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Hendrickson ZM, Tomko C, Galai N, Sisson LN, Glick JL, Sherman SG. A Longitudinal Analysis of Residential Mobility and Experience of Client Violence Among Women Who Exchange Sex in Baltimore. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11017-11045. [PMID: 37395208 DOI: 10.1177/08862605231178492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Residential mobility remains an underexplored yet critical construct that may influence the risk of violence among women who exchange sex. This study examined the longitudinal relationship between residential mobility and experience of client-perpetrated physical or sexual violence among women who exchange sex in Baltimore, Maryland. Participants were at least at 18 years of age, were cisgender women, reported having engaged in transactional sex three or more times within the last 3 months, and were willing to be contacted for 6-, 12-, and 18-month follow-up visits. Analyses of responses from 370 women who exchange sex participating in at least one study visit were conducted. Unadjusted and adjusted Poisson regression models of the association over time between residential mobility and recent experience of physical or sexual violence were fit. Generalized estimating equations with an exchangeable correlation structure and robust variance estimation were used to account for clustering of participants' responses over time. Findings demonstrated that those who had lived in at least four places in the past 6 months had a 39% increased risk of client-perpetrated physical violence (aRR: 1.39; 95% CI: 1.07-1.80; p < .05) and a 63% increased risk of sexual violence (aRR: 1.63; 95% CI: 1.14-2.32; p < .01) compared to their less-mobile counterparts. These findings provide necessary evidence of correlations over time between residential mobility and experience of client-perpetrated violence among women who exchange sex. Strengthening our understanding of how residential mobility intersects with violence is critical for the development of public health interventions that are relevant to women's lives and needs. Future interventions should explore including residential mobility, a critical pillar of housing instability, with efforts to address client-perpetrated violence.
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Affiliation(s)
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Haifa, Mt Carmel, Haifa, Israel
| | | | - Jennifer L Glick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rock A, McNaughton Reyes HL, Go V, Maman S, Perez M, Donastorg Y, Kerrigan D, Barrington C. Relationships Between Stigma and Intimate Partner Violence Among Female Sex Workers Living With HIV: Social and Economic Exclusion. Violence Against Women 2023; 29:1971-1997. [PMID: 36344251 PMCID: PMC10387732 DOI: 10.1177/10778012221127722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Violence against female sex workers (FSWs) perpetrated by their intimate (i.e., non-commercial) partners, particularly against FSWs living with HIV, is understudied. Stigma can deplete the economic resources, social relationships, and mental well-being of stigmatized people, which may increase their intimate partner violence (IPV) risk. We quantitatively assessed relationships between HIV stigma and sex work stigma and IPV victimization among FSWs living with HIV in the Dominican Republic (n = 266). Enacted HIV stigma, in the form of job loss, and anticipated HIV stigma, in the form of fear of exclusion by family, were associated with increased IPV risk. Potential association mechanisms, including increased economic vulnerability and social isolation, and programmatic responses are discussed.
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Affiliation(s)
- Amelia Rock
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | | | - Vivian Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Suzanne Maman
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Deanna Kerrigan
- Department of Prevention and Community Health, GWU Milken Institute School of Public Health, USA
| | - Clare Barrington
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
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Dickson MF, Tillson M, Calvert JM, Staton M. Transactional sex among rural, justice-involved Appalachian women who use drugs. J Rural Health 2023; 39:789-794. [PMID: 36648452 PMCID: PMC10350464 DOI: 10.1111/jrh.12741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Transactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high-risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice-involved Appalachian women who use drugs. METHODS Participants (N = 400) were randomly selected, screened, and interviewed face-to-face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex. FINDINGS On average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration. CONCLUSIONS Results suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice-involved and may signal other HIV-related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk-reduction interventions, including jail-based interventions, to educate vulnerable, hard-to-reach populations on the risks associated with HIV.
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Affiliation(s)
- Megan F. Dickson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Joseph M. Calvert
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
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Goldenberg SM, Buglioni N, Krüsi A, Frost E, Moreheart S, Braschel M, Shannon K. Housing Instability and Evictions Linked to Elevated Intimate Partner and Workplace Violence Among Women Sex Workers in Vancouver, Canada: Findings of a Prospective, Community-Based Cohort, 2010-2019. Am J Public Health 2023; 113:442-452. [PMID: 36888950 PMCID: PMC10003487 DOI: 10.2105/ajph.2022.307207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings. Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions with intimate partner violence (IPV) and workplace violence among a community-based longitudinal cohort of cisgender and transgender women sex workers in Vancouver, Canada, from 2010 through 2019. Results. Of 946 women, 85.9% experienced unstable housing, 11.1% eviction, 26.2% IPV, and 31.8% workplace violence. In multivariable generalized estimating equation models, recent exposure to unstable housing (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI] = 1.45, 2.87) and evictions (AOR = 2.45; 95% CI = 0.99, 6.07) were associated with IPV, and exposure to unstable housing was associated with workplace violence (AOR = 1.46; 95% CI = 1.06, 2.00). Conclusions. Women sex workers face a high burden of unstable housing and evictions, which are linked to increased odds of intimate partner and workplace violence. Increased access to safe, women-centered, and nondiscriminatory housing is urgently needed. (Am J Public Health. 2023;113(4):442-452. https://doi.org/10.2105/AJPH.2022.307207).
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Affiliation(s)
- Shira M Goldenberg
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Natalie Buglioni
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Andrea Krüsi
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Elizabeth Frost
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Sarah Moreheart
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Melissa Braschel
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Kate Shannon
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
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Palimaru AI, McDonald K, Garvey R, D’Amico E, Tucker J. The association between housing stability and perceived quality of life among emerging adults with a history of homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2023; 2023:2402610. [PMID: 37711365 PMCID: PMC10501741 DOI: 10.1155/2023/2402610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Many cities across the United States are experiencing homelessness at crisis levels, including rises in the numbers of unhoused emerging adults (18-25). Emerging adults experiencing homelessness may be at higher risk of experiencing negative outcomes, given that being unhoused increases risk for a variety of behaviors. To better understand the current living circumstances of emerging adults with a history of homelessness, as well as their perceptions about associations between housing stability and quality of life (QOL), we conducted 30 semi-structured in-depth interviews with individuals recruited from drop-in centers for youth experiencing homelessness. At the time of recruitment n=19 were stably housed and n=11 were unstably housed. Two coders analyzed these data inductively and deductively, using pre-identified domains and open coding. Coding reliability was assessed. Three main themes emerged, each with subthemes: 1) Housing quality (neighborhood safety, convenience, housing unit characteristics); 2) QOL before stable housing (physical and mental wellbeing, social wellbeing, and other determinants of QOL, such as encounters with law enforcement); and 3) Changes in QOL after stable housing (same subthemes as for pre-housing stability QOL). Findings indicated a pattern of perceived relationships between housing stability, housing quality, built and social environments, and QOL in the context of emerging adults who experienced or continued to experience homelessness. However, results were mixed with regards to the perceived effects of housing stability on alcohol and other drug use. Taken together, results indicate several areas of challenge, but also highlight opportunities to facilitate improvements in QOL among vulnerable emerging adults who experience homelessness.
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Affiliation(s)
| | | | - Rick Garvey
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407, US
| | | | - Joan Tucker
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407, US
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Farero A, Sullivan CM, López-Zerón G, Bowles RP, Sprecher M, Chiaramonte D, Engleton J. Development and validation of the housing instability scale. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2022; 33:142-151. [PMID: 38854663 PMCID: PMC11160560 DOI: 10.1080/10530789.2022.2127852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/19/2022] [Indexed: 06/11/2024]
Abstract
Despite increasing attention to the importance of examining factors that impact housing instability and homelessness, the field lacks a validated scale of housing instability. The current study examined the reliability and validity of a seven-item scale that measures housing instability. Data were taken from a larger study which implemented the Domestic Violence Housing First model across five domestic violence agencies in the Pacific Northwest. A total of 406 participants were interviewed every six months over a period of two years. A Spanish version of the scale was administered to Spanish-speaking participants. Results provide an overview of the psychometric functioning of the scale and support its utility in assessing housing instability and homelessness. Specifically, the scale demonstrated concurrent and predictive validity, and showed evidence of scalar equivalence over time and across both language and locality. The current scale is therefore a succinct and psychometrically sound measure of housing instability which can be used moving forward to track housing instability in English and Spanish speakers, as well as in urban and rural settings.
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Affiliation(s)
- Adam Farero
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Cris M. Sullivan
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | - Ryan P. Bowles
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Department of Human Development and Family Studies, University of Michigan, Ann Arbor, MI, USA
| | - Mackenzie Sprecher
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Danielle Chiaramonte
- Yale School of Public Health, Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
| | - Jasmine Engleton
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Murray LR, Ferraz D, Zucchi EM, da Silva Sorrentino I, Grangeiro A. Autonomy and Care in Context: The Paradox of Sex Workers' Acceptability of HIV Self-Tests in São Paulo, Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2699-2710. [PMID: 34820782 PMCID: PMC8612389 DOI: 10.1007/s10508-021-02129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 06/13/2023]
Abstract
Cisgender female sex workers (CFSW) continue to face structural barriers to HIV prevention. We analyzed the acceptability of the oral HIV self-test (HIV-ST) among CFSW as part of a pragmatic trial on HIV prevention in Brazil. Data from in-depth interviews conducted with 12 women from diverse sex worker contexts and participant observation were analyzed using thematic analysis. CFSW valued autonomy in their workplaces and saw the HIV-ST as a possibility for self-care. Some feared clients' reactions, manager reprimands, and a positive result. HIV and sex work stigma largely drove self-care practices and perceived acceptability of the self-test. We argue that the autonomy offered by the self-test presents a paradox: increasing autonomy on the one hand while risking sidestepping structural dimensions of HIV vulnerability on the other. These nuances must be considered in interventions promoting the HIV-ST by considering the specificities of sex worker contexts, addressing stigma, and effectively involving CFSW and their organizations in intervention development.
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Affiliation(s)
- Laura Rebecca Murray
- Núcleo de Estudos de Políticas Públicas em Direitos Humanos, Universidade Federal do Rio de Janeiro, Anexo do CFCH, 3º Andar, Av. Pasteur 250 Urca, Rio de Janeiro, RJ, 22290-140, Brazil.
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília, Fundação Oswaldo Cruz, Brasília, DF, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia, Desenvolvimento e Políticas Públicas, Universidade Católica de Santos, Santos, SP, Brazil
| | - Isa da Silva Sorrentino
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Silberg C, Likindikoki S, Mbwambo J, Mmari K, Saleem HT. Housing instability and violence among women who use drugs in Dar es Salaam, Tanzania. Harm Reduct J 2022; 19:68. [PMID: 35761376 PMCID: PMC9237973 DOI: 10.1186/s12954-022-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Women who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam. METHODS This analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics. RESULTS Approximately 35% of participants were classified as housing unstable. More than half of participants (62%) reported experiencing physical violence in the past 12 months, and more than a third (36%) reported sexual violence in the same time period. Housing instability was found to be independently associated with both physical and sexual violence victimization in the past year when adjusting for covariates (Model 1 adjusted odds ratio [AOR]: 2.40, 95% CI 1.22-4.46; Model 2 AOR: 1.93. 95% CI 1.02-3.67). CONCLUSION To our knowledge, this is the first study to document a significant association between housing instability and violence among WWUD communities in sub-Saharan Africa. This analysis adds to the growing body of literature on the relationship between stable housing and livelihood and health outcomes across differing populations. The cyclical nature of housing instability and violence may be disrupted through housing programming that provides safety, security, and stability for WWUD.
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Affiliation(s)
- Claire Silberg
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Samuel Likindikoki
- grid.25867.3e0000 0001 1481 7466Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Kristin Mmari
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Haneefa T. Saleem
- grid.21107.350000 0001 2171 9311Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5033, Baltimore, MD 21205 USA
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Hosseini-Hooshyar S, Mirzazadeh A, Karamouzian M, Sharifi H, Khajehkazemi R, Haghdoost AA, Shokoohi M. Prevalence and Correlates of Sexual Violence Experienced by Female Sex Workers in Iran: Results from a National HIV Bio-Behavioral Surveillance Survey. Violence Against Women 2022; 28:872-889. [PMID: 34057851 PMCID: PMC8785289 DOI: 10.1177/10778012211008992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sexual violence increases the risk of adverse health outcomes among female sex workers (FSWs). Using data from the 2015 national bio-behavioral survey, we explored the experience of sexual violence and its associated factors among Iranian FSWs. Lifetime and recent sexual violence were reported by 40.1% and 16.9%, respectively. History of substance use, ever engaging in anal sex, engaging in group sex within the last year, a high number of clients, recent unstable housing, and incarceration increased the likelihood of experiencing recent sexual violence. These findings underscore the need for community-empowerment and policy-level interventions to address violence among FSWs in Iran.
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Affiliation(s)
- Samira Hosseini-Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Razieh Khajehkazemi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,Social Determinants of Health Research Centre, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Mostafa Shokoohi, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, Canada M5T 3M7.
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Vásquez-Vera C, Fernández A, Borrell C. Gender-based inequalities in the effects of housing on health: A critical review. SSM Popul Health 2022; 17:101068. [PMID: 35360438 PMCID: PMC8961216 DOI: 10.1016/j.ssmph.2022.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Gender and its power relations are produced and reproduced in the housing sphere, leading to inequalities in living conditions and, therefore, in gender inequalities in health outcomes. The aim of the study is to review the published literature on gender, housing and health, to critically evaluate the incorporation of the gender perspective, and to incorporate this perspective into the conceptual framework of housing and health. Using the critical review method, we conducted a literature review in MEDLINE, Scopus, WOS and Redalyc, without restriction of publication date, including studies published up to October 2020. We analyzed the gender perspective in health research using the Gender Perspective in Health Research Questionnaire and described the results according to main housing dimensions. Of the 20,988 articles identified, we selected 90 for full-text analysis, of which 18 were included in the feminist research category, 27 in gender-sensitive, 31 in sex difference and 14 did not include any gender perspective. Regarding the association between housing and health, most studies analyzed affordability (36%) and physical conditions (32%), and trends in health outcomes by gender varied according to each exposure analyzed, although overall the effects were worse for women and non-binary or trans people. To date, very few studies consider the gender perspective. It is urgent to address gender relations in housing and health studies, and to open an interdisciplinary and intersectoral agenda to address this complex relationship.
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Saleem HT, Zhang L, Silberg C, Latkin C, Likindikoki S. Structural, everyday, and symbolic violence and the heightened vulnerability to HIV of women who use drugs in Tanzania. SSM - QUALITATIVE RESEARCH IN HEALTH 2021; 1. [PMID: 35174337 PMCID: PMC8846603 DOI: 10.1016/j.ssmqr.2021.100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Women who use drugs shoulder a disproportionate burden of the HIV epidemic in Tanzania. The mechanisms through which violence contributes to their excessively high rates of HIV have not been explored. In this paper, we use concepts of everyday, symbolic, and structural violence to critically examine the relationship between violence and heightened HIV vulnerability of women who use drugs in Dar es Salaam, Tanzania. We conducted cross-sectional surveys with 200 women who use drugs and follow-up, in-depth interviews with 30 survey participants who identified as living with HIV between November 2018 and March 2019. We drew from grounded theory methods to analyze qualitative data and complemented qualitative findings with survey results. Structural violence perpetuated constraints on women's economic opportunities and reduced their agency in sexual encounters manifesting in their disproportionately high rates of HIV. Nearly all women in our study engaged in sex work to meet basic needs and to support their drug use. Their involvement in overlapping drug use and sex work scenes exposed them to physical and sexual violence. Despite the pervasiveness of structural and everyday violence, some women reenacted agency by adopting strategies to maintain control and safety, and to exercise harm reduction. A multi-pronged, structural harm reduction strategy is critical to reducing violence experienced by women who use drugs and their ability to protect themselves from HIV.
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Sherman SG, Tomko C, White RH, Nestadt DF, Silberzahn BE, Clouse E, Haney K, Galai N. Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers. Sex Transm Dis 2021; 48:648-653. [PMID: 33633073 PMCID: PMC8360669 DOI: 10.1097/olq.0000000000001400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population. METHODS Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia). RESULTS Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion. CONCLUSIONS More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs.
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Affiliation(s)
- Susan G. Sherman
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catherine Tomko
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca Hamilton White
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Danielle Friedman Nestadt
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Emily Clouse
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine Haney
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Nestadt DF, Park JN, Galai N, Beckham SW, Decker MR, Zemlak J, Sherman SG. Sex workers as mothers: Correlates of engagement in sex work to support children. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 8:251-261. [PMID: 36935888 PMCID: PMC10019358 DOI: 10.1007/s40609-021-00213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Globally, most female sex workers (FSW) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSW who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSW in Baltimore, Maryland, United States (U.S.). METHODS The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell's theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers. RESULTS Our sample included 214 FSW with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p<0.001). 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p=0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR=2.62; 95% CI:1.18-5.82; p=0.018); less housing instability (aOR=0.42; 95% CI:0.20-0.89; p=0.024); initiating sex work at age <23 (aOR=2.59; 95% CI:1.23-5.46; p=0.012); less frequent intoxication during sex with clients (aOR=0.31; 95% CI:0.14-0.67; p=0.003); and reporting mental health as most important health concern (aOR=2.37; 95% CI:1.09-5.17; p=0.029). CONCLUSIONS FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSW as whole social beings and center their experiences and needs as mothers.
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Affiliation(s)
- Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Mount Carmel, Israel
| | - S. W. Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R. Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Zemlak
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Motsoeneng M. Violence and HIV among female street sex workers in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2020.1871219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Molefi Motsoeneng
- Scholarship of Teaching and Learning, Central University of Technology, Free Sate, Bloemfontein, South Africa
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15
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Couture MC, Evans JL, Draughon Moret J, Stein ES, Muth S, Phou M, Len A, Ngak S, Sophal C, Neak Y, Carrico AW, Maher L, Page K. Syndemic Psychosocial Health Conditions Associated with Recent Client-Perpetrated Violence Against Female Entertainment and Sex Workers in Cambodia. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:3055-3064. [PMID: 32342257 PMCID: PMC7935451 DOI: 10.1007/s10508-020-01705-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 05/23/2023]
Abstract
Female entertainment and sex workers (FESW) are vulnerable to violence, which impedes safer sex behaviors and increases risk of HIV. FESW are also disproportionately affected by co-occurring psychosocial health conditions, including substance use, depression, and economic insecurity, which increased risk of exposure to violence. We used a syndemic framework to examine the effects of co-occurring psychosocial conditions on the risk of client-perpetrated physical and sexual violence against FESW. Data were collected among 1198 Cambodian FESW on recent client-perpetrated physical and sexual violence, and psychosocial conditions (psychological distress, alcohol consumption, amphetamine-type stimulant (ATS) use, debts, housing, and food insecurity). Bivariate and multivariate logistic regressions were conducted. Prevalence of physical and sexual violence from clients was 4.8% and 6.9%, respectively. Client-perpetrated physical violence was associated with housing insecurity, ATS use, and psychological distress. All psychosocial conditions, except ATS, were associated with exposure to sexual violence. In multivariable models, odds of client-perpetrated physical violence were twice higher among women with ≥ 4 compared to ≤ 3 psychosocial conditions. Risk of sexual violence increased with the number of psychosocial conditions. Compared to those with ≤ 1 condition, FESW with two psychosocial conditions had twice the odds (AOR = 2.08; 95% CI 1.00-4.31) and women with 5-6 psychosocial conditions had eightfold higher odds (AOR = 8.10; 95% CI 3.4-19.31) of sexual violence from clients. Our findings support a syndemic model of co-occurring psychosocial conditions among FESW that are associated with increased risk of violence. Violence prevention interventions targeting FESW should adopt comprehensive approaches that address co-occurring psychosocial conditions.
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Affiliation(s)
- Marie-Claude Couture
- Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton, San Francisco, CA, 94117, USA.
| | - Jennifer L Evans
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Draughon Moret
- The Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Ellen S Stein
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Chhit Sophal
- Department of Mental Health and Substance Abuse, Ministry of Health, Phnom Penh, Cambodia
| | - Yuthea Neak
- National Authority for Combating Drugs, Phnom Penh, Cambodia
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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16
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Lyons CE, Schwartz SR, Murray SM, Shannon K, Diouf D, Mothopeng T, Kouanda S, Simplice A, Kouame A, Mnisi Z, Tamoufe U, Phaswana-Mafuya N, Cham B, Drame FM, Aliu Djaló M, Baral S. The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nat Commun 2020; 11:773. [PMID: 32071298 PMCID: PMC7028952 DOI: 10.1038/s41467-020-14593-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022] Open
Abstract
Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011-2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.
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Affiliation(s)
- Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Sheree R Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins School of Public Health, Hampton House 624 N. Broadway 8th Floor, Baltimore, MD, 21205, USA
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Daouda Diouf
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, Institut Africain de Santé Publique, 12 BP 199, Ouagadougou, Burkina Faso
| | | | - Abo Kouame
- Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Zandile Mnisi
- Health Research Department, Strategic Information Division, Ministry of Health, Cooper Centre Office 106, Mbabane, Eswatini
| | - Ubald Tamoufe
- Metabiota. Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, 15939, Yaoundé, Cameroon
| | - Nancy Phaswana-Mafuya
- DVC Research and Innovation Office, North-West University, Potchefstroom Campus, Private Bag X6001 Potchefstroom, 2520, Potchefstroom, South Africa
| | - Bai Cham
- Actionaid, Banjul The Gambia, MDI Road, Kanifing South PMB 450, Serrekunda PO Box 725, Banjul, The Gambia
| | - Fatou M Drame
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
- Gaston Berger University, Department of Geography, School of Social Sciences. BP: 234 - Saint-Louis, Nationale 2, route de Ngallèle, St. Louis, Senegal
| | - Mamadú Aliu Djaló
- Enda Santé, Guiné-Bissau. Bairro Santa Luzia, Rua s/n, CP 1041, Bissau, Guinea-Bissau
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Ranjan A, Shannon K, Chettiar J, Braschel M, Ti L, Goldenberg S. Barriers and facilitators to hepatitis B vaccination among sex workers in Vancouver, Canada: Implications for integrated HIV, STI, and viral hepatitis services. Int J Infect Dis 2019; 87:170-176. [PMID: 31404673 DOI: 10.1016/j.ijid.2019.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. METHODS Questionnaire data were drawn from a community-based cohort of SWs (2010-2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination. RESULTS Among 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32-0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27- 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14-3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26-2.97) and recent STI testing (AOR 2.95, 95% CI 1.99-4.39) correlated with recent HBV vaccination. CONCLUSIONS Im/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.
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Affiliation(s)
- Anuisa Ranjan
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Chettiar
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - Lianping Ti
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use (BCCSU), Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Global Public Health, University of California, La Jolla, CA, USA
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18
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Davey C, Dirawo J, Mushati P, Magutshwa S, Hargreaves JR, Cowan FM. Mobility and sex work: why, where, when? A typology of female-sex-worker mobility in Zimbabwe. Soc Sci Med 2018; 220:322-330. [PMID: 30500610 DOI: 10.1016/j.socscimed.2018.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
Abstract
Sex-worker mobility may have implications for health and access to care but has not been described in sub-Saharan Africa. We described sex-worker mobility in Zimbabwe and a mobility typology using data from 2591 and 2839 female sex workers in 14 sites from 2013 and 2016. We used latent class analysis to identify a typology of mobile sex workers. More women travelled for work in 2016 (59%) than in 2013 (27%), usually to find clients with more money (57% of the journeys), spending a median of 21 (2013) and 24 (2016) days away. A five-class mixture model best fitted the data, with 39% women in an infrequent work-mobility class, 21% in a domestic-high-mobility class, 16% in an international-high-mobility class, 16% in an infrequent opportunistic-non-work-mobility class, and 7% who travel with clients. More-mobile classes were better educated; risk behaviours differed by class. Mobility is increasing among sex worker in Zimbabwe, multi-faceted, and not explained by other vulnerabilities.
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Affiliation(s)
- Calum Davey
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK.
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
| | - Sitholubuhle Magutshwa
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Conners EE, Gaines TL, Strathdee SA, Magis-Rodriguez C, Brouwer KC. Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico. Drug Alcohol Rev 2018; 37 Suppl 1:S294-S302. [PMID: 29218799 PMCID: PMC5940512 DOI: 10.1111/dar.12633] [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] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Smoking methamphetamine is associated with increased risk of HIV among female sex workers (FSW). The structural context of substance use is an important shaper of individual behaviour; however, structural determinants of methamphetamine use among FSWs are largely unknown. We identified individual, structural and neighbourhood factors associated with smoking methamphetamine among FSWs in the border city of Tijuana, Baja California, Mexico. DESIGN AND METHODS A prospective cohort of 301 FSWs sampled from indoor and outdoor sex work venues throughout Tijuana participated in quantitative surveys on behaviours and mapping of home and work neighbourhoods across three visits. Multinomial logistic regression using generalised estimating equations identified individual, structural and neighbourhood variables associated with smoking methamphetamine. RESULTS Methamphetamine use, particularly smoking, was highly prevalent among FSWs. Over half (61%) of FSWs had ever used methamphetamine in their lifetime and at baseline, 38% currently smoked methamphetamine. Smoking methamphetamine daily was associated with living in the red light district [adjusted odds ratio (AOR) = 2.72, 95% confidence interval (CI) = 1.23-6.02] and with perceived homelessness, but only among women in a good financial situation (AOR = 4.08, 95% CI = 1.58-10.50). Smoking methamphetamine less than daily was associated with older age (AOR = 1.06, 95% CI = 1.02-1.10). DISCUSSION AND CONCLUSIONS Our findings point to the important dynamic between the residential environment and more severe methamphetamine use. FSWs may prioritise the purchase of methamphetamine over stable housing if they have the financial means. Given the high prevalence of smoking methamphetamine among FSWs in Tijuana, drug treatment options, especially for women living in the red light district, are needed.
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Affiliation(s)
- Erin E. Conners
- Department of Medicine, University of California, San Diego, USA
- San Diego State University, San Diego, USA
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, USA
| | | | - Carlos Magis-Rodriguez
- National Center for the Prevention and Control of HIV and AIDS, Col Anzures, Distrito Federal, Mexico
| | - Kimberly C. Brouwer
- Department of Family Medicine & Public Health, University of California, San Diego, USA
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20
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Shokoohi M, Karamouzian M, Sharifi H, Rahimi-Movaghar A, Carrico AW, Hosseini Hooshyar S, Mirzazadeh A. Crystal methamphetamine use and its correlates in women engaged in sex work in a developing country setting. Drug Alcohol Depend 2018; 185:260-265. [PMID: 29477085 DOI: 10.1016/j.drugalcdep.2017.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/22/2017] [Accepted: 12/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Worldwide, crystal methamphetamine (CM) use and associated high-risk sexual behaviors are a concern, but they are less studied among female sex workers (FSW) in developing countries. This study aimed to characterize the prevalence and individual, interpersonal, and structural correlates of self-reported past-month CM use among FSW in Iran. METHODS FSW aged ≥ 18 years who reported penetrative sex with more than one client in the last year were recruited (analytic sample: 1295). Data were collected in one-on-one interviews using a standardized behavioral questionnaire. Poisson regression model was used to assess the correlated of past-month self-reported CM use by crude and adjusted prevalence ratio (APR) and 95% confidence intervals (CI). RESULTS Non-injecting and injecting CM use was reported by 15.0% (95% CI: 8.7, 24.7) and 0.9% (95% CI: 0.4, 2.1) of participants. CM use was positively associated with concurrent use of opioids (APR from 2.08 to 3.84, P-value < 0.01), higher number of sexual partners (APR: 2.05, P-value: 0.018), housing instability (APR: 3.54, P-value: 0.001), and history of forced sex (APR: 1.47, P-value: 0.050). CONCLUSIONS A considerable number of FSWs use CM along with opioids, have a higher number of sexual partners, forced sex, and housing instability. Both prevention strategies as well as strategies to reduce harm associated with CM need to be added to current programs that predominantly focus on opioid dependency and male drug injectors.
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Affiliation(s)
- Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1151 Richmond St., London, ON, Canada.
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada.
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th St., Miami, FL, USA.
| | - Samira Hosseini Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California San Francisco, 550 16th St., San Francisco, CA, USA.
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21
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Duff P, Birungi J, Dobrer S, Akello M, Muzaaya G, Shannon K. Social and structural factors increase inconsistent condom use by sex workers' one-time and regular clients in Northern Uganda. AIDS Care 2017; 30:751-759. [PMID: 29067831 DOI: 10.1080/09540121.2017.1394966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While sex workers (SWs) bear the brunt of the epidemic in Uganda, there remains a dearth of empirical research on the structural drivers of HIV prevention among SWs. This study examined the drivers of inconsistent condom use by one-time and regular clients of young women SWs in Gulu, Northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young SWs, aged 14 years and older (2011-2012). SWs were recruited using peer/SW-led outreach, in partnership with The AIDS Support Organization and other CBOs. Multivariable logistic regression was used to examine the correlates of inconsistent condom use by one-time and regular clients. In total, 84.5% of the 381 SWs servicing regular clients and 76.8% of the 393 SWs servicing one-time clients reported inconsistent client condom use. In multivariable analysis, physical/sexual violence by clients (AOR = 5.39; 95%CI 3.05-9.49), low sexual control by workers (measured by the validated Pulweritz scale) (AOR = 2.86; 95%CI 1.47-5.58), alcohol/drug use while working (AOR = 1.98; 95%CI 1.17-3.35) and migration to Gulu for sex work (AOR = 1.73; 95%CI 0.95-3.14) were positively correlated with inconsistent condom use by one-time clients. Correlates of inconsistent condom use by regular clients included: low sexual control by workers (AOR = 4.63; 95%CI 2.32-9.23); physical/sexual violence by clients (AOR = 3.48; 95%CI 1.85-6.53); police harassment (AOR = 2.57; 95%CI 1.17-5.65); and being a single mother (AOR = 2.07; 95%CI 1.09-3.93). Structural and interpersonal factors strongly influence inconsistent condom use by clients, with violence by clients and police, low sexual control by workers, migration and single-parenthood all linked to non-condom use. There is a need for peer-led structural interventions that improve access to occupational health and safety standards (e.g., violence prevention and alcohol/drug harm reduction policies/programming). Shifts away from the current punitive approaches towards SWs are integral to the success of such interventions, as they continue to undermine HIV prevention efforts.
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Affiliation(s)
- Putu Duff
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada
| | | | - Sabina Dobrer
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | | | | | - Kate Shannon
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada
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The Effects of Housing Status, Stability and the Social Contexts of Housing on Drug and Sexual Risk Behaviors. AIDS Behav 2017; 21:2079-2092. [PMID: 28243936 DOI: 10.1007/s10461-017-1738-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on the relationship between housing instability and HIV risk has often focused on two different conceptions of stability. In one conceptualization, housing stability is defined according to physical location with homeless or unstably housed individuals defined as those who reside in places not meant for human habitation or in emergency shelters. The other conceptualization has defined housing stability as individuals' degree of transience, often operationalized as the number of moves or evictions a person has had within a specified amount of time. Less studied has been the social context of living situation, e.g. living with other drug users, conflict over living expenses, or having to have sex in order to stay. This paper uses data from 392 low-income residents in Hartford, CT to explore how people in different housing situations-including those who are housed and homeless-experience housing stability, feelings of security in their homes, and the social context of their housing. We then explore how these varied measures of housing context affect drug use frequency and sexual risk. Results show that participants who are homeless feel more overall housing instability in terms of number of moves and negative reasons for moving. Those who were doubled up with family or friends were more likely to experience conflict over household expenses and more likely to live with drug users. Among homeless and housed, hard drug use was associated with experiencing violence in the place where they lived, perceiving greater housing stability, having moved for a positive reason, doubling up, and longer periods of homelessness, while number of moves and longer prison sentence predicted sexual risk. Among the housed, living with other drug users was associated with more hard drug use, while contributing money toward household expenses was associated with less hard drug use. Two significant interactions were associated with sexual risk among the housed. Those with longer prison sentences who lived with drug users had more sexual partners, and those with longer prison sentences who doubled up had more sex partners. Results of this study indicate that measures of housing status not often considered in the literature such as the social context of housing have significant effects on HIV risk.
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Correlates of Sexual Risk among Recent Gay and Bisexual Immigrants from Western and Eastern Africa to the USA. J Urban Health 2017; 94:330-338. [PMID: 28258531 PMCID: PMC5481211 DOI: 10.1007/s11524-017-0135-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined correlates of sexual risk among gay and bisexual men, who recently migrated from western and eastern African countries to the USA and lived in New York City and who are HIV negative or of unknown status. These men migrate from countries where same-sex sexuality is socially rejected and mostly illegal contributing to the motivation to migrate. Their background might predispose these men to engagement in sexual risk practices, while they are not specifically addressed in HIV prevention programming. Participants (N = 62) reported in face-to-face interviews on pre- and postmigration experiences, psychosocial determinants of sexual risk, and current sexual practices. Operationalization of sexual risk was based on the number of men with whom they had condomless receptive and/or insertive anal sex. Over a third of the men reported always having used condoms in the past year; among the other men, sexual risk varied. Multivariate analyses showed that sexual risk was lower among men with a stronger motivation to avoid HIV infection and higher among men who currently engaged in transactional sex. Further analyses indicated that housing instability was independently associated with reduced motivation to avoid HIV infection and with engagement in transactional sex in the USA. In recent western and eastern African gay and bisexual immigrants to the USA, structural factors, including housing instability, are strongly associated with sexual risk.
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Kim H, Burgard SA, Seefeldt KS. Housing Assistance and Housing Insecurity: A Study of Renters in Southeastern Michigan in the Wake of the Great Recession. THE SOCIAL SERVICE REVIEW 2017; 91:41-70. [PMID: 38585345 PMCID: PMC10997347 DOI: 10.1086/690681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This article examines the factors shaping longitudinal patterns of housing insecurity in the wake of the Great Recession, with a focus on whether housing assistance helped renters who received it. We use data from the first two waves (2009-10 and 2011) of the Michigan Recession and Recovery Study, a population-representative sample of working-aged adults from Southeast Michigan. We use detailed reports from renters and other non-homeowners to construct measures of instability and cost-related housing problems at both waves, and we compare the changes in these over follow-up between housing assistance recipients and their income-eligible but non-recipient counterparts. Our findings suggest that receiving housing assistance reduced the chance of experiencing housing insecurity problems over follow-up regardless of baseline housing insecurity.
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Khan S, Lorway R, Chevrier C, Dutta S, Ramanaik S, Roy A, Bhattacharjee P, Mishra S, Moses S, Blanchard J, Becker M. Dutiful daughters: HIV/AIDS, moral pragmatics, female citizenship and structural violence among Devadasis in northern Karnataka, India. Glob Public Health 2017; 13:1065-1080. [PMID: 28102112 DOI: 10.1080/17441692.2017.1280070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Decades of research have documented how sex workers worldwide, particularly female sex workers (FSWs), shoulder a disproportionate burden of the HIV epidemic. In India, although a substantial progress has been made in controlling the epidemic, its prevalence among FSWs and the Devadasis (also called traditional sex workers) in northern Karnataka is still significantly high. On the other hand, much of the HIV prevention research has focused on their mapping and size estimation, typologies, bio-behavioural surveillance, condom use and other prevention technologies. In this article, drawing on critical theoretical perspectives, secondary historical sources and in-depth interviews, we unravel wider social, cultural and political economic complexities surrounding the lives of Devadasis, and specifically illuminate the moral pragmatics that shed light on their entry into sex trade and vulnerability to HIV. Findings from this research are extremely important since while much is known about Devadasis in social sciences and humanities, relatively little is known about the complexities of their lives within public health discourses related to HIV. Our work has direct implications for ongoing HIV prevention and health promotion efforts in the region and beyond.
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Affiliation(s)
- Shamshad Khan
- a Department of Communication , University of Texas at San Antonio , San Antonio , TX , USA
| | - Robert Lorway
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Claudyne Chevrier
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Sumit Dutta
- c Department of Sociology , Dr. K. N. Modi University , Niwai , Rajasthan , India
| | - Satyanarayana Ramanaik
- d Centre for Multi-Disciplinary Development Research , Dharwad , India.,f Karnataka Health Promotion Trust , Bengaluru , India
| | - Anu Roy
- e Independent Consultant , Stanford , CA , USA
| | | | - Sharmistha Mishra
- g Department of Medicine , St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - Stephen Moses
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - James Blanchard
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Marissa Becker
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Reed E, Erausquin JT, Biradavolu M, Servin AE, Blankenship KM. Non-barrier contraceptive use and relation to condom use behaviour by partner type among female sex workers in Andhra Pradesh, India. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:60-66. [PMID: 26699872 PMCID: PMC5284462 DOI: 10.1136/jfprhc-2014-100918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners. METHODS FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients. RESULTS Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) [adjusted odds ratio (AOR) 2.2, 95% confidence interval (CI) 1.2-4.0] and with an occasional client (past week) (AOR 2.6, 95% CI 1.6-5.3), as well as accepting more money for sex without a condom (past 30 days) (AOR 2.5, 95% CI 1.5-4.3). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners. CONCLUSIONS Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.
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Affiliation(s)
- Elizabeth Reed
- Assistant Professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA,USA
| | - Jennifer Toller Erausquin
- Assistant Professor, Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Monica Biradavolu
- Scholar in Residence, Department of Sociology, American University, Washington, DC, USA
| | - Argentina E Servin
- Postdoctoral Fellow, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA,USA
| | - Kim M Blankenship
- Professor and Chair, Department of Sociology, American University, Washington, DC, USA
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Reed E, Fisher CB, Blankenship KM, West BS, Khoshnood K. Why female sex workers participate in HIV research: the illusion of voluntariness. AIDS Care 2016; 29:914-918. [PMID: 28030960 DOI: 10.1080/09540121.2016.1271935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine factors influencing the motivation for and perceived voluntariness of participation in non-intervention HIV research among female sex workers (FSW) in India. FSW (n = 30) who participated in non-intervention HIV studies in the previous three years were recruited from a local community-based organization. Semi-structured qualitative interviews focused on women's personal and economic motivations for participation and their perceptions of the informed consent process. Interviews were audio-recorded, translated, transcribed, and reviewed for common themes. Content analysis indicated that while many women reported willing participation, reports of obligatory participation were also a common theme. Obligations included money-related pressures and coercion by other FSW, social pressures, not wanting to disappoint the researchers, and perceiving that they had a contractual agreement to complete participation as a result of signing the consent form. Findings suggest a need for additional efforts during and following informed consent to prevent obligatory participation in HIV research studies among FSW. Findings emphasize the importance of integrating ongoing participant feedback into research ethics practices to identify issues not well addressed via standard ethics protocols when conducting HIV research among vulnerable populations.
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Affiliation(s)
- Elizabeth Reed
- a Graduate School of Public Health, Health Promotion & Behavioral Science , San Diego State University , San Diego , CA , USA.,b Division of Global Public Health, School of Medicine , University of California , La Jolla , CA , USA
| | - Celia B Fisher
- c Department of Psychology , Fordham University , New York , NY , USA
| | - Kim M Blankenship
- d Department of Sociology , American University , Washington , DC , USA
| | - Brooke S West
- b Division of Global Public Health, School of Medicine , University of California , La Jolla , CA , USA
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Ganju D, Patel SK, Prabhakar P, Adhikary R. Knowledge and exercise of human rights, and barriers and facilitators to claiming rights: a cross-sectional study of female sex workers and high-risk men who have sex with men in Andhra Pradesh, India. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:29. [PMID: 27855692 PMCID: PMC5112884 DOI: 10.1186/s12914-016-0102-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 10/18/2016] [Indexed: 11/10/2022]
Abstract
Background HIV prevention interventions recognize the need to protect the rights of key populations and support them to claim their rights as a vulnerability reduction strategy. This study explores knowledge of human rights, and barriers and facilitators to claiming rights, among female sex workers (FSWs) and high-risk men who have sex with men (HR-MSM) who are beneficiaries of a community mobilization intervention in Andhra Pradesh, India. Methods Data are drawn from a cross-sectional survey (2014) among 2400 FSWs and 1200 HR-MSM. Human rights awareness was assessed by asking respondents if they had heard of human rights (yes/no); those reporting awareness of rights were asked to spontaneously name specific rights from the following five pre-defined categories: right to health; dignity/equality; education; property; and freedom from discrimination. Respondents were classified into two groups: more knowledgeable (could identify two or more rights) and less knowledgeable (could identify one or no right). Univariate and bivariate analyses and chi-square tests were used. Data were analyzed using STATA 11.2. Results Overall 17% FSWs and 8% HR-MSM were not aware of their rights. Among those aware, 62% and 31% respectively were aware of just one or no right (less knowledgeable); only around half (54% vs 57%) were aware of health rights, and fewer (20% vs 16%) aware of their right to freedom from discrimination. Notably, 27% and 17% respectively had not exercised their rights. Barriers to claiming rights among FSWs and HR-MSM were neighbors (35% vs 37%), lack of knowledge (15% vs 14%), stigma (13% vs 22%) and spouse (19% FSWs). Community organizations (COs) were by far the leading facilitator in claiming rights (57% vs 72%). Conclusions The study findings show that awareness of human rights is limited among FSWs and HR-MSM, and a large proportion have not claimed their rights, elevating their HIV vulnerability. For a sustained HIV response, community mobilization efforts must focus on building key populations’ awareness of rights, and addressing the multiple barriers to claiming rights, with a view to creating a safe environment where vulnerable groups can demand and use services without fear of stigma, discrimination and violation of rights.
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Affiliation(s)
- Deepika Ganju
- HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India.
| | - Sangram Kishor Patel
- HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India
| | - Parimi Prabhakar
- India HIV/AIDS Alliance, Sarovar Centre, Secretariat Road, Hyderabad, 500063, India
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Beattie TS, Isac S, Bhattacharjee P, Javalkar P, Davey C, Raghavendra T, Nair S, Ramanaik S, Kavitha DL, Blanchard JF, Watts C, Collumbien M, Moses S, Heise L. Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India. BMC Public Health 2016; 16:660. [PMID: 27473180 PMCID: PMC4966746 DOI: 10.1186/s12889-016-3356-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are at increased risk of HIV and STIs compared to women in the general population, and frequently experience violence in their working and domestic lives from a variety of perpetrators, which can enhance this risk. While progress has been made in addressing violence by police and clients, little work has been done to understand and prevent violence by intimate partners (IPs) among FSW populations. METHODS Samvedana Plus is a multi-level intervention programme that works with FSWs, their IPs, the sex worker community, and the general population, and aims to reduce violence and increase consistent condom use within these 'intimate' relationships. The programme involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The programme will aim to cover 800 FSWs and their IPs living in 47 villages in Bagalkot district, northern Karnataka. The study is designed to assess two primary outcomes: the proportion of FSWs who report: (i) physical or sexual partner violence; and (ii) consistent condom use in their intimate relationship, within the past 6 months. The evaluation will employ a cluster-randomised controlled trial design, with 50 % of the village clusters (n = 24) randomly selected to receive the intervention for the first 24 months and the remaining 50 % (n = 23) receiving the intervention thereafter. Statisticians will be blinded to treatment arm allocation. The evaluation will use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months) and endline (24 months). The evaluation design will involve quantitative and qualitative assessments with (i) all FSWs who report an IP (ii) IPs; and process/ implementation monitoring. Baseline data collection was completed in April 2015, and endline data collection is anticipated in May 2017. CONCLUSIONS This is an innovative intervention programme that aims to address violence by IPs as part of HIV prevention programming with FSWs. Reducing violence is expected to reduce vulnerability to HIV acquisition, and help women to work and live without fear of violence. TRIAL REGISTRATION Clinical Trials NCT02807259 Jun 24 2016 (retrospectively registered).
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | - Calum Davey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Sapna Nair
- Karnataka Health Promotion Trust, Bangalore, India
| | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | | | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Lori Heise
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
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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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Reed E, Erausquin JT, Groves AK, Salazar M, Biradavolu M, Blankenship KM. Client-perpetrated and husband-perpetrated violence among female sex workers in Andhra Pradesh, India: HIV/STI risk across personal and work contexts. Sex Transm Infect 2016; 92:424-9. [PMID: 26905080 PMCID: PMC4992639 DOI: 10.1136/sextrans-2015-052162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 02/01/2016] [Indexed: 12/04/2022] Open
Abstract
Objectives This study examines violence experienced in work and personal contexts and relation to HIV risk factors in these contexts among female sex workers (FSW) in Andhra Pradesh, India. Methods FSW at least 18 years of age (n=2335) were recruited through three rounds of respondent-driven sampling between 2006 and 2010 for a survey on HIV risk. Using crude and adjusted logistic regression models, any sexual/physical violence (last 6 months) perpetrated by clients and husbands were separately assessed in association with accepting more money for sex without a condom (last 30 days), consistent condom use with clients and husbands (last 30 days), and sexually transmitted infection (STI) symptoms (last 6 months). Results The mean age among participants was 32, 22% reported being currently married, and 22% and 21% reported physical/sexual violence by clients and husbands, respectively. In adjusted logistic regression models, FSW who experienced client violence were more likely to report accepting more money for unprotected sex trades (adjusted OR (AOR)=1.7; 95% CI 1.4 to 2.2), less likely to report consistent condom use with clients (AOR=0.6; 95% CI 0.5 to 0.7) and more likely to report STI symptoms (AOR=3.5; 95% CI 2.6 to 4.6). Women who reported husband violence were more likely to report accepting more money for unprotected sex trades (AOR=2.1; 95% CI 1.2 to 3.7), less likely to report consistent condom use with clients (AOR=0.5; 95% CI 0.3 to 0.8) and more likely to report STI symptoms (AOR=2.6; 95% CI 1.6 to 4.1). Conclusions Among FSW, experiences of violence in work and personal contexts are associated with sexual HIV risk behaviours with clients as well as STI symptoms.
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Affiliation(s)
- Elizabeth Reed
- Division of Global Public Health, School of Medicine: La Jolla, University of California, San Diego, CA, USA
| | - J T Erausquin
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Allison K Groves
- Department of Sociology, American University, Washington DC, USA
| | - Marissa Salazar
- Division of Global Public Health, School of Medicine: La Jolla, University of California, San Diego, CA, USA
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Jennings L, Ssewamala FM, Nabunya P. Effect of savings-led economic empowerment on HIV preventive practices among orphaned adolescents in rural Uganda: results from the Suubi-Maka randomized experiment. AIDS Care 2015; 28:273-82. [PMID: 26548549 DOI: 10.1080/09540121.2015.1109585] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US12.32, ±1.12, p < .001) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group (p < .001). The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home (ΔT1-T0 = +14.9, p < .001), pursue vocational training (ΔT1-T0 = +8.8, p < .01), and start a business (T1-T0 = +6.7, p < .01). Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores (b = +0.19, ±0.09, p < .05), most commonly toward perceived risk of HIV (95.8%, n = 159), sexual abstinence or postponement (91.6%, n = 152), and consistent condom use (93.4%, n = 144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR = 2.017, 95%CI: 1.43-2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.
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Affiliation(s)
- Larissa Jennings
- a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Fred M Ssewamala
- b International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA
| | - Proscovia Nabunya
- c School of Social Service Administration , University of Chicago , Chicago , IL , USA
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Women Who Use or Inject Drugs: An Action Agenda for Women-Specific, Multilevel, and Combination HIV Prevention and Research. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S182-90. [PMID: 25978486 DOI: 10.1097/qai.0000000000000628] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Women account for more than half of all individuals living with HIV globally. Despite increasing drug and HIV epidemics among women, women who use drugs are rarely found in research, harm reduction programs, or drug and HIV treatment and care. Women who use drugs continue to face challenges that increase their vulnerability to HIV and other comorbidities because of high rates of gender-based violence, human rights violations, incarceration, and institutional and societal stigmatization. This special issue emphasizes how the burdens of HIV, drug use, and their co-occurring epidemics affect women in a global context. Articles included focus on the epidemiologies of HIV and hepatitis C virus and other comorbidities; HIV treatment, prevention, and care; and policies affecting the lives of women who use drugs. This issue also highlights the state of the science of biomedical and behavioral research related to women who use drugs. The final article highlights the major findings of articles covered and presents a call to action regarding needed research, treatment, and preventive services for women who use drugs. To address these needs, we advocate for women-specific thinking and approaches that consider the social, micro, and macro contexts of women's lives. We present a women-specific risk environment framework that reflects the unique lives and contexts of women who use drugs and provides a call to action for intervention, prevention, and policies.
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Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, Reza-Paul S, Lau J, Deering K, Pickles MR, Boily MC. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet 2015; 385:55-71. [PMID: 25059947 PMCID: PMC4297548 DOI: 10.1016/s0140-6736(14)60931-4] [Citation(s) in RCA: 516] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1-31) and 20% in Canada (95% UI 3-39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25-42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8-36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33-46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.
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Affiliation(s)
- Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.
| | | | - Shira M Goldenberg
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - Putu Duff
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - Peninah Mwangi
- Bar Hostesses Empowerment and Support Program, African Sex Workers Alliance, Nairobi, Kenya
| | | | | | | | - Kathleen Deering
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
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Reed E, Khoshnood K, Blankenship KM, Fisher CB. Confidentiality, privacy, and respect: experiences of female sex workers participating in HIV research in Andhra Pradesh, India. J Empir Res Hum Res Ethics 2014; 9:19-28. [PMID: 24572080 DOI: 10.1525/jer.2014.9.1.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Female sex workers (FSWs) from Andhra Pradesh, India, who had participated in HIV research were interviewed to examine participant perspectives on research ethics. Content analysis indicated that aspects of the consent process, staff gender and demeanor, study environment, survey content, time requirements for study participation, and perceived FSW community support for research were key factors influencing whether FSWs perceived their confidentiality and privacy had been maintained, and whether they felt the study was conducted respectfully. Findings suggest that partnership with community-based organizations and investigation of participant's experiences in HIV prevention research can provide critical information to best inform research ethics protocols, a particular priority among research studies with highly stigmatized populations, such as FSWs.
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Navani-Vazirani S, Solomon D, Krishnan G, Heylen E, Srikrishnan AK, Vasudevan CK, Ekstrand ML. Mobile phones and sex work in South India: the emerging role of mobile phones in condom use by female sex workers in two Indian states. CULTURE, HEALTH & SEXUALITY 2014; 17:252-265. [PMID: 25301669 PMCID: PMC4425944 DOI: 10.1080/13691058.2014.960002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to examine female sex workers' solicitation of clients using mobile phones and the association between this and condom use with clients. Cross-sectional data were utilised to address the study's aim, drawing on data collected from female sex workers in Calicut, Kerala, and Chirala, Andhra Pradesh. Use of mobile phone solicitation was reported by 46.3% (n = 255) of Kerala participants and 78.7% (n = 464) of those in Andhra Pradesh. Kerala participants reporting exclusive solicitation using mobile phones demonstrated 1.67 times higher odds (95% CI: 1.01-2.79) of inconsistent condom use than those reporting non-use of mobile phones for solicitation. However, those reporting exclusive solicitation through mobile phones in Andhra Pradesh reported lower odds of inconsistent condom use (OR: 0.03; 95% CI: 0.01-0.26) than those not using mobile phones for solicitation. Findings indicate that solicitation of clients using mobile phones facilitates or hampers consistency in condom use with clients depending on the context, and how mobile phones are incorporated into solicitation practices. Variations in sex work environments, including economic dependence on sex work or lack thereof may partially account for the different effects found.
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Affiliation(s)
| | - D Solomon
- SHADOWS, Solomon Hospital, Chirala, India
| | | | - E Heylen
- Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - AK Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, ChennaiIndia
| | - CK Vasudevan
- Y.R. Gaitonde Centre for AIDS Research and Education, ChennaiIndia
| | - ML Ekstrand
- Center for AIDS Prevention Studies, University of California, San Francisco, USA
- St. John's Research Institute, Bangalore, India
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Kumar SG. Control of HIV: Role of female sex workers in risk of HIV transmission. Indian J Sex Transm Dis AIDS 2014; 35:165-6. [PMID: 26396457 DOI: 10.4103/0253-7184.142421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Ganesh Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Beattie TSH, Mohan HL, Bhattacharjee P, Chandrashekar S, Isac S, Wheeler T, Prakash R, Ramesh BM, Blanchard JF, Heise L, Vickerman P, Moses S, Watts C. Community mobilization and empowerment of female sex workers in Karnataka State, South India: associations with HIV and sexually transmitted infection risk. Am J Public Health 2014; 104:1516-25. [PMID: 24922143 DOI: 10.2105/ajph.2014.301911] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We examined the impact of community mobilization (CM) on the empowerment, risk behaviors, and prevalence of HIV and sexually transmitted infection in female sex workers (FSWs) in Karnataka, India. METHODS We conducted behavioral-biological surveys in 2008 and 2011 in 4 districts of Karnataka, India. We defined exposure to CM as low, medium (attended nongovernmental organization meeting or drop-in centre), or high (member of collective or peer group). We used regression analyses to explore whether exposure to CM was associated with the preceding outcomes. Pathway analyses explored the degree to which effects could be attributable to CM. RESULTS By the final survey, FSWs with high CM exposure were more likely to have been tested for HIV (adjusted odd ratio [AOR] = 25.13; 95% confidence interval [CI] = 13.07, 48.34) and to have used a condom at last sex with occasional clients (AOR = 4.74; 95% CI = 2.17, 10.37), repeat clients (AOR = 4.29; 95% CI = 2.24, 8.20), and regular partners (AOR = 2.80; 95% CI = 1.43, 5.45) than FSWs with low CM exposure. They were also less likely to be infected with gonorrhea or chlamydia (AOR = 0.53; 95% CI = 0.31, 0.87). Pathway analyses suggested CM acted above and beyond peer education; reduction in gonorrhea or chlamydia was attributable to CM. CONCLUSIONS CM is a central part of HIV prevention programming among FSWs, empowering them to better negotiate condom use and access services, as well as address other concerns in their lives.
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Affiliation(s)
- Tara S H Beattie
- Tara S. H. Beattie, Lori Heise, Peter Vickerman, Charlotte Watts, and Sudha Chandrashekar are with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Harnalli L. Mohan, Parinita Bhattacharjee, Shajy Isac, and Ravi Prakash are with the Karnataka Health Promotion Trust (KHPT), Bangalore, India. Tisha Wheeler is with the Futures Group, Durham, NC. Banadakoppa M. Ramesh, James F. Blanchard, and Stephen Moses are with The University of Manitoba, Winnipeg
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Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P, Argento E, Shannon K. A systematic review of the correlates of violence against sex workers. Am J Public Health 2014; 104:e42-54. [PMID: 24625169 DOI: 10.2105/ajph.2014.301909] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We conducted a systematic review in June 2012 (updated September 2013) to examine the prevalence and factors shaping sexual or physical violence against sex workers globally. We identified 1536 (update = 340) unique articles. We included 28 studies, with 14 more contributing to violence prevalence estimates. Lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%. Growing research links contextual factors with violence against sex workers, alongside known interpersonal and individual risks. This high burden of violence against sex workers globally and large gaps in epidemiological data support the need for research and structural interventions to better document and respond to the contextual factors shaping this violence. Measurement and methodological innovation, in partnership with sex work communities, are critical.
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Affiliation(s)
- Kathleen N Deering
- Kathleen N. Deering, Putu Duff, Elena Argento, Ariel Nesbitt, and Kate Shannon are with Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia. Kathleen N. Deering and Kate Shannon are also with Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver. Putu Duff, Ariel Nesbitt, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia. Avni Amin and Claudia García-Moreno are with Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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HIV/STI risk among venue-based female sex workers across the globe: a look back and the way forward. Curr HIV/AIDS Rep 2013; 10:65-78. [PMID: 23160840 DOI: 10.1007/s11904-012-0142-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Female sex workers (FSWs) continue to represent a high-risk population in need of targeted HIV prevention interventions. Targeting environmental risk factors should result in more sustainable behavior change than individual-level interventions alone. There are many types of FSWs who operate in and through a variety of micro- (eg, brothels) and macro-level (eg, being sex-trafficked) contexts. Efforts to characterize FSWs and inform HIV prevention programs have often relied on sex work typologies or categorizations of FSWs by venue or type. We conducted a systematic search and qualitatively reviewed 37 published studies on venue-based FSWs to examine the appropriateness of sex work typologies, and the extent to which this research has systematically examined characteristics of different risk environments. We extracted information on study characteristics like venue comparisons, HIV/STI prevalence, and sampling strategies. We found mixed results with regards to the reliability of typologies in predicting HIV/STI infection; relying solely on categorization of FSWs by venue or type did not predict seroprevalence in a consistent manner. Only 65 % of the studies that allowed for venue comparisons on HIV/STI prevalence provided data on venue characteristics. The factors that were assessed were largely individual-level FSW factors (eg, demographics, number of clients per day), rather than social and structural characteristics of the risk environment. We outline a strategy for future research on venue-based FSWs that ultimately aims to inform structural-level HIV interventions for FSWs.
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Kennedy DP, Wenzel SL, Brown R, Tucker JS, Golinelli D. Unprotected sex among heterosexually active homeless men: results from a multi-level dyadic analysis. AIDS Behav 2013; 17:1655-67. [PMID: 23212852 DOI: 10.1007/s10461-012-0366-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV is a serious public health problem for homeless populations. Homeless men who have sex with women have received less attention in the HIV risk literature than other homeless populations. This research uses multi-level modeling to investigate the context of unprotected sex among heterosexually active homeless men in the Skid Row area of Los Angeles. Based on interviews with 305 randomly selected men who discussed 665 of their recent female sexual relationships, this project investigates the correlates of unprotected sex during the past 6 months at the partnership, individual, and social network levels. Several different measures of relationship closeness and lack of communication about HIV/condoms were associated with unprotected sex. Controlling for relationship factors, men's negative attitudes towards condoms, mental health, and higher number of male sex partners also were associated with having unprotected sex with female partners. We discuss the implications of these findings for health interventions.
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The Association between Noncommercial Partnerships and Risk of HIV among Female Sex Workers: Evidences from a Cross-Sectional Behavioral and Biological Survey in Southern India. AIDS Res Treat 2013; 2013:108630. [PMID: 23533729 PMCID: PMC3603613 DOI: 10.1155/2013/108630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/30/2013] [Indexed: 11/18/2022] Open
Abstract
This paper examines the association between female sex workers' (FSWs) noncommercial partnerships with risk of HIV in Andhra Pradesh, India. Data were drawn from a cross-sectional behavioral and biological survey conducted in 2009 among 3225 FSWs from Andhra Pradesh. Participants were asked about their sexual partnerships, condom use, and vulnerability factors and tested for HIV and sexually transmitted infections. The key independent variables considered were presence of a noncommercial sexual partner (no, yes) and the nature of such partnerships (regular, nonregular). FSWs who reported husband as noncommercial partner were considered to have a regular partner, while the rest were defined as having nonregular partners. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to measure the associations between variables of interest. Almost three-fourths (74.8%) of FSWs reported having noncommercial partners (regular: 55.6%; nonregular: 19.3%). FSWs in nonregular partnerships were more likely to be HIV positive (13.1% versus 10.9%, adjusted OR: 1.4, 95% CI: 1.1–1.8), have syphilis (10.3% versus 4.2%, adjusted OR: 2.3, 95% CI: 1.6–3.3), use condoms inconsistently with occasional clients (21.0% versus 16.5%, adjusted OR: 1.5, 95% CI: 1.2–1.9), and report forced sex (25.1% versus 14.1%, adjusted OR: 1.9, 95% CI: 1.5–2.4) as compared to those in regular partnerships. HIV prevention programs need to emphasize safe sex behaviors, particularly among FSWs who have nonregular partners.
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Motherhood and HIV risk among female sex workers in Andhra Pradesh, India: the need to consider women's life contexts. AIDS Behav 2013; 17:543-50. [PMID: 22782790 DOI: 10.1007/s10461-012-0249-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examines whether the challenges of motherhood among female sex workers (FSW) are linked with vulnerability to sexual risk factors for HIV. FSW at least 18 years of age (n = 850) were recruited through respondent driven sampling for a survey on HIV risk in the Rajahmundry area of Andhra Pradesh, India. Logistic regression models adjusted for demographic characteristics were used to assess the relation between reported caretaking challenges and sexual risk indicators for HIV. In adjusted logistic regression models, FSW who reported three or more children in their household or current child health concerns were significantly less likely to report consistent condom use (adjusted odds ratios (AORs) range: 0.5-0.6) and more likely to take more money for sex without a condom (both AORs: 2.5). Women who reported current child health concerns were also more likely to report an STI symptom in the past 6 months (AOR = 1.6; 95 % confidence interval: 1.1-2.3). Findings suggest that challenging responsibilities related to caretaking of children are associated with heightened vulnerability to HIV risk among FSW. Such findings add to the cumulating evidence urging for the implementation of HIV prevention interventions that consider the multiple challenges across various domains of women's lives.
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Izugbara CO. Client retention and health among sex workers in Nairobi, Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1345-1352. [PMID: 22434396 DOI: 10.1007/s10508-012-9928-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 01/31/2012] [Accepted: 02/04/2012] [Indexed: 05/31/2023]
Abstract
It is still a small body of research that directly addresses female sex workers' relationships with their regular commercial male partners. I used ethnographic data from Nairobi, Kenya to interrogate motivations and strategies for recruiting and retaining regular male clients among female sex workers (FSWs). Regular commercial male partners, popularly called customer care, wera or wesh by Nairobi's FSWs, played diverse roles in their lives. Client retention enabled sex workers to manage the risk of reduced marriage prospects, guaranteed them steady work, livelihoods, and incomes, and prevented their victimization and harassment. To retain clients, sex workers obliged them a great deal, pretended they had quit prostitution, and sometimes resorted to magical practices. However, these strategies were also accompanied by risks that reinforced the vulnerability of sex workers. Lack of critical attention to sex workers' practices for managing perceived risks in their particular type of work may hamper current programmatic efforts to make their job safer.
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Affiliation(s)
- Chimaraoke O Izugbara
- African Population and Health Research Center, APHRC Campus, Box 10787-00100, Nairobi, Kenya.
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Punyam S, Pullikalu RS, Mishra RM, Sandri P, Mutupuru BP, Kokku SB, Parimi P. Community advocacy groups as a means to address the social environment of female sex workers: a case study in Andhra Pradesh, India. J Epidemiol Community Health 2012; 66 Suppl 2:ii87-94. [PMID: 22495774 PMCID: PMC3433220 DOI: 10.1136/jech-2011-200478] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND To examine the association between the presence of community advocacy groups (CAGs) and female sex workers' (FSWs) access to social entitlements and outcomes of police advocacy. METHODS Data were used from a cross-sectional survey conducted in 2010-2011 among 1986 FSWs and 104 NGO outreach workers from five districts of Andhra Pradesh. FSWs were recruited using a probability-based sampling from 104 primary sampling units (PSUs). A PSU is a geographical area covered by one outreach worker and is expected to have an active CAG as per community mobilisation efforts. The presence of active CAGs was defined as the presence of an active committee or advocacy group in the area (PSU). Outcome indicators included acquisition of different social entitlements and measures of police response as reported by FSWs. Multivariate linear and logistic regression analyses were used to examine the associations. RESULTS Areas with active CAGs compared with their counterparts had a significantly higher mean number of FSWs linked to ration cards (12.8 vs 6.8; p<0.01), bank accounts (9.3 vs 5.9; p=0.05) and health insurance (13.1 vs 7.0; p=0.02). A significantly higher percentage of FSWs from areas with active CAGs as compared with others reported that the police treat them more fairly now than a year before (79.7% vs 70.3%; p<0.05) and the police explained the reasons for arrest when arrested the last time (95.7% vs 87%; p<0.05). CONCLUSION FSWs from areas with active CAGs were more likely to access certain social entitlements and to receive a fair response from the police, highlighting the contributions of CAGs in community mobilisation.
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Affiliation(s)
- Swarup Punyam
- India HIV/AIDS Alliance, Sarovar Center, 5-9-22, Secretariat Road, Hyderabad 500063, Andhra Pradesh, India.
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Amaro H, Raj A, Reed E, Ulibarri M. Getting Personal: Progress and Pitfalls in HIV Prevention Among Latinas. PSYCHOLOGY OF WOMEN QUARTERLY 2011; 35:655-670. [PMID: 22539868 PMCID: PMC3334297 DOI: 10.1177/0361684311426692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hortensia Amaro
- Institute on Urban Health Research, Bouve' College of Health Sciences, Northeastern University
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