Committee Opinion No 708: Improving Awareness of and Screening for Health Risks Among Sex Workers

Health implications of sex trading characteristics in Long Beach, California, USA

This study examined the comparative health risk behaviors of women who (a) traded sex for money, (b) traded sex for drugs, (c) traded sex for both drugs and money, or (d) did not trade sex. Self-report data were collected from 2369 women who received services through HIV and sexually transmitted infection (STI) testing programs and a subset were tested for HIV, hepatitis B, hepatitis C, and syphilis. Results revealed those women who traded sex only for money used condoms, were tested for HIV, and received the HIV test results more often than the other women. Women who traded sex for both drugs and money reported a significantly higher prevalence of gonorrhea, hepatitis B, and syphilis; were more likely to test positive for hepatitis B, syphilis, and HIV; engaged more often in sex acts without condoms; and were incarcerated for significantly more days. Based on these findings, the targets with greatest potential for STI prevention interventions are female sex workers who trade sex for both drugs and money.

Gender-Based Violence, Physiological Stress, and Inflammation: A Cross-Sectional Study

BACKGROUND

Female sex workers (FSWs) are at high risk for gender-based violence (GBV) and HIV infection. This study aimed to identify associations between GBV exposure in the past 12 months and biomarkers of physiologic stress and inflammation that may play a role in increased HIV risk among Kenyan FSWs.

MATERIALS AND METHODS

Participating women responded to a detailed questionnaire on GBV and mental health. Plasma was collected for assessment of systemic C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Hair proximal to the scalp was collected to measure cortisol concentration. CRP and IL-6 were measured by enzyme-linked immunosorbent assay, and hair cortisol concentration was determined by enzyme immunoassay. Log-transformed biomarker values were compared across GBV exposure categories using Kruskal-Wallis or Wilcoxon rank sum tests. Multivariable linear regression was used to explore associations between recent GBV and hair cortisol concentration.

RESULTS

Two hundred eighty-three women enrolled, of whom 112 (39.6%) reported physical, sexual, or emotional violence in the past 12 months, 134 (47.3%) reported more remote exposure, and 37 (13.1%) reported no exposure. CRP and IL-6 levels did not differ across groups (p = 0.57 and p = 0.62, respectively). Among 141 women who provided hair, cortisol concentrations were higher among recently exposed women compared to the other two groups combined (p = 0.02). In multivariable regression, recently exposed women had higher hair cortisol levels than remotely exposed or unexposed women (adjusted beta = 0.52, 95% confidence interval 0.02-1.02, p = 0.04).

CONCLUSIONS

While CRP and IL-6 levels did not differ by GBV category, recent GBV was associated with increased hair cortisol concentration. GBV-related increases in cortisol could affect health outcomes and merit study in relation to HIV acquisition risk.