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Shan Migrant Sex Workers Living with HIV Who Remain Active in Sexual Entertainment Venues in Chiang Mai, Thailand. J Racial Ethn Health Disparities 2021; 9:1616-1625. [PMID: 34231161 DOI: 10.1007/s40615-021-01101-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Migrant female sex workers (MFSW) are at a high and increasing risk of HIV infection and may also be a source of transmission. In Northern Thailand, most MSFW are Shan ethnic nationals from Myanmar. This study aims to understand how the risks of HIV infection and transmission are perceived and acted upon by Shan MFSW living with HIV who remain active in sex work. The paper employs a narrative approach, offering insight into the lives of eight Shan MFSW living with HIV in Chiang Mai, Thailand. Their risk behaviors are examined, from when they first entered sex work through to becoming HIV-positive and adopting antiretroviral treatment, as well as the reasons for continuing sex work. The findings reveal several ways in which stigmatized identities and life conditions influence risk perceptions and behaviors of Shan MFSW. Shan MFSW exemplify biopolitical vulnerability as female migrants, and sex workers in addition to living with HIV and the constraints of poverty, and limited education and skills. Understanding the complexities in their life conditions suggested several ways to improve care for them.
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Decker M, Rouhani S, Park JN, Galai N, Footer K, White R, Allen S, Sherman S. Incidence and predictors of violence from clients, intimate partners and police in a prospective US-based cohort of women in sex work. Occup Environ Med 2020; 78:oemed-2020-106487. [PMID: 33144359 DOI: 10.1136/oemed-2020-106487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Gender-based violence threatens women's health and safety. Female sex workers (FSWs) experience violence disproportionately, yet prospective data on violence predictors is lacking. In the first US-based prospective FSW cohort study, we examine incidence rates (IRs) and predictors of violence from distinct perpetrators: paying clients, non-paying intimate partners and police. METHODS The parent cohort (Sex Workers and Police Promoting Health In Risky Environments) recruited street-based cisgender FSWs in urban Baltimore, MD (n=250) with 5 assessments at 3-month intervals through 12-month follow-up. Stratifying by violence perpetrator, we characterise violence at baseline, IR over the study period and time-varying predictors using Poisson models. RESULTS The violence IR per person year was highest for client-perpetrated violence (0.78), followed by intimate partner violence (IPV; IR 0.39), and police violence (IR 0.25). Prevalence over the 12-month follow-up period among participants with complete visit data (n=103), was 42% for client violence, 22% for IPV and 16% for police violence. In adjusted analyses, risk factors for incident violence varied across perpetrators and included entry to sex work through force or coercion (adjusted IR ratio (aIRR)IPV 2.0; 95% CI 1.2 to 3.6), homelessness (aIRRIPV 2.0; 95% CI 1.3 to 2.9; aIRRpolice 2.7; 95% CI 1.3 to 5.8) and daily injection drug use (aIRRclient 1.9; 95% CI 1.2 to 3.0). Risk of incident client violence and IPV was elevated by past abuse from each respective perpetrator. Help-seeking following abuse was limited. CONCLUSIONS FSWs face profound, enduring risk for violence from a range of perpetrators, likely enabled by criminalisation-related barriers to justice and perpetrator impunity. FSWs represent a priority population for access to justice, trauma-informed healthcare and violence-related support services. Structural vulnerabilities including homelessness and addiction represent actionable priorities for improving safety and health.
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Affiliation(s)
- Michele Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Public Health & Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - Katherine Footer
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca White
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sean Allen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Sherman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Decker MR, Park JN, Allen ST, Silberzahn B, Footer K, Huettner S, Galai N, Sherman SG. Inconsistent Condom Use Among Female Sex Workers: Partner-specific Influences of Substance Use, Violence, and Condom Coercion. AIDS Behav 2020; 24:762-774. [PMID: 31254189 PMCID: PMC10132468 DOI: 10.1007/s10461-019-02569-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Female sex workers (FSWs) are disproportionately affected by HIV. Inconsistent condom use (ICU) represents the most proximal risk for acquisition and transmission. We evaluate associations of partner-specific factors including physical and sexual violence, coercion, and substance use with ICU with clients and regular non-paying partners, respectively, among FSWs. Baseline survey data from a prospective cohort of 250 street-based FSW in Baltimore, Maryland, USA included partner-level drug and alcohol use, violence, condom coercion and ICU, in addition to individual and structural exposures. Logistic regression analyses were stratified by partner type, followed by path analysis where indicated. Within client and regular non-paying partnerships, FSWs reported prevalent recent violence (34.8%, 16%, respectively), condom coercion (42.4%, 9.9%, respectively) and ICU (39.2%, 44.4%, respectively). Recent physical or sexual violence enabled coercive condom negotiation (AORclient 8.22, 95% CI 4.30, 15.73; AORnonpayingpartner 3.01 95% CI 1.05, 8.63). ICU with clients was associated with client condom coercion (AOR 1.76, 95% CI 1.03, 3.02), and client intoxication during sex (AOR 2.25, 95% CI 1.13, 4.45). In path analysis of client-FSW partnerships, condom coercion fully mediated the influences of both sex worker intoxication and recent violence on ICU. ICU with non-paying partners was associated with FSW intoxication during sex (AOR 8.66, 95% CI 3.73, 20.10), and past-year police violence (AOR 2.92, 1.30, 6.57). Partner-level substance use and gendered power differentials influenced FSWs' ICU patterns differently by partner type. ICU with clients was rooted solely in partner factors, and coercive condom negotiation mediated the roles of violence and partner-level substance use on ICU. By contrast, ICU with non-paying partners was rooted in partner-level substance use and police violence as a structural determinant. Addressing HIV risk behavior for FSWs requires condom promotion efforts tailored to partner type that addresses power differentials.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. .,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Bradley Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Katherine Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Steven Huettner
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Mahapatra B, Bhattacharya R, Atmavilas Y, Saggurti N. Measuring vulnerability among female sex workers in India using a multidimensional framework. PLoS One 2018; 13:e0204055. [PMID: 30252879 PMCID: PMC6155505 DOI: 10.1371/journal.pone.0204055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/31/2018] [Indexed: 11/18/2022] Open
Abstract
Measuring vulnerability and identifying determinants of vulnerability are key to designing interventions for marginalized groups like sex workers. The current study introduces a new approach of measuring vulnerability among female sex workers (FSWs) by adopting a multidimensional poverty measurement framework. A multidimensional vulnerability index was created from four dimensions and 16 indicators using a dual cut-off approach. The study found that 55% of FSWs were multidimensionally vulnerable with 48% of intensity in vulnerability. The overall value of multidimensional vulnerability index was 0.265. FSWs in Maharashtra were most vulnerable (82%). Lack of financial security contributed mostly to FSWs’ vulnerability. Further, compared to less vulnerable FSWs, multidimensionally vulnerable ones were more to engage in behaviors that put them at risk such as inconsistent use of condoms with clients, alcohol consumption, engaging in anal sex with clients and experiencing sexually transmitted infections. Findings suggest that structural, social and financial vulnerabilities of FSWs need to be addressed concurrently.
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Affiliation(s)
| | - Ruchira Bhattacharya
- Population Council, Zone 5A, India Habitat Center, New Delhi, India
- National Institute of Rural Development and Panchayati Raj, Rajendranagar Mandal, Hyderabad, India
| | - Yamini Atmavilas
- Bill & Melinda Gates Foundation, The Capital Court, New Delhi, India
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Bhattacharjee P, Campbell L, Thalinja R, Nair S, Doddamane M, Ramanaik S, Isac S, Beattie TS. Understanding the Relationship Between Female Sex Workers and Their Intimate Partners: Lessons and Initial Findings From Participatory Research in North Karnataka, South India. HEALTH EDUCATION & BEHAVIOR 2018; 45:824-835. [PMID: 29618240 PMCID: PMC6139989 DOI: 10.1177/1090198118763934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While traditional HIV prevention programs with female sex workers (FSWs) in Karnataka, India, have focused on reducing HIV transmission between FSWs and clients through increased condom use, these programs have not fully addressed the transmission risk between FSWs and their nonpaying intimate partners (IPs). Condom use is infrequent and violence is recurrent in these relationships: Furthermore, there is little evidence on the precise nature of FSW–IP relationships. Our study addresses this knowledge gap to inform HIV programs targeted at FSWs. A series of workshops, using participatory tools, was held to explore FSW-IP relationships; 31 FSWs and 37 IPs participated. Three aspects of FSW–IP relationships were examined: how FSWs and IPs understand and interpret their relationships, factors influencing condom use, and the role of violence and its consequences. FSWs wish to be perceived as their IPs’ wives, while IPs expect their FSW partners to accept their dominance in the relationship. Nonuse of condoms signals fidelity and elevates the status of the relationship almost to that of marriage, which helps FSWs enter the category of “good” (married) women. Tolerating and accepting violence in these relationships is normative, as in other marital relationships; IPs justify violence as necessary to establish and maintain their power within the relationship. Both FSWs and IPs value their relationships despite the high degree of risk posed by low condom use and high levels of violence. Implications for program design include addressing current norms around masculinity and gender roles, and improving communication within relationships.
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Affiliation(s)
- Parinita Bhattacharjee
- 1 Karnataka Health Promotion Trust, Bangalore, India.,2 University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Sapna Nair
- 1 Karnataka Health Promotion Trust, Bangalore, India.,4 Institute for Financial Management and Research, Chennai, India
| | | | | | - Shajy Isac
- 1 Karnataka Health Promotion Trust, Bangalore, India.,2 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara S Beattie
- 5 London School of Hygiene and Tropical Medicine, London, UK
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Karamouzian M, Sadeghirad B, Sharifi H, Sedaghat A, Haghdoost AA, Mirzazadeh A. Consistent Condom Use with Paying and Nonpaying Partners among Female Sex Workers in Iran: Findings of a National Biobehavioral Survey. J Int Assoc Provid AIDS Care 2017; 16:572-578. [PMID: 28974161 DOI: 10.1177/2325957417732834] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Little is known about the dynamics of condom use among female sex workers (FSWs) in Iran. We investigated the correlates of consistent condom use (CCU) among FSWs, using data from a national biobehavioral surveillance survey in 2010. METHODS A total of 872 FSWs were recruited using a facility-based sampling strategy from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews using a standardized questionnaire. RESULTS Overall, 33.6% and 17.3% of FSWs reported CCU with paying and nonpaying sex partners, respectively. Consistent condom use with paying partners was significantly associated with temporary marriage, accessing family planning services and history of working in brothels. Conversely, temporary marriage or married status, condom rupture/slippage, and HIV seropositivity remained independently significantly associated with CCU with nonpaying sex partners. CONCLUSION Our findings indicated the urgent need for scaling up condom promotion interventions catered toward FSWs and their sex partners to practice safe sex consistently.
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Affiliation(s)
- Mohammad Karamouzian
- 1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,2 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Behnam Sadeghirad
- 3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,4 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- 1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sedaghat
- 5 Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Akbar Haghdoost
- 6 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- 1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,7 Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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Amoo EO, Oni GA, Ajayi MP, Idowu AE, Fadayomi TO, Omideyi AK. Are Men's Reproductive Health Problems and Sexual Behavior Predictors of Welfare? Am J Mens Health 2017; 11:487-497. [PMID: 26231731 PMCID: PMC5675243 DOI: 10.1177/1557988315598832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study examined men's reproductive health problems and sexual behavior and their implications for men's welfare in Nigeria. It used the Nigeria Demographic and Health Survey data set of 2013. The analysis used only male recode files, representing 17,359 males. The dependent variable is the computed wealth index, which was selected as proxy for welfare condition. Analysis involved univariate and multivariate levels. The findings indicated that 49.3% of the respondents currently have more than one sexual partner. The total lifetime sexual partner index identifies 70.2% of the men interviewed have had at least two sexual partners in their lifetime. It revealed that men who experience reproductive health challenges, such as sexually transmitted infections and genital ulcer, are 44% and 93%, respectively, less likely to enjoy good welfare condition. It also indicated that men in urban area are 7.256 times more likely to enjoy good welfare condition compared with their rural counterparts. There is a negative association between total lifetime sexual partnerships and exposure to good welfare. The study concludes that social workers, marriage counselors, other health personnel, and policy makers need to focus on the practice of multiple sexual partnership and reproductive health diseases as major determinants of men's welfare. The authors suggest that the index of welfare should include reproductive health issues and indicators of sexual behavior. Also, there is need for the establishment of specialized reproductive health care services and centers that are accessible to all men for effective servicing of reproductive health needs of men in the country.
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Tracas A, Bazzi AR, Artamonova I, Rangel MG, Staines H, Ulibarri MD. Changes in Condom Use Over Time Among Female Sex Workers and Their Male Noncommercial Partners and Clients. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:312-24. [PMID: 27427926 PMCID: PMC5356484 DOI: 10.1521/aeap.2016.28.4.312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Female sex workers (FSWs) often report inconsistent condom use with clients and noncommercial male partners, yet changes in condom use with various partner types during participation in observation studies remains underexplored. This longitudinal study of 214 FSWs and their male, noncommercial partners in the Mexico-U.S. border region, where HIV prevalence among FSWs continues to be high, utilized negative binomial regressions to examine changes in condom use with intimate partners and clients (regular and nonregular) over 24 months. Condom use decreased over time among couples in Ciudad Juarez, but there was no change in condom use among couples in Tijuana. FSWs' condom use with regular and nonregular clients significantly increased over time, which is consistent with previous research finding behavioral changes when participating in observational studies. Findings suggest the need for continued efforts to promote condom use among FSWs and their noncommercial male partners in addition to clients.
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Affiliation(s)
- Ashley Tracas
- Department of Psychology, San Diego State University, San Diego, California
| | - Angela Robertson Bazzi
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
| | - Irina Artamonova
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - M Gudelia Rangel
- Comisión de Salud Fronteriza México-Estado Unidos, Tijuana, Baja California, México
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahua, México
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, La Jolla
- California School of Professional Psychology, Alliant International University, San Diego, California
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Occupational and demographic factors associated with drug use among female sex workers at the China-Myanmar border. Drug Alcohol Depend 2016; 161:42-9. [PMID: 26897586 DOI: 10.1016/j.drugalcdep.2016.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Within the last decade, the use of amphetamine type stimulants (ATS) has swelled in Myanmar. Regionally, female sex workers have reported turning to ATS for occupational reasons. In doing so, drug-using female sex workers (FSW) face compounded risks for HIV and other sexually transmitted infections (STI). Here, we examine the factors that impact FSW drug use in Muse, a town along the China-Myanmar border. METHODS In 2012, 101 FSW were recruited from entertainment venues and brothels along the Myanmar-Chinese border. Participants participated in a self-administered behavioral survey covering demographics, drug use, sex work, and risk behaviors. Bivariate and regression analyses were conducted in SPSS. RESULTS Thirty four percent of respondents indicated current drug use. ATS derivatives were the most commonly used drugs (87.5%) with injection drug use being nearly non-existent in the sample. Drug using FSWs were older, had engaged in sex work longer, had more Chinese clients, and were more likely to have a previous boyfriend who had used drugs. They were also 3.5 times more likely to report a STI. Client condom use, HIV testing rates, and familiarity with public health resources did not statistically differ by drug use status. CONCLUSION More research is needed to examine how romantic and professional sexual relationships push-and-pull FSW into using drugs. Our results suggest that diverse safer sex strategies, beyond client condom use, should be promoted with drug using FSWs, including strategies that acknowledge the impact of ATS use.
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Argento E, Shannon K, Nguyen P, Dobrer S, Chettiar J, Deering KN. The role of dyad-level factors in shaping sexual and drug-related HIV/STI risks among sex workers with intimate partners. Drug Alcohol Depend 2015; 157:166-73. [PMID: 26585612 PMCID: PMC4678956 DOI: 10.1016/j.drugalcdep.2015.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/30/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite high HIV burden among sex workers (SWs) globally, and relatively high prevalence of client condom use, research on potential HIV/STI risk pathways of intimate partnerships is limited. This study investigated partner/dyad-level factors associated with inconsistent condom use among SWs with intimate partners in Vancouver, Canada. METHODS Baseline data (2010-2013) were drawn from a community-based prospective cohort of women SWs. Multivariable generalized estimating equations logistic regression examined dyad-level factors associated with inconsistent condom use (<100% in last six months) with up to three male intimate partners per SW. Adjusted odds ratios and 95% confidence intervals were reported (AOR[95%CI]). RESULTS Overall, 369 SWs reported having at least one intimate partner, with 70.1% reporting inconsistent condom use. Median length of partnerships was 1.8 years, with longer duration linked to inconsistent condom use. In multivariable analysis, dyad factors significantly associated with increased odds of inconsistent condom use included: having a cohabiting (5.43[2.53-11.66]) or non-cohabiting intimate partner (2.15[1.11-4.19]) (versus casual partner), providing drugs (3.04[1.47-6.30]) or financial support to an intimate partner (2.46[1.05-5.74]), physical intimate partner violence (2.20[1.17-4.12]), and an intimate partner providing physical safety (2.08[1.11-3.91]); non-injection drug use was associated with a 68% reduced odds (0.32[0.17-0.60]). CONCLUSIONS Our study highlights the complex role of dyad-level factors in shaping sexual and drug-related HIV/STI risk pathways for SWs from intimate partners. Couple and gender-focused interventions efforts are needed to reduce HIV/STI risks to SWs through intimate partnerships. This research supports further calls for integrated violence and HIV prevention within broader sexual/reproductive health efforts for SWs.
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Affiliation(s)
- Elena Argento
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kate Shannon
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Paul Nguyen
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Sabina Dobrer
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Jill Chettiar
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Kathleen N Deering
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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