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

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.

Mental health and HIV risk differs by co-occurring structural vulnerabilities among women who sell sex

Female sex workers (FSW) experience many structural vulnerabilities (SV; e.g., violence, economic insecurity) which contribute to increased risk of HIV and mental distress. However, little research has examined how SV co-occur to shape HIV risk, and none have studied mental distress. Among FSW (n = 385) in Baltimore, Maryland, latent class analysis of five binary indicators (housing insecurity; financial dependence on others; client-perpetrated physical or sexual violence; food insecurity) determined classes of SV and differential HIV risk behavior and mental health outcomes. A 3-class model fit the data best: minimal SV (i.e., low probabilities of all indicators); material needs (i.e., housing, food insecurity); and high SV (i.e., high probability of all indicators). Compared to minimal SV, high SV and material needs had significantly greater adjusted probability of drug injection and poorer adjusted depression, post-traumatic stress disorder, and mental distress scores. The high SV class had significantly higher probability of reporting condomless sex with clients compared to material needs and minimal SV. Results show the deleterious effect of co-occurring SV on HIV risk behaviors among FSW with particular emphasis on co-occurring food and housing insecurities. This is the first study of co-occurring SV on mental health outcomes in this key population.

Mapping Interests in Event-Driven and Long-Acting Pre-exposure Prophylaxis Formulations onto the HIV Risk Environment of Street-Based Female Sex Workers: A Latent Class Analysis

Despite growing availability, HIV pre-exposure prophylaxis (PrEP) uptake and adherence remains suboptimal among female sex workers (FSW) in the United States. Using cross-sectional data from a survey of 236 street-based cisgender FSW in Baltimore, Maryland, we examined interest in event-driven and long-acting PrEP formulations. Latent class analysis identified discrete patterns of interest in five novel PrEP agents. Multinomial latent class regression then examined factors associated with probabilistic class membership. A three-class solution emerged as the best-fit latent class model: Injectable Acceptors (~ 24% of sample), Universal Acceptors (~ 18%), and Non-Acceptors (~ 58%). Compared to Non-Acceptors, Universal Acceptors had significantly (p < 0.05) higher odds of reporting condomless vaginal sex with clients, client condom coercion, and client-perpetrated physical violence. Relative to Non-Acceptors, Injectable Acceptors were distinguished by significantly higher rates of condomless vaginal sex with clients and injection drug use. Expanding PrEP options for FSW could help overcome barriers to PrEP initiation and persistence.

Co-occurring Threats to Agency Among Female Sex Workers in Baltimore, Maryland

Driven largely by the unequal distribution of power, female sex workers (FSW) globally bear a disproportionately high burden of HIV, sexually transmitted infections, and interpersonal violence. Prior literature has identified a number of multi-level factors that may serve to constrain FSWs' agency, or their ability to define and take action to realize goals. Among these are work-based violence and substance use, which are potentiated by the criminalization of sex work and structural vulnerability. Quantitative research related to U.S.-based FSWs' own sense of agency, as well as the barriers that may impede it, is sparse. We sought to identify patterns of various threats to agency and explore to what extent they were associated with perceived agency among a cohort of 381 FSW in Baltimore, Maryland, United States, using latent class analysis. Latent class indictors were past-six-month experience of client-perpetrated sexual violence, client-perpetrated physical violence, homelessness, food insecurity, arrest, daily crack-cocaine use, and daily heroin use. Perceived agency was measured using the short form of the Pearlin Mastery Scale. We identified three typologies of threatened agency among women in our sample: a "threatened by structural factors, drug use, and violence" class, a "threatened by structural factors and drug use" class, and a "less threatened" class. Mean perceived agency score was significantly lower for the class characterized by client-perpetrated violence than for either of the other classes. This suggests violence, in the context of deeper, structural power imbalances embedded in hunger, homelessness, and drug use, may dramatically reduce one's sense of agency and operate as a critical barrier to empowerment. Our study adds important insights to the broader FSW community empowerment literature and supports the need for interventions to bolster both individual and collective agency among U.S.-based FSW, including interventions to prevent sex work-related violence.

The role of local business employees and community members in the HIV risk environment of female sex workers in an urban setting: associations between negative interactions and inconsistent condom use

Background

The role of business employees and community members in the HIV risk environment of female sex workers (FSW) is underexplored, despite sex work often located in commercial and residential urban areas. We explored the effect of negative interactions between business employees and community members on inconsistent condom use with clients of female sex workers.

Methods

This study uses baseline data from the EMERALD study, a community empowerment intervention with FSW. We recruited a sample of 361 FSW in Baltimore, Maryland using targeted sampling techniques in ten zones characterized by high rates of sex work, located throughout the city. Participants were recruited between September 2017 and January 2019 and completed a survey, HIV rapid testing, and self-administered gonorrhea and chlamydia testing. The outcome, inconsistent condom use, was defined as not reporting “always” using condoms with paying clients. Poisson regressions with robust variance were used to model the effect of business employee and/or community member interactions on inconsistent condom use.

Results

Over half (54%) the sample was between 18 and 40 years old, 44% Black or another race, and experienced a range of structural vulnerabilities such as housing instability and food insecurity. Forty-four percent of the sample reported inconsistent condom use with clients. FSW reported being reported to the police weekly or daily for selling drugs (14% by employees, 17% by community), for selling sex (19% by employees, 21% by community), and experiencing weekly or daily verbal or physical threats (18% by employees, 24% by community). In multivariable models, being reported to the police for selling sex weekly or daily by community members (vs. never, aRR = 1.42, 95% CI = 1.08, 1.86) and business owners (vs. never, aRR = 1.36, 95% CI = 1.05, 1.76) increased risk of inconsistent condom use, as did monthly verbal or physical threats by community members (vs. never, aRR = 1.43, 95% CI = 1.08, 1.91).

Conclusions

Results show that both actors play important roles in FSWs’ HIV risk environment. Businesses and community members are important targets for holistic HIV prevention interventions among FSW in communities where they coexist in close proximity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12293-4.

Patterns of Sex Work Client Solicitation Settings and Associations with HIV/STI Risk Among a Cohort of Female Sex Workers in Baltimore, Maryland

Female sex workers' (FSWs) risk for HIV/STIs is influenced by their work environments. While previous research has characterized vulnerability in a single workplace, many FSWs solicit clients from multiple settings. Using latent class analysis (LCA), we examined client solicitation patterns and associated HIV/STI-related behaviors (consistent condom use with clients, asking clients about HIV/STIs, and past 6-month HIV/STI testing) among 385 FSWs in Baltimore, Maryland. The LCA yielded a three-class solution: predominantly street (61.2%), mixed street/venue (23.7%), and multisource (street, venue, and online) (15.1%). Consistent condom use differed significantly (p < 0.01) by class, with the mixed street/venue having the lowest (40.6%) rate and the multisource having the highest (70.6%). Classes differed on HIV/STI testing (p < 0.01), with the predominantly street class having the lowest testing rate (56.2%) and multisource with the highest (85.7%). These findings underscore the importance of considering how solicitation patterns are linked to HIV/STI susceptibility of FSWs and adapting interventions accordingly.

Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers

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.

A Practice-Inspired Mindset for Researching the Psychophysiological and Medical Health Effects of Recreational Dance (Dance Sport)

“Dance” has been associated with many psychophysiological and medical health effects. However, varying definitions of what constitute “dance” have led to a rather heterogenous body of evidence about such potential effects, leaving the picture piecemeal at best. It remains unclear what exact parameters may be driving positive effects. We believe that this heterogeneity of evidence is partly due to a lack of a clear definition of dance for such empirical purposes. A differentiation is needed between (a) the effects on the individual when the activity of “dancing” is enjoyed as a dancer within different dance domains (e.g., professional/”high-art” type of dance, erotic dance, religious dance, club dancing, Dance Movement Therapy (DMT), and what is commonly known as hobby, recreational or social dance), and (b) the effects on the individual within these different domains, as a dancer of the different dance styles (solo dance, partnering dance, group dance; and all the different styles within these). Another separate category of dance engagement is, not as a dancer, but as a spectator of all of the above. “Watching dance” as part of an audience has its own set of psychophysiological and neurocognitive effects on the individual, and depends on the context where dance is witnessed. With the help of dance professionals, we first outline some different dance domains and dance styles, and outline aspects that differentiate them, and that may, therefore, cause differential empirical findings when compared regardless (e.g., amount of interpersonal contact, physical exertion, context, cognitive demand, type of movements, complexity of technique and ratio of choreography/improvisation). Then, we outline commonalities between all dance styles. We identify six basic components that are part of any dance practice, as part of a continuum, and review and discuss available research for each of them concerning the possible health and wellbeing effects of each of these components, and how they may relate to the psychophysiological and health effects that are reported for “dancing”: (1) rhythm and music, (2) sociality, (3) technique and fitness, (4) connection and connectedness (self-intimation), (5) flow and mindfulness, (6) aesthetic emotions and imagination. Future research efforts might take into account the important differences between types of dance activities, as well as the six components, for a more targeted assessment of how “dancing” affects the human body.

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.

Sexual behaviors and seroprevalence of HIV, HBV, and HCV among hill tribe youths of Northern Thailand

Background

Sexual behaviors reflect the degree of exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV), especially in people in sexually active stages, such as youths. Hill tribe people have their own cultures, beliefs and lifestyles related to their behaviors, including sexual behaviors, which may lead to HIV, HBV, and HCV infections, especially among youths. The study aimed to examine sexual behaviors and assess the seroprevalence of HIV, HBV, and HCV among hill tribe youths.

Methods

A cross-sectional study was conducted. The participants were recruited from 60 randomly selected hill tribe villages in Chiang Rai Province, Thailand. A validated questionnaire and 5 mL blood specimens were used to collect data. Data were collected by a self-reporting method. Rapid immunochromatographic tests were used to detect hepatitis B surface antibody (anti-HBs), hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), and human immunodeficiency virus antibody-I and- II (anti-HIV-1 and -2). Chi-square and Fisher’s exact test were used to detect the associations between variables.

Results

A total of 1325 participants were recruited for the analysis. The majority were females (60.5%) and aged 15–17 years (58.9%). A total of 14.5% smoked, 22.4% drank alcohol, 14.2% were tattooed, and 61.4% had their ears pierced. Among the 30.3% who had sexual experience, 42.0% experienced one-night stands, 26.9% had sexual contact with a prostitute within 1 year prior to the study, 18.9% used alcohol prior to having sexual intercourse, and 15.7% had been tested for HIV/AIDS previously. Among males, 11.5% were males who had sex with males (MSM), and 4.6% were bisexual. Among females, 83.0% were females who had sex with males, and 5.0% were females who had sex with females. Different sexes and tribes were found to have significantly different risk behaviors and sexual behaviors, such as overall males having a greater proportion of sexual experience than females, and Lahu, Akha and Hmong had a higher proportion of sexual experience, having sexual experience with one-night stands, and having sexual experience with a prostitute 1 year prior to the study than others. Among the 836 obtained blood samples, none were positive for anti-HIV-I and -II, 6.4% were positive for anti-HBs, 1.9% were positive for HBsAg, and 0.2% were positive for anti-HCV.

Conclusion

Hill tribe youths in Thailand are at risk of STIs such as HBV and HCV infections according to their risk behaviors and sexual behaviors, which differ between sexes and tribes. Effective behavioral interventions should be promoted among hill tribe youths to minimize the risk for these diseases in the future.