that are associated with HIV risk in these places, to review HIV prevention interventions based in alcohol venues, and to discuss appropriate methodologies for alcohol venue research. Alcohol venues are defined here as places that sell or serve alcohol for onsite consumption, including bars, bottle stores, nightclubs, wine shops, and informal shebeens. Despite the many established HIV risk factors at play in alcohol venues, limited prevention strategies have been implemented in such places. A total of 11 HIV prevention interventions or programs were identified. HIV prevention interventions in alcohol venues may be conducted at the individual, social, or structural level. However, multilevel interventions that target more than one level appear to lead to the most sustainable behavior change. Strategies to incorporate alcohol venues in biomedical prevention strategies including antiretroviral therapy for alcohol users are also discussed.
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21
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Servin AE, Brouwer KC, Gordon L, Rocha-Jimenez T, Staines H, Vera-Monroy RB, Strathdee SA, Silverman JG. Vulnerability Factors and Pathways Leading to Underage Entry into Sex Work in two Mexican-US Border Cities. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2015; 6:3. [PMID: 25932343 PMCID: PMC4412591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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22
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Robertson AM, Syvertsen JL, Ulibarri MD, Rangel MG, Martinez G, Strathdee SA. Prevalence and correlates of HIV and sexually transmitted infections among female sex workers and their non-commercial male partners in two Mexico-USA border cities. J Urban Health 2014; 91:752-67. [PMID: 24488651 PMCID: PMC4134454 DOI: 10.1007/s11524-013-9855-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Female sex workers (FSWs) acquire HIV and other sexually transmitted infections (STIs) through unprotected sex with commercial and non-commercial (intimate) male partners. Little research has focused on FSWs' intimate relationships, within which condom use is rare. We sought to determine the prevalence and correlates of HIV/STIs within FSWs' intimate relationships in Northern Mexico. From 2010 to 2011, we conducted a cross-sectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month). Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals' HIV/STI positivity using bivariate probit regression. Among 212 couples (n = 424), prevalence of HIV was 2.6 % (n = 11). Forty-two (9.9 %) tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %, p < 0.05). FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients. Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs. Higher sexual decision-making power was protective against HIV/STIs for women. Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs. Within FSWs' intimate relationships in two Mexican-US border cities, nearly one in ten partners tested positive for HIV/STIs. Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability.
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Affiliation(s)
- Angela M. Robertson
- />Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- />The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215 USA
| | - Jennifer L. Syvertsen
- />Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210 USA
| | - Monica D. Ulibarri
- />Department of Psychiatry, University of California at San Diego, 9500 Gilman Drive, Mail Code 0603, La Jolla, CA 92093-0603 USA
| | - M. Gudelia Rangel
- />Department of Population Studies, El Colegio de La Frontera Norte, Carretera Escénica Tijuana-Ensenada, Km 18.5, San Antonio del Mar, 22560 Tijuana, Baja California Mexico
| | - Gustavo Martinez
- />Federación Mexicana de Asociaciones Privadas (FEMAP), Ave. Malecón No. 788 Col. Centro C.P., 32000 Ciudad Juárez, Chihuahua Mexico
| | - Steffanie A. Strathdee
- />Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA 92093-0507 USA
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Goodman-Meza D, Pitpitan EV, Semple SJ, Wagner KD, Chavarin CV, Strathdee SA, Patterson TL. Hazardous drinking and HIV-risk-related behavior among male clients of female sex workers in Tijuana, Mexico. Am J Addict 2014; 23:502-9. [PMID: 25066863 DOI: 10.1111/j.1521-0391.2014.12138.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/14/2014] [Accepted: 04/12/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Male clients of female sex workers (FSWs) are at high risk for HIV. Whereas the HIV risks of alcohol use are well understood, less is known about hazardous alcohol use among male clients of FSWs, particularly in Mexico. We sought to identify risk factors for hazardous alcohol use and test associations between hazardous alcohol use and HIV risk behavior among male clients in Tijuana. METHOD Male clients of FSWs in Tijuana (n = 400) completed a quantitative interview in 2008. The AUDIT was used to characterize hazardous alcohol use. Multivariate logistic regression was used to determine independent associations of demographic and HIV risk variables with hazardous alcohol use (vs. non-hazardous). RESULTS Forty percent of our sample met criteria for hazardous alcohol use. Variables independently associated with hazardous drinking were reporting any sexually transmitted infection (STI), having sex with a FSW while under the influence of alcohol, being younger than 36 years of age, living in Tijuana, and ever having been jailed. Hazardous drinkers were less likely ever to have been deported or to have shared injection drugs. DISCUSSION AND CONCLUSIONS Hazardous alcohol use is associated with HIV risk, including engaging in sex with FSWs while intoxicated and having an STI among male clients of FSWs in Tijuana. SCIENTIFIC SIGNIFICANCE We systematically described patterns and correlates of hazardous alcohol use among male clients of FSWs in Tijuana, Mexico. The results suggest that HIV/STI risk reduction interventions must target hazardous alcohol users, and be tailored to address alcohol use.
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Affiliation(s)
- David Goodman-Meza
- Division of Global Public Health, Department of Medicine, University of California at San Diego, La Jolla, California
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Gaines TL, Rudolph AE, Brouwer KC, Strathdee SA, Lozada R, Martinez G, Goldenberg SM, Rusch MLA. The longitudinal association of venue stability with consistent condom use among female sex workers in two Mexico-USA border cities. Int J STD AIDS 2013; 24:523-9. [PMID: 23970766 DOI: 10.1177/0956462412473890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the relationship between venue stability and consistent condom use (CCU) among female sex workers who inject drugs (FSW-IDUs; n = 584) and were enrolled in a behavioural intervention in two Mexico-USA border cities. Using a generalized estimating equation approach stratified by client type and city, we found venue stability affected CCU. In Tijuana, operating primarily indoors was significantly associated with a four-fold increase in the odds of CCU among regular clients (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.44, 9.89), and a seven-fold increase among casual clients (OR: 7.18, 95% CI: 2.32, 22.21), relative to FSW-IDUs spending equal time between indoor and outdoor sex work venues. In Ciudad Juarez, the trajectory of CCU increased over time and was highest among those operating primarily indoors. Results from this analysis highlight the importance of considering local mobility, including venue type and venue stability, as these characteristics jointly influence HIV risk behaviours.
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Affiliation(s)
- T L Gaines
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA.
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25
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Robertson AM, Syvertsen JL, Amaro H, Martinez G, Rangel MG, Patterson TL, Strathdee SA. Can't buy my love: a typology of female sex workers' commercial relationships in the Mexico-U.S. Border Region. JOURNAL OF SEX RESEARCH 2013; 51:711-20. [PMID: 23659340 PMCID: PMC3890374 DOI: 10.1080/00224499.2012.757283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who "fell in love" with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.
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Affiliation(s)
- Angela M Robertson
- a Division of Global Public Health, School of Medicine , University of California , San Diego
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Gaines TL, Rusch MLA, Brouwer KC, Goldenberg SM, Lozada R, Robertson AM, Perkins E, Strathdee SA, Patterson TL. Venue-level correlates of female sex worker registration status: a multilevel analysis of bars in Tijuana, Mexico. Glob Public Health 2013; 8:405-16. [PMID: 23534477 DOI: 10.1080/17441692.2013.779386] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards issued to female sex workers (FSWs) for an annual fee. Registration has been associated with decreased drug use and increase condom use and HIV testing. Previously, it was demonstrated that FSWs operating in bars were more likely than street-based FSWs to be registered. This implies that certain venues may be more accessible to local authorities for the enforcement of this type of programme. Taking a novel multilevel approach, we examined whether venue characteristics of bars reflecting greater organised management and visibility affect registration status of FSWs. In an analysis of venue-level characteristics, predictors of being registered were availability of free condoms at work and distance to the main sex strip; however, these were not independently associated after inclusion of FSWs' income, illicit drug use and history of HIV testing. Our findings suggest that sex work regulations may inadvertently exclude venues in which the more vulnerable and less visible FSWs, such as injection drug users and those with limited financial resources, are situated. Efforts to revise or reconsider sex work regulations to ensure that they best promote FSWs' health, human and labour rights are recommended.
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Affiliation(s)
- Tommi L Gaines
- Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
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Syvertsen JL, Robertson AM, Rolón ML, Palinkas LA, Martinez G, Rangel MG, Strathdee SA. "Eyes that don't see, heart that doesn't feel": coping with sex work in intimate relationships and its implications for HIV/STI prevention. Soc Sci Med 2013; 87:1-8. [PMID: 23631772 DOI: 10.1016/j.socscimed.2013.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 11/15/2022]
Abstract
Partner communication about HIV sexual risk behaviors represents a key area of epidemiologic and social importance in terms of infection acquisition and potential for tailored interventions. Nevertheless, disclosing sexual risk behaviors often presents myriad challenges for marginalized couples who engage in stigmatized behaviors. Using qualitative data from a social epidemiology study of risk for HIV and other sexually transmitted infections (STIs) among female sex workers and their intimate, non-commercial male partners along the Mexico-U.S. border, we examined both partners' perspectives on sex work and the ways in which couples discussed associated HIV/STI risks in their relationship. Our thematic analysis of individual and joint interviews conducted in 2010 and 2011 with 44 couples suggested that broader contexts of social and economic inequalities profoundly shaped partner perspectives of sex work. Although couples accepted sex work as an economic contribution to the relationship in light of limited alternatives and drug addiction, it exacted an emotional toll on both partners. Couples employed multiple strategies to cope with sex work, including psychologically disconnecting from their situation, telling "little lies," avoiding the topic, and to a lesser extent, superficially discussing their risks. While such strategies served to protect both partners' emotional health by upholding illusions of fidelity and avoiding potential conflict, non-disclosure of risk behaviors may exacerbate the potential for HIV/STI acquisition. Our work has direct implications for designing multi-level, couple-based health interventions.
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Affiliation(s)
- Jennifer L Syvertsen
- Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA.
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Syvertsen JL, Robertson AM, Palinkas LA, Rangel MG, Martinez G, Strathdee SA. 'Where sex ends and emotions begin': love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border. CULTURE, HEALTH & SEXUALITY 2013; 15:540-54. [PMID: 23473586 PMCID: PMC3674135 DOI: 10.1080/13691058.2013.773381] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study explores the affective dimensions of female sex workers' relationships with their intimate, non-commercial partners and assesses how emotions shape each partner's sexual and drug-related risk within their relationship. We draw on qualitative data from a study of HIV, sexually transmitted infections and high-risk behaviours among female sex workers and their non-commercial partners in Tijuana and Ciudad Juárez, Mexico, to illustrate that these couples share relationships based on love, trust, respect and emotional and material support. These relationships range in emotional intensity, which shapes partners' decisions not to use condoms with each other. Drugs were important in most couples' relationships. Among injectors, syringe sharing was common and represented both a sign of care and a pragmatic reaction to conditions of material scarcity. Our findings suggest that couple-based HIV interventions to address dual sexual and drug-related risks should be tailored to the emotional dynamics of sex workers' intimate relationships.
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Affiliation(s)
- Jennifer L. Syvertsen
- Division of Global Public Health, School of Medicine, University of California at San Diego, USA
| | - Angela M. Robertson
- Division of Global Public Health, School of Medicine, University of California at San Diego, USA
| | | | - M. Gudelia Rangel
- El Colegio de La Frontera Norte, Carretera Escénica Tijuana-Ensenada
| | - Gustavo Martinez
- Salud y Desarrollo Comunitario de Ciudad Juárez A.C. (SADEC) and Federación Mexicana de Asociaciones Privadas (FEMAP), Ave. Malecón Chihuahua, México
| | - Steffanie A. Strathdee
- Division of Global Public Health, School of Medicine, University of California at San Diego, USA
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Strathdee SA, Magis-Rodriguez C, Mays VM, Jimenez R, Patterson TL. The emerging HIV epidemic on the Mexico-U.S. border: an international case study characterizing the role of epidemiology in surveillance and response. Ann Epidemiol 2012; 22:426-38. [PMID: 22626001 DOI: 10.1016/j.annepidem.2012.04.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 04/09/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome surveillance data are critical for monitoring epidemic trends, but they can mask dynamic subepidemics, especially in vulnerable populations that underuse HIV testing. In this case study, we describe community-based epidemiologic data among injection drug users (IDUs) and female sex workers (FSWs) in two northern Mexico-U.S. border states that identified an emerging HIV epidemic and generated a policy response. METHODS We draw from quantitative and qualitative cross-sectional and prospective epidemiologic studies and behavioral intervention studies among IDUs and FSWs in Tijuana, Baja California, and Ciudad Juarez, Chihuahua. RESULTS The recognition that the HIV epidemic on Mexico's northern border was already well established in subgroups in whom it had been presumed to be insignificant was met with calls for action and enhanced prevention efforts from researchers, nongovernmental organizations, and policy makers. CONCLUSIONS Successful policies and program outcomes included expansion of needle-exchange programs, a nationwide mobile HIV prevention program targeting marginalized populations, a successful funding bid from the Global Fund for HIV, TB, and Malaria to scale up targeted HIV-prevention programs, and the establishment of bi-national training programs on prevention of HIV and substance use. We discuss how epidemiologic data informed HIV prevention policies and suggest how other countries may learn from Mexico's experience.
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Affiliation(s)
- Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
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Age Differences among Female Sex Workers in the Philippines: Sexual Risk Negotiations and Perceived Manager Advice. AIDS Res Treat 2012; 2012:812635. [PMID: 22848800 PMCID: PMC3405561 DOI: 10.1155/2012/812635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/19/2012] [Accepted: 05/19/2012] [Indexed: 12/02/2022] Open
Abstract
Consistent condom use among high risk groups such as female sex workers (FSWs) remains low. Adolescent female sex workers are especially at higher risk for HIV/STI infections. However, few published studies have compared the sexual risk negotiations among adolescent, emerging adult, and older age groups or the extent a manager's advice about condom use is associated with an FSW's age. Of 1,388 female bar/spa workers surveyed in the southern Philippines, 791 FSW who traded sex in the past 6 months were included in multivariable logistic regression models. The oldest FSWs (aged 36–48) compared to adolescent FSWs (aged 14–17) were 3.3 times more likely to negotiate condoms when clients refused condom use. However, adolescent FSWs received more advice from their managers to convince clients to use condoms or else to refuse sex, compared to older FSWs. Both adolescent and the oldest FSWs had elevated sexually transmitted infections (STIs) and inconsistent condom use compared to other groups. Having a condom rule at the establishment was positively associated with condom negotiation. Factors such as age, the advice managers give to their workers, and the influence of a condom use rule at the establishment need to be considered when delivering HIV/STI prevention interventions.
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Circular migration by Mexican female sex workers who are injection drug users: implications for HIV in Mexican sending communities. J Immigr Minor Health 2012; 14:107-15. [PMID: 21833727 DOI: 10.1007/s10903-011-9512-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Circular migration and injection drug use increase the risk of HIV transmission in sending communities. We describe female sex workers who are injection drug users' (FSW-IDUs) circular migration and drug use behaviors. Between 2008-2010, 258 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. 24% of FSW-IDUs were circular migrants. HIV prevalence was 3.2% in circular migrants and 6.1% in non-circular migrants; 50% of circular and 75% of non-circular migrants were unaware of their HIV infection. Among circular migrants, 44% (n = 27) consumed illicit drugs in their birthplace; 74% of these (n = 20) injected drugs and one-half of injectors shared injection equipment in their birthplace. Women reporting active social relationships were significantly more likely to return home. Circular migrant FSW-IDUs exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing and treatment and access to substance use services is critical for FSW-IDUs and their sexual/drug-using contacts.
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Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, Sherman SG, Kerrigan D. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2012; 12:538-49. [PMID: 22424777 DOI: 10.1016/s1473-3099(12)70066-x] [Citation(s) in RCA: 861] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age. METHODS We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age. FINDINGS Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99,878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6-12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0-18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2-31·3; 8627 of 28,075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1-14·8). INTERPRETATION Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed. FUNDING The World Bank, UN Population Fund.
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Affiliation(s)
- Stefan Baral
- Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
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