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Semá Baltazar C, Muleia R, Ribeiro Banze A, Boothe M. Prevalence and correlates of hazardous alcohol drinking and drug use among female sex workers and men who have sex with men in Mozambique. BMC Public Health 2024; 24:872. [PMID: 38515116 PMCID: PMC10956320 DOI: 10.1186/s12889-024-18273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Hazardous drinking and drug consumption are associated with an increased risk of HIV due to the complex interplay of factors influencing decision-making capability, stigma and social marginalization. In this study, we explore the patterns of hazardous alcohol and drug use and correlates of risk factors among female sex workers (FSW) and men who as sex with men (MSM) in Mozambique. METHODS We conducted a secondary data analysis of bio-behavioral surveys (BBS) among FSW and MSM using a respondent-driven sampling methodology conducted in five main urban areas of Mozambique from 2019 to 20. The survey included a standardized questionnaire, where hazardous drinking was assessed (using AUDIT-C scores ≥ 4 for men, ≥ 3 for women) and drug use in the last year (FSW). Chi-squared test was used to analyze the association between socio-demographic and behavioral variables, and multivariate logistic regression measured the impact of the associated factors. RESULTS The prevalence of hazardous alcohol drinking was 47.1% (95% CI:44.8-49.5) for FSW and 46.5 (95% CI: 44.0-49.0) for MSM. Current drug use was reported in 13.3% of FSW. FSW engaging in hazardous alcohol drinking reported more sexual partners in the last month than those no reporting hazardous alcohol use (55.3% vs. 47,1%, p < 0.001), higher rates of self-reported STIs in the last year (62,5% vs. 48,2%, p < 0.001), physical (53.5% vs. 46.7%, p < 0.0001) and sexual violence (54.7% vs. 44.2%, p < 0.001), and HIV prevalence (55.2% vs. 44.2 p < 0.001). Among MSM with hazardous alcohol drinking, there was a higher prevalence of self-reported STIs (52.8% vs. 45.4%, p < 0.001), experiences of sexual violence (18.0% vs. 8.3%, p < 0.001), and HIV prevalence (53.0% vs. 46.3%, p < 0.001). In addition, FSW who reported illicit drug use were more likely to self-reported HIV own risk (14.2% vs. 9.7%), early start sexual activity (15.4% vs. 5.3%), self-reported STIs (17.9% vs. 10.2%), and experiences of both physical (17.4% vs. 7.0%) and sexual violence (18.6% vs. 8.9%). CONCLUSION There is an immediate need for the introduction and integration of comprehensive substance use harm mitigation and mental health interventions into HIV prevention programs, particularly those targeting key populations in Mozambique.
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Affiliation(s)
| | - Rachid Muleia
- Instituto Nacional de Saúde, Maputo, P.O. Box 264, Mozambique
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Rock A, McNaughton Reyes HL, Go V, Maman S, Perez M, Donastorg Y, Kerrigan D, Barrington C. Relationships Between Stigma and Intimate Partner Violence Among Female Sex Workers Living With HIV: Social and Economic Exclusion. Violence Against Women 2023; 29:1971-1997. [PMID: 36344251 PMCID: PMC10387732 DOI: 10.1177/10778012221127722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Violence against female sex workers (FSWs) perpetrated by their intimate (i.e., non-commercial) partners, particularly against FSWs living with HIV, is understudied. Stigma can deplete the economic resources, social relationships, and mental well-being of stigmatized people, which may increase their intimate partner violence (IPV) risk. We quantitatively assessed relationships between HIV stigma and sex work stigma and IPV victimization among FSWs living with HIV in the Dominican Republic (n = 266). Enacted HIV stigma, in the form of job loss, and anticipated HIV stigma, in the form of fear of exclusion by family, were associated with increased IPV risk. Potential association mechanisms, including increased economic vulnerability and social isolation, and programmatic responses are discussed.
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Affiliation(s)
- Amelia Rock
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | | | - Vivian Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Suzanne Maman
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Deanna Kerrigan
- Department of Prevention and Community Health, GWU Milken Institute School of Public Health, USA
| | - Clare Barrington
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
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Martín-Romo L, Sanmartín FJ, Velasco J. Invisible and stigmatized: A systematic review of mental health and risk factors among sex workers. Acta Psychiatr Scand 2023; 148:255-264. [PMID: 37105542 DOI: 10.1111/acps.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Sex work is a common phenomenon, but socially invisible and stigmatized. Due to exposure to work-related risks, sex workers (SWs) are vulnerable to developing health problems. However, little attention has been paid to their mental health. The purpose of this systematic review was to synthesize the existing literature on mental health and to explore risk factors related to psychopathology in sex workers. METHODS A systematic review (CRD42021268990) was conducted on the Web of Science, PubMed, Scopus, and PsycInfo for peer reviewer papers published between 2010 and 2022. The Newcastle-Ottawa Scale (NOS) was used to examine the quality of the studies. Of the 527 studies identified, 30 met the inclusion criteria. RESULTS Mental health problems were prevalent among sex workers. Depression was the most common mental health problem; however, other psychological problems were also high, including anxiety, substance abuse, and suicidal ideation. Sex workers are exposed to numerous work-related risks, including violence and high-risk sexual behaviors. Despite the high prevalence of mental health problems, SWs often encounter significant barriers to accessing healthcare services. CONCLUSION These results suggest the need to focus on preventive measures to promote psychological well-being among sex workers.
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Affiliation(s)
| | - Francisco J Sanmartín
- Department of Psychology, University of Córdoba, Spain
- The Maimonides Institute for Biomedical Research of Cordoba, Córdoba, Spain
- Reina Sofía Hospital, Córdoba, Spain
| | - Judith Velasco
- Department of Psychology, University of Córdoba, Spain
- The Maimonides Institute for Biomedical Research of Cordoba, Córdoba, Spain
- Reina Sofía Hospital, Córdoba, Spain
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Bhardwaj A, Comins CA, Guddera V, Mcingana M, Young K, Phetlhu R, Mulumba N, Mishra S, Hausler H, Baral S, Schwartz S. Prevalence of depression, syndemic factors and their impact on viral suppression among female sex workers living with HIV in eThekwini, South Africa. BMC Womens Health 2023; 23:232. [PMID: 37147708 PMCID: PMC10161481 DOI: 10.1186/s12905-023-02392-2] [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: 08/31/2022] [Accepted: 04/24/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Over half of female sex workers (FSW) in South Africa are living with HIV and clinical depression has been frequently documented among FSW. Data characterizing structural determinants of depression and the role of syndemic theory, synergistically interacting disease states, on viral suppression among FSW in South Africa are limited. METHODS Between July 2018-March 2020, non-pregnant, cisgender women (≥ 18 years), reporting sex work as their primary income source, and diagnosed with HIV for ≥ 6 months were enrolled into the Siyaphambili trial in eThekwini, South Africa. Using baseline data, robust Poisson regression models were used to assess correlates of depression and associations between depression and syndemic factors on viral suppression. RESULTS Of 1,384 participants, 459 (33%) screened positive for depression, defined as a score of ≥ 10 on the PHQ-9. Physical and sexual violence, drug use, alcohol use, anticipated stigma and internalized stigma were univariately associated with depression (all p's < 0.05) and included the multivariate model. In the multivariate regression, prevalence of depression was higher among participants experiencing sexual violence (PR = 1.47 95% CI:1.24,1.73), physical violence 5 times or more in < 6 months (PR = 1.38 95% CI:1.07, 1.80), using illicit drugs in the last month (PR = 1.23 95%:CI 1.04, 1.48), and reporting higher levels of internalized stigma (PR = 1.11, 95% CI:1.04,1.18). Depression in the absence of the Substance Abuse, Violence and AIDS SAVA syndemic factors was associated with increased prevalence of unsuppressed viral load (aPR 1.24; 95% CI:1.08,1.43), and the SAVA substance use and violence syndemic was associated with an increase in unsuppressed viral load among non-depressed FSW (aPR 1.13; 95% CI:1.01, 1.26). Compared to those experiencing neither factors, those jointly experiencing depression and the SAVA syndemics were at increased risk for unsuppressed viral load (aPR 1.15; 95% CI:1.02,1.28). CONCLUSION Substance use, violence, and stigma were all associated with depression. Depression and syndemic factors (substance use + violence) were related to unsuppressed viral load; we did not observe higher unsuppressed viral load amongst those experiencing both depression and syndemic factors. Our findings point to the need to understand the unmet mental health needs of FSW living with HIV. TRIAL REGISTRATION Clinical Trial Number: NCT03500172.
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Affiliation(s)
- Anvita Bhardwaj
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Carly A Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | | | | | - Rene Phetlhu
- TB HIV Care, Café Town, South Africa
- University of Western Cape, Café Town, South Africa
| | | | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, ON, USA
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, USA
- Institute of Medical Science and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, USA
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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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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Gaur PS, Saha S, Goel A, Ovseiko P, Aggarwal S, Agarwal V, Haq AU, Danda D, Hartle A, Sandhu NK, Gupta L. Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent. Front Psychol 2023; 14:1060543. [PMID: 36743255 PMCID: PMC9895954 DOI: 10.3389/fpsyg.2023.1060543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.
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Affiliation(s)
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Ashish Goel
- Department of Medicine, Dr. B. R. Ambedkar State Institute of Medical Sciences, Mohali, India
| | - Pavel Ovseiko
- Radcliffe Department of Medicine, Oxford, United Kingdom
| | - Shelley Aggarwal
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Atiq Ul Haq
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Debashish Danda
- Department of Rheumatology and Clinical Immunology, Christian Medical College Hospital, Vellore, India
| | - Andrew Hartle
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nimrat Kaur Sandhu
- Department of Public Health, University of California, Merced, Merced, CA, United States
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India,Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom,Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom,City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom,*Correspondence: Latika Gupta, ; orcid.org/0000-0003-2753-2990
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Pandey AK, Seelman K. History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15908. [PMID: 36497981 PMCID: PMC9735961 DOI: 10.3390/ijerph192315908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.
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Affiliation(s)
- Ajay Keshav Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Kristie Seelman
- School of Social Work, Georgia State University, Atlanta, GA 30302, USA
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Martinez-Donate AP, Dsouza N, Cuellar S, Connor G, Zumaeta-Castillo C, Lazo-Elizondo M, Yamasaki Y, Perez C, Carroll-Scott A, Martinez O, Hassrick EM. Provider perceptions of availability, accessibility, and adequacy of health and behavioral services for Latino immigrants in Philadelphia: a qualitative study. BMC Public Health 2022; 22:1645. [PMID: 36042441 PMCID: PMC9427076 DOI: 10.1186/s12889-022-14066-z] [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: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Latino populations in the United States are disproportionately affected by substance use, HIV/AIDS, violence, and mental health issues (SAVAME). A growing body of evidence demonstrates the syndemic nature of SAVAME and the need for integrated strategies to reduce their impact. This study sought to understand the network of SAVAME services for Latino immigrants in Philadelphia to inform future interventions for SAVAME prevention and mitigation. METHODOLOGY Key informant interviews (N = 30) were conducted with providers working in Latino-serving organizations providing SAVAME services. Interviews were analyzed using thematic coding and grounded theory. RESULTS Latino-serving providers perceived a large need for, and important limitations in the availability, accessibility, and adequacy of SAVAME services for Latino immigrants. Gaps were seen as especially acute for mental health and substance use services, partly because of insufficient funding for these services. Latino immigrants' lack of health insurance, immigration status, limited English proficiency (LEP), stigma surrounding SAVAME issues, and limited knowledge of available services were identified as significant barriers preventing access to services. Providers noted that scarcity of well-trained, culturally competent, and ethnically concordant providers reduced the adequacy of SAVAME services for Latino immigrant clients. The small size, low levels of infrastructure, and limited capacity were reported as additional factors limiting the ability of many Latino-serving organizations to adopt a syndemic approach in the prevention and treatment of SAVAME services. CONCLUSIONS The results call for changes in the structure of funding streams and communitywide strategies to foster collaboration across SAVAME providers working with Latino immigrant clients.
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Affiliation(s)
- Ana P. Martinez-Donate
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Nishita Dsouza
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Sierra Cuellar
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Gabrielle Connor
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Claudia Zumaeta-Castillo
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Mariana Lazo-Elizondo
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | | | - Cristina Perez
- WOAR Philadelphia Center Against Sexual Violence, Philadelphia, PA USA
| | - Amy Carroll-Scott
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Omar Martinez
- grid.264727.20000 0001 2248 3398College of Public Health, Temple University, Philadelphia, PA USA
| | - Elizabeth McGhee Hassrick
- grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.166341.70000 0001 2181 3113A.J. Drexel Autism Institute, Drexel University, PA Philadelphia, USA
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Elmes J, Stuart R, Grenfell P, Walker J, Hill K, Hernandez P, Henham C, Rutsito S, Sarker MD, Creighton S, Browne C, Boily MC, Vickerman P, Platt L. Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK. Sex Transm Infect 2022; 98:323-331. [PMID: 34702782 PMCID: PMC9340007 DOI: 10.1136/sextrans-2021-055088] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine legal and social determinants of violence, anxiety/depression among sex workers. METHODS A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4). RESULTS 197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression. CONCLUSIONS Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.
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Affiliation(s)
- Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Carolyn Henham
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - M D Sarker
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Ong JJ, Xiong M, Tucker JD, Wang Y, Smith MK, Tang W, Fu H, Zheng H, Yang B, Wang C. Sexualized Drug Use Among Female Sex Workers from Eight Cities in China: A Cross-Sectional Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2689-2698. [PMID: 34786656 PMCID: PMC8594644 DOI: 10.1007/s10508-021-02117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
There is a rich literature on sexualized drug use (i.e., drug use before or during sex) for men who have sex with men but less data from female sex workers (FSW), particularly from low- and middle-income countries. We describe the sexual and reproductive health outcomes in FSW reporting sexualized drug use. In 2019, we conducted a cross-sectional study in eight cities from seven provinces in China. We recruited FSW through community organizations working with sex workers and included those aged 18 years or above, exchanged sex at least once for money or goods in the past three months, and had traded sex for longer than a year. Multivariable logistic regression models were used. In total, 650 women participated: average age was 38.8 years (SD 10.2), 57.1% reported a monthly income over 5000 RMB ($USD 707), and 12.8% completed high school or above. Among participants, 65 (10.0%, 95% confidence interval (CI) 7.8-12.6) reported a history of sexualized drug use. Compared to FSW who never reported a history of sexualized drug use, FSW who reported a history of sexualized drug use had greater odds of working for a manager compared to being self-employed (adjusted odds ratio (AOR) 4.04, 95% CI 2.12-7.69), work in a sauna (AOR 2.43, 95% CI 1.09-5.41), charging a higher price for vaginal sex (AOR 2.15, 95% CI 1.14-4.06), and ever diagnosed with STIs (AOR 4.51, 95% CI 2.61-7.80). One in ten FSW reported sexualized drug use. Although they had similar risk profiles in terms of consistency of condom use and reproductive health outcomes, these women were more likely to report past STIs than those who reported no sexualized drug use. Health workers who work with substance users should devote attention to the sexual practices of their clients to make sure that they have safer sex.
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Affiliation(s)
- Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mingzhou Xiong
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yajie Wang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota, Twin Cities, MN, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China.
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.
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11
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Argento E, Goldenberg S, Deering K, Lavalley J, Braschel M, Bingham B, Shannon K. Interest in receiving psychedelic-assisted therapy among marginalized women: Implications and findings from a community-based study in Canada. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100044. [PMID: 36845985 PMCID: PMC9948919 DOI: 10.1016/j.dadr.2022.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Background Psychedelic-assisted therapies are receiving mounting attention for their therapeutic potential. However, little is known about interest among women who experience elevated risk of mental health and substance use disorders. This study examined interest in receiving psychedelic-assisted therapy and socio-structural factors associated with interest among marginalized women. Methods Data (2016-2017) were drawn from two community-based, prospective open cohorts of >1000 marginalized women in Metro Vancouver, Canada. Bivariate and multivariable logistic regression examined associations with interest in receiving psychedelic-assisted therapy. Among women who used psychedelics, additional data were collected to describe ratings of personal meaningfulness, sense of wellbeing, and spiritual significance. Results Of 486 eligible participants (aged 20-67 years), 43% (n = 211) were interested in receiving psychedelic-assisted therapy. Over half identified as Indigenous (First Nations, Métis or Inuit). Factors independently associated with interest in psychedelic-assisted therapy in multivariable analysis included: daily crystal methamphetamine use in the last six months (Adjusted Odds Ratio [AOR] 3.02; 95%Confidence Interval (CI) 1.37-6.65), lifetime mental health conditions (depression, anxiety, post-traumatic stress disorder) (AOR 2.13; 95%CI 1.27-3.59), childhood abuse (AOR 1.99; 95%CI 1.02-3.88), lifetime psychedelic use (AOR 1.97; 95%CI 1.14-3.38), and younger age (AOR 0.97 per year older; 95%CI 0.95-0.99). Conclusions Several mental health and substance use-related variables that have been demonstrated to be amenable to psychedelic-assisted therapy were associated with interest in receiving psychedelic-assisted therapy among women in this setting. As access to psychedelic-assisted therapies continues to expand, any future approaches to extend psychedelic medicine to marginalized women should integrate trauma-informed care and broader socio-structural supports.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- BC Centre on Substance Use, 1045 Howe Street, Vancouver V6Z 1Y6, BC, Canada
| | - Shira Goldenberg
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Kathleen Deering
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| | - Jennifer Lavalley
- BC Centre on Substance Use, 1045 Howe Street, Vancouver V6Z 1Y6, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver V6T 1Z4, BC, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- Vancouver Coastal Health, Aboriginal Health, 2750 East Hastings Street, Vancouver V5K 1Z9, BC, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
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12
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Kamacooko O, Bagiire D, Kasujja FX, Mirembe M, Seeley J, King R. Prevalence of probable depression and factors associated with mean Hopkins Symptom Checklist (HSCL) depression score among young women at high risk aged 15-24 years in Kampala, Uganda. PLoS One 2022; 17:e0270544. [PMID: 35771894 PMCID: PMC9246240 DOI: 10.1371/journal.pone.0270544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In populations at high risk of HIV infection, rates of depression can be elevated with far-reaching effects on overall well-being. There is limited research on depression among young women engaged in high-risk sexual behaviour in low and middle-income settings. We investigated the prevalence, correlates and factors associated with mean HSCL depression score among young women at high risk (aged 15-24 years old) in Kampala, Uganda. METHODS We conducted a baseline analysis of a randomized controlled trial. Probable depression was measured using the 15-item Hopkins Symptoms Checklist for depression (HSCL). This checklist has been validated in Ugandan populations, and our reliability test gave a Cronbach alpha coefficient of 0.89. The test was administered to all the participants. Participants whose HSCL mean score was greater than 1.75 were categorized as having probable depression. Socio-demographics and behaviour data were collected and factors associated with mean HSCL depression score were analysed using multiple linear regression. RESULTS Data was available for 600 participants, mean age 20.4 (SD±2.44) years. The prevalence of probable depression was 56% (95% CI, 52%-60%). Probable depression symptoms were most prevalent among those who reported ever-experiencing violence from a sexual partner (64.7%), those aged between 20-24 years (58.2%) and those who reported more than 10 sexual exposures in the month prior to the interview (56.8%). At the adjusted analysis level, condom use during their last sexual intercourse prior to the survey decreased probable depression symptoms by 0.147 units compared to those who never used condoms (β = -0.147, 95% CI -0.266-0.027). Having experienced physical violence by a sexual partners increased mean HSCL depression score by 0.183 units compared to those who have never experienced violence (β = 0.183, 95% CI 0.068-0.300). Participants who reported ever using drugs of addiction had their mean HSCL depression scoreincrease by 0.20 units compared to those who have never used (β = 0.20,95% CI 0.083-0.317). CONCLUSIONS Probable depression is high in this population and increased mean HSCL depression score is related to violence. Periodic screening for depression and interventions targeting depression, partner violence and risky sexual behaviours are recommended.
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Affiliation(s)
| | | | | | | | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel King
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
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13
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Millan-Alanis JM, Carranza-Navarro F, de León-Gutiérrez H, Leyva-Camacho PC, Guerrero-Medrano AF, Barrera FJ, Garza Lopez LE, Saucedo-Uribe E. Prevalence of suicidality, depression, post-traumatic stress disorder, and anxiety among female sex workers: a systematic review and meta-analysis. Arch Womens Ment Health 2021; 24:867-879. [PMID: 34110487 DOI: 10.1007/s00737-021-01144-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
The purpose was to assess prevalence of suicidality, depression, post-traumatic stress disorder (PTSD), and anxiety among female sex workers (FSW). A systematic review and meta-analysis was performed. Search strategy was performed in MEDLINE, Scopus, Web of Science, EMBASE, Ovid and Cochrane Central Database from inception until March 2020. Considered for inclusion were cross-sectional studies performed on FSW that assessed prevalence of any of the following: suicide attempt or suicidal ideation, depression, PTSD, or anxiety. Five reviewers, independently and in duplicate, selected all eligible articles in an abstract and full-text screening phase and, moreover, extracted information from each study. A binomial-normal generalized linear mixed model was employed to estimate prevalence of the conditions. From 8035 studies yielded in the search strategy, 55 were included for analysis. The overall prevalence of suicidal ideation and attempt was 27% (95% C.I. 18-39%) and 20% (95% C.I. 13-28%), respectively. Furthermore, overall prevalence of depression and PTSD was 44% (95% C.I. 35-54%) and 29% (95% C.I. 18-44%), respectively. Eleven studies were classified as high quality. Findings indicate that there is an overall high prevalence of suicidality, depression, and PTSD among FSW. Development of accessible large-scale interventions that assess mental health among this population remains critical.
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Affiliation(s)
- Juan Manuel Millan-Alanis
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Farid Carranza-Navarro
- Department of Psychiatry, Hospital Universitario "Dr, José Eleuterio González", Francisco I. Madero Avenue n.n. & Gonzalitos Avenue, Mitras Centro, P.C. 64460, Monterrey, Nuevo León, Mexico
| | | | - Paloma C Leyva-Camacho
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Andrea Fernanda Guerrero-Medrano
- Department of Psychiatry, Hospital Universitario "Dr, José Eleuterio González", Francisco I. Madero Avenue n.n. & Gonzalitos Avenue, Mitras Centro, P.C. 64460, Monterrey, Nuevo León, Mexico
| | - Francisco J Barrera
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Leticia Elizabeth Garza Lopez
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Erasmo Saucedo-Uribe
- Department of Psychiatry, Hospital Universitario "Dr, José Eleuterio González", Francisco I. Madero Avenue n.n. & Gonzalitos Avenue, Mitras Centro, P.C. 64460, Monterrey, Nuevo León, Mexico.
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14
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Argento E, Strathdee SA, Shoveller JA, Braschel M, Shannon K. Correlates of Suicidality Among A Community-Based Cohort of Women Sex Workers: The Protective Effect of Social Cohesion. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:9709-9724. [PMID: 31431099 PMCID: PMC7608559 DOI: 10.1177/0886260519870167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.
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Affiliation(s)
- Elena Argento
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | | | - Jean A. Shoveller
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Ouma S, Ndejjo R, Abbo C, Tumwesigye NM. Client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda: a cross-sectional study. BMJ Open 2021; 11:e046894. [PMID: 34518251 PMCID: PMC8438829 DOI: 10.1136/bmjopen-2020-046894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY OBJECTIVE To determine the prevalence and associated factors of client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda. DESIGN AND SETTINGS We conducted a cross-sectional study among female sex workers in Gulu district in conflict-affected Northern Uganda. PARTICIPANTS The study participants included 300 female sex workers aged 18+ years. The participants were selected using simple random sampling from a database of female sex workers maintained at a national non-governmental organisation in Gulu. OUTCOME MEASURE The outcome measure was self-reported exposure to client-perpetrated gender-based violence. METHODS We used a pretested semistructured questionnaire to collect data on sociodemographic characteristics, sex work-related characteristics, alcohol use, illicit drug use, HIV status and self-reported exposure to client-perpetrated gender-based violence. Then, data were entered into Epi Info V.7 and analysed using Stata V.14.0. RESULTS Among participants, 61.0% reported client-perpetrated gender-based violence. Economic (58.7%) and emotional (52.0%) violence were the most common forms of client-perpetrated gender-based violence in this population. Independently, being: street-based (adjusted OR=9.66, 95% CI 2.78 to 33.5), mobile (adjusted OR=3.21, 95% CI 1.83 to 5.64), HIV-positive (adjusted OR=1.90, 95% CI 1.09 to 3.31) and a low-income earner (<USh200 000 monthly) (adjusted OR=2.26, 95% CI 1.18 to 4.30) were positively associated with exposure to client-perpetrated gender-based violence. CONCLUSIONS There is a high prevalence of client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda. Furthermore, female sex workers who were street-based, mobile, HIV-positive and low-income earners were more likely to experience client-perpetrated gender-based violence. The ministry of health and the development partners need to provide targeted public health interventions to prevent and manage the rampant gender-based violence among this underserved population.
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Affiliation(s)
- Simple Ouma
- Research Department, The AIDS Support Organization, Kampala, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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16
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Kerrigan D, Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Mbwambo J, Likindikoki S, Davis W, Wilson Beckham S, Mantsios A, Galai N, Sibinga E. Mindfulness, Mental Health and HIV Outcomes Among Female Sex Workers in the Dominican Republic and Tanzania. AIDS Behav 2021; 25:2941-2950. [PMID: 33511496 DOI: 10.1007/s10461-021-03168-1] [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] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
We examined the relationship between mindfulness, mental health and HIV outcomes among female sex workers (FSW) from the Dominican Republic (DR) (n = 201) and Tanzania (n = 208) using cross-sectional survey and biologic data. We employed stratified multivariate linear and logistic regression. Depression was associated with lower odds of ART adherence in the DR (AOR 0.25, 95% CI: 0.08-0.78) and of viral suppression in Tanzania (AOR 0.49, 95% CI: 0.24-0.97). In both countries, mindfulness was associated with lower odds of moderate to severe depression (AOR 0.82, 95% CI: 0.76-0.88 for the DR; AOR 0.85, 95% CI: 0.77-0.95 for Tanzania). In the DR, mindfulness was associated with lower odds of anxiety (AOR 0.83, 95% CI: 0.77-0.89), lower HIV stigma (β = - 0.28 per unit change, 95% CI: - 0.37 to - 0.19) and greater odds of viral suppression (AOR 1.09, 95% CI: 1.02-1.15). Findings demonstrate the potential of tailored mindfulness interventions to improve mental health and HIV outcomes among FSW.
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17
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Ouma S, Tumwesigye NM, Ndejjo R, Abbo C. Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study. BMC Public Health 2021; 21:1134. [PMID: 34120613 PMCID: PMC8201688 DOI: 10.1186/s12889-021-11207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda. Methods We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0. Results The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression. Conclusions There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11207-8.
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Affiliation(s)
- Simple Ouma
- Department of Research, The AIDS Support Organization (TASO), Kampala, Uganda. .,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Nazarius Mbona Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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18
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Lathan EC, Hong JH, Heads AM, Borgogna NC, Schmitz JM. Prevalence and Correlates of Sex Selling and Sex Purchasing among Adults Seeking Treatment for Cocaine Use Disorder. Subst Use Misuse 2021; 56:2229-2241. [PMID: 34559026 PMCID: PMC8717456 DOI: 10.1080/10826084.2021.1981391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Exchange sex places individuals with cocaine use disorder (CUD) at particularly high risk for deleterious safety and health outcomes. A substance use treatment provider who is aware of a patient's exchange sex behavior is better able to provide appropriate screening, care, and/or referral to risk reduction services. However, little is known about exchange sex, especially purchasing, among treatment-seeking adults with CUD. The current study examined the prevalence and correlates of sex selling and sex purchasing among treatment-seeking men and women with CUD (n = 109; ClinicalTrials.gov #NCT02896712). Separate binary logistic regressions via backward elimination were used to identify best fitting models for sex selling and sex purchasing. Over 41% of participants endorsed exchange sex within the last 30 days; 20.2% reported selling sex and 30.3% reported purchasing sex. Sex selling and sex purchasing rates differed by gender and race. Number of sexual partners (OR = 5.83, 95% CI = 2.07-16.43), concern about contracting HIV/AIDS (OR = 2.01, 95% CI = 1.31-3.44), cumulative interpersonal trauma exposure (OR = 1.82, 95% CI = 1.20-2.77), years using cocaine (OR = 1.11, 95% CI = 1.03-1.20), drug-related problem days (OR = 1.07, 95% CI = 1.00-1.14), and sexual preference (OR = 9.50, 95% CI = .69-130.35) were retained in the final model estimating sex selling (Nagelkerke R2 = .56). In the final sex purchasing model (Nagelkerke R2 = .46), gender (OR = 36.17, 95% CI = 2.96-441.75), number of sexual partners (OR = 6.28, 95% CI = 2.69-14.66), number of convictions (OR = 1.13, 95% CI = 1.02-1.25), and drug-related problem days (OR = 0.96, 95% CI = .92-1.01) were retained. Predictive models in this study identified distinct sets of variables related to sex selling and purchasing. Findings may be used to improve identification of exchange sex in the substance use treatment setting and referral to targeted interventions to reduce associated risk.
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Affiliation(s)
- Emma C Lathan
- Center for Neurobehavioral Research on Addiction, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Judy H Hong
- Center for Neurobehavioral Research on Addiction, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Angela M Heads
- Center for Neurobehavioral Research on Addiction, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nicholas C Borgogna
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Joy M Schmitz
- Center for Neurobehavioral Research on Addiction, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Patel R, Redmond NM, Kesten JM, Linton MJ, Horwood J, Wilcox D, Munafo J, Coast J, Macleod J, Jeal N. Drug Use in Street Sex worKers (DUSSK) study: results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers. BMJ Open 2020; 10:e036491. [PMID: 33323428 PMCID: PMC7745311 DOI: 10.1136/bmjopen-2019-036491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 10/13/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study. SETTING Female SSW charity premises in a large UK inner city. PARTICIPANTS Females aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month. INTERVENTION Female SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service. RESULTS (1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant's lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating. CONCLUSIONS Recruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial.
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Affiliation(s)
- Rita Patel
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Niamh M Redmond
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna M Kesten
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences & NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Myles-Jay Linton
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences & Health Economics Bristol, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences & Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - David Wilcox
- Acer Unit, Blackberry Hill Hospital, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Jess Munafo
- Acer Unit, Blackberry Hill Hospital, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Joanna Coast
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences & Health Economics Bristol, University of Bristol, Bristol, UK
| | - John Macleod
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences & Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Nicola Jeal
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Devon Sexual Health - North Devon, Northern Devon Healthcare NHS Trust, Barnstaple, UK
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20
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Heijdra Suasnabar JM, Hipple Walters B. Community-based psychosocial substance use disorder interventions in low-and-middle-income countries: a narrative literature review. Int J Ment Health Syst 2020; 14:74. [PMID: 33062049 PMCID: PMC7542947 DOI: 10.1186/s13033-020-00405-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (SUDs) are the world's leading cause of years lived with disability; in low-and-middle income countries (LIMCs), the treatment gap for SUDs is at least 75%. LMICs face significant structural, resource, political, and sociocultural barriers to scale-up SUD services in community settings. AIM This article aims to identify and describe the different types and characteristics of psychosocial community-based SUD interventions in LMICs, and describe what context-specific factors (policy, resource, sociocultural) may influence such interventions in their design, implementation, and/or outcomes. METHODS A narrative literature review was conducted to identify and discuss community-based SUD intervention studies from LMICs. Articles were identified via a search for abstracts on the MEDLINE, Academic Search Complete, and PsycINFO databases. A preliminary synthesis of findings was developed, which included a description of the study characteristics (such as setting, intervention, population, target SUD, etc.); thereafter, a thematic analysis was conducted to describe the themes related to the aims of this review. RESULTS Fifteen intervention studies were included out of 908 abstracts screened. The characteristics of the included interventions varied considerably. Most of the psychosocial interventions were brief interventions. Approximately two thirds of the interventions were delivered by trained lay healthcare workers. Nearly half of the interventions targeted SUDs in addition to other health priorities (HIV, tuberculosis, intimate partner violence). All of the interventions were implemented in middle income countries (i.e. none in low-income countries). The political, resource, and/or sociocultural factors that influenced the interventions are discussed, although findings were significantly limited across studies. CONCLUSION Despite this review's limitations, its findings present relevant considerations for future SUD intervention developers, researchers, and decision-makers with regards to planning, implementing and adapting community-based SUD interventions.
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Affiliation(s)
- Jan Manuel Heijdra Suasnabar
- Trimbos Institute, Utrecht, The Netherlands
- London School of Hygiene and Tropical Medicine, Public Health for Development, London, UK
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21
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Deyessa N, Senbete B, Abdo A, Mundia BM. Population estimation and harm reduction among people who inject drugs in Addis Ababa, Ethiopia. Harm Reduct J 2020; 17:61. [PMID: 32894153 PMCID: PMC7487880 DOI: 10.1186/s12954-020-00407-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Injecting drug use is known to contribute significantly to the spread of the HIV epidemic in many parts of the developing world. Due to the hidden nature and stigma of the problem, it is difficult to study using routine surveys. Therefore, this study aims to estimate the number of people who inject drugs in Addis Ababa, Ethiopia, and to describe the epidemiological and social situation related to HIV among people who inject drugs. Methods The study used rapid assessment methods, followed by combined methods of estimating populations, using nomination and multiplier methods. The combined methods used two datasets: the first includes the proportion of people who use services within a year as a multiplier, and the second, a count of the list of people with a problem who used the specific service within a year as a benchmark. The rapid assessment incorporated different qualitative tools to elicit information related to injectable drugs, using existing data sources, in-depth interviews, and focus group discussions. Results The study estimated a total of 4068; with 95% CI (3196, 5207) people who inject drugs (PWIDs) in Addis Ababa. The study found people who inject drugs were young in age, male, with a lower educational status, unmarried, and living in small clerical business. People who inject drugs and participated in the study were more likely to use additional substances like alcohol, khat, and cannabis. The most common form of injectable drug used was heroin, and most of the people who inject drugs reported sharing syringes and needles. A high proportion of study subjects also disclosed having positive test results for HIV, hepatitis B, and C. Conclusion The population size of people who inject drugs in Addis Ababa is high. Lack of service in harm reduction in the city has made PWIDs vulnerable and at higher risk for HIV/AIDs and hepatitis B and C. Therefore, responsible bodies must start implementing the essential harm reduction strategies given by the World Health Organization.
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Affiliation(s)
- Negussie Deyessa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, P.O. Box 3253, Addis Ababa, Ethiopia.
| | - Bekele Senbete
- Organization for Social Services, Health, and Development, Addis Ababa, Ethiopia
| | - Aman Abdo
- Organization for Social Services, Health, and Development, Addis Ababa, Ethiopia
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22
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Beattie TS, Smilenova B, Krishnaratne S, Mazzuca A. Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003297. [PMID: 32931504 PMCID: PMC7491736 DOI: 10.1371/journal.pmed.1003297] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Shari Krishnaratne
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Canada
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23
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Jain JP, Abramovitz D, Strathdee SA, Gonzalez-Zuniga P, Rangel G, West BS, Pitpitan EV. Sex Work as a Mediator Between Female Gender and Incident HIV Infection Among People Who Inject Drugs in Tijuana, Mexico. AIDS Behav 2020; 24:2720-2731. [PMID: 32185596 PMCID: PMC7453791 DOI: 10.1007/s10461-020-02828-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We studied mechanisms driving gender differences in HIV incidence among 651 women and men who inject drugs (PWID) in Tijuana, Mexico, hypothesizing that sex work will mediate the association between female gender and HIV incidence. Of 43 HIV seroconversions occurring between 2011 and 2018, 8.8% were among females and 5.2% among males. HIV incidence density was significantly higher among females versus males (1.75 per 100 person years [PY], 95% CI 1.16-2.66, vs. 0.95 per 100 PY, 95% CI 0.62-1.47). Factors significantly associated with HIV seroconversion were: sex work (adjusted hazard ratio [aHR] = 2.25, 95% CI 1.05-4.80); methamphetamine injection (aHR = 2.30, 95% CI 1.12-4.73); and methamphetamine and heroin co-injection in the past six months (aHR = 2.26, 95% CI 1.23-4.15). In mediation analyses, sex work mediated a substantial proportion (84.3%) of the association between female gender and HIV incidence. Interventions should target female PWID who engage in sex work to reduce gender-related disparities in HIV incidence.
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Affiliation(s)
- Jennifer P Jain
- School of Medicine, University of California, San Diego, La Jolla, USA.
- School of Medicine, University of California, San Francisco, San Francisco, USA.
| | | | | | | | - Gudelia Rangel
- United States-Mexico Border Health Commission and El Colegio de la Frontera Norte, Tijuana, Mexico
- El Colegio de La Frontera Norte, Tijuana, Mexico
| | - Brooke S West
- School of Social Work, Columbia University, New York, United States
| | - Eileen V Pitpitan
- School of Medicine, University of California, San Diego, La Jolla, USA
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24
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Jain JP, Strathdee SA, Patterson TL, Semple SJ, Harvey-Vera A, Magis-Rodríguez C, Martinez G, Pines HA. Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis. AIDS Care 2020; 32:557-566. [PMID: 31163975 PMCID: PMC6891112 DOI: 10.1080/09540121.2019.1626338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/29/2019] [Indexed: 12/17/2022]
Abstract
Female sex workers (FSWs) experience syndemic factors (e.g., polydrug use, hazardous alcohol consumption, client-perpetrated violence, depression, and sexually transmitted infections) that often heighten vulnerability to HIV and limit healthcare utilization. We hypothesized that syndemic factors will limit FSWs' uptake of pre-exposure prophylaxis (PrEP). From 2016 to 2017, 295 HIV-negative FSWs were enrolled in a behavioral HIV prevention trial in Tijuana and Ciudad Juarez, Mexico, underwent STI testing, and completed surveys on syndemic factors and perceived barriers to PrEP use. Syndemic scores (0-5) were calculated by summing syndemic factors. Latent class analysis (LCA) was used to identify homogeneous classes with respect to perceived barriers to PrEP use. We identified four classes: (1) perceived healthcare access barriers (8.3%), (2) perceived financial barriers (18.7%), (3) high level of perceived barriers (19.9%), and (4) low level of perceived barriers (53.0%) to PrEP use. Those experiencing three (adjusted odds ratio [aOR] = 3.63, 95% confidence interval [CI] = 1.24-10.67) and four or five (aOR = 6.30, 95% CI = 1.70-23.35) syndemic factors had a higher odds of membership in the class characterized by a high level of perceived barriers than in the class characterized by a low level of perceived barriers. Addressing syndemic factors may maximize PrEP's impact among FSWs along Mexico's northern border.
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Affiliation(s)
- Jennifer P. Jain
- Department of Medicine, University of California, San Diego, La Jolla, USA
| | | | - Thomas L. Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
| | - Shirley J. Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, La Jolla, USA
| | - Carlos Magis-Rodríguez
- Centro Nacional para la Prevención del VIH/SIDA (CENSIDA), Ministry of Health, Mexico City, Mexico
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas, Ciudad Juarez, Chihuahua, Mexico
| | - Heather A. Pines
- Department of Medicine, University of California, San Diego, La Jolla, USA
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25
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Jiwatram-Negrón T, El-Bassel N. Overlapping intimate partner violence and sex trading among high-risk women: Implications for practice. Women Health 2019; 59:672-686. [PMID: 30543494 PMCID: PMC6565517 DOI: 10.1080/03630242.2018.1544967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Despite research indicating higher than average rates of intimate partner violence (IPV) across groups of vulnerable women, less is known about the prevalence and types of IPV experienced by women who trade sex for money, drugs, shelter or food, a high risk group for poor health and psychosocial outcomes. Using a cross-sectional design and multivariate logistic regression analyses, this study examined the relationship between IPV and sex trading in a convenience sample of 346 HIV-negative, drug-involved women in relationships, recruited during 2005-2010 in New York City. About 41% and 36% of participants reported lifetime and recent IPV, respectively, by their main partner, with significant differences by recent engagement in sex trading (p < 0.01). Results of multivariate analyses indicated that sex trading was associated with recent severe physical or sexual IPV (OR = 3.07, p < 0.01) and that depression, having ever been married, child sexual abuse, and income were associated with IPV (p < 0.05). Women who reported childhood sexual abuse and recent sex trading had a 7.37 higher odds (p < 0.01) for reporting severe physical or sexual IPV compared to those who reported neither. Findings highlight the need to expand screening and interventions among women who trade sex.
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Affiliation(s)
- Tina Jiwatram-Negrón
- School of Social Work, Arizona State University, 411 N. Central Avenue, Suite 800, Phoenix, AZ 85004, , 602.496.0677
| | - Nabila El-Bassel
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8 Floor, New York, NY, USA, , 212.851.2391
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26
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Semple SJ, Pines HA, Vera AH, Pitpitan EV, Martinez G, Rangel MG, Strathdee SA, Patterson TL. Maternal role strain and depressive symptoms among female sex workers in Mexico: the moderating role of sex work venue. Women Health 2019; 60:284-299. [PMID: 31195898 DOI: 10.1080/03630242.2019.1626792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Stressors that arise in parenting are likely to have an adverse impact on the psychological well-being of female sex workers (FSWs), particularly in low- to middle-income countries (LMIC). This study examined the association between maternal role strain and depressive symptoms among 426 FSW mothers with dependent-age children (aged < 18 years) in Tijuana and Cd. Juarez, Mexico (2016-2017). Four dimensions of maternal role strain (e.g., child emotional and behavioral problems) were examined in relation to maternal depressive symptoms. We also investigated whether the relationship between maternal role strain and depressive symptoms was modified by venue of sex work. Compared to indoor/establishment-based FSWs, street-based FSWs reported significantly more child-related financial strain. In multiple regression analysis, having more depressive symptoms was associated with identifying as a street-based FSW, greater use of drugs, lower emotional support, more child-related financial strain and more emotional and behavioral problems in children. A significant interaction was identified such that the association between maternal role strain and depressive symptoms was stronger for indoor/establishment-based compared to street-based FSWs. These findings suggest the need to address parenting strain and type of sex work venue in the development of counseling programs to improve the mental health of FSWs in LMIC.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Heather A Pines
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alicia Harvey Vera
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Eileen V Pitpitan
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gustavo Martinez
- Department of Patient Care, Federación Méxicana de Asociaciones Privadas, A.C. (FEMAP), Ciudad Juarez, Mexico
| | - M Gudelia Rangel
- Department of Migrant Health, US-Mexico Border Health Commission, Tijuana, Mexico
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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27
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Ranjbar F, Sadeghi-Bazargani H, Pishgahi A, Nobari O, Farahbakhsh M, Farhang S, Adlnasab L, Dareshiri S. Mental health status among female sex workers in Tabriz, Iran. Arch Womens Ment Health 2019; 22:391-397. [PMID: 30128846 DOI: 10.1007/s00737-018-0907-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Female sex workers are a deprived part of Islamic communities. It is necessary for public health policy makers to have knowledge about their mental health status. This study aims to have an evaluation of mental health among female sex workers in Tabriz for the first time in northwest of Iran. In this cross-sectional study, 48 female sex workers who had accepted to be evaluated were included. Sociodemographic and general mental health statuses, using General Health Questionnaire (GHQ-28), were recorded. Those with GHQ-28 score more than 23/24 in the first session were thoroughly interviewed in a second session in order to find out their specific mental disorder, using Structured Clinical Interview for DSM-IV axis 1 and 2 Disorders (SCID 1 and 2). This study suggests that 62.5% of female sex workers suffer from a mental health problem which is in accordance with previous studies. Mood and anxiety disorder were two of the most common, and there were also records of personality disorders among participants of this survey. There were also high rates of addiction in female sex workers of this study. Based on findings of this study, high rates of mental disorders such as personality disorders, anxiety disorder, and mood disorder were detected among female sex workers in the northwest of Iran. Financial incentive was reported to be the primary motivation for choosing sex work as a source of income.
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Affiliation(s)
- Fateme Ranjbar
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Science, Tabriz, Iran.,Psychiatry Department, Razi Hospital, El-goli Street, Tabriz, East Azerbaijan Province, Iran
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Statistics and Epidemiology Department, Tabriz University of Medical Science, Golgasht Street, Tabriz, East Azerbaijan Province, Iran
| | - Alireza Pishgahi
- Physical Medicine and Rehabilitation Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Physical Medicine and Rehabilitation Ward, Imam Reza Hospital, Golgasht Street, Tabriz, East Azerbaijan Province, Iran
| | - Ozra Nobari
- Psychology Department, University of Minnesota, Minneapolis, MN, USA.,Psychiatry Department, University of Minnesota, Minneapolis, MN, USA
| | - Mostafa Farahbakhsh
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Science, Tabriz, Iran.,Psychiatry Department, Razi Hospital, El-goli Street, Tabriz, East Azerbaijan Province, Iran
| | - Sara Farhang
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Science, Tabriz, Iran.,Psychiatry Department, Razi Hospital, El-goli Street, Tabriz, East Azerbaijan Province, Iran
| | - Ladan Adlnasab
- Psychology Department, University of Tabriz, Tabriz, Iran.,Psychiatry Department, Tabriz University, Tabriz, Iran
| | - Shahla Dareshiri
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Science, Tabriz, Iran. .,Psychiatry Department, Razi Hospital, El-goli Street, Tabriz, East Azerbaijan Province, Iran.
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28
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Argento E, Braschel M, Walsh Z, Socias ME, Shannon K. The moderating effect of psychedelics on the prospective relationship between prescription opioid use and suicide risk among marginalized women. J Psychopharmacol 2018; 32:1385-1391. [PMID: 30255717 PMCID: PMC6355147 DOI: 10.1177/0269881118798610] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Given high rates of depression and suicide among marginalized women, and increasing calls to integrate trauma-informed biomedical and community-led structural interventions, this study longitudinally examines the potential moderating effect of psychedelic use on the relationship between other illicit drug use and suicide risk. METHODS Data (2010-2017) were drawn from a community-based, prospective open cohort of marginalized women in Vancouver, Canada. Extended Cox regression analyses examined the moderating effect of psychedelic use on the association between other illicit drug use and incidence of suicidal ideation or attempt over follow-up. RESULTS Of 340 women without suicidal ideation or attempt at baseline, 16% ( n=53) reported a first suicidal episode during follow-up, with an incidence density of 4.63 per 100 person-years (95% confidence interval 3.53-6.07). In unadjusted analysis, psychedelic use moderated the relationship between prescription opioid use and suicide risk: among women who did not use psychedelics, prescription opioid use increased the hazard of suicide (hazard ratio 2.91; 95% confidence interval 1.40-6.03) whereas prescription opioid use was not associated with increased suicidal ideation or attempt among those who used psychedelics (hazard ratio 0.69; 95% confidence interval 0.27-1.73) (interaction term p-value: 0.016). The moderating effect of psychedelics remained significant when adjusted for confounders (interaction term p-value: 0.036). CONCLUSIONS Psychedelic use had a protective moderating effect on the relationship between prescription opioid use and suicide risk. In the context of a severe public health crisis around prescription opioids and lack of addiction services tailored to marginalized women, this study supports calls for innovative, evidence-based and trauma-informed interventions, including further research on the potential benefits of psychedelics.
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Affiliation(s)
- Elena Argento
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - M. Eugenia Socias
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,BC Centre on Substance Use, Vancouver, BC, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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29
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Jeal N, Patel R, Redmond NM, Kesten JM, Ramsden S, Macleod J, Coast J, Telfer M, Wilcox D, Nowland G, Horwood J. Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers. BMJ Open 2018; 8:e022728. [PMID: 30391916 PMCID: PMC6231566 DOI: 10.1136/bmjopen-2018-022728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Poor health of sex workers continues to be a source of international concern. Sex work is frequently linked with problematic drug use and drug-dependent sex workers typically work on the street, experiencing the greatest risks to health compared with the general population. Street sex workers (SSWs) are much more likely to have experienced incidences of physical and sexual assault, increasing their risk of developing post-traumatic stress disorder (PTSD). We have developed a novel complex intervention designed to reduce illicit drug use in drug-dependent female SSWs which involves: female SSW drug treatment groups (provided by a specialist charity) in a female SSW setting (female sex worker charity premises) provided by female-only staff, PTSD care with eye movement desensitisation and reprocessing (EMDR) therapy provided by female staff from National Health Service (NHS) mental health services. METHODS AND ANALYSIS A mixed methods study investigating the feasibility and acceptability of this intervention to inform the design of a future randomised controlled trial. The study aims to recruit up to 30 participants from November 2017 to March 2018 at a single site, with the intervention being delivered until December 2018. It will gather quantitative data using questionnaires and group attendance. Drug treatment group observations and in-depth interviews undertaken with up to 20 service users and 15 service providers to examine experiences and acceptability of the intervention. Study feasibility will be assessed by evaluating the recruitment and retention of participants to the intervention; the feasibility of NHS and third sector organisations working closely to coordinate care for a SSW population; the potential for specialist NHS mental health services to screen and provide EMDR therapy for drug-dependent SSWs and potential costs of implementing the intervention. ETHICS AND DISSEMINATION This study was approved by South West-Frenchay Research Ethics Committee (REC reference: 17/SW/0033; IRAS ID: 220631) and the Health Research Authority (HRA). Findings will be disseminated through research conferences and peer-reviewed journals.
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Affiliation(s)
- Nicola Jeal
- University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rita Patel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
| | - Niamh M Redmond
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
| | - Joanna M Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Sophie Ramsden
- University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- Health Economics at Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - David Wilcox
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | | | - Jeremy Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Roberts ST, Flaherty BP, Deya R, Masese L, Ngina J, McClelland RS, Simoni J, Graham SM. Patterns of Gender-Based Violence and Associations with Mental Health and HIV Risk Behavior Among Female Sex Workers in Mombasa, Kenya: A Latent Class Analysis. AIDS Behav 2018; 22:3273-3286. [PMID: 29603110 PMCID: PMC6146064 DOI: 10.1007/s10461-018-2107-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gender-based violence (GBV) is common among female sex workers (FSWs) and is associated with multiple HIV risk factors, including poor mental health, high-risk sexual behavior, and sexually transmitted infections (STIs). Prior studies have focused on GBV of one type (e.g. physical or sexual) or from one kind of perpetrator (e.g., clients or regular partners), but many FSWs experience overlapping types of violence from multiple perpetrators, with varying frequency and severity. We examined the association between lifetime patterns of GBV and HIV risk factors in 283 FSWs in Mombasa, Kenya. Patterns of GBV were identified with latent class analysis based on physical, sexual, or emotional violence from multiple perpetrators. Cross-sectional outcomes included depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, disordered alcohol and other drug use, number of sex partners, self-reported unprotected sex, prostate-specific antigen (PSA) in vaginal secretions, and a combined unprotected sex indicator based on self-report or PSA detection. We also measured HIV/STI incidence over 12 months following GBV assessment. Associations between GBV patterns and each outcome were modeled separately using linear regression for mental health outcomes and Poisson regression for sexual risk outcomes. Lifetime prevalence of GBV was 87%. We identified 4 GBV patterns, labeled Low (21% prevalence), Sexual (23%), Physical/Moderate Emotional (18%), and Severe (39%). Compared to women with Low GBV, those with Severe GBV had higher scores for depressive symptoms, PTSD symptoms, and disordered alcohol use, and had more sex partners. Women with Sexual GBV had higher scores for disordered alcohol use than women with Low GBV, but similar sexual risk behavior. Women with Physical/Moderate Emotional GBV had more sex partners and a higher prevalence of unprotected sex than women with Low GBV, but no differences in mental health. HIV/STI incidence did not differ significantly by GBV pattern. The prevalence of GBV was extremely high in this sample of Kenyan FSWs, and different GBV patterns were associated with distinct mental health and sexual risk outcomes. Increased understanding of how health consequences vary by GBV type and severity could lead to more effective programs to reduce HIV risk in this vulnerable population.
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Affiliation(s)
- Sarah T Roberts
- Women's Global Health Imperative, RTI International, 351 California St, Ste 500, San Francisco, CA, 94104, USA.
| | - Brian P Flaherty
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Ruth Deya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Linnet Masese
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jacqueline Ngina
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - R Scott McClelland
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan M Graham
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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31
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Berger BO, Grosso A, Adams D, Ketende S, Sithole B, Mabuza XS, Mavimbela MJ, Baral S. The Prevalence and Correlates of Physical and Sexual Violence Affecting Female Sex Workers in Swaziland. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:2745-2766. [PMID: 26872508 DOI: 10.1177/0886260516629385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Female sex workers (FSW) have a heightened vulnerability to violence and negative sexual/reproductive health outcomes. Limited research has examined how experiencing physical and sexual violence (PSV) mediates risk for poor health outcomes among FSW in Swaziland. The present analyses aim to contribute to literature linking violence with poor health outcomes, high-risk behaviors, and reduced health service-seeking among FSW. Data were analyzed from a cross-sectional study conducted in Swaziland between July and September 2011 with 325 adult women who reported exchanging sex for money, goods, or favors in the last 12 months, recruited through respondent-driven sampling (RDS). Logistic regression was used to assess the relationship between PSV and ancillary violence/abuse exposures, risk behaviors, and sexual/reproductive and mental health outcomes. PSV was conceptualized as either ever having been beaten up as a result of selling sex or ever being forced to have sex since the age of 18, or both. Prevalence of PSV in this sample was 59.0% in crude estimation, and 48.4% (95% confidence interval [CI]:[39.2,57.6]) with RDS weighting. Separate RDS-weighted estimates of being beaten up as a result of sex work and ever being forced to have sex were 32.4% (95%CI=[24.4,40.4]) and 33.1% (95%CI =[25.0,41.2%]), respectively. Experiencing PSV was associated with being blackmailed (adjusted odds ratio [aOR]= 1.93, 95%CI= [1.07,3.52]), non-injection drug use in the last 12 months (aOR= 1.84, 95%CI= [1.02,3.33]), and feeling afraid to seek health services as a result of selling sex (aOR = 1.74, 95%CI= [1.01,2.99]). Given these findings, violence prevention strategies should be prioritized in programs that address Swazi FSW health, empowerment, and safety.
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Pinedo M, Burgos JL, Zúñiga ML, Perez R, Macera CA, Ojeda VD. Deportation and mental health among migrants who inject drugs along the US-Mexico border. Glob Public Health 2018; 13:211-226. [PMID: 27132880 PMCID: PMC5191974 DOI: 10.1080/17441692.2016.1170183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (adjusted odds ratio (AOR): 5.27; 95% CI: 1.79-15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01-4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy.
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Affiliation(s)
- Miguel Pinedo
- Alcohol Research Group, 6475 Christie Avenue Suite 400, Emeryville, CA 94608
| | - José Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, Hepner Hall 203D, San Diego, CA 92182
| | - Ramona Perez
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-6022
| | - Caroline A. Macera
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162
| | - Victoria D. Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093
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Lau JTF, Gu J, Tsui HY, Chen H, Wang Z, Cao W. Anticipated suicidal ideation among female injecting drug users who are sex workers of negative or unknown HIV status in China. Women Health 2017; 58:774-789. [PMID: 29261438 DOI: 10.1080/03630242.2017.1353571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In China, female injection drug users who are also sex workers (IDUFSW) have a high prevalence of HIV and low prevalence of HIV testing. They are concerned about HIV infection and may be subjected to the risk of suicidal ideation if they become infected, due to stress and discrimination. During 2005-2006, we recruited 199 IDUFSW who self-reported negative/unknown HIV sero-status in Dazhou, Sichuan, China, to investigate the prevalence of and factors associated with suicidal ideation if they became HIV positive. Among the participants, 40.7% responded affirmatively to the question "Whether you would commit suicide if you were infected with HIV in the future?" In multivariate analyses, hatred toward oneself, perception of dying within 2-3 years, perceived nonavailability of HIV-related treatment, inability to cope with HIV-related trauma, and inclination to leave one's family if one contracted HIV were significant factors related to anticipated suicidal ideation under the hypothetical situation of HIV infection. The odds ratios (OR) ranged from 2.38 to 10.36 (p < .05). These findings can facilitate the planning of primary suicidal prevention services targeting high-risk, non-HIV-positive IDUFSW. Such programs may enhance psychosocial support, empowerment, cultivation of positive coping strategies, and perceived accessibility to treatment, and be integrated with HIV testing.
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Affiliation(s)
- Joseph T F Lau
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China.,b Centre for Medical Anthropology and Behavioral Health , Sun Yat-sen University , Guangzhou, China
| | - Jing Gu
- c Department of Medical Statistics and Epidemiology, School of Public Health , Sun Yat-sen University , Guangzhou, China.,d Sun Yat-sen Global Health Institute , Sun Yat-sen University , Guangzhou, China
| | - Hi Yi Tsui
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Hongyao Chen
- e Department of HIV/AIDS Prevention , Dazhou Center for Disease Control and Prevention , Dazhou , China
| | - Zixin Wang
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Wangnan Cao
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
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Puri N, Shannon K, Nguyen P, Goldenberg SM. Burden and correlates of mental health diagnoses among sex workers in an urban setting. BMC WOMENS HEALTH 2017; 17:133. [PMID: 29258607 PMCID: PMC5735638 DOI: 10.1186/s12905-017-0491-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Abstract
Background Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. While much research has focused on HIV and sexually transmitted infections (STIs) among sex workers, there remains a gap in evidence regarding the broader health issues faced by this population, including mental health. Given limited evidence describing the mental health of women in sex work, our objective was to evaluate the burden and correlates of mental health diagnoses among this population in Vancouver, Canada. Methods An Evaluation of Sex Workers Health Access (AESHA) is a prospective, community-based cohort of on- and off-street women in sex work in Vancouver, Canada. Participants complete interviewer-administered questionnaires semi-annually. We analyzed the lifetime burden and correlates of self-reported mental health diagnoses using bivariate and multivariable logistic regression. Results Among 692 sex workers enrolled between January 2010 and February 2013, 338 (48.8%) reported ever being diagnosed with a mental health issue, with the most common diagnoses being depression (35.1%) and anxiety (19.9%). In multivariable analysis, women with mental health diagnoses were more likely to identify as a sexual/gender minority (LGBTQ) [AOR=2.56, 95% CI: 1.72—3.81], to use non-injection drugs [AOR=1.85, 95% CI: 1.12—3.08], to have experienced childhood physical/sexual trauma [AOR=2.90, 95% CI: 1.89—4.45], and work in informal indoor [AOR=1.94, 95% CI: 1.12 – 3.40] or street/public spaces [AOR=1.76, 95% CI: 1.03–2.99]. Conclusions This analysis highlights the disproportionate mental health burden experienced by women in sex work, particularly among those identifying as a sexual/gender minority, those who use drugs, and those who work in informal indoor venues and street/public spaces. Evidence-informed interventions tailored to sex workers that address intersections between trauma and mental health should be further explored, alongside policies to foster access to safer workspaces and health services.
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Affiliation(s)
- Nitasha Puri
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Paul Nguyen
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira M Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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35
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MacLean SA, Lancaster KE, Lungu T, Mmodzi P, Hosseinipour MC, Pence BW, Gaynes BN, Hoffman IF, Miller WC. Prevalence and correlates of probable depression and post-traumatic stress disorder among female sex workers in Lilongwe, Malawi. Int J Ment Health Addict 2017; 16:150-163. [PMID: 29556159 DOI: 10.1007/s11469-017-9829-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Globally, female sex workers (FSW) experience a high prevalence of mental health disorders, but in sub-Saharan Africa these are rarely identified. If left untreated, mental health disorders may place FSW and their partners at risk for HIV/sexually transmitted infections (STIs). We assessed the prevalence and correlates of probable depression, post-traumatic stress disorder (PTSD), and suicidal ideation (SI) in a cohort of 200 FSW in Lilongwe, Malawi. FSW completed the Patient Health Questionnaire-9 and the PTSD Check List-Civilian Version. The prevalence of depression was 8%, as was the prevalence of PTSD. Nearly half (49%) of FSW were experiencing mild depression. FSW were more likely to have probable depression if they completed primary school or initiated sex work before 18 years. They were more likely to have probable PTSD if they had ≥ 20 clients per week or initiated sex work before 18 years. Interventions are needed to diagnose mental health disorders among FSW at great risk for HIV/STIs.
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Affiliation(s)
- Sarah A MacLean
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Kathryn E Lancaster
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd Chapel Hill, North Carolina 27599 USA
| | - Thandie Lungu
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Pearson Mmodzi
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Mina C Hosseinipour
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd Chapel Hill, North Carolina 27599 USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599 USA
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, North Carolina 27599 USA
| | - Irving F Hoffman
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, 302 Cunz Hall, 1841 Neil Avenue, Columbus, Ohio 43210 USA
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Abstract
CONTEXT Psychological distress is higher in women working in sex industry. The various psycho social issues are associated with female commercial sex workers (FCSWs). The host of psychosocial vulnerabilities including, childhood sexual abuse, exposure to childhood physical abuse, poverty, interpersonal violence in adulthood, sexually transmitted diseases, and substance use, forms a fertile ground for psychiatric morbidity. AIM This study aims to assess the psychiatric morbidity among FCSWs in Shillong, India. MATERIALS AND METHODS In the present study, 100 FCSWs were selected. For the recruitment of sample, simple random sampling procedure was followed; sociodemographic data sheet and the Mini International Neuropsychiatric Interview were administered. RESULTS In the study, it was found that 9% of the respondents reported having major depressive episode (current), 25% of the respondents reported major depressive episode (past), 3% were having major depressive episode with melancholic features (current), 21% of the respondents reported posttraumatic stress disorder (PTSD), 8% of the respondents reported to have alcohol dependence, 3% of the respondents reported to have nonalcohol psychoactive substance use disorder, 8% of the respondents were found to have generalized anxiety disorder, and 9% of the respondents were found to have antisocial personality disorder. CONCLUSIONS There is a prevalence of mental health problems in the FCSW. Assessment of the psychiatric morbidity in FCSW is significant in developing health policy and interventions to reduce their impact on their well-being. It is the immediate need that the governmental and nongovernmental agencies, mental health professionals, and workers in this area need to be sensitized to the issue of mental health status of the commercial sex workers.
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Affiliation(s)
- Marboh Goretti Iaisuklang
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Arif Ali
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
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Jeal N, Macleod J, Salisbury C, Turner K. Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study. BMJ Open 2017; 7:e013018. [PMID: 28336736 PMCID: PMC5372151 DOI: 10.1136/bmjopen-2016-013018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS To explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes. DESIGN In-depth interviews. SETTING Bristol, UK. PARTICIPANTS 24 current and exited SSWs with current or previous experience of problematic use of heroin and/or crack cocaine. FINDINGS Participants described how feeling unable to discuss their sex work in drug treatment groups undermined their engagement in the treatment process. They outlined how disclosure of sex work resulted in stigma from male and female service users as well as adverse interactions with male service users. Participants highlighted that non-disclosure meant they could not discuss unresolved trauma issues which were common and which emerged or increased when they reduced their drug use. As trauma experiences had usually involved men as perpetrators participants said it was not appropriate to discuss them in mixed treatment groups. SSWs in recovery described how persistent trauma-related symptoms still affected their lives many years after stopping sex work and drug use. Participants suggested SSW-only services and female staff as essential to effective care and highlighted that recent service changes were resulting in loss of trusted staff and SSW-only treatment services. This was reported to be reducing the likelihood of SSWs engaging in drug services, with the resultant loss of continuity of care and reduced time with staff acting as barriers to an effective therapeutic relationship. CONCLUSIONS SSWs face many barriers to effective drug treatment. SSW-only treatment groups, continuity of care with treatment staff and contact with female staff, particularly individuals who have had similar lived experience, could improve the extent to which SSWs engage and benefit from drug treatment services. Service engagement and outcomes may also be improved by drug services that include identification and treatment of trauma-related symptoms.
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Affiliation(s)
- Nikki Jeal
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katrina Turner
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Urada LA, Simmons J, Wong B, Tsuyuki K, Condino-Enrera G, Hernandez LI, Simbulan NP, Raj A. A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study. Int J Public Health 2016; 61:945-957. [PMID: 27600733 DOI: 10.1007/s00038-016-0875-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study evaluated a brief human rights-focused HIV community mobilization intervention for sex workers in the Philippines, a country with one of the fastest rising number of HIV cases worldwide. METHODS Five single-session group interventions to reduce sexual risk and increase HIV testing among 86 sex workers in Manila were evaluated with pre-post-test data via Wilcoxon's signed-ranks and Mann-Whitney tests. The 4-h intervention, Kapihan (August-November, 2013), integrated human rights with HIV skill-building. Demographic data, violence/trafficking victimization, human rights knowledge, and intentions to HIV test and treat were collected. RESULTS Participants were median aged 23; female (69 %); had children (55; 22 % had 3+ children); used drugs (past 3 months: 16 %); sexually/physically abused by clients (66 %); 20 % street sex workers ever took an HIV test. Pre-post-test scores significantly improved in knowledge of HIV (z = -8.895, p < 0.001), reproductive health (z = -3.850, p < 0.001), human rights (z = -4.391, p < 0.001), ethical rights of research participants (z = -5.081, p < 0.001), and intentions to HIV test (z = -4.868, p < 0.001). CONCLUSIONS Integrating human rights into HIV interventions may empower sex workers to address their health and human rights and test for HIV.
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Affiliation(s)
- Lianne A Urada
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA. .,College of Health and Human Services, School of Social Work, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Janie Simmons
- National Development and Research Institutes, Inc., 71 W 23rd St, New York, NY, 10010, USA
| | - Betty Wong
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Kiyomi Tsuyuki
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Gerlita Condino-Enrera
- Woodwater Center for Healing, 8 Nicanor Reyes St, Loyola Heights, Quezon City, Philippines
| | - Laufred I Hernandez
- Department of Behavioral Sciences, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Nymia Pimentel Simbulan
- College of Arts and Science and College of Public Health, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Anita Raj
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
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Rael CT, Davis A. Depression and key associated factors in female sex workers and women living with HIV/AIDS in the Dominican Republic. Int J STD AIDS 2016; 28:433-440. [PMID: 27189491 DOI: 10.1177/0956462416651374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the mental health of female sex workers and women living with HIV/AIDS in the Dominican Republic, which impedes HIV prevention, testing, and treatment. This project estimates the prevalence of depression and identifies key contributing factors to this outcome in female sex workers, women living with HIV/AIDS, and a comparison group. Participants were female sex workers (N = 349), women living with HIV/AIDS (N = 213), and a comparison group of HIV-negative women who were not sex workers (N = 314) from the Dominican Republic. Participants completed questionnaires assessing demographic characteristics and depression. Female sex workers and women living with HIV/AIDS completed additional questionnaires ascertaining HIV or sex work-related internalized stigma. Depression was prevalent among female sex workers (70.2%), women living with HIV/AIDS (81.1%), and the comparison group (52.2%). Adjusted logistic regressions showed that internalized stigma was associated with depression for female sex workers (OR = 2.73; 95% CI = 1.95-3.84) and women living with HIV/AIDS (OR = 3.06; 95% CI = 1.86-5.05). Permanent income was associated with this outcome for female sex workers (OR = 0.08; 95% CI = 0.01-0.80) and the comparison group (OR = 0.04; 95% CI = 0.00-0.45).
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Affiliation(s)
- Christine T Rael
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, NY, USA
| | - Alissa Davis
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, NY, USA
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40
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Ferraiolo N, Pinedo M, McCurley J, Burgos JL, Vargas-Ojeda AC, Rodriguez MA, Ojeda VD. Depressive symptoms among patients at a clinic in the Red Light District of Tijuana, Mexico. ACTA ACUST UNITED AC 2016; 9:151-163. [PMID: 28042307 DOI: 10.1080/17542863.2016.1144776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Little is known about depression among structurally vulnerable groups living in Tijuana (e.g., migrants, deportees, substance users, sex workers, homeless) who may be at high risk for poor mental health. This study investigates the prevalence and correlates of depressive symptoms among vulnerable patients receiving services at a free clinic in Tijuana, Mexico. A convenience sample of 584 adult Mexican patients completed an interviewer-administered questionnaire in English or Spanish that included the 8-item NIH PROMIS depression short form and measures of individual, social, and structural factors affecting health. The prevalence of clinically significant depressive symptoms in our sample was 55%. In the multivariate analysis, female gender, poor/fair self-rated health, recent illicit drug use (past six months), feeling rejected (past six months), history of forced sex, and history of violence were independently associated with increased odds of experiencing depressive symptoms. When stratified by gender, we found important differences in significant factors, including recent illicit drug use in men and deportation in women. Among study participants, prevalence of depressive symptoms exceeds prevalence rates reported elsewhere in the U.S.-Mexico border region. These findings suggest that public health efforts to support mental health services in the border region are needed.
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Affiliation(s)
- Natalie Ferraiolo
- University of California, San Diego School of Medicine, La Jolla CA, USA
| | - Miguel Pinedo
- Alcohol Research Group, University of California, Berkeley, Emeryville CA, USA
| | - Jessica McCurley
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jose Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla CA, USA
| | - Adriana Carolina Vargas-Ojeda
- Postgraduate Studies and Research Department, School of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Baja California, México
| | - Michael A Rodriguez
- Department of Family Medicine/UCLA Blum Center on Poverty and Health in Latin America, University of California, Los Angeles, Los Angeles CA, USA
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla CA, USA
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Bazzi AR, Syvertsen JL, Rolón ML, Martinez G, Rangel G, Vera A, Amaro H, Ulibarri MD, Hernandez DO, Strathdee SA. Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities. J Subst Abuse Treat 2016; 61:26-33. [PMID: 26470596 PMCID: PMC4695257 DOI: 10.1016/j.jsat.2015.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/03/2015] [Accepted: 08/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Available drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts. METHODS This mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n=82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences. RESULTS Perceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs. CONCLUSIONS Affordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.
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Affiliation(s)
- Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA.
| | - Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174W. 18th Avenue, Columbus OH 43210, USA
| | - María Luisa Rolón
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas, Plutarco Elías Calles No. 744 Norte, Col. Progresista, C.P. 32310, Ciudad Juárez, Chihuahua, México
| | - Gudelia Rangel
- Comisión de Salud Fronteriza México-Estados Unidos, Sección México, Paseo del Centenario #10851, Zona Río. C.P. 22010, Tijuana, Baja California, México; Secretaría de Salud, Homero 213, piso 19, Col. Chapultepec Morales, Delegación Miguel Hidalgo C.P. 11570, México, D.F
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México
| | - Hortensia Amaro
- School of Social Work and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Montgomery Ross Fisher Building, Room 221 669W. 34th St., Los Angeles, CA 90089
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0849, USA; California School of Professional Psychology, Alliant International University-San Diego, San Diego, CA
| | - Daniel O Hernandez
- School of Medicine, University of California, Davis, 4610 X Street, Sacramento, CA 95817, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA
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Semple SJ, Stockman JK, Pitpitan EV, Strathdee SA, Chavarin CV, Mendoza DV, Aarons GA, Patterson TL. Prevalence and Correlates of Client-Perpetrated Violence against Female Sex Workers in 13 Mexican Cities. PLoS One 2015; 10:e0143317. [PMID: 26599083 PMCID: PMC4657898 DOI: 10.1371/journal.pone.0143317] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Globally, client-perpetrated violence against female sex workers (FSWs) has been associated with multiple health-related harms, including high-risk sexual behavior and increased exposure to HIV/STIs. This study examined correlates of client-perpetrated sexual, physical, and economic violence (e.g., robbery) against FSWs in 13 cities throughout Mexico. METHODS FSWs (N = 1,089) who were enrolled in a brief, evidence-based, sexual risk reduction intervention for FSWs (Mujer Segura) were interviewed about their work context, including experiences of violence perpetrated by clients, sexual risk and substance use practices, financial need, and social supports. Three broad categories of factors (sociodemographic, work context, behavioral and social characteristics of FSWs) were examined as correlates of sexual, physical, and economic violence. RESULTS The prevalence of different types of client-perpetrated violence against FSWs in the past 6 months was: sexual (11.7%), physical (11.8%), economic (16.9%), and any violence (22.6%). Greater financial need, self-identification as a street worker, and lower perceived emotional support were independently associated with all three types of violence. Alcohol use before or during sex with clients in the past month was associated with physical and sexual violence. Using drugs before or during sex with clients, injection drug use in the past month, and population size of city were associated with sexual violence only, and FSWs' alcohol use score (AUDIT-C) was associated with economic violence only. CONCLUSIONS Correlates of client-perpetrated violence encompassed sociodemographic, work context, and behavioral and social factors, suggesting that approaches to violence prevention for FSWs must be multi-dimensional. Prevention could involve teaching FSWs strategies for risk avoidance in the workplace (e.g., avoiding use of alcohol with clients), enhancement of FSWs' community-based supports, development of interventions that deliver an anti-violence curriculum to clients, and programs to address FSWs' financial need by increasing their economic opportunities outside of the sex trade.
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Affiliation(s)
- Shirley J. Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California, 92093–0680, United States of America
| | - Jamila K. Stockman
- Department of Psychiatry, University of California San Diego, La Jolla, California, 92093–0680, United States of America
| | - Eileen V. Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, 92093–0507, United States of America
| | - Steffanie A. Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, 92093–0507, United States of America
| | - Claudia V. Chavarin
- Department of Psychiatry, University of California San Diego, La Jolla, California, 92093–0680, United States of America
| | - Doroteo V. Mendoza
- Evaluation and Research Department, Mexican Foundation for Family Planning (Mexfam), Distrito Federal, 14000, Mexico
| | - Gregory A. Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, California, 92093–0680, United States of America
| | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, 92093–0680, United States of America
- * E-mail:
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Gaines TL, Urada LA, Martinez G, Goldenberg SM, Rangel G, Reed E, Patterson TL, Strathdee SA. Short-term cessation of sex work and injection drug use: evidence from a recurrent event survival analysis. Addict Behav 2015; 45:63-9. [PMID: 25644589 DOI: 10.1016/j.addbeh.2015.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/15/2014] [Accepted: 01/12/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation. METHODS We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico. RESULTS Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation. CONCLUSIONS Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry.
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Affiliation(s)
- Tommi L Gaines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA.
| | - Lianne A Urada
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA
| | - Gustavo Martinez
- Federacion Mexicana de Asociaciones Privadas, Ave. Malecon e Ing. M Cardona, No. 788 Zona Centro, 32000 Cd., Juarez, Chihuahua, Mexico
| | - Shira M Goldenberg
- BC Center for Excellence in HIV/AIDS and Division of AIDS, Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, Canada
| | | | - Elizabeth Reed
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive MC0680, La Jolla, CA 92093-0680, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive MC0507, La Jolla, CA 92093-0507, USA
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44
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Sherwood JA, Grosso A, Decker MR, Peitzmeier S, Papworth E, Diouf D, Drame FM, Ceesay N, Baral S. Sexual violence against female sex workers in The Gambia: a cross-sectional examination of the associations between victimization and reproductive, sexual and mental health. BMC Public Health 2015; 15:270. [PMID: 25886187 PMCID: PMC4375842 DOI: 10.1186/s12889-015-1583-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 02/25/2015] [Indexed: 11/12/2022] Open
Abstract
Background Female sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence. Methods A cross-sectional survey was administered among 251 FSW accrued through a combination of chain referral and venue-based sampling in The Gambia. Eligibility criteria included being over 16 years old and having exchanged sex for money, goods, or favors in the past 12 months. Results There is a high prevalence of sexual violence against FSW in The Gambia, with 29% (n = 70) of participants reporting a client forced them to have sex in their lifetime. Women who reported forced sex by a client were more likely to report symptoms of depression (aOR 2.15, CI: 1.10 – 4.16 p < 0.05), unwanted pregnancy (aOR: 2.69, CI: 1.12 – 6.49 p < 0.05) and report “no”, “difficult” or “somewhat difficult” access to condoms (aOR: 3.31, CI: 1.76 – 6.26 p < .01) compared to women who did not report forced sex. Client-perpetrated forced sex was also negatively associated with receiving any sexually transmitted infection (STI) test in the past 12 months (aOR: 0.49, CI: .26 – .91 p < .05). Conclusion FSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strategy to improve the health and safety of FSW as well as impact the spread of HIV/STIs in The Gambia.
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Affiliation(s)
- Jennifer A Sherwood
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Ashley Grosso
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Michele R Decker
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Sarah Peitzmeier
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Erin Papworth
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Daouda Diouf
- Enda Santé Senegal, 56, Comico VDN, BP, 3370, Dakar, Sénégal.
| | | | - Nuha Ceesay
- Lilunga House, Fifth Floor, Somhlolo Street, Mbabane, Swaziland.
| | - Stefan Baral
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
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Ulibarri MD, Roesch S, Rangel MG, Staines H, Amaro H, Strathdee SA. "Amar te Duele" ("love hurts"): sexual relationship power, intimate partner violence, depression symptoms and HIV risk among female sex workers who use drugs and their non-commercial, steady partners in Mexico. AIDS Behav 2015; 19:9-18. [PMID: 24743959 PMCID: PMC4201896 DOI: 10.1007/s10461-014-0772-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A significant body of research among female sex workers (FSWs) has focused on individual-level HIV risk factors. Comparatively little is known about their non-commercial, steady partners who may heavily influence their behavior and HIV risk. This cross-sectional study of 214 FSWs who use drugs and their male steady partners aged ≥18 in two Mexico-U.S. border cities utilized a path-analytic model for dyadic data based upon the Actor-Partner Interdependence Model to examine relationships between sexual relationship power, intimate partner violence (IPV), depression symptoms, and unprotected sex. FSWs' relationship power, IPV perpetration and victimization were significantly associated with unprotected sex within the relationship. Male partners' depression symptoms were significantly associated with unprotected sex within the relationship. Future HIV prevention interventions for FSWs and their male partners should address issues of sexual relationship power, IPV, and mental health both individually and in the context of their relationship.
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Affiliation(s)
- Monica D Ulibarri
- Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0849, USA,
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Socio-ecological factors associated with depression, suicidal ideation and suicidal attempt among female injection drug users who are sex workers in China. Drug Alcohol Depend 2014; 144:102-10. [PMID: 25236890 PMCID: PMC5581303 DOI: 10.1016/j.drugalcdep.2014.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/17/2014] [Accepted: 08/17/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Female injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China. METHODS Using snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors. RESULTS Thirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07-1.31). Self-stigma (OR=1.08, 95% CI: 1.01-1.15), depression (OR=1.11, 95% CI: 1.05-1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35-5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32-3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10-1.16), depression (OR=1.12, 95% CI: 1.04-1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09-4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression. CONCLUSIONS There are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.
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Werb D, Mora MEM, Beletsky L, Rafful C, Mackey T, Arredondo J, Strathdee SA. Mexico's drug policy reform: cutting edge success or crisis in the making? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:823-5. [PMID: 24974368 PMCID: PMC4169748 DOI: 10.1016/j.drugpo.2014.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Dan Werb
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Leo Beletsky
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; Northeastern University School of Law & Bouve College of Health Sciences, Boston, United States
| | - Claudia Rafful
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States
| | - Tim Mackey
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; Department of Anesthesiology, University of California, San Diego, School of Medicine, United States
| | - Jaime Arredondo
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States.
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