Exotic Dance in Baltimore: From Entry to STI/HIV Risk

Young Adult Nightclub Participants Who Attend Adult Entertainment Clubs: Sexual Risk and Substance Use Behaviors

This secondary analysis of cross-sectional baseline data from an intervention trial study examines demographics, sexually transmitted infection (STI) history, substance use and sexual risk behaviors among young adult nightclub participants who do (n = 79) and do not (n = 419) frequent "strip" or adult entertainment clubs (AECs) in Miami, Florida. AEC patrons were older, and more likely to identify as Black race and report STI history. Compared to those who do not, AEC patrons also reported greater recent (past 90-day) frequencies of alcohol and ecstasy use, higher numbers of recent sex partners and were more likely to report recently being high during sex a majority of the time. Increased HIV/STI prevention efforts among young adult AEC patrons appear warranted.

Systematic Review of Contraceptive Use Among Sex Workers in North America

OBJECTIVE

To systematically review the literature regarding contraceptive use by sex workers in North America and to understand factors that limit reproductive agency and affect contraceptive use and decision making.

DATA SOURCES

We searched PubMed, CINAHL, and Embase databases using the search terms "sex work(ers)," "transactional sex," "exchange sex," "prostitution," "contraception," "contraceptive agents," "birth control," "female," and "women."

STUDY SELECTION

Articles were eligible for inclusion in this review if they (a) reported quantitative or qualitative studies based in North America, (b) were written in English, (c) included sex workers (self-identified sex workers or engaged in sex work behavior) as the primary or secondary population of the study, (d) included a population assigned female sex at birth, (e) reported contraceptive outcomes for sex workers, and (f) were published in peer-reviewed journals. The initial search yielded 2,455 articles, and seven met the inclusion criteria.

DATA EXTRACTION

Two authors independently reviewed the articles and organized data in a table to capture study design, sample size and study population, study aims, and contraceptive use. We applied Connell's theory of gender and power as an analytic framework to further identify factors that limited reproductive agency.

DATA SYNTHESIS

Condoms were the most common method of contraceptive used across studies. The use of contraceptives varied by partner type (client vs. nonpaying intimate partners). Access to highly effective contraception was limited by perceived stigma, financial constraints, and substance use. Reproductive and harm reduction services that were co-located where women worked improved contraceptive use. Contraceptive use was affected by factors that limited reproductive agency, including stigma, substance use, intimate partner violence, and condom coercion.

CONCLUSION

The reliance of sex workers on partner-dependent contraception, such as condoms, combined with factors that limit reproductive agency over contraceptive use and decision making contribute to high potential for contraceptive failure and unintended pregnancy. More research is needed to understand the influence of different sexual partner types, pregnancy intention, and contraceptive decision making on the reproductive agency of sex workers.

Patterns and Correlates of New Drug Initiation among Female Exotic Dancers: The Contribution of Occupational and Structural Risks

Introduction: Exotic dance clubs (EDCs) can play pivotal roles in the production of drug-related risks for female exotic dancers (FED). We aimed to characterize the structural and occupational factors associated with new drug initiation post-EDC entry among new FED (N = 117) in Baltimore, Maryland. Materials and Methods: Logistic regression models tested the associations of new drug uptake, measured as initiating any illicit drug (including non-prescribed and diverted prescription narcotics) not used prior to EDC employment, with structural (e.g. debt sources, housing instability) and occupational (e.g. sex work, dancing as sole income source) vulnerabilities. Results: Most FED were younger than 24 years-old (60%), identified as Black/African American (61%), and did not complete high school (56%). Twenty-nine (25%) reported using any new drug post-EDC entry, with cocaine (34%) cited most frequently among newly initiated substances. In multivariable analysis, drug initiation was significantly associated with cumulative debt sources (Adjusted Odds Ratio [AOR] = 1.82, 95% Confidence Interval [CI]: 1.19-2.77), dancing as only income source (AOR = 4.21, CI: 1.29-13.71), and sex work (AOR = 9.26, CI: 2.74-31.32). Conclusions: Our findings implicate co-occurring structural and occupational factors in FED's initiation of illicit drugs proceeding EDC employment. Results demonstrate the coping role of drug use for FED in stressful working environments and the multiple vulnerabilities associated with illicit drug uptake. The study reinforces a need for harm reduction interventions (i.e. debt relief, employment connections, increased hourly pay) that consider the contribution of overlapping financial insecurities to the production of occupational risks motivating drug uptake.

Contraceptive utilization among new exotic dancers: a cross-sectional study

Background

Female exotic dancers are a population at high risk of unintended pregnancy. The objective of this study is to describe the reproductive health needs and contraceptive utilization of exotic dancers.

Methods

New exotic dancers (< 6 months dancing) from 26 clubs in Baltimore City/County completed a one-time survey.

Results

Of 117 participants, 96 (82%) had current contraceptive need. The mean age was 24 years, and 55% were black. Sex work (45%), alcohol use disorder (73%), illicit (44%; e.g., heroin, crack, cocaine), and injection drug use (8%) were common. The majority (66%) reported contraception use in the prior 6 months. Condoms were reported by 46% whereas 45% reported non-barrier methods, most commonly hormonal injection. Consistent condom use was rare (3%), and only 11% used a long-acting reversible method.

Conclusions

Despite their unique reproductive health vulnerabilities, female exotic dancers have unmet contraceptive needs. Targeted harm reduction strategies are needed to fill this gap.

Structural risk and limits on agency among exotic dancers: HIV risk practices in the exotic dance club

This paper provides longitudinal examination of women's health and sexual risk trajectories in US exotic dance clubs, which represent an important commercial setting for the economic mainstreaming of sexual services and an important target for public health programmes. Between July 2014 and May 2015, two semi-structured interviews (at baseline and at three months) were conducted with 24 female exotic dancers who had recently started working in in Baltimore City, USA. Results from a constant comparative analysis point to the interrelationship between the structures of the club setting, including the social context, and women's agentic practices concerning their sexual health. Study findings highlight the centrality of the interrelationship between individual- and structural-level experiences in influencing dancers' risk behavior. Findings point to the need for interventions to empower women both individually and collectively so as to provide the foundation for longer-term structural change.

Experiences of structural vulnerability among exotic dancers in Baltimore, Maryland: Co-occurring social and economic antecedents of HIV/STI risk

BACKGROUND

Women who grow up in economic scarcity often face limited opportunities for upward mobility, as a result of challenges securing stable housing, quality education, and steady employment. Chronic instability may limit the capacity of women to protect themselves against HIV/STI-related harm when engaging in sexual activity or drug use. Characterizing the structural contexts that facilitate HIV/STI risk among women are critical to effective design and implementation of drug and sexual harm reduction interventions.

METHODS

Semi-structured in-depth interviews were completed with 25 female exotic dancers working in Baltimore City and County exotic dance clubs July 2014-May 2015. Using thematic analysis, interviews were examined to understand the nature of structural vulnerability experienced by dancers during their early lives through the initial months of exotic dancing, including an examination of the roles of drug use and social relationships in engagement of sexual risk behavior.

RESULTS

Dancers depicted early experiences of social and economic disadvantage, which accumulated through early adulthood. Substance use emerged as an important subject for the majority of women, operating cyclically as both precursor to and product of accumulating social and economic hardship. Dancers revealed social strategies that buffered the effects of structural vulnerability and minimized exposure to workplace-related drug and sexual harms.

CONCLUSION

This study provides insight on an understudied group of at-risk women with a unique demographic profile. Findings illustrate how the effects of structural vulnerability, substance abuse, social strategies, and opportunities for economic gain through sexual services in the workplace converge to produce varying levels of HIV/STI risk among exotic dancers.

Client and Partner Violence Among Urban Female Exotic Dancers and Intentions for Seeking Support and Justice

Urban female exotic dancers are thought to experience unique risk for violence and barriers to care, though limited research has focused on this aspect of urban sex industries. We characterize recent client-perpetrated and intimate partner violence (IPV) and their correlates, and describe women's intentions for violence-related help-seeking, among venue-based exotic dancers in a high-risk urban environment. We conducted a cross-sectional study with new female exotic dancers (n = 117) in Baltimore, MD. Over one third (36%) reported intimate partner violence (IPV), and 16% reported client physical or sexual violence, in the six months prior to the survey. Both forms of violence were correlated with arrest, sex trade, substance use, and childhood abuse. Violence-related help-seeking intentions were highest for club management. Intentions to seek help from police and violence-related support hotlines were lowest among those with recent experiences of violence. Recent violence, particularly from intimate partners, was pervasive in this sample of female exotic dancers, and enabled by substance use, criminal history, and sex trade. Preferences for help within venues, rather than the justice sector and publicly funded support services, indicate the need for systems reform to meet the needs of this high-risk group of women.

The Development of an HIV Risk Environment Scale of Exotic Dance Clubs

Exotic dancers have received little research attention despite evidence of high-risk behaviours within exotic dance clubs (EDCs). We developed and assessed the reliability and validity of a risk environment score, examining differences between dancers (n = 107) and other staff (n = 172). In the summer of 2013, anonymous surveys were administered via A-CASI in EDCs (N = 26) in Baltimore among exotic dancers and staff. Surveys consisted of a brief demographic section followed by 65 statements. The overall domain had an alpha = 0.77 and subdomains had the following: social (alpha = 0.87), economic (alpha = 0.92), drug (alpha = 0.89), and policy (alpha = 0.66). In a factor analysis, each domain contributed significantly to the overall latent construct. The results indicate a high level of HIV/STI risk for dancers in EDCs and underscore the need for targeted interventions in these environments. As we continue to unpack the function of the broader environment in STI/HIV risk transmission, the scale could be instructive for other settings.