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Katumba KR, Haumba M, Mayanja Y, Machira YW, Gafos M, Quaife M, Seeley J, Greco G. Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study. BMC Womens Health 2024; 24:371. [PMID: 38918714 PMCID: PMC11202390 DOI: 10.1186/s12905-024-03216-7] [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: 03/26/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients. METHODS We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews. RESULTS Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients. CONCLUSIONS To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.
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Affiliation(s)
- Kenneth Roger Katumba
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Mercy Haumba
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Yunia Mayanja
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Quaife
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Giulia Greco
- London School of Hygiene and Tropical Medicine, London, UK
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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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Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis 2024; 78:e12-e26. [PMID: 38018174 DOI: 10.1093/cid/ciad664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine at San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
| | - Jacinda C Abdul Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California-San Diego, La Jolla, California, USA
| | - Amelia Goff
- Section of Addiction Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica Brown
- Department of Care Management, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Kathleen Fairfield
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Alysse Wurcel
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medicine, Boston, Massachusetts, USA
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Perry C, Goldenberg S, Deering K, Patrick L, Braschel M, Shannon K, Bingham B. Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3450143. [PMID: 37961370 PMCID: PMC10635380 DOI: 10.21203/rs.3.rs-3450143/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objectives Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic. Methods Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020-August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months. Results Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33-16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33-11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43-15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06-6.94) had higher odds of experiencing recent difficulty accessing routine healthcare. Discussion Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.
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Goldenberg SM, Buglioni N, Krüsi A, Frost E, Moreheart S, Braschel M, Shannon K. Housing Instability and Evictions Linked to Elevated Intimate Partner and Workplace Violence Among Women Sex Workers in Vancouver, Canada: Findings of a Prospective, Community-Based Cohort, 2010-2019. Am J Public Health 2023; 113:442-452. [PMID: 36888950 PMCID: PMC10003487 DOI: 10.2105/ajph.2022.307207] [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] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings. Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions with intimate partner violence (IPV) and workplace violence among a community-based longitudinal cohort of cisgender and transgender women sex workers in Vancouver, Canada, from 2010 through 2019. Results. Of 946 women, 85.9% experienced unstable housing, 11.1% eviction, 26.2% IPV, and 31.8% workplace violence. In multivariable generalized estimating equation models, recent exposure to unstable housing (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI] = 1.45, 2.87) and evictions (AOR = 2.45; 95% CI = 0.99, 6.07) were associated with IPV, and exposure to unstable housing was associated with workplace violence (AOR = 1.46; 95% CI = 1.06, 2.00). Conclusions. Women sex workers face a high burden of unstable housing and evictions, which are linked to increased odds of intimate partner and workplace violence. Increased access to safe, women-centered, and nondiscriminatory housing is urgently needed. (Am J Public Health. 2023;113(4):442-452. https://doi.org/10.2105/AJPH.2022.307207).
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Affiliation(s)
- Shira M Goldenberg
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Natalie Buglioni
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Andrea Krüsi
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Elizabeth Frost
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Sarah Moreheart
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Melissa Braschel
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Kate Shannon
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
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Jennings Mayo-Wilson L, Yen BJ, Nabunya P, Bahar OS, Wright BN, Kiyingi J, Filippone PL, Mwebembezi A, Kagaayi J, Tozan Y, Nabayinda J, Witte SS, Ssewamala FM. Economic Abuse and Care-seeking Practices for HIV and Financial Support Services in Women Employed by Sex Work: A Cross-Sectional Baseline Assessment of a Clinical Trial Cohort in Uganda. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1920-NP1949. [PMID: 35510547 PMCID: PMC9636073 DOI: 10.1177/08862605221093680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Economic hardship is a driver of entry into sex work, which is associated with high HIV risk. Yet, little is known about economic abuse in women employed by sex work (WESW) and its relationship to uptake of HIV prevention and financial support services. This study used cross-sectional baseline data from a multisite, longitudinal clinical trial that tests the efficacy of adding economic empowerment to traditional HIV risk reduction education on HIV incidence in 542 WESW. Mixed effects logistic and linear regressions were used to examine associations in reported economic abuse by demographic characteristics, sexual behaviors, HIV care-seeking, and financial care-seeking. Mean age was 31.4 years. Most WESW were unmarried (74%) and had less than primary school education (64%). 48% had savings, and 72% had debt. 93% reported at least one economic abuse incident. Common incidents included being forced to ask for money (80%), having financial information kept from them (61%), and being forced to disclose how money was spent (56%). WESW also reported partners/relatives spending money needed for bills (45%), not paying bills (38%), threatening them to quit their job(s) (38%), and using physical violence when earning income (24%). Married/partnered WESW (OR = 2.68, 95% CI:1.60-4.48), those with debt (OR = 1.70, 95% CI:1.04-2.77), and those with sex-work bosses (OR = 1.90, 95% CI:1.07-3.38) had higher economic abuse. Condomless sex (β = +4.43, p < .05) was higher among WESW experiencing economic abuse, who also had lower odds of initiating PrEP (OR = .39, 95% CI:.17-.89). WESW experiencing economic abuse were also more likely to ask for cash among relatives (OR = 2.36, 95% CI:1.13-4.94) or banks (OR = 2.12, 95% CI:1.11-4.03). The high prevalence of HIV and economic abuse in WESW underscores the importance of integrating financial empowerment in HIV risk reduction interventions for WESW, including education about economic abuse and strategies to address it. Programs focusing on violence against women should also consider economic barriers to accessing HIV prevention services.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- University of North Carolina Gillings School
of Global Public Health, Chapel Hill,
NC, USA
- Community, Global and Public Health
Division, Johns
Hopkins University School of Nursing,
Baltimore, MD, USA
| | - Bing-Jie Yen
- Department of Applied Health
Science, Center for Sexual Health Promotion, Indiana University School of Public
Health, Bloomington, IN, USA
| | - Proscovia Nabunya
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | - Brittanni N. Wright
- Department of Applied Health
Science, Center for Sexual Health Promotion, Indiana University School of Public
Health, Bloomington, IN, USA
| | - Joshua Kiyingi
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | | | - Abel Mwebembezi
- International Center for Child Health and
Development, Masaka, Uganda
- Reach the Youth
Uganda, Kampala, Uganda
| | | | - Yesim Tozan
- New York University College of Global Public
Health, New York, NY, USA
| | - Josephine Nabayinda
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | | | - Fred M. Ssewamala
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
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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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Harris MTH, Laks J, Stahl N, Bagley SM, Saia K, Wechsberg WM. Gender Dynamics in Substance Use and Treatment: A Women's Focused Approach. Med Clin North Am 2022; 106:219-234. [PMID: 34823732 PMCID: PMC8881090 DOI: 10.1016/j.mcna.2021.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gender impacts substance use initiation, substance use disorder development, engagement with treatment, and harms related to drug and alcohol use. Using the biopsychosocial model of addiction, this review provides a broad summary of barriers and facilitators to addiction services among women. It also reviews substance use among pregnant and parenting women and approaches to care. Given the increasing rates of substance use among women, there is a need to implement and scale-up gender-responsive addiction programming and pursue advocacy at the policy level that addresses the root drivers of substance use inequities among women.
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Affiliation(s)
- Miriam T H Harris
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
| | - Jordana Laks
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Natalie Stahl
- Yale Program in Addiction Medicine, Yale University School of Medicine, E.S. Harkness Memorial Building A, 367 Cedar Street, Suite 417A, New Haven, CT 06520-8023, USA
| | - Sarah M Bagley
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, 801 Albany Street, Boston, MA 02118, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 850 Harrison Avenue 5th Floor, Boston, MA 02118, USA
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC 27709-2194, USA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Psychology, North Carolina State University, Raleigh, NC 27599-7400, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, USA
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