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Harris MT, Weinberger E, O'Brien C, Althoff M, Paltrow-Krulwich S, Taylor JL, Judge A, Samet JH, Walley AY, Gunn CM. PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs. Addict Sci Clin Pract 2024; 19:47. [PMID: 38831359 PMCID: PMC11145858 DOI: 10.1186/s13722-024-00476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Women who engage in sex work and use drugs (WSWUD) experience disproportionate HIV risks. Substance use treatment bridge clinics offer an opportunity to increase HIV pre-exposure prophylaxis (PrEP) delivery to WSWUD, but research on best practices is lacking. Therefore, we explored facilitators and barriers to PrEP across the PrEP care continuum in these settings. METHODS Bridge clinic and affiliated harm reduction health service providers and WSWUD from Boston were recruited using passive and active outreach between December 2021 and August 2022. Participants were invited to take part in semi-structured phone or in-person interviews to explore HIV prevention and PrEP care experiences overall and within bridge clinic settings. Deductive codes were developed based on HIV risk environment frameworks and the Information-Motivation-Behavioral Skills model and inductive codes were added based on transcript review. Grounded content analysis was used to generate themes organized around the PrEP care continuum. RESULTS The sample included 14 providers and 25 WSWUD. Most WSWUD were aware of PrEP and more than half had initiated PrEP at some point. However, most who initiated PrEP did not report success with daily oral adherence. Providers and WSWUD described facilitators and barriers to PrEP across the steps of the care continuum: Awareness, uptake, adherence, and retention. Facilitators for WSWUD included non-stigmatizing communication with providers, rapid wraparound substance use treatment and HIV services, having a PrEP routine, and service structures to support PrEP adherence. Barriers included low HIV risk perceptions and competing drug use and survival priorities. Provider facilitators included clinical note templates prompting HIV risk assessments and training. Barriers included discomfort discussing sex work risks, competing clinical priorities, and a lack of PrEP adherence infrastructure. CONCLUSION WSWUD and bridge clinic providers favored integrated HIV prevention and substance use services in harm reduction and bridge clinic settings. Harm reduction and bridge clinic programs played a key role in HIV prevention and PrEP education for WSWUD. Effective behavioral and structural interventions are still needed to improve PrEP adherence for WSWUD.
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Affiliation(s)
- Miriam Th Harris
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA.
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA.
| | - Emma Weinberger
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
| | - Christine O'Brien
- Project Trust Boston Area Substance Abuse and Harm Reduction, Boston Medical Center, Boston, MA, 02118, USA
| | - Mary Althoff
- AIDS Action Committee, Cambridge, MA, 02119, USA
| | - Samantha Paltrow-Krulwich
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Abigail Judge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, 03756, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
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Zemlak JL, Singer R, Christianson J, Stenersen M, Singh M, Lerret S. Telehealth resources and utilization interest among women who sell sex: An explanatory sequential mixed methods study. PUBLIC HEALTH IN PRACTICE 2024; 7:100502. [PMID: 38800541 PMCID: PMC11127207 DOI: 10.1016/j.puhip.2024.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Among a sample of women who sell sex (WSS), we examined unmet health needs, resources for telehealth, utilization interest, and attributes associated with interest in using telehealth. Study design Explanatory sequential mixed methods. Methods WSS (N = 52) completed a fixed choice survey and focus group (N = 6, 26 individuals) from drop-in centers serving WSS. Chi-square/t-tests and results from the survey data informed the semi-structured focus group interview guide. Thematic analysis of focus group data was conducted to identify themes. Results Over half (58 %) of participants expressed interest in using telehealth; however, some lack the necessary resources for use. While 60 % of participants own mobile phones and 46 % have access to a computer, only 35 % have a secure, private space for telehealth appointments. Interest in telehealth was higher among participants who self-identified as having high risk for HIV compared to low risk for HIV (79 % versus 46 %, p = 0.024), and among those considering PrEP for HIV prevention versus not considering PrEP (68 % versus 32 %, p = 0.046). Focus group participants preferred face-to-face encounters for complex medical concerns but expressed interest in telehealth for improved access to healthcare providers for routine care and mental health. Conclusion Incorporating telehealth into community organizations could be one strategy to address health inequities experienced by WSS. Access to resources, including technology and safe spaces may be well-accepted if offered at trusted community organizations. Such accessibility addresses a gap in care for WSS and paves the way for new avenues for HIV prevention, mental health support, and research related to unmet health needs among WSS.
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Affiliation(s)
- Jessica L. Zemlak
- Marquette University College of Nursing, Clark Hall, 510 N. 16th St., Milwaukee, WI, 53233, USA
| | - Randi Singer
- University of IL-Chicago, College of Nursing, USA
| | | | | | | | - Stacee Lerret
- Marquette University, College of Nursing, USA
- Medical College of Wisconsin, Pediatrics, USA
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Rosen JG, Beckham SW, Glick JL, White RH, Park JN, Footer KH, Sherman SG. Acceptability of Event-Driven and Long-Acting HIV Pre-Exposure Prophylaxis Formulations Among Transgender Women Engaged in Street-Based Sex Work in Baltimore, Maryland. Transgend Health 2024; 9:185-191. [PMID: 38585249 PMCID: PMC10998007 DOI: 10.1089/trgh.2022.0057] [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: 11/07/2022] Open
Abstract
We assessed acceptability of nonoral HIV pre-exposure prophylaxis (PrEP) formulations among transgender women (TW) engaged in street-based sex work in Baltimore, Maryland. In a K-means cluster analysis, TW (N=36) were partitioned into groups characterized by high interest in long-acting injectable PrEP only (Injectable Enthusiasts, 36%), high interest in injectables and subdermal implants (Long-Acting Acceptors, 36%), and low interest across PrEP formulations (Non-Acceptors, 28%). TW's interest in novel PrEP agents varied widely across formulations (range: 22-66%) and clustered around numerous relational, occupational, and structural factors, highlighting the importance of availing multiple PrEP formulations for this impacted population.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health and Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S. Wilson Beckham
- Department of International Health and Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine H.A. Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Paine EA, Rivera-Cash D, Lopez JM, LeBlanc AJ, Singh AA, Bockting WO. Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities. AIDS Behav 2024; 28:1197-1209. [PMID: 37698637 PMCID: PMC11218028 DOI: 10.1007/s10461-023-04143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/13/2023]
Abstract
Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships-termed economic marginality-are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.
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Affiliation(s)
- Emily Allen Paine
- Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA.
| | - Dennis Rivera-Cash
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
| | - Jasmine M Lopez
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
| | - Allen J LeBlanc
- Health Equity Institute, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Anneliese A Singh
- Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Walter O Bockting
- Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
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5
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Zemlak JL, Alexander KA, Wilson D, Singer R, Williams JS, Sherman SG. Sex Workers' Experiences of Screening for Intimate Partner Violence. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00034-0. [PMID: 38490264 DOI: 10.1016/j.jogn.2024.02.005] [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: 08/20/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To examine experiences of intimate partner violence (IPV) screening among women who sell sex. DESIGN A qualitative descriptive study. SETTING Telephone interviews during the COVID-19 pandemic (June 2020 to October 2020). PARTICIPANTS Women aged 18 to 49 years who sold or traded sex for food, drugs, money, or shelter at least three times during the past 3 months before recruitment (N = 22). METHODS We used individual, semistructured telephone interviews to collect data about participants' experiences with IPV and IPV screening during health care encounters. We used reflexive thematic analysis to examine these data. RESULTS We identified two overarching themes related to IPV screening experiences: Preferences for IPV Screening and Barriers to Disclosure of IPV Experiences. Participants described a preference for IPV screening done face-to-face with providers who show a genuine interest in their responses. Stigma was a barrier of IPV disclosure. CONCLUSION Health care providers are a trusted safety net for disclosure of IPV experiences. Providing screening in a trauma-informed, nonstigmatizing manner may facilitate disclosure of IPV by women who sell sex. Future research among marginalized populations is needed to examine ways to address IPV in clinical settings with a harm reduction empowerment lens.
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Stenersen MR, Thomas K, McKee S. Police Harassment and Violence Against Transgender & Gender Diverse Sex Workers in the United States. JOURNAL OF HOMOSEXUALITY 2024; 71:828-840. [PMID: 36228168 DOI: 10.1080/00918369.2022.2132578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sex workers continue to experience high rates of abuse and violence around the world. However, information regarding police-perpetrated harassment and violence against transgender and gender diverse (TGD) sex workers in the United States remains extremely limited. The current study is the first known examination of police interaction, harassment, and violence among TGD sex workers in the United States using a large nationwide dataset. Data from 23,372 TGD people were used. Results revealed that sex workers were more likely to experience police interaction, harassment, and violence compared to non-sex workers. Among sex workers with police interaction while doing sex work, 89.2% reported experiencing at least one type of harassment and/or violence. Regression analyses revealed that individuals with no reported income and trans women were more likely to experience multiple types of police harassment/violence. Taken together, TGD sex workers continue to experience alarming rates of interaction, harassment, and violence from police in the United States. Urgent, and effective intervention is needed to eliminate police harassment and violence toward TGD sex workers and provide support for TGD sex workers who survive this violence.
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Affiliation(s)
- Madeline R Stenersen
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn Thomas
- Justice Collaboratory, Yale Law School & SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sherry McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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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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8
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Cooney EE, Footer KHA, Glick JL, Passaniti A, Howes M, Sherman SG. Understanding the social and structural context of oral PrEP delivery: an ethnography exploring barriers and facilitators impacting transgender women who engage in street-based sex work in Baltimore, Maryland. AIDS Res Ther 2023; 20:69. [PMID: 37730616 PMCID: PMC10510123 DOI: 10.1186/s12981-023-00556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Transgender women who sell sex (TWSS) experience high rates of HIV acquisition. Antiretrovirals for pre-exposure prophylaxis (PrEP) represent an efficacious HIV prevention strategy. The social and structural factors affecting PrEP delivery amongst TWSS are underexplored in the literature. We conducted ethnographic research to examine how multilevel social and structural factors manifest in TWSS's lived experiences and affect PrEP delivery and use. Twenty-four transgender women were recruited from the SAPPHIRE cohort and completed interviews focused on barriers and facilitators to PrEP engagement in the context of street-based sex work. Stakeholder interviews (N = 7) were also conducted. Our findings suggest there are unique features of the risk environment that can collectively impede PrEP use among TWSS.
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Affiliation(s)
- Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Katherine H A Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Jennifer L Glick
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anna Passaniti
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Meridian Howes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Maclin BJ, Wang Y, Rodriguez-Diaz C, Donastorg Y, Perez M, Gomez H, Barrington C, Kerrigan D. Comparing typologies of violence exposure and associations with syndemic health outcomes among cisgender and transgender female sex workers living with HIV in the Dominican Republic. PLoS One 2023; 18:e0291314. [PMID: 37695770 PMCID: PMC10495030 DOI: 10.1371/journal.pone.0291314] [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] [Received: 12/28/2022] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
Violence against women research largely excludes transgender women's experiences and violence from perpetrators other than intimate partners. This study compares patterns of violence exposure among cisgender and transgender female sex workers (FSWs) and the associations with syndemic health outcomes. We used cross-sectional surveys from samples of cisgender and transgender FSWs living with HIV in the Dominican Republic (N = 211 and 100, respectively). We used latent class analysis to identify patterns of emotional, physical, and sexual violence and harassment by partners, clients, and police. We assessed sociodemographic and occupational predictors in relation to class membership, and class membership in relation to health (HIV continuum of care outcomes, mental health, substance use), using logistic regression. Two classes were identified in cisgender sample: Low Reported Violence Exposure (Class 1) and Sex Work-related Police Harassment (Class 2). Class 2 participants had greater odds of scoring abnormal or borderline abnormal anxiety on the Hospital Anxiety and Depression Scale (HADS-A) (adjusted OR = 3.97, p<0.01), moderate-to-severe depression per the Patient Health Questionnaire-9 (PHQ-9) (aOR = 5.74, p<0.01), and any illicit drug use in the past six months (aOR = 3.06, p<0.05), compared to Class 1. The transgender sample produced three classes: Low Reported Violence Exposure (Class 1); Sex Work-related Police Harassment (Class 2); and Sex Work-related Violence and Harassment (Class 3). Class 3 participants had greater odds of having anxiety (aOR = 6.65, p<0.01) and depression (aOR = 4.45, p<0.05), while Class 2 participants had greater odds of perfect ART adherence during the previous four days (aOR = 2.78, p<0.05), compared to Class 1. The more diverse and extreme violence patterns uncovered for the transgender sample show this group's heightened risk, while similar patterns across groups regarding police abuse highlight a need for police-focused violence prevention interventions. Each sample's highest violence class was associated with poor mental health, underscoring the need for mental health interventions for all FSWs.
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Affiliation(s)
- Beth J. Maclin
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Carlos Rodriguez-Diaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
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10
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Cooper L, Rosen JG, Zhang L, Pelaez D, Olatunde PF, Owczarzak J, Park JN, Glick JL. Exploring the impact of the COVID-19 pandemic on healthcare and substance use service access among women who inject drugs: a qualitative study. Harm Reduct J 2023; 20:71. [PMID: 37296423 PMCID: PMC10251329 DOI: 10.1186/s12954-023-00793-y] [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] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare and substance use services engagement, including primary and mental health services as well as residential and outpatient drug treatment. Women who inject drugs (WWID) face known barriers to healthcare and substance use service engagement, which pre-date the COVID-19 pandemic. The impact of COVID-19 on WWID's engagement with healthcare and substance use services, however, remains understudied. METHODS To explore the impact of the COVID-19 pandemic on service-seeking and utilization, we conducted in-depth interviews with 27 cisgender WWID in Baltimore, Maryland, in April-September 2021. Iterative, team-based thematic analysis of interview transcripts identified disruptions and adaptations to healthcare and substance use services during the COVID-19 pandemic. RESULTS The COVID-19 pandemic disrupted service engagement for WWID through service closures, pandemic safety measures restricting in-person service provision, and concerns related to contracting COVID-19 at service sites. However, participants also described various service adaptations, including telehealth, multi-month prescriptions, and expanded service delivery modalities (e.g., mobile and home delivery of harm reduction services), which overwhelmingly increased service engagement. CONCLUSION To build upon service adaptations occurring during the pandemic and maximize expanded access for WWID, it is vital for healthcare and substance use service providers to continue prioritizing expansion of service delivery modality options, like telehealth and the provision of existing harm reduction services through alternative platforms (e.g., mobile services), that facilitate care continuity and increase coverage.
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Affiliation(s)
- Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Oakland, USA
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Praise F. Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI USA
- Center for Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI USA
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
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11
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Sherman SG, Tomko C, Nestadt DF, Silberzahn BE, Clouse E, Haney K, Allen ST, Galai N. Impact of a Community Empowerment Intervention on Sexually Transmitted Infections Among Female Sex Workers in Baltimore, Maryland. Sex Transm Dis 2023; 50:374-380. [PMID: 36749851 DOI: 10.1097/olq.0000000000001781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Female sex workers ( FSWs) are vulnerable to a number of health issues, but often delay seeking health care due to structural barriers. Multiservice drop-in centers have been shown to increase FSW access to health services globally, but their impact on FSW in the United States is lacking. This study seeks to evaluate the effect of a community-level empowerment intervention (the multiservice drop-in SPARC center) on cumulative sexually transmitted infections (STIs) among FSW in a city in the United States. METHODS Between September 2017 and January 2019, 385 FSWs were recruited in Baltimore. Participants from areas served by SPARC were recruited to the intervention; other areas of Baltimore were the control. Follow-up occurred at 6, 12, and 18 months. The primary outcome is cumulative STI (ie, positive gonorrhea or chlamydia test at any follow-up). We tested effect modification by condomless sex with paying clients reported at baseline. Logistic regressions with propensity score weighting were used to estimate intervention effect, accounting for loss to follow-up, with bootstrap confidence intervals. RESULTS Participants completed 713 follow-up study visits (73%, 70%, 64% retention at 6, 12, and 18 months, respectively). Baseline STI prevalence was 28% and cumulative STI prevalence across follow-ups was 26%; these both did not differ between control and intervention communities in bivariate analyses. After adjusting for covariates, FSW in the intervention had a borderline-significant decrease in odds of cumulative STI compared with control (odds ratio, 0.61, P = 0.09 ) . There was evidence of effect modification by baseline condomless sex, such that FSW in the intervention who reported condomless sex had lower odds of cumulative STI compared with FSW in the control community who also reported baseline condomless sex (odds ratio, 0.29; P = 0.04). CONCLUSIONS Results demonstrate the value of a low-barrier, multiservice model on reducing STIs among the highest-risk FSW.Clinical Trial Number: NCT04413591.
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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
| | - Danielle F 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
| | - Sean T Allen
- 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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12
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Allen ST, White RH, Nestadt DF, Tomko C, Decker MR, Sherman SG. Who Asks About HIV/STI Status?: An Analysis of Women Who Sell Sex and Inject Drugs. AIDS Behav 2023; 27:1666-1673. [PMID: 36318423 DOI: 10.1007/s10461-022-03898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 05/16/2023]
Abstract
Communication about HIV and sexually transmitted infections (STI) is a cornerstone of risk reduction, yet there is a dearth of research that examines communication patterns among persons with dual risks for HIV/STI acquisition, such as women who sell sex and inject drugs (WSSID). We used logistic regression to identify factors associated with WSSID (N = 211) in Baltimore, Maryland always asking new clients about their HIV/STI status. Most WSSID were non-Hispanic White (73%) and 74% reported current homelessness. 50% of WSSID reported always asking new clients about their HIV/STI status. Experiencing depressive symptoms (adjusted odds ratio [aOR]: 0.53; 95% confidence interval [CI]: 0.29, 0.96) and having condomless sex with clients (aOR 0.31; 95% CI: 0.17, 0.57) were inversely associated with WSSID always asking new clients about their HIV/STI status. Recent entry into sex work (aOR 2.99; 95% CI: 1.30, 6.87) was positively associated with always asking new clients about their HIV/STI status. Enhancing HIV/STI communication in combination with engagement in other risk mitigation strategies may decrease disease incidence among WSSID.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Danielle F Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., 21205, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
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13
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Sherman SG, Tomko C, Rouhani S. De Facto Decriminalization for Drug Possession and Sex Work in Baltimore, Maryland. Am J Prev Med 2023; 64:567-568. [PMID: 36690542 DOI: 10.1016/j.amepre.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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TOMKO C, MUSCI RJ, KAUFMAN MR, UNDERWOOD CR, DECKER MR, SHERMAN SG. Mental health and HIV risk differs by co-occurring structural vulnerabilities among women who sell sex. AIDS Care 2023; 35:205-214. [PMID: 36102030 PMCID: PMC10011022 DOI: 10.1080/09540121.2022.2121374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
- Catherine TOMKO
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rashelle J. MUSCI
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle R. KAUFMAN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carol R. UNDERWOOD
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R. DECKER
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan G. SHERMAN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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Nestadt DF, Schneider KE, Tomko C, Sherman SG. Criminalization and coercion: sexual encounters with police among a longitudinal cohort of women who exchange sex in Baltimore, Maryland. Harm Reduct J 2023; 20:11. [PMID: 36707897 PMCID: PMC9881257 DOI: 10.1186/s12954-023-00738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The criminalization of sex work and drug use creates unequal power dynamics easily exploited by police. Women who exchange sex (WES) in settings around the globe have reported coerced sex and sexual assault by police, and some have reported police as paying clients. Little research has examined nuances underlying WES's sexual interactions with police. METHODS A cohort of cisgender WES (N = 308) was recruited through targeted sampling in Baltimore, Maryland and completed a structured survey every 6 months for 18 months. Follow-up surveys included detailed questions about recent sexual encounters with police. In bivariate and multivariate models using generalized estimating equations to account for intra-person correlation, we examined correlates of reporting recent sex with police over time. RESULTS One-third reported recent sex with police at any study visit. At each time point, about 90% of women who reported sex with police reported any uniformed or non-uniformed police had paid for sex. Between 72 and 85% had been solicited for paid sex by uniformed police. Between 41 and 50% of women who reported recent sex with police indicated they had done so because they feared arrest otherwise; one-third were directly pressured for sex by police to avoid arrest or trouble. In the final adjusted model, severe food insecurity [adjusted odds ratio (aOR) = 2.05; 95% confidence interval (CI) 1.13-3.71], Black race (vs. white, non-Hispanic; aOR = 1.90; 95% CI 1.13-3.17), recent arrest (aOR = 1.51; 95% CI 1.01-2.27), nonfatal overdose (aOR = 1.94; 95% CI 1.24-3.01), and client- or non-paying intimate partner-perpetrated violence (aOR = 2.46; 95% CI 1.63-3.71) were significantly independently associated with recent sex with police. CONCLUSIONS Sexual encounters between WES and police in Baltimore are common and often coerced to avoid arrest in a setting where both drug use and sex work are criminalized. Recent sex with police was more prevalent among WES who were racially marginalized, highly structurally vulnerable, and/or at high risk for drug overdose-and therefore subject to the dual-criminalization of sex work and drug use. This indicates deep power imbalances and their exploitation by police as the root of such sexual encounters and adds to the evidence regarding the need for decriminalization to support the health and wellbeing of WES.
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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.
| | - Kristin E. Schneider
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Catherine Tomko
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Susan G. Sherman
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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16
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Xu L, Chang R, Chen Y, Xia D, Xu C, Yu X, Chen H, Wang R, Liu Y, Liu S, Ge X, Ma T, Zhou Y, Wang Y, Ma S, Cai Y. The prevalence of childhood sexual experiences and intimate partner violence among transgender women in China: Risk factors for lifetime suicidal ideation. Front Public Health 2023; 10:1037622. [PMID: 36755737 PMCID: PMC9900504 DOI: 10.3389/fpubh.2022.1037622] [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: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Several studies highlighted childhood sexual experiences (CSEs) and intimate partner violence (IPV) as risk factors that affected lifetime suicidal ideation. TW had higher rates of CSEs and IPV than cisgender people. The aim of this study was to comprehensively assess the prevalence of CSEs and IPV among TW and their association with lifetime suicidal ideation. Methods A cross-sectional survey was conducted among 247 TW in Shenyang and Kunming, China, from April to September 2018. CSEs, IPV, and lifetime suicidal ideation were assessed. Logistic regression models were used to examine the association between self-reported CSEs under 18 years of age, IPV in adulthood, and lifetime suicidal ideation. Results In the study, 14.2% (35/247) of the sample participants reported CSEs under 18 years of age; 44.9% (111/247) reported experiencing IPV in adulthood, including 18.6% (44/247) of physical IPV, 27.1% (67/247) of trans-specific identity IPV, 31.6% (78/247) of verbal IPV, and 19.4% (48/247) of sexual IPV; and 26.3% (65/247) had thought about attempting suicide at least one time. CSEs and any form of IPV were significantly associated with suicidal ideation in this sample population. A final stepwise multivariate logistic regression model found that both physical and verbal IPVs were significantly associated with suicidal ideation when controlling for other factors (ORm1 = 2.58, 95% confidence interval (CI) = 1.163-5.724; ORm2 = 2.72, 95% CI = 1.334-5.547). Conclusions The findings highlight the effects of CSEs and IPV among TW and suggest the need for research on suicide in the future. Suicide prevention efforts for this invisible and vulnerable population should focus on those with physical and verbal IPV.
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Affiliation(s)
- Lulu Xu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruijie Chang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingjie Chen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Danni Xia
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Xu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Chen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rongxi Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yujie Liu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shangbin Liu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Ge
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tiecheng Ma
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China
| | - Yiwen Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sunxiang Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Sunxiang Ma ✉
| | - Yong Cai
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Center for Community Health Care, Hospital Development Institute Shanghai Jiao Tong University, Shanghai, China,Yong Cai ✉
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17
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Tomko C, Clouse E, Haney K, Galai N, Footer K, Ferryman K, Smith KC, Sherman SG. A study protocol to explore and implement community-based point-of-care COVID-19 testing for women who use drugs in Baltimore, Maryland: The CARE study. PLoS One 2022; 17:e0277605. [PMID: 36542613 PMCID: PMC9770432 DOI: 10.1371/journal.pone.0277605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Women who use drugs (WWUD) experience structural vulnerabilities (e.g., housing, food insecurities) and comorbidities that elevate their susceptibility to more severe COVID-19 symptoms or fatality compared to similarly-aged women who do not use illicit drugs. Testing is a cornerstone of effective COVID prevention, however, entrenched barriers to healthcare utilization means that WWUD may have diminished accessing to COVID testing. The CARE (COVID Action Research Engagement) study first examines predisposing and enabling factors that predict COVID testing uptake over six months (baseline, 3-, and 6-month follow-up) among a cohort of WWUD (N = 250) in Baltimore, Maryland, providing a nuanced and holistic understanding of how to meaningfully engage WWUD in COVID testing. Then, point-of-care COVID testing will be implemented on a mobile outreach van affiliated with a local community-based organization primarily serving WWUD; anonymous surveys of mobile outreach guests (N = 100) will assess feasibility and acceptability of this integrated testing. The study is grounded in the Behavioral Model for Vulnerable Populations and the Theoretical Framework of Acceptability. We hypothesize that point-of-care COVID testing integrated into a low-barrier harm reduction service, such as a mobile outreach program, will be an enabling environment for COVID testing uptake in part by reducing structural impediments to testing and will be highly feasible and acceptable to participants. Strengths, limitations, and plans for results dissemination are discussed.
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Affiliation(s)
- Catherine Tomko
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Emily Clouse
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Haney
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kadija Ferryman
- Berman Institute of Bioethics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Clegg Smith
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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18
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Rosen JG, Schneider KE, Allen ST, Morris M, Urquhart GJ, Rouhani S, Sherman SG. Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland. Harm Reduct J 2022; 19:115. [PMID: 36242081 PMCID: PMC9569095 DOI: 10.1186/s12954-022-00697-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men's selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. METHODS Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. RESULTS Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97-0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81-7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05-3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02-3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. CONCLUSIONS Synergistic sources of social and structural marginalization-from sexuality to hunger, homelessness, and injection drug use-are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Glenna J Urquhart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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19
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Schneider KE, Tomko C, Nestadt DF, Rouhani S, White RH, Decker MR, Galai N, Sherman SG. Understanding the longitudinal relationship between substance use and violent victimization among street-based women who exchange sex in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103824. [PMID: 35985083 DOI: 10.1016/j.drugpo.2022.103824] [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: 02/21/2022] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Women who exchange sex (WES) experience extensive interpersonal violence from multiple perpetrators. Violence towards WES contributes to poor mental and behavioral health outcomes, including high rates of drug use. However, it is difficult to disentangle the temporal relationship between drug use and violence among WES. METHODS We used data from 251 WES, who completed baseline and 6-month follow up surveys. WES reported baseline sociodemographic characteristics, including homelessness and hunger. Participants reported their drug use by type and violent experiences by perpetrator at each time point. We conducted a path analysis examining the associations between drug use and violent victimization over time. RESULTS Participants were on average 37.8 years old, non-Hispanic White (57.4%) and experiencing high levels of structural vulnerability (59.4% homelessness; 58.6% weekly hunger). Drug use and violence were significantly correlated within each time point. Prospectively, baseline violent victimization was significantly associated with drug use (ß (SE) = 0.13 (0.06)) and violence (ß (SE) = 0.47 (0.05)) at follow up. Baseline drug use was associated with drug use at follow up (ß (SE) = 0.45 (0.05)) but was not significantly associated with violence at follow up (ß (SE) = 0.10 (0.06)). CONCLUSIONS Violence and drug use are closely linked in this population; and violence appears to facilitate sustained drug use. Interventions to address the dual epidemics of violence and substance use in this population should address underlying trauma as well as socio-structural drivers of violence as well as tailored harm reduction services for this population.
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Affiliation(s)
- Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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20
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Glick JL, Jivapong B, Russo R, Pelaez D, Piser R, Footer K, Sherman SG. Cultivating PEARL (Promoting Empowerment and Risk Reduction): Formative Research for a PrEP Intervention Among Female Sex Workers in Baltimore, Maryland. AIDS Behav 2022; 26:2664-2675. [PMID: 35124751 PMCID: PMC9885761 DOI: 10.1007/s10461-022-03600-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a vital component of comprehensive HIV prevention among female sex workers (FSW). There are limited PrEP interventions targeting FSW in the U.S., who have high HIV risk. Formative research was conducted to inform PEARL (Promoting Empowerment And Risk Reduction), a PrEP intervention for FSW in Baltimore, MD, including a community forum, key informant interviews with providers, and focus group discussions with FSW. FSW and providers acknowledged challenges to building rapport and establishing continuity in care settings. FSW reported low PrEP awareness, with high interest once aware. FSW and providers reported uptake barriers including perceived financial issues, lack of PrEP awareness, and mistrust of the pharmaceutical industry. Concerns were raised about substance use and daily PrEP adherence. Developing a tailored PrEP intervention for FSW necessitates multiple perspectives (e.g. FSW, service providers). Resumen La profilaxis preexposición (PrEP) es un componente vital de la prevención integral del VIH para las trabajadoras sexuales (TSF). En los Estados Unidos, hay pocas intervenciones de PrEP dirigidas a las TSF, quienes experiencian un riesgo elevado de contraer el VIH. Se realizó una investigación formativa para informar a PEARL (Promoción del empoderamiento y la reducción de riesgos), una intervención de PrEP para TSF en Baltimore, MD-la cual incluyó un foro comunitario, entrevistas con proveedores de servicios a las TSF y discusiones entre grupos focales de TSF. TSF y proveedores de servicio reconocieron los retos de mantener buenas relaciones y establecer continuidad en los servicios de salud. TSF exhibieron conocimiento limitado sobre la PrEP, pero expresaron gran interés en la PrEP después de estar informadas. TSF y los proveedores de servicios hablaron de barreras aceptando a la PrEP, incluyendo problemas financieros percibidos, falta de conocimiento sobre la PrEP y desconfianza en la industria farmacéutica. Se expresaron preocupaciones sobre el uso de sustancias y la adherencia diaria a la PrEP. El desarrollo de una intervención de PrEP personalizada para TSF requiere varias perspectivas (por ejemplo, TSF, proveedores de servicios).
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Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Belinda Jivapong
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rienna Russo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rebecca Piser
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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21
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Rosen JG, Park JN, Schneider KE, White RH, Beckham SW, Glick JL, Footer KHA, Sherman SG. 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. AIDS Behav 2022; 26:1992-2002. [PMID: 35362908 DOI: 10.1007/s10461-022-03613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
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.
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Nestadt DF, Tomko C, Schneider KE, Kerrigan D, Decker MR, Sherman SG. Co-occurring Threats to Agency Among Female Sex Workers in Baltimore, Maryland. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8818-NP8843. [PMID: 33300442 PMCID: PMC9136478 DOI: 10.1177/0886260520978188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
| | - Catherine Tomko
- 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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Sexual Risk Behavior and Lifetime HIV Testing: The Role of Adverse Childhood Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074372. [PMID: 35410050 PMCID: PMC8998687 DOI: 10.3390/ijerph19074372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
Despite the success of HIV prevention drugs such as PrEP, HIV incident transmission rates remain a significant problem in the United States. A life-course perspective, including experiences of childhood adversity, may be useful in addressing the HIV epidemic. This paper used 2019 BRFSS data to elucidate the role that childhood adversity plays in the relationship between HIV risk and HIV testing. Participants (n = 58,258) completed self-report measures of HIV risk behaviors, HIV testing, and adverse childhood experiences (ACEs). The median number ACEs in the sample was 1, with verbal abuse (33.9%), and parental separation (31.3%) being the most common ACEs reported. Bivariate findings showed that all ACEs were associated with increased HIV risk and testing. However, increased risk was not correlated with increased HIV testing, with the highest incongruence related to mental health problems of household member (53.48%). While both self-reported HIV risk and ACEs were positively associated with HIV testing, their interaction had a negative association with testing (aPR = 0.51, 95%CI 0.42, 0.62). The results highlight the need for targeted HIV prevention strategies for at-risk individuals with a history of childhood adversity.
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Beckham SW, Glick JL, Schneider KE, Allen ST, Shipp L, White RH, Park JN, Sherman SG. Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073783. [PMID: 35409469 PMCID: PMC8997521 DOI: 10.3390/ijerph19073783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023]
Abstract
We describe patterns of polysubstance use and associations with HIV risk-related behaviors among women engaged in street-based transactional sex, an understudied yet important population and area of research. This sample was restricted to cisgender women who reported drug use (n = 244) in the baseline of the longitudinal SAPPHIRE cohort study. Latent class analysis (LCA) was conducted using drug use measures (route of administration (injection/non-injection); type of drug (specific opioids, stimulants)) and selection based on fit statistics and qualitative interpretation of the classes. Polysubstance use was prevalent (89% ≥ 2), and 68% had injected drugs in the past 3 months. A three-class solution was selected: Class 1 ("heroin/cocaine use", 48.4% of sample), Class 2 ("poly-opioid use", 21.3%), and Class 3 ("poly-route, polysubstance use", 30.3%). Class 3 was significantly younger, and Class 2 was disproportionately non-White. Women reported high levels of housing (63%) and food (55%) insecurity, condomless sex with clients (40%), and client-perpetrated violence (35%), with no significant differences by class. Obtaining syringes from syringe services programs differed significantly by class, despite injection behaviors in all classes. Tailored HIV and overdose prevention programming that considers drug use patterns would strengthen their impact.
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Affiliation(s)
- Sam Wilson Beckham
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
- Correspondence:
| | - Jennifer L. Glick
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Kristin E. Schneider
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21201, USA;
| | - Sean T. Allen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Lillian Shipp
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21201, USA;
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
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Cyrus E, Johnson SA, Perez-Gilbe HR, Wuyke G, Fajardo FJ, Garba NA, Deviéux J, Jimenez D, Garcia S, Holder CL. Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida. Transgend Health 2022; 7:52-60. [PMID: 35224190 PMCID: PMC8867217 DOI: 10.1089/trgh.2020.0066] [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: 11/12/2022] Open
Abstract
Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.
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Affiliation(s)
- Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA.,*Address correspondence to: Elena Cyrus, PhD, MPH, Department of Population Health Sciences, College of Medicine, University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA,
| | - Shaina A. Johnson
- Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Hector R. Perez-Gilbe
- Health Sciences UCI Libraries, University of California-Irvine, Irvine, California, USA
| | - Gabriella Wuyke
- Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Francisco J. Fajardo
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Nana Aisha Garba
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jessy Deviéux
- Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Daniel Jimenez
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, Florida, USA
| | - Stephanie Garcia
- Integrated Biostatistics and Data Management Center, Florida International University, Miami, Florida, USA
| | - Cheryl L. Holder
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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Sherman SG, Tomko C, Silberzahn BE, White RH, Nestadt DF, Clouse E, Haney K, Galai N. 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. BMC Public Health 2021; 21:2265. [PMID: 34895195 PMCID: PMC8666055 DOI: 10.1186/s12889-021-12293-4] [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: 07/17/2020] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Susan G Sherman
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Hampton House 180, Baltimore, MD, 21205, USA.
| | - Catherine Tomko
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Hampton House 180, Baltimore, MD, 21205, USA
| | - Bradley E Silberzahn
- Sociology, The University of Texas at Austin, 305 E 23rd St, A1700, RLP 3.306, Austin, TX, 78712, USA
| | - Rebecca Hamilton White
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Hampton House 180, Baltimore, MD, 21205, USA
| | - Danielle Friedman Nestadt
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Hampton House 180, Baltimore, MD, 21205, USA
| | - Emily Clouse
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Hampton House 180, Baltimore, MD, 21205, USA
| | - Katherine Haney
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Hampton House 180, Baltimore, MD, 21205, USA
| | - Noya Galai
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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27
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Stutterheim SE, van Dijk M, Wang H, Jonas KJ. The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS One 2021; 16:e0260063. [PMID: 34851961 PMCID: PMC8635361 DOI: 10.1371/journal.pone.0260063] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.
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Affiliation(s)
- Sarah E. Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mart van Dijk
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Experiences with substance use disorder treatment during the COVID-19 pandemic: Findings from a multistate survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103537. [PMID: 34871945 PMCID: PMC8602971 DOI: 10.1016/j.drugpo.2021.103537] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
Background Drug overdoses surged during the COVID-19 pandemic, underscoring the need for expanded and accessible substance use disorder (SUD) treatment. Relatively little is known about the experiences of patients receiving treatment during the pandemic. Methods We worked with 21 harm reduction and drug treatment programs in nine states and the District of Columbia from August 2020 to January 2021. Programs distributed study recruitment cards to clients. Clients responded to the survey by calling a study hotline and providing a unique study identification number. Our survey included detailed questions about use of SUD treatment prior to and since the COVID-19 pandemic. We identified settings where individuals received treatment and, for those treated for opioid use disorder, we examined use of medications for opioid use disorder. Individuals also reported whether they had received telehealth treatment and pandemic related treatment changes (e.g., more take-home methadone). We calculated p-values for differences pre and since COVID-19. Results We interviewed 587 individuals of whom 316 (53.8%) were in drug treatment both before and during the COVID-19 pandemic. Individuals in treatment reported substantial reductions in in-person service use since the start of the pandemic, including a 27 percentage point reduction (p<.001) in group counseling sessions and 28 percentage point reduction in mutual aid group participation (p<.001). By contrast, individuals reported a 21 percentage point increase in receipt of overdose education (p<.001). Most people receiving medications for opioid use disorder reported taking methadone and had high continuity of treatment (86.1% received methadone pre-COVID and 87.1% since-COVID, p=.71). Almost all reported taking advantage of new policy changes such as counseling by video/phone, increased take-home medication, or fewer urine drug screens. Overall, respondents reported relatively high satisfaction with their treatment and with telehealth adaptations (e.g., 80.2% reported “I'm able to get all the treatment that I need”). Conclusions Accommodations to treatment made under the federal public health emergency appear to have sustained access to treatment in the early months of the pandemic. Since these changes are set to expire after the official public health emergency declaration, further action is needed to meet the ongoing need.
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Park JN, Decker MR, Bass JK, Galai N, Tomko C, Jain KM, Footer KHA, Sherman SG. Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10383-10404. [PMID: 31679445 PMCID: PMC7195245 DOI: 10.1177/0886260519884694] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity (p < .05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity (p < .05). Binge drinking also appeared to be a contributing factor (p < .05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.
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Affiliation(s)
- Ju Nyeong Park
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith K Bass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kriti M Jain
- 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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30
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Okonji EF, van Wyk B, Mukumbang FC, Hughes GD. Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis. AIDS Res Ther 2021; 18:66. [PMID: 34627300 PMCID: PMC8501534 DOI: 10.1186/s12981-021-00391-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Achieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa. METHODS A cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. RESULTS The mean age of the participants was 14.75 years (SD = 2.9), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9386 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among ALHIV who were: female (AOR = 1.21, 95% CI 1.05-1.39), and had most recent CD4 count > 200 (AOR = 2.53, 95% CI 2.06-3.11). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count > 200 at baseline (AOR = 0.73, 95% CI 0.61-0.87), and who were switched to second line regimen (AOR = 0.41, 95% CI 0.34-0.49). CONCLUSIONS Viral suppression amongst ALHIV at 74% is considerably lower than the WHO target of 95%. Of particular concern for intervention is the lower rates of viral suppression amongst male ALHIV. Greater emphasis should be placed to early enrolment of ALHIV on ART and keeping them engaged in care (beyond 6 months). Furthermore, improved and regular viral load monitoring will help to adequately identify and manage ALHIV with unsuppressed viral load and subsequently switching to second line treatment.
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Affiliation(s)
- Emeka F Okonji
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa.
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Gail D Hughes
- Medical Biosciences Department, University of the Western Cape, Bellville, South Africa
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Chien J, Schneider KE, Tomko C, Galai N, Lim S, Sherman SG. Patterns of Sex Work Client Solicitation Settings and Associations with HIV/STI Risk Among a Cohort of Female Sex Workers in Baltimore, Maryland. AIDS Behav 2021; 25:3386-3397. [PMID: 33974166 DOI: 10.1007/s10461-021-03293-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Jessie Chien
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Hampton House Suite 749, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Hampton House Suite 749, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Sahnah Lim
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Hampton House Suite 749, Baltimore, MD, 21205, USA
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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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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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Poteat T, Cooney E, Malik M, Restar A, Dangerfield DT, White J. HIV Prevention Among Cisgender Men Who have Sex with Transgender Women. AIDS Behav 2021; 25:2325-2335. [PMID: 33634354 PMCID: PMC8222096 DOI: 10.1007/s10461-021-03194-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
Cisgender men who have sex with transgender women face elevated risk for HIV, yet are understudied in prevention research. We conducted in-depth interviews with 19 men who have sex with transgender women in Baltimore, Maryland and Atlanta, Georgia to explore perspectives on HIV prevention. Participants used several strategies to reduce HIV risk: condoms, frequent HIV testing, communication about HIV status with partners, and limiting the types of sex acts performed. While condom use was inconsistent, it was preferred over pre-exposure prophylaxis, in part due to medical distrust. HIV self-testing was generally viewed unfavorably. Although most participants were referred to the study by their transgender women partners, they recommended reaching other men who have sex with transgender women in bars, nightclubs, online, and through social media. HIV prevention interventions should be inclusive of the needs and experiences of men who have sex with transgender women.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, 333 S. Columbia Street, CB #7240, Chapel Hill, NC, 27599, USA.
- Department of Health Behavior, Gillings School of Public Health, Chapel Hill, NC, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Erin Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mannat Malik
- Department of Health Behavior, Gillings School of Public Health, Chapel Hill, NC, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arjee Restar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek T Dangerfield
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Us Helping Us, People into Living, Inc., Washington DC, USA
| | - Jordan White
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bachelors of Social Work Department, Morgan State University, Baltimore, MD, USA
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Hall CDX, Moran K, Newcomb ME, Mustanski B. Age of Occurrence and Severity of Childhood Sexual Abuse: Impacts on Health Outcomes in Men Who Have Sex with Men and Transgender Women. JOURNAL OF SEX RESEARCH 2021; 58:763-774. [PMID: 33215945 PMCID: PMC8134626 DOI: 10.1080/00224499.2020.1840497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Childhood sexual abuse (CSA) is associated with a wide range of health outcomes and is more prevalent among men who have sex with men (MSM) compared to men who have sex with women exclusively and among transgender women (TW) compared to cisgender peers; however, there is a lack of consensus regarding an explanatory theoretical model. This analysis examined these models across health outcomes using baseline data from a longitudinal study of MSM and TW in Chicago (n = 1,035) collected from 2015 to 2019. Severity of CSA was measured for two age ranges (prior to 13 and 13-17). Logistic regression and negative binomial regressions were estimated. Teenage experiences of CSA were associated with alcohol problems, cannabis problems, suicide ideation/attempt, depression, condomless anal sex partners, rectal STI, and HIV. Pre-teenage CSA was associated with alcohol use and depressive symptoms. Significant interactions across age of experience of CSA were found for alcohol problems, cannabis problems, and condomless anal sex partners. Consistent with previous literature, this analysis found CSA to be a significant influence on various health outcomes. No single explanatory framework emerged; however, adolescent exposures may be more closely linked to health outcomes and risk behaviors than pre-teenage or cumulative exposures.
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Affiliation(s)
- Casey D. Xavier Hall
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender
Minority Health and Wellbeing, Chicago, IL
| | - Kevin Moran
- Northwestern University Institute for Sexual and Gender
Minority Health and Wellbeing, Chicago, IL
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender
Minority Health and Wellbeing, Chicago, IL
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender
Minority Health and Wellbeing, Chicago, IL
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Tomko C, Nestadt DF, Rouhani S, Silberzahn BE, Haney K, Park JN, Galai N, Logie CH, Sherman SG. Confirmatory Factor Analysis and Construct Validity of the Internalized Sex Work Stigma Scale among a Cohort of Cisgender Female Sex Workers in Baltimore, Maryland, United States. JOURNAL OF SEX RESEARCH 2021; 58:713-723. [PMID: 32401075 PMCID: PMC7666019 DOI: 10.1080/00224499.2020.1755821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Internalized sex work stigma among cisgender female sex workers (FSW) is produced within contexts of social marginalization and associated with a range of ill-effects, including psychological distress, and lower rates of healthcare-seeking. This study seeks to uncover latent domains of the new Internalized Sex Work Stigma Scale (ISWSS) using data from 367 FSW in Baltimore, Maryland, USA. The sample was 56% white with high substance use (82% smoked crack cocaine, 58% injected any drug). The average ISWSS score was 34.8 (s.d. = 5.8, possible range: 12-48) and internal consistency was high (0.82). Confirmatory factor analysis revealed four subscales: worthlessness, guilt and shame, stigma acceptance, and sex work illegitimacy. Internal consistency of subscales was high (0.69-0.90); the scale also demonstrated construct validity with depression and agency. In bivariate logistic regressions, higher ISWSS, worthlessness, shame and guilt, and acceptance scores predicted higher odds of rushing client negotiations due to police. In unadjusted multinomial regressions, feeling respected by police predicted lower ISWSS, worthlessness, guilt and shame, acceptance, and illegitimacy scores. Identified factors are congruent with existing literature about how FSW manage sex work-specific stigma. Understanding the unique dimensions and impacts of internalized sex work stigma can inform interventions and policy to reduce morbidities experienced by FSW.
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Affiliation(s)
- Catherine Tomko
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle Friedman Nestadt
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saba Rouhani
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bradley E. Silberzahn
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine Haney
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Noya Galai
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Statistics, University of Haifa, Haifa, Israel
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Susan G. Sherman
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Schneider KE, Tomko C, Nestadt DF, Silberzahn BE, White RH, Sherman SG. Conceptualizing overdose trauma: The relationships between experiencing and witnessing overdoses with PTSD symptoms among street-recruited female sex workers in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:102859. [PMID: 32712164 PMCID: PMC7854789 DOI: 10.1016/j.drugpo.2020.102859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The opioid crisis has rendered witnessing and experiencing overdoses a common occurrence, especially among marginalized and drug using populations, including female sex workers (FSW). Such exposures may confer psychological trauma that has gone unrecognized. We explored relationships between experiencing and witnessing overdoses and PTSD symptomology to understand the traumatic nature of these experiences. METHODS Data were from FSW (N = 380) in Baltimore City, Maryland, who reported whether they had witnessed/experienced any overdoses in the past 6 months ("overdose traumas") and PTSD symptoms (PCL-5). We tested for associations between overdose traumas and PTSD diagnoses/symptomology in bivariate logistic regression models and multivariate models, adjusting for sociodemographic, experiences of violence, and drug use characteristics. RESULTS In our sample, 35.3% witnessed a fatal overdose, 51.9% witnessed a non-fatal overdose, and 28.3% experienced an overdose in the past 6 months. More than half (52.4%) met criteria for PTSD. Most endorsed symptoms within each PTSD domain: 63.2% for intrusive, 58.4% for avoidance, 66.1% for cognition/mood, and 64.7% for arousal/reactivity symptoms. Experiencing an overdose was associated with meeting PTSD criteria and symptoms in all domains in bivariate models. Witnessing an overdose was associated with PTSD diagnoses and intrusive and arousal/reactivity symptoms in bivariate models. Adjusting for sociodemographic characteristics and drug use, experiencing an overdose was associated with intrusive and cognition/mood symptoms, while neither trauma remained associated with PTSD diagnoses. CONCLUSIONS Traumas related to overdose, coined "overdose traumas" appear to be extremely psychologically traumatic, though the relationships vary by type and symptom. Programs should be cognizant of psychological trauma to address the full spectrum of overdose harms. Existing measures of PTSD do not accurately represent the effects of overdose traumas in populations like FSW due to the structural barriers to avoiding locations/situations where overdoses may occur and the overlap between symptoms, drug effects, and adaptive responses to homelessness.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Bradley E Silberzahn
- Department of Sociology, The University of Texas at Austin, 305 E. 23rd St., Austin, TX 78712, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Ogden SN, Harris MT, Childs E, Valente PK, Edeza A, Collins AB, Drainoni ML, Mimiaga MJ, Biello KB, Bazzi AR. "You need money to get high, and that's the easiest and fastest way:" A typology of sex work and health behaviours among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103285. [PMID: 33985886 DOI: 10.1016/j.drugpo.2021.103285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the United States, the criminalization and stigmatization of drug use and sex work contribute to infectious disease transmission and healthcare disengagement. People who inject drugs (PWID) and engage in sex work experience exacerbated HIV risk. In the context of the ongoing HIV and overdose epidemics little research describes why PWID engage in sex work and its relative HIV risk. To inform intervention needs, we aimed to create a typology of sex work among PWID with a focus on HIV risk and healthcare utilization behaviours. METHODS We drew from in-depth interviews conducted across Massachusetts and Rhode Island from 2016-2019. Participants were ≥18 years old and self-reported past-month injection drug use and HIV-negative status. Using data from individuals reporting sex work experience (n=33/78), we utilized the framework method to develop a typology of perspectives on sex work engagement and attributes pertaining to HIV risk and healthcare utilization behaviours. RESULTS We uncovered varying perspectives on sex work and associated HIV risks and prevention needs. A typology included three groups who viewed their sex work engagement as a (1) consistent job, (2) income supplement, or (3) survival method to abate withdrawal symptoms. The first group described more consistent sexual and injection behaviours to mitigate HIV risk than the second group. The third group appeared particularly vulnerable to HIV, describing inconsistent condom use and frequent sharing of injection equipment, low healthcare utilization, and limited disclosure of sex work and injection drug use to healthcare providers. CONCLUSION Findings highlight distinct perspectives on sex work among PWID involved in it and corresponding perceptions of HIV risk and healthcare utilization behaviours. Understanding the nuances in sex work engagement among PWID can inform interventions to prevent infectious disease transmission, including efforts to further connect this marginalized population to harm reduction, health, and low barrier opioid treatment services.
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Affiliation(s)
- Shannon N Ogden
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Miriam Th Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston MA, USA; Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | | | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| | - Matthew J Mimiaga
- UCLA Center for LGBTQ Advocacy, Research, and Health, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
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Poteat T, White RH, Footer KHA, Park JN, Galai N, Huettner S, Silberzahn BE, Allen ST, Glick J, Beckham SW, Gaydos CA, Sherman SG. Characterising HIV and STIs among transgender female sex workers: a longitudinal analysis. Sex Transm Infect 2021; 97:226-231. [PMID: 32366602 PMCID: PMC7769682 DOI: 10.1136/sextrans-2019-054414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/13/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Though highly vulnerable to HIV and STIs, transgender female sex workers (TFSWs) are understudied in the US HIV and STI response. This study examined the correlates of laboratory-confirmed STIs among a cohort of 62 TFSWs followed over the course of 1 year and explored associations between specimen site and self-reported engagement in insertive and receptive anal intercourse. METHODS Participants completed an interviewer-administered computer-assisted personal interview at baseline, 3-, 6-, 9- and 12-month visits where self-administered anal swabs and urine samples for gonorrhea, chlamydia and trichomoniasis were also collected. HIV testing was conducted at baseline, 6-month and 12-month visits. RESULTS Baseline HIV prevalence was 40.3% with no HIV seroconversions over follow-up. Baseline prevalence of gonorrhea, chlamydia and trichomoniasis was 9.7%, 17.7% and 14.5%, respectively. In the multivariable regression modelling, recent arrest was significantly associated with testing positive for any STI (adjusted risk ratio (RR) 1.77; 95% CI: 1.10 to 2.84). Insertive anal sex with clients was associated with increased risk of testing positive for an STI via urine specimen (RR 3.48; 95% CI: 1.14 to 10.62), while receptive anal sex was not significantly associated with specimen site. CONCLUSION Our findings confirm a high prevalence of STIs among TFSWs and highlight the importance of addressing structural drivers such as criminal justice involvement as well as the need to ensure screening for STIs at all anatomical sites regardless of self-reported sites of potential exposure. More research is needed to better understand HIV and STI vulnerabilities and appropriate interventions for TFSWs in the USA.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine H A Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven Huettner
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brad E Silberzahn
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Wilson Beckham
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Silberzahn BE, Tomko CA, Clouse E, Haney K, Allen ST, Galai N, Footer KHA, Sherman SG. The EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) Study: Protocol for the Design, Implementation, and Evaluation of a Community-Based Combination HIV Prevention Intervention for Female Sex Workers in Baltimore, Maryland. JMIR Res Protoc 2021; 10:e23412. [PMID: 33861210 PMCID: PMC8087969 DOI: 10.2196/23412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
Abstract
Background Cisgender female sex workers (FSWs) experience high rates of HIV and sexually transmitted infections (STIs), including chlamydia and gonorrhea. Community empowerment–based responses to the risk environment of FSWs have been associated with significant reductions in HIV and STI risk and associated risk behaviors; however, evaluations of US-based interventions targeting FSWs are limited. Objective The objective of this study is to describe the design, implementation, and planned evaluation strategy of an ongoing comprehensive community-level intervention in Baltimore City, Maryland, which aims to improve HIV and STI risk and cumulative incidence among FSWs. The two intervention components are the SPARC (Sex Workers Promoting Action, Risk Reduction, and Community Mobilization) drop-in center and the accompanying comprehensive mobile outreach program. The mission of SPARC is to provide low-barrier harm reduction services to FSWs, with a special focus on women who sell sex and use drugs. Services are provided through a harm reduction framework and include reproductive health and sexual health care; medication-assisted treatment; legal aid; counseling; showers, lockers, and laundry; and the distribution of harm reduction tools, including naloxone and sterile drug use supplies (eg, cookers, cotton, syringes, and pipes). Methods The SPARC intervention is being evaluated through the EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) study, which consists of a prospective 2-group comparative nonrandomized trial (n=385), a cross-sectional survey (n=100), and in-depth interviews assessing SPARC implementation (n=45). Participants enrolled in the nonrandomized trial completed a survey and HIV and STI testing at 4 intervals (baseline and 6, 12, and 18 months). Participants recruited from predefined areas closest to SPARC comprised the intervention group, and participants from all other areas of Baltimore were included in the control group. Results We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer outreach, will improve the HIV and STI risk environment, leading to community empowerment, and reduce the HIV and STI cumulative incidence and behavioral risks of FSWs. Data collection is ongoing. A baseline description of the cohort is presented. Conclusions In the United States, structural interventions aimed at reducing HIV and STIs among FSWs are scarce; to our knowledge, this is the first intervention of its kind in the United States. The results of the EMERALD study can be used to inform the development of future interventions targeting FSWs and other at-risk populations. Trial Registration ClinicalTrials.gov NCT04413591; https://clinicaltrials.gov/ct2/show/NCT04413591. International Registered Report Identifier (IRRID) DERR1-10.2196/23412
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Affiliation(s)
- Bradley E Silberzahn
- Department of Sociology, The University of Texas at Austin, Austin, TX, United States
| | - Catherine A Tomko
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily Clouse
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Haney
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sean T Allen
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine H A Footer
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan G Sherman
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Wang M, Lim SH, Gibson BA, Azwa I, Guadamuz TE, Altice FL, Kamarulzaman A, Wickersham JA. Correlates of newly diagnosed HIV infection among cisgender women sex workers and transgender women sex workers in Greater Kuala Lumpur, Malaysia. Int J STD AIDS 2021; 32:609-619. [PMID: 33752518 DOI: 10.1177/0956462420970417] [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: 11/17/2022]
Abstract
Globally, cisgender women sex workers (CWSWs) and transgender women sex workers (TWSWs) experience increased vulnerabilities to HIV infection. Unfortunately, there is limited data on the drivers of HIV infection in these two understudied populations, particularly in Southeast Asia. To better understand factors associated with HIV infection, we evaluated correlates of newly diagnosed HIV infection in these two populations in Greater Kuala Lumpur, Malaysia. A total of 469 women (CWSW: n = 283; TWSW: n = 186) were included in this study. Most participants who tested HIV+ were unaware of their infection (59.6%; n = 34/57). Separate binary and multivariable logistic regressions were conducted to identify correlates of newly diagnosed HIV in CWSWs and TWSWs. Among CWSWs, Chlamydia trachomatis (aOR = 5.66; p = 0.007) and lifetime use of ecstasy/MDMA (aOR = 5.34; p = 0.03) were associated with newly diagnosed HIV, while condomless vaginal sex with clients was associated with lower likelihood of HIV infection (aOR = 0.98; p = 0.01). Among TWSWs, being single (aOR = 6.76; p = 0.03), using mobile application to solicit clients (aOR = 25.33; p = 0.006), and having C. trachomatis infection (aOR = 88.22, p = 0.02) were associated with newly diagnosed HIV. Expansion of HIV/sexually transmitted infection screening is needed to increase detection of HIV and linkage to care for sex workers. Interventions to reduce HIV infection among CWSWs and TWSWs should be tailored to these populations' unique vulnerabilities.
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Affiliation(s)
- Melinda Wang
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Sin How Lim
- Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia.,Faculty of Medicine, Department of Social and Preventive Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Britton A Gibson
- Frank H. Netter MD School of Medicine, 472529Quinnipiac University, North Haven, CT, USA
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Thomas E Guadamuz
- Department of Society and Health, Faculty of Social Sciences and Humanities, 26685Mahidol University, Nakhon Pathom, Thailand
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia.,Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
| | - Adeeba Kamarulzaman
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 12228Yale University School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), 37447University of Malaya, Kuala Lumpur, Malaysia
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White RH, O’Rourke A, Kilkenny ME, Schneider KE, Weir BW, Grieb SM, Sherman SG, Allen ST. Prevalence and correlates of receptive syringe-sharing among people who inject drugs in rural Appalachia. Addiction 2021; 116:328-336. [PMID: 32533612 PMCID: PMC7736103 DOI: 10.1111/add.15151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Syringe-sharing significantly increases the risk of HIV and viral hepatitis acquisition among people who inject drugs (PWID). Clearer understanding of the correlates of receptive syringe-sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia. DESIGN Observational, cross-sectional sample from a capture-recapture parent study. SETTING Cabell County, West Virginia (WV), USA, June-July 2018. PARTICIPANTS The sample was restricted to people who reported injecting drugs in the past 6 months (n = 420). A total of 180 participants (43%) reported recent (past 6 months) RSS. Participants reported high levels of homelessness (56.0%), food insecurity (64.8%) and unemployment (66.0%). MEASUREMENTS The main outcome was recent re-use of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS. FINDINGS PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity and unemployment than their non-RSS-engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work [adjusted odds ratio (aOR) = 2.27, 95% confidence interval (CI) = 1.26-4.09], unemployment (aOR = 1.67, 95% CI = 1.03-1.72), number of drug types injected (aOR = 1.33, 95% CI = 1.15-1.53) and injection in a public location (aOR = 2.59, 95% CI = 1.64-4.08). Having accessed sterile syringes at an SSP was protective against RSS (aOR = 0.57, 95% CI = 0.35-0.92). CONCLUSION The prevalence of receptive syringe-sharing among people who inject drugs in a rural US county appears to be high and comparable to urban-based populations. Receptive syringe-sharing among people who inject drugs in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.
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Affiliation(s)
- Rebecca Hamilton White
- Department of Health, Behavior, and Society; Bloomberg School of Public Health; Johns Hopkins University; Baltimore, MD, USA
| | - Allison O’Rourke
- Department of Psychology; DC Center for AIDS Research; George Washington University; Washington, DC, USA
| | | | - Kristin E. Schneider
- Department of Mental Health; Bloomberg School of Public Health; Johns Hopkins University; Baltimore, MD, USA
| | - Brian W. Weir
- Department of Health, Behavior, and Society; Bloomberg School of Public Health; Johns Hopkins University; Baltimore, MD, USA
| | - Suzanne M. Grieb
- Department of Health, Behavior, and Society; Bloomberg School of Public Health; Johns Hopkins University; Baltimore, MD, USA,School of Medicine; Johns Hopkins University, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior, and Society; Bloomberg School of Public Health; Johns Hopkins University; Baltimore, MD, USA
| | - Sean T. Allen
- Department of Health, Behavior, and Society; Bloomberg School of Public Health; Johns Hopkins University; Baltimore, MD, USA
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Santana ADDS, Araújo ECD, Abreu PDD, Lyra J, Lima MSD, Moura JWDS. HEALTH VULNERABILITIES OF TRANSGENDER SEX WORKERS: AN INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify the health vulnerabilities of transgender sex workers. Method: an integrative review conducted in July 2020 in the PubMed, Web of Science, SCOPUS, CINAHL, IBECS and LILACS databases, with no language or time restrictions. The following descriptors indexed in DeCS and MESH and their respective synonyms were used: “Transgender persons”, “Sex workers” and “Health vulnerability”. The data were analyzed based on thematic analysis. Results: a total of 547 articles were retrieved and, after the selection and analysis process, 34 were included in this review. Four thematic classes emerged: “Knowledge, prevention and exposure to STIs in sex work”; “Use (and abuse) of illegal substances and alcohol”; “The social and structural dimension of vulnerabilities: from weakened support networks to violence reproduced against dissident bodies”; and “Psychosocial diseases, discrimination and challenges of transgender sex workers”. Conclusion: the health vulnerabilities experienced by transgender sex workers are marked by discrimination, social exclusion, stigma, incarceration contexts, physical, psychological and sexual violence and use of illegal substances and alcohol, in addition to difficulties in accessing essential services such as health, education and leisure.
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Affiliation(s)
| | | | | | - Jorge Lyra
- Universidade Federal de Pernambuco, Brasil
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Sherman SG, Nestadt DF, Silberzahn BE, Decker M, Park JN, Footer KH. The Role of Sexually Transmitted Infections in Police as Clients Among Street-Based Female Sex Workers in Baltimore City. Sex Transm Dis 2021; 48:12-18. [PMID: 33315782 PMCID: PMC7737865 DOI: 10.1097/olq.0000000000001292] [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: 01/28/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research among street-based female sex workers (FSWs) has documented many harms caused by police. One harm that has received little attention is that of police as clients. We examined this interaction in a 12-month longitudinal cohort study of street-based FSWs in Baltimore, MD. METHODS We explored longitudinal bivariate and multivariate associations between having police clients and independent variables that focused on sexually transmitted infections (STIs), as well as demographic, structural, substance use, police interaction, and violence-related factors. RESULTS Mean participant age was 35.8 years, 65.9% were White, and more than half (53.3%) had less than a high school education. Most (70.3%) used heroin daily, and 24.8% reported having police as clients over the study period. In a multivariate model, factors independently associated with recent police clients were recent arrest (adjusted odds ratio [aOR], 1.76; 95% confidence interval [CI], 1.03-2.99; P = 0.037), coerced or forced sex by police (aOR, 4.47; 95% CI, 1.79-11.12; P = 0.001), higher number of egregious police practices experienced (aOR, 1.77; 95% CI, 1.38-2.29; P < 0.001), and prevalent STI infection (aOR, 2.43; 95% CI, 1.46-4.04; P = 0.001). CONCLUSIONS The study uniquely documents both the frequency with which street-based FSWs take police as clients and the role of egregious police practices and prevalent STIs in association with police as clients. Results indicate the police-as-client association as a form of "everyday violence," which both normalizes and legitimizes police power and structural violence. Alongside the urgent need for decriminalization of sex work and STI prevention programs tailored for this complex population, prompt investigation and harsher penalties for police officers who engage in sex with FSW could help shift police culture away from abuse.
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Affiliation(s)
| | | | | | - Michele Decker
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Pelaez D, Weicker NP, Glick J, Mesenburg JV, Wilson A, Kirkpatrick H, Clouse E, Sherman SG. The PEARL study: a prospective two-group pilot PrEP promotion intervention for cisgender female sex workers living in Baltimore, MD, U.S. AIDS Care 2021; 33:1-10. [PMID: 33627006 PMCID: PMC7983056 DOI: 10.1080/09540121.2021.1889954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
HIV remains elevated among female sex workers (FSW) globally, with a number of structural (e.g., poverty, access to care) factors driving these persistently high rates. Pre-exposure prophylaxis (PrEP), a user-controlled prevention method, is a promising means of empowering vulnerable populations to protect themselves and enhance agency. Yet there is a dearth of PrEP research and interventions targeting cisgender women in the United States, and even fewer aimed to reach FSW. We developed and implemented a multifaceted PrEP pilot intervention, the Promoting Empowerment And Risk Reduction (PEARL) study, to meet this gap. This paper describes the development process and nature of a community-informed intervention for tenofovir/emticitrabine (TDF/FTC) pre-exposure prophylaxis engagement among street-based cisgender FSW in Baltimore, Maryland, U.S. In the course of the study's implementation, structural, programmatic, and medical barriers have already posed significant barriers to full engagement. PEARL implemented a number of strategies in an effort to counter barriers and facilitate increased success of PrEP uptake and maintenance. The study will provide critical insights into the nature of intervention components that could help FSW to initiate PrEP and reduce PrEP care cascade gaps.
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Affiliation(s)
- D Pelaez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N P Weicker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Glick
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J V Mesenburg
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Division of Population Health and Disease Prevention, Baltimore, MD, USA
| | - A Wilson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Kirkpatrick
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Clouse
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Aggarwal NK, Consavage KE, Dhanuka I, Clement KW, Bouey JH. Health and Health Care Access Barriers Among Transgender Women Engaged in Sex Work: A Synthesis of U.S.-Based Studies Published 2005-2019. LGBT Health 2020; 8:11-25. [PMID: 33297834 DOI: 10.1089/lgbt.2019.0243] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: Transgender women (TW) are likely to experience job discrimination and engage in commercial sex transactions. As a group, they have the highest risk for HIV/AIDS. However, little is known about the health needs of transgender women sex workers (TWSW) in the United States and the structural and psychosocial barriers to their health care access. The objective of this systematic review was to systematically document these needs and barriers by using a framework approach. Methods: We searched PubMed, JSTOR, and Google Scholar for primary and secondary studies published in 2005-2019 that addressed the health of TWSW in the United States. We used a standardized data extraction form to gather data from eligible articles. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess study quality. Results: Fifty-three articles met the inclusion criteria, including mentioning health-related topics among TWSW. More articles appeared in recent years. Most studies collected data with convenience samples in urban areas. Structural barriers reported included transphobia, lack of pre-exposure prophylaxis targeted at TW, and lack of health insurance coverage. Psychosocial barriers included distrust of the health care system, self-esteem, alcohol and substance use, and mental health. Conclusions: TWSW have unique health care needs that are not being addressed due to barriers to health care access. More research is required to identify non-HIV-related health burdens and details about psychosocial barriers to health care access.
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Affiliation(s)
- Neena K Aggarwal
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Katherine E Consavage
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Ida Dhanuka
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Kesiah W Clement
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Jennifer H Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
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Yoosefi lebni J, Irandoost SF, Ziapour A, Mohammadi Gharehghani MA, Ebadi Fard Azar F, Soofizad G, Khosravi B, Solhi M. Experiences and challenges of Prostitute Women in Iran: A phenomenological qualitative study. Heliyon 2020; 6:e05649. [PMID: 33319103 PMCID: PMC7724161 DOI: 10.1016/j.heliyon.2020.e05649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 01/06/2023] Open
Abstract
Background Prostitutes in Iran are faced with many challenges and problems that pose risks to their health. Objective The present study is an attempt to identify and narrate the challenges and experiences of Iranian prostitutes based on a qualitative approach. Methods This qualitative study was conducted with a phenomenological approach in (2018) in Tehran, Iran. The data were collected through semi-structured interviews with 22 prostitutes who were selected using a snowball sampling method and analyzed with Colaizzi's method. In order to examine the quality of findings, Guba and Lincoln's measures were used. Results Data analysis results were classified into five main categories and 14 subcategories. The main issues are: The experience of violence, Heath risk, social ostracism, objectifying, and lack of social and legal supporting structures. Conclusion Prostitutes in Iran experience numerous problems at personal and social levels. By providing social, economic, and legal supports for them such as social services (e.g. educations on how to use contraceptives, how to have safe sexual intercourse, and free counseling services for mental support), we can improve their health and welfare.
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Affiliation(s)
- Javad Yoosefi lebni
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Fahim Irandoost
- Department of Public Health, School of Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Arash Ziapour
- Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Goli Soofizad
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Khosravi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahnaz Solhi
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author.
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Decker M, Rouhani S, Park JN, Galai N, Footer K, White R, Allen S, Sherman S. Incidence and predictors of violence from clients, intimate partners and police in a prospective US-based cohort of women in sex work. Occup Environ Med 2020; 78:oemed-2020-106487. [PMID: 33144359 DOI: 10.1136/oemed-2020-106487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Gender-based violence threatens women's health and safety. Female sex workers (FSWs) experience violence disproportionately, yet prospective data on violence predictors is lacking. In the first US-based prospective FSW cohort study, we examine incidence rates (IRs) and predictors of violence from distinct perpetrators: paying clients, non-paying intimate partners and police. METHODS The parent cohort (Sex Workers and Police Promoting Health In Risky Environments) recruited street-based cisgender FSWs in urban Baltimore, MD (n=250) with 5 assessments at 3-month intervals through 12-month follow-up. Stratifying by violence perpetrator, we characterise violence at baseline, IR over the study period and time-varying predictors using Poisson models. RESULTS The violence IR per person year was highest for client-perpetrated violence (0.78), followed by intimate partner violence (IPV; IR 0.39), and police violence (IR 0.25). Prevalence over the 12-month follow-up period among participants with complete visit data (n=103), was 42% for client violence, 22% for IPV and 16% for police violence. In adjusted analyses, risk factors for incident violence varied across perpetrators and included entry to sex work through force or coercion (adjusted IR ratio (aIRR)IPV 2.0; 95% CI 1.2 to 3.6), homelessness (aIRRIPV 2.0; 95% CI 1.3 to 2.9; aIRRpolice 2.7; 95% CI 1.3 to 5.8) and daily injection drug use (aIRRclient 1.9; 95% CI 1.2 to 3.0). Risk of incident client violence and IPV was elevated by past abuse from each respective perpetrator. Help-seeking following abuse was limited. CONCLUSIONS FSWs face profound, enduring risk for violence from a range of perpetrators, likely enabled by criminalisation-related barriers to justice and perpetrator impunity. FSWs represent a priority population for access to justice, trauma-informed healthcare and violence-related support services. Structural vulnerabilities including homelessness and addiction represent actionable priorities for improving safety and health.
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Affiliation(s)
- Michele Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Public Health & Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - Katherine Footer
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca White
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sean Allen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Sherman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Park JN, Tomko C, Silberzahn BE, Haney K, Marshall BDL, Sherman SG. A fentanyl test strip intervention to reduce overdose risk among female sex workers who use drugs in Baltimore: Results from a pilot study. Addict Behav 2020; 110:106529. [PMID: 32683172 PMCID: PMC8214920 DOI: 10.1016/j.addbeh.2020.106529] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND In 2018, there were over 67,000 drug overdose deaths in the United States, with almost half involving illicit fentanyl and other synthetic opioids. While overall age-adjusted drug overdose deaths decreased by 4.6% from 2017 to 2018, synthetic opioid deaths increased 10.0%. This pilot study evaluates the impact of a brief fentanyl test strip (FTS) intervention to increase fentanyl awareness and reduce overdose risk. METHODS Female sex workers (FSW) reporting past month illicit opioid use were recruited between April 2018 through February 2019 in Baltimore City, Maryland. At baseline, they completed a baseline survey, and received tailored harm reduction messaging, 5 FTS and training, and a naloxone kit, then completed a survey after one month. McNemar's test was used to compare repeated measures. RESULTS Among N = 103, 54% were <40 years, 59% were white, and 24% had overdosed in the past year. Among 68 who completed follow-up, most (84%) used ≥1 FTS to test their drugs, 86% had ≥1 fentanyl-positive result, 57% were surprised by the result, and 69% engaged in harm reduction behaviors following the result (e.g., asked someone to check on them, did a tester shot, used a smaller amount). Significant pretest-posttest reductions in daily illicit opioid use (77% to 56%; p = 0.003), injection frequency (40% to 25%; p = 0.004), benzodiazepine use (22% to 7%; p = 0.008), and solitary drug use (96% vs. 68%; p < 0.001) were observed. No change in preferring drugs containing fentanyl was found. Some (18%) gave their FTS to others. All but three (96%) reported being likely to use FTS in the future. CONCLUSIONS We found high FTS acceptability and reductions in drug use frequency and solitary drug use following FTS use among FSW who use drugs in Baltimore. These findings demonstrate that FTS-based interventions hold potential in reducing overdose risk.
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Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley E Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine Haney
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 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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White RH, Park JN, Galai N, Decker MR, Allen ST, Footer KHA, Sherman SG. Short-term interruptions to sex work among a prospective cohort of street-based cisgender female sex workers in Baltimore. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102858. [PMID: 32726687 DOI: 10.1016/j.drugpo.2020.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Street-based female sex workers (FSW) often cycle in and out of sex work engagement. For many FSW, substance use plays a critical role in sex work entry, continuation, and interruptions. We examined individual, interpersonal, and structural correlates of short-term interruptions of sex work among street-based FSW in an urban environment. METHODS Data were from 205 FSW in Baltimore, MD, USA followed as part of an observational prospective cohort study between April 2016-Februrary 2018. The primary outcome was short-term interruptions of sex work (stopping sex work) over the past 3 months, asked every 3 months over a 12-month follow-up. We assessed the relationship between individual, structural, and interpersonal factors for each woman's prior visit and current visit with short-term sex work interruptions. We employed modified Poisson regression with Generalized Estimating Equations to identify correlates of short-term interruptions of sex work. RESULTS Eighty-two women (40%) reported stopping sex work over the past 3 months at least once during follow-up. Past drug treatment (adjusted incidence rate ratio [aIRR] 1.40; 95% CI: 1.06-1.86) and not having used drugs in the past 3 months (aIRR 2.70; 95% CI: 1.96-3.71) were positively associated with short-term interruption to sex work. Past intimate partner violence (IPV) (aIRR 0.52; 95% CI: 0.31-0.86) and current homelessness (aIRR 0.61; 95% CI: 0.41-0.91) were negatively associated with short-term interruption. Results were inconclusive for the association between recent prostitution arrest and short-term interruptions to sex work (IRR 0.86; 95% CI: 0.40-1.86). CONCLUSION The study suggests that similar to other professions, women leave sex work for numerous reasons. Substance use cessation and participation in drug treatment programs may contribute to short-term interruptions of sex work by reducing reliance on sex work for income among street-based FSW. Structural vulnerabilities including homelessness and IPV are driving continued street-based sex work, speaking to the need for holistic structural interventions.
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Affiliation(s)
- Rebecca Hamilton White
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E6608, Baltimore, MD 21205, USA; Department of Statistics, University of Haifa, 199 Aba Khushi Street, Mount Carmel, Haifa 3498838, Israel.
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4142, Baltimore, MD 21205, USA.
| | - Sean T Allen
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
| | - Katherine H A Footer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 180B, Baltimore, MD 21205, USA.
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