1
|
Llangarí-Arizo LM, Broad CE, Zhou L, Martin Mateo M, Moreno CI, Moreno Cevallos M, Cooper PJ, Romero-Sandoval N, Sadiq ST. Sexually transmitted infections among at-risk women in Ecuador: implications for global prevalence and testing practices for STIs detected only at the anorectum in female sex workers. Sex Transm Infect 2024:sextrans-2023-056075. [PMID: 39117400 DOI: 10.1136/sextrans-2023-056075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES Anorectal sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However, there are limited global prevalence data for anorectal STIs. We conducted a cross-sectional study to assess the prevalence and risk factors of non-viral genital and extragenital STIs in female sex workers (FSW) and female non-sex workers (NSW) in Ecuador. METHODS 250 adult street and brothel FSWs and 250 NSWs, recruited from settlements in north-west Ecuador provided oropharyngeal and vulvo-vaginal swabs (VVS) as well as socio-demographic data. FSWs also provided anorectal swabs. PCR was used to detect CT, NG, Mycoplasma genitalium (MG) from all swabs and additionally Trichomonas vaginalis (TV) from VVS. Risk factors were analysed using logistic regression. RESULTS Prevalence of FSW vaginal, anorectal and oropharyngeal infection was 32.0% (95% CI 26.5% to 38.0%), 19.7% (95% CI 15.1% to 25.2%) and 3.2% (95% CI 1.6% to 6.2%), respectively, with most vaginal infections being TV (23.4%; 95% CI 18.5% to 29.2%). Overall FSW STI prevalence, at any anatomical site was 39.7% (95% CI 33.8% to 46.1%), with 12.1% (95% CI 8.5% to 16.9%) of infections detected only at the anorectum. Of all the CT and/or NG infections, 64.4% (95% CI 50.4% to 78.4%) were detected only at the anorectum. STI prevalence in NSWs in the vagina and oropharynx were 5.6% (95% CI 3.4% to 9.2%) and 0.8% (95% CI 0.2% to 2.9%), respectively, with most vaginal infections being MG (3.2%; 95% CI 1.6% to 6.2%). In multivariable analysis, risk factors among brothel-based FSWs for having an anorectal STI were vaginal CT, NG or MG (p<0.001), vaginal TV (p=0.029) and being 'in a relationship' (p=0.038). CONCLUSIONS High prevalence of CT and NG detected only at the anorectum in these FSWs indicate the possibility of missing significant infections if providing only genital testing and calls for greater research into the potential impact on global STI estimates if extragenital infections among at-risk women are not identified.
Collapse
Affiliation(s)
| | | | - Liqing Zhou
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miguel Martin Mateo
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Autonomous University of Barcelona, Barcelona, Spain
- Red Internacional Grups de Recerca d'América i África Llatines-GRAAL, Barcelona, Spain
| | | | | | - Philip J Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Natalia Romero-Sandoval
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Red Internacional Grups de Recerca d'América i África Llatines-GRAAL, Barcelona, Spain
| | - Syed Tariq Sadiq
- Institute for Infection and Immunity, St George's University of London, London, UK
| |
Collapse
|
2
|
Gnaim-Mwassi N, Winterstein TB, Avieli H. I'm a 45-year-old woman in the body of an 80-year-old: The multiple losses of living and aging in the shadow of prostitution. J Nurs Scholarsh 2024; 56:405-416. [PMID: 38263887 DOI: 10.1111/jnu.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Research on aging women who are involved in prostitution is currently limited, both in terms of the number of studies conducted and their scope. Nevertheless, the available research suggests that women who are aging while involved in prostitution may confront some unique challenges. Thus, the study aims to explore the experiences of aging as narrated by Arab women in prostitution, using Intersectionality as a theoretical framework. METHOD Interpretive phenomenological analysis was used, and semistructured interviews were performed with 12 participants. FINDINGS Four themes emerged: "I'm a 45-year-old woman in the body of an 80-year-old:" Loss of physical and mental health; "There is no retirement plan in prostitution: Economic and social losses; As they were taken, my soul went with them too: The loss of the parenting experience and motherhood"; and "I'm going to get older with the disgust clinging to me:" The loss of authentic identity and dignity. CONCLUSION The findings demonstrate how aging serves to exacerbate overlapping forms of discrimination and marginalization. CLINICAL RELEVANCE Healthcare professionals, including nurses caring for older women in prostitution, should be aware of their unique circumstances, considering the social, economic, and healthcare obstacles they face. By being cognizant of these factors, healthcare practitioners can provide meaningful assistance in their pursuit of improved quality of life.
Collapse
Affiliation(s)
- Nora Gnaim-Mwassi
- The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- The Department of Gerontology, University of Haifa, Haifa, Israel
| | - Tova Band Winterstein
- The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- The Department of Gerontology, University of Haifa, Haifa, Israel
| | - Hila Avieli
- The Department of Criminology, Ariel University, Ariel, Israel
| |
Collapse
|
3
|
Gnaim-Mwassi N, Avieli H, Band-Winterstein T. Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences. J Elder Abuse Negl 2024; 36:117-147. [PMID: 38566491 DOI: 10.1080/08946566.2024.2331503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.
Collapse
Affiliation(s)
- Nora Gnaim-Mwassi
- Minerva Center on Intersectionality in Aging, Department of Gerontology, University of Haifa, Haifa, Israel
| | - Hila Avieli
- Department of Criminology, Ariel University, Ariel, Israel
| | - Tova Band-Winterstein
- Minerva Center on Intersectionality in Aging, Department of Gerontology, University of Haifa, Haifa, Israel
| |
Collapse
|
4
|
Murayama H, Nishi A, Endo A. Different time scales used for sexual partner surveys pose a challenge in modelling dynamics of sexually transmitted infections. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.25.23300526. [PMID: 38234724 PMCID: PMC10793542 DOI: 10.1101/2023.12.25.23300526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Mathematical models for sexually transmitted infections (STIs) are parameterised by empirical data on sexual behaviour (e.g. the number of partners over a given period) obtained from surveys. However, the time window for reporting sexual partnerships may vary between surveys and how data for different windows can be translated from one to another remains an open question. To highlight this issue, we compared the distributions of the number of sexual partners over one year and four weeks from the British National Surveys of Sexual Attitudes and Lifestyles. The results show that simple linear rescaling did not render the one-year and four-week partner distributions aligned. Parameterising STI models using survey-based sexual encounter rates without considering the implication of the reporting window used can lead to misleading results.
Collapse
Affiliation(s)
- Hiroaki Murayama
- School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Akihiro Nishi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, US
| | - Akira Endo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- The Centre of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
5
|
Kaur W, Balakrishnan V, Zhi Wei IN, Chen AYY, Ni Z. Understanding Women's Knowledge, Awareness, and Perceptions of STIs/STDs in Asia: A Scoping Review. Healthcare (Basel) 2023; 11:2643. [PMID: 37830681 PMCID: PMC10572356 DOI: 10.3390/healthcare11192643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE This study aimed to conduct a scoping review to collect current literature on the knowledge, awareness, and perception (KAP) of sexually transmitted infections/diseases (STIs/STDs) among women in Asia. METHODOLOGY The PRISMA-Scoping methodology was used in this study to extract papers from four databases published between 2018 and 2022. Sixty-eight articles were included after screening and elimination. RESULTS The studies on KAP of STIs/STDs among women were largely undertaken in Southeast Asia (Indonesia, Malaysia, and Vietnam) and South Asia (India, Pakistan, and Bangladesh). Regardless of the specific cohort of women studied, research indicates consistently low levels of knowledge and awareness across Asia. This trend seems to be more prevalent among female commercial sex workers, women with lower educational levels, and those in poorer socioeconomic positions. In South Asia, cultural, sociological, economic, and gender inequalities, particularly male domination, all have a significant impact on KAP levels. CONCLUSION As education is a major factor that influences health behaviour, this review underscores the need to allocate more resources to educational initiatives, particularly targeting vulnerable groups such as sex workers, transgender women, pregnant women, and rural housewives. This strategic focus may contribute significantly to preventing STIs/STDs, particularly in less developed regions/countries.
Collapse
Affiliation(s)
- Wandeep Kaur
- Faculty of Information Science & Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
| | - Vimala Balakrishnan
- Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Ian Ng Zhi Wei
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (I.N.Z.W.); (A.Y.Y.C.)
| | - Annabel Yeo Yung Chen
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (I.N.Z.W.); (A.Y.Y.C.)
| | - Zhao Ni
- School of Nursing, Yale University, New Haven, CT 06477, USA
| |
Collapse
|
6
|
Wariso FB, Ayalew J, Barba A, Bedassa BB, Ebo GG, Tura JB, Rameto M, Belihu WB, Asfaw D, Amogne MD, Negeri L, Lulseged S, Abrahim SA. Determinants of sexually transmitted infections among female sex workers in Ethiopia: a count regression model approach. Front Public Health 2023; 11:1190085. [PMID: 37601188 PMCID: PMC10437068 DOI: 10.3389/fpubh.2023.1190085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Background Sexually transmitted infections (STIs) remain a major public health problem worldwide, with the burden of these infections being high among female sex workers (FSWs), who are often not aware of their infection status. This study aimed to determine the factors that are associated with the number of STIs among FSWs in Ethiopia. Methods A cross-sectional bio-behavioral study involving respondent-driven sampling (RDS) was conducted among 6,085 FSWs in 16 towns in Ethiopia. The hurdle Poisson regression model was fitted using STATA Version 16.2. The incident rate ratio and adjusted odds ratio with a 95% confidence interval were employed to show the strength and direction of the association. A p-value of ≤0.05 was used as a threshold for statistical significance. Results At least one STI was identified in 1,444 (23.64%) of the FSWs. Age group 35-49 years [IRR = 2.32; 95% CI (1.43, 3.74)], forced first sex [IRR = 1.32; 95% CI (1.01, 1.74)], condom breakage [IRR = 1.32; 95% CI (1.01, 1.74)], and a history of depression [IRR = 1.55; 95% CI (1.12, 2.18)] increase the number of STIs. FSWs aged 25-34 years [AOR = 2.99; % CI (2.54, 3.52)] and 35 = 59 years [AOR = 8.05; % CI (6.54, 9.91)], who were selling sex for 5-10 years [AOR = 1.30; 95% CI (1.1, 1.55)], and above 11 years [AOR = 1.21; 95% CI (1.03, 1.43)] were more likely to get STIs. Conclusion STIs are common in Ethiopia. The covariates age, educational status, monthly income, condom failure, age at the first sexual encounter, and long duration of sexual practice are significant predictors of STIs. Health interventions among FSWs need to include awareness generation about the prevention and control of STIs and address the determinants identified in this analysis.
Collapse
Affiliation(s)
| | - Jemal Ayalew
- College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Ammar Barba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Lemessa Negeri
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | |
Collapse
|
7
|
Jansson M, Smith M, Benoit C, Magnuson D, Healey P. Challenges and Benefits of Disclosure of Sex Work to Intimate Partners. JOURNAL OF SEX RESEARCH 2022:1-13. [PMID: 35877549 DOI: 10.1080/00224499.2022.2092587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex workers' noncommercial intimate partnerships are marginalized on two counts - they are non-monogamous and at least one partner is in sex work, an occupation with much stigma. We asked a heterogeneous sample of Canadian sex workers (N = 218) about their decisions to reveal/not reveal their sex work to intimate partners, and the resulting challenges and benefits. A minority (58/183) of participants who had been or were currently involved in an intimate relationship kept their work secret from at least one partner or disclosed limited information, shielding them from stigma but resulting in a burden of secrecy. The majority of participants (151/183) who had been/were currently involved in an intimate relationship chose to disclose their sex work to at least one partner, which for most, had one or more negative consequences. A small group of participants related that disclosure resulted in acceptance, support, and understanding from their intimate partner. Some participants avoided the disclosure dilemma by forming intimate relationships from social connections where sex work status was already known. These relationships were generally supportive. We conclude that intimate relationships provide positive experiences for many people who sell sexual services and that these relationships could be stronger if societal stigma was reduced.
Collapse
Affiliation(s)
- Mikael Jansson
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria
| | | | | |
Collapse
|
8
|
Farahmand M, Moghoofei M, Dorost A, Abbasi S, Monavari SH, Kiani SJ, Tavakoli A. Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis. BMC Public Health 2020; 20:1455. [PMID: 32977797 PMCID: PMC7519561 DOI: 10.1186/s12889-020-09570-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and the distribution of HPV types among FSWs across the world. METHODS Five computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable sources of heterogeneity. The meta-analysis was performed using the "Metaprop" function in the R package Meta. RESULTS Sixty-two studies involving 21,402 FSWs from 33 countries were included in this meta-analysis, and the pooled HPV prevalence was 42.6% (95% confidence interval (CI): 38.5-46.7%). HPV-16 (10.1, 95% CI: 8.2-12.5%), HPV-52 (7.9, 95% CI: 5.9-10.7%), and HPV-53 (6.0, 95% CI: 4.4-8.1%) were the most common high-risk HPV types identified among FSWs. The pooled estimated prevalence of HPV infection among FSWs before and after 2010 were slightly different, 43.6% (95% CI: 36.1-51.4%) and 41.9% (95% CI: 37.2-46.8%), respectively. CONCLUSION Due to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and the incidence of HPV-associated malignancies among the general population.
Collapse
Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Moghoofei
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abolfazl Dorost
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Abbasi
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamidreza Monavari
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jalal Kiani
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|