Partner violence and psychosocial distress among female sex workers in China

On the Overlap of Commercial Sexual Exploitation and Intimate Partner Violence: An Exploratory Examination of Trauma-Related Shame

Every year, millions of people experience intimate partner violence (IPV) and commercial sexual exploitation (CSE), with researchers increasingly discussing the overlap between these two forms of interpersonal violence. However, researchers have not yet used quantitative methods to examine the link between IPV and CSE or to explore potential mechanisms underlying the overlap, including child maltreatment risk factors and psychological mechanisms. One potential mechanism is trauma-related shame, a symptom of post-traumatic stress disorder commonly experienced by both victims of CSE and IPV. The current study explores trauma-related shame, childhood maltreatment, and IPV and their associations with CSE using a sample of 174 primarily Black women. Binomial logistic regression is used to analyze the impact of IPV, child abuse and neglect, and trauma-related shame on CSE. Results indicate that IPV and trauma-related shame are both significant predictors of CSE. Implications for future research and the incorporation of shame in trauma-related treatment are discussed.

Relationships Between Stigma and Intimate Partner Violence Among Female Sex Workers Living With HIV: Social and Economic Exclusion

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.

A Confounding Discourse Analysis of Vietnamese Sex Workers' Talk in the City of Kaiyuan, China

BACKGROUND

Vietnamese female sex workers (VFSWs) cross the border into Kaiyuan City, Yunnan Province yearly. However, very little is known about both the health and psychological issues VFSWs experience. The objectives of this study were to explore the dominant discourses that emerged from the VFSWs' talk. The interviews occurred between May 2018 and June 2018 with 20 VFSWs who worked in Kaiyuan City, China. The English translated transcripts were analyzed using an eclectic feminist method of discourse analysis. Two discourses emerged. First, "Agency when working in Karaoke Bars and other Indoor Venues", and second, "Negative Impacts on Psychological Well-being and Other Problems from Migration." As for Discourse 1, the VFSWs positioned themselves as having agency over choosing their clientele as well as agency over what they were willing to negotiate with their clients to establish boundaries of their bodies. As for the Discourse 2, while there was a discourse of agency in their work there was also a contrasting, confounding discourse around the negative impact on psychological well-being and reports of stress as a migrant worker. Discourse 1 and Discourse 2 are confounding. When analyzed together, the discourses suggest that the impacts on psychological well-being may be more related to the migrant status of the women, supporting the notion of systemically influenced agency.

Prevalence of depression, syndemic factors and their impact on viral suppression among female sex workers living with HIV in eThekwini, South Africa

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.

Risk and Protective Factors Associated With Intimate Partner Violence Against Chinese Women: A Systematic Review

Intimate partner violence (IPV) is a global health challenge leading to various detrimental health outcomes. Chinese women are a vulnerable population often overlooked in IPV research. Guided by the social-ecological model, this systematic review aims to synthesize literature on the risk and protective factors for IPV among Chinese women. A comprehensive search was conducted in nine major English and Chinese databases for articles with data collected since 2006 on adult Chinese women, leading to 29 papers in the final analysis. Risk and protective factors associated with IPV identified in this review include factors at the individual level such as demographics (e.g., a younger age, unplanned pregnancy, abortion, having children, and migration), socioeconomic status (e.g., income and partners' education level), attitudinal factors (e.g., attitudes justifying IPV and traditional beliefs about gender roles), behavioral factors (e.g., alcohol use of women, partners' alcohol use and frequency, and partners' high frequency of gambling), adverse childhood experiences (e.g., witnessed violence in childhood), and other personal characteristics (e.g., chronic illness and good health status). Factors at the relationship level include conflicts, power in intimate relationships, and social capital (e.g., the size of social networks, network participation of women and their partners, and social control). Community-level factors related to geographic locations were also explored while no factors were identified at the societal level. None of the included studies examined the intersections of factors within the same level or across different levels. Recommendations for future research, practice, and policy are also discussed.

Client-Perpetrated Violence Experience Among Female Sex Worker in Guangdong, South China: Results from a Cross-Sectional Study

Client-perpetrated violence (CPV) can lead to worse health consequences. However, little attention is paid to the CPV experience among Chinese female sex workers. Our study aimed to assess the association between CPV experience and health risk behaviors among FSWs in China. Data used in this study was from the baseline interviewer-administered questionnaire of a cluster randomized controlled trial conducted in June-October 2020. The collected information included sociodemographic characteristics, HIV/STI symptoms, number of clients, quality of the workplace, and past CPV experience. The association between violence experience and potential HIV/STI risk factors was explored using multivariable regression. Among 480 FSWs who participated in this study, 13.5% experienced CPV in the past. Compared to those who had never experienced CPV, FSWs who experienced CPV were more likely to report previous STI-related symptoms (aOR 4.29, 95% CI 1.73-10.64), more than 15 clients in the past month (aOR 2.56, 95% CI 1.18-5.52), a history of HIV testing (aOR 2.99, 95% CI 1.64-5.46), and work at low-tier workplaces (aOR 2.09, 95% CI 1.18-3.70). Overall, CPV prevalence is not low among Chinese FSWs, and there are some associations with HIV/STI risk factors; a future intervention targeting CPV in HIV/STI prevention programs is needed.

Mental health and HIV risk differs by co-occurring structural vulnerabilities among women who sell sex

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.

Mindfulness, psychological distress, and somatic symptoms among women engaged in sex work in China

Women engaged in sex work (WSW) in China encounter numerous disadvantages (e.g., exposure to violence) and have substantial risk for psychological distress and somatic symptoms. Intervention literature has attended to mindfulness, which is a protective factor for psychological outcomes, and its influences can further improve physical health. However, mindfulness has not been well studied in WSW. We aimed to examine the association among mindfulness, psychological distress, and somatic symptoms among Chinese WSW. Data were collected from 410 WSW in Guangxi, China, using an anonymous, self‐administered survey evaluating demographics, mindfulness, psychological distress (i.e., depression, loneliness, and perceived stress), and somatic symptoms (i.e., pain, cardiopulmonary, and gastrointestinal/fatigue symptoms). Structural equation modeling was utilized for data analyses. Mindfulness was negatively associated with psychological distress and somatic symptoms. Psychological distress was positively associated with somatic symptoms. Psychological distress mediated the association between mindfulness and somatic symptoms. Mindfulness appears to be a protective factor for psychological distress among WSW, and such an effect is further influential to their somatic symptoms. Our findings add to the growing literature on mindfulness, suggesting that mindfulness‐based interventions could be beneficial for WSW. Future research should explore other cognitive factors underlying the psychosomatic mechanism of mindfulness.

Mental Health Status of Female Sex Workers Exposed to Violence in Yangon, Myanmar

Female sex workers (FSWs) are at considerable risk of developing mental disorders due to the potential for violence associated with their work. However, few studies have comprehensively investigated the types of violence and their impact on the mental health of FSWs. Using data collected from 403 FSWs in Yangon, Myanmar, we investigated how various types of violence perpetrated by clients, employers, and partners affect the severity of mental disorders (anxiety and depression) among FSWs. Our results indicate that economic violence perpetrated by clients and threats of violence from partners induce severe symptoms of anxiety and depression. Furthermore, sexual and economic violence perpetrated by employers results in severe symptoms of anxiety.

Gender-Based Violence and Factors Associated with Victimization among Female Entertainment Workers in Cambodia: A Cross-Sectional Study

Women working in the entertainment industry are confronted with various forms of gender-based violence (GBV). However, their vulnerability remains understudied, particularly in resource-limited settings. This study aims to examine the prevalence of GBV among female entertainment workers (FEWs) in Cambodia and identify factors associated with victimization. We conducted a cross-sectional study in November 2018 for the impact evaluation of a randomized controlled trial. We used a stratified random sampling method to recruit 600 FEWs from different entertainment venues in the capital city and three other provinces. Female data collectors administered a structured questionnaire, and we performed multiple logistic regression analyses. Of the total, 60.5% had experienced a form of GBV during their lifetime; of whom, 37.5% experienced the GBV in the past 6 months. The prevalence of emotional abuse, forced substance use, physical abuse, and forced sex was 51.5%, 25.0%, 20.6%, and 2.9%, respectively. Forced substance use and forced sex were mainly perpetrated by clients, physical abuse by intimate partners, and emotional abuse by others such as entertainment establishment owners or managers. FEWs victimized by clients (relative risk ratio [RRR] = 0.19, 95% confidence interval [CI] = [0.07, 0.53]) and others (RRR = 0.11, 95% CI = [0.03, 0.44]) were less likely to be married compared with victims of intimate partner violence. Factors associated with sexual harassment were working in beer gardens (adjusted odds ratio [aOR] = 2.39, 95% CI = [1.20, 4.73]) and restaurants/cafés (aOR = 1.65, 95% CI = [1.01, 2.69]), and having higher acceptance of violence against women (aOR = 1.12, 95% CI = [1.01, 1.24]). FEWs in Cambodia experience high levels and unique forms of GBV as they are confronted with different types of perpetrators. Interventions need to be tailored to fit the specific needs of FEWs. Interventions aimed at reducing client-perpetrated violence should specifically focus on forced substance use and forced sex, while physical abuse by intimate partners should also be addressed.

Prevalence of suicidality, depression, post-traumatic stress disorder, and anxiety among female sex workers: a systematic review and meta-analysis

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.

Tolerance of Violence against Women and the Risk of Psychosocial Distress in Humanitarian Settings in Northern Uganda

BACKGROUND

Violence against women (VAW) remains a public health concern, which can sometimes lead to mental or psychological stress among other negative consequences.

DATA AND METHODS

we fitted a binary logistic regression model on 657 respondents from host and refugee settings in three humanitarian districts (Adjumani, Obongi, and Lamwo) to examine the determinants of psychosocial stress.

RESULTS

experience of psychosocial distress is higher among refugees than host populations. Results indicate a higher proportion of respondents who ever experienced psychosocial stress in the 6 months preceding the survey among those who believed that a woman should tolerate violence (59% vs. 53%). Respondents who believed that a woman should tolerate violence had higher odds of experiencing psychosocial stress than their counterparts who believed a woman should not tolerate violence (OR = 6.86; 95%CI = 1.23-38.22). The likelihood to experience psychosocial stress was higher among females (OR = 6.94; 95%CI = 1.76-27.32), those with primary education (OR = 4.73; 95%CI = 1.24-18.00), and respondents with less than USD 2.7 as personal income one month before the survey (OR = 3.37; 95%CI = 1.32-8.62). Respondents who said that women should engage in income generation activities had higher odds to experience psychosocial stress (OR = 0.39; 95%CI = 0.17-0.89).

CONCLUSION

results suggest that income and positive attitudes toward female-led income generating activities act as protective measures against psychosocial distress. Given the associations between VAW and psychosocial distress, efforts aimed at prevention and response to VAW in humanitarian settings should integrate mental health and psychosocial support interventions.

Nonmedical use of prescription drugs and biopsychosocial correlates among females who are sex workers in China

Background: Nonmedical use of prescription drugs (NMPUD) has become a critical public health concern. Chinese literature has paid growing attention to NMUPD, but scarce research has focused on females who are sex workers (FSWs), who have a high risk of substance use. The current study aimed to examine NMUPD and its biopsychosocial correlates in Chinese FSWs. Methods: A total of 410 FSWs (mean age = 33.58 years) from Guangxi, China, completed an anonymous, self-administered survey evaluating NMUPD, somatic symptoms, and psychosocial distress. Results: Overall, 46.6% of FSWs reported lifetime NMUPD and 17.6% reported past-3-month NMUPD. The most commonly reported medications that were used nonmedically were analgesics (46.3%, lifetime; 17.6%, past 3 months). A majority of FSWs (69.1%) reported "relieving pain" as the motive of their NMUPD. FSWs reporting NMUPD were more likely to be younger, be unmarried, have higher income, and work in multiple venues/high-paying venues. Somatic symptoms and psychosocial distress were associated with NMUPD in Chinese FSWs. Conclusions: NMUPD was prevalent in Chinese FSWs and was associated with biopsychosocial factors. Critical attention should be paid to NMUPD in FSWs. Future NMUPD prevention intervention among FSWs may benefit from attending to biopsychosocial factors.

Violence in Commercial Sex Work: A Case Study on the Impact of Violence Among Commercial Female Sex Workers in India and Strategies to Combat Violence

Violence is one of the primary contextual factors that significantly raise sex workers' sexually transmitted infection risk. The current study examines how violence affects sexual health behavior among commercial female sex workers in a red light district in Calcutta, India. The study which employs in-depth interviews of 37 commercial female sex workers also discusses an innovative multilayered strategy devised by the sex workers to combat violence through a community mobilization drive. The current study shows that the sex workers can confront the system that precipitates violence and actively engage with it to mitigate the impact of structural barriers to empowerment.

Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis

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.

"Mouth Wide Shut": Strategies of Female Sex Workers for Coping With Intimate Partner Violence

The aim of this study was to explore the relationship between possible violence suffered by female sex workers in their intimate relationships, with their affects, coping strategies, and emotional regulation to overcome such violence and improve their well-being. Structured personal interviews were carried out with female sex workers in three different settings: street, club, and flats. The sample was composed of 137 Spanish female sex workers (85.4% are foreign and 20% Spanish-born sex workers). High levels of tension and problems with their partners were linked to an affective imbalance and poor well-being. Positive affectivity determined the use of adaptive strategies, whereas negative affectivity predicted dysfunctional strategies. Three different path analyses and theoretical support concluded that self-control was the only strategy related to improve well-being in female sex workers who reported lower potential tension and difficulty in their intimate relationships. In contrast, inhibition was associated with an increase on distress levels when negative affectivity predominated and sex workers had reported potential tension and difficulty situations with their partners. It was a cross-sectional study, and thus we cannot infer causality or direction from the observed associations. Given these findings, violence prevention strategies in the intimate relationships should be prioritized in the prostitution context.

Client-Perpetrated Violence Toward Female Sex Workers in Kathmandu

This qualitative study explores the experiences of client-perpetrated violence toward female sex workers in Kathmandu, Nepal. Individual interviews were conducted with 30 female sex workers. Data were analyzed using qualitative coding methods and thematic development. Two main themes emerged. Contexts in which client-perpetrated violence corresponded with (a) conditions associated with exchange of services, and (b) alcohol use. The first theme involved five factors: negotiating condom use, number of clients, requesting payment, length of service time, and negotiating sex acts. Alcohol use by clients and/or sex workers exacerbated violence. Implications for practice and research are discussed.

Prevalence and correlates of probable depression and post-traumatic stress disorder among female sex workers in Lilongwe, Malawi

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.

Does psychedelic drug use reduce risk of suicidality? Evidence from a longitudinal community-based cohort of marginalised women in a Canadian setting

OBJECTIVE

This study aimed to longitudinally investigate whether ever having used a psychedelic drug can have a protective effect on incidence of suicidality among marginalised women.

DESIGN

Longitudinal community-based cohort study.

SETTING

Data were drawn from a prospective, community-based cohort of marginalised women in Metro Vancouver, Canada.

PARTICIPANTS

766 women completed the baseline questionnaire between January 2010 and August 2014. Participants who did not report suicidality at baseline and who completed at least one follow-up visit were included.

MAIN OUTCOME MEASURE

Extended Cox regression was used to model predictors of new suicidality (suicide ideation or attempts) over 54-month follow-up.

RESULTS

Nearly half (46%; n=355) of participants reported prior suicidality and were thus excluded from the present analyses. Of 290 women eligible at baseline, 11% (n=31) reported recent suicidality during follow-up, with an incidence density of 4.42 per 100 person-years (95% CI 3.10 to 6.30). In multivariable analysis, reported lifetime psychedelic drug use was associated with a 60% reduced hazard for suicidality (adjusted HR (AHR) 0.40; 95% CI 0.17 to 0.94). Crystal methamphetamine use (AHR 3.25; 95% CI 1.47 to 7.21) and childhood abuse (AHR 3.54; 95% CI 1.49 to 8.40) remained independent predictors of suicidality.

CONCLUSION

The high rate of suicidality identified in this study is of major concern. Alongside emerging evidence on the potential of psychedelic-assisted therapy to treat some mental illness and addiction issues, our findings demonstrate that naturalistic psychedelic drug use is independently associated with reduced suicidality, while other illicit drug use and childhood trauma predispose women to suicidality. While observational, this study supports calls for further investigation of the therapeutic utility of psychedelic drugs in treating poor mental health and promoting mental wellness.

Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011-January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31-5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46-4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20-3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86-5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.

Violence From a Sexual Partner is Significantly Associated With Poor HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic

BACKGROUND

Female sex workers (FSWs) experience high rates of violence from their sexual partners. Although violence is associated with HIV risk behaviors among FSWs, there is limited evidence on the association between violence and HIV treatment outcomes.

METHODS

We analyzed data from a socio-behavioral survey with a cohort of FSWs living with HIV in the Dominican Republic (n = 268) to describe the burden of violence from a sexual partner in the last 6 months. We assessed the relationship between violence and HIV treatment outcomes, comparing findings across 2 types of sexual partners: intimate partners and clients.

RESULTS

Nearly one-fifth of women (18.3%) experienced violence in the last 6 months. More women experienced violence from an intimate partner (12.3%) than a client (8.3%), with some (2.6%) reporting both. Although violence from an intimate partner was significantly associated with not currently being on antiretroviral treatment [ART; adjusted odds ratio (AOR): 4.05, 95% confidence interval (CI): 1.00 to 16.36] and missing an ART dose in the last 4 days (AOR: 5.26, 95% CI: 1.91 to 14.53), violence from a client was associated with never having received HIV care (AOR: 2.85, 95% CI: 1.03 to 7.92) and ever interrupting ART (AOR: 5.45, 95% CI: 1.50 to 19.75).

CONCLUSIONS

Violence from a sexual partner is associated with poor HIV treatment outcomes among FSWs. Different patterns by type of partner reflect how relationship dynamics may influence these associations. Violence prevention and support services should be tailored based on type of partner. Violence screening and referrals should be integrated into HIV care services for FSWs to improve their health and reduce ongoing transmission.

Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study

Background. Our study aimed to assess the burden of depression and evaluate factors associated with depression and status of HIV risk behaviors among female sex workers (FSWs) in Guangdong, China. Method. We recruited FSWs from massage parlors, saunas, restaurants, hotels, hair salons, and streets in Guangdong, China, in 2014. Information on demographic characteristics, HIV testing history, and sexual behaviors was collected using a questionnaire. A blood sample was collected to test for HIV, syphilis, and HCV. A participant was defined as being depressed if she obtained 6 points or above using the 12-item General Health Questionnaire. Results. Among the 653 participants, 41.7% were 21–30 years old and 43.6% married. Overall, 52.4% were found to be depressed. FSWs who had correct syphilis related knowledge [aOR = 1.45; 95% CI: 1.04–2.03] and had primary sex partner (1.63, 1.14–2.33) were more likely to be depressed. FSWs who did not use a condom during their last sex with the primary sex partner were less likely to be depressed (0.47, 0.31–0.71). Conclusion. Our study observed high level of depression and HIV risk behaviors among Chinese FSWs. Future interventions should integrate mental health services in comprehensive interventions to prevent depression among Chinese FSWs.

Prevalence and correlates of sexual and gender-based violence against Chinese adolescent women who are involved in commercial sex: a cross-sectional study

OBJECTIVES

Despite the vast quantity of research among Chinese female sex workers (FSWs) to address concerns regarding HIV/sexually transmitted infection (STI) risk, there is a paucity of research on issues of sexual and gender-based violence (SGBV) and the missed opportunity for sexual and reproductive health (SRH) promotion among young FSWs. Our research aimed to assess the prevalence and correlates of SGBV among Chinese adolescent FSWs, and to explore SRH service utilisation.

DESIGN AND METHODS

A cross-sectional study using a one-stage cluster sampling method was employed. A semistructured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine individual and structural correlates of SGBV.

SETTING AND PARTICIPANTS

Between July and September 2012, 310 adolescent women aged 15-20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months were recruited and completed their interview in Kunming, Yunnan Province, China.

RESULTS

Findings confirm the high prevalence of SGBV against adolescent FSWs in China, with 38% (118/310) of participants affected in the past year. Moreover, our study demonstrated the low uptake of public health services and high rates of prior unwanted pregnancy (52%; 61/118), abortion (53%; 63/118) and self-reported STI symptoms (84%; 99/118) in participants who were exposed to SGBV. Forced sexual debut was reported by nearly a quarter of FSWs (23%; 70/310) and was independently associated with having had a drug-using intimate partner and younger age (<17 years old) at first abortion. When controlling for potential confounders, having experienced SGBV was associated with frequent alcohol use, having self-reported symptoms of STI, having an intimate partner and having an intimate partner with illicit drug use.

CONCLUSIONS

This study calls for effective and integrated interventions addressing adolescent FSWs' vulnerability to SGBV and broader SRH consequences.

Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India

BACKGROUND

Female sex workers (FSWs) are at increased risk of HIV and STIs compared to women in the general population, and frequently experience violence in their working and domestic lives from a variety of perpetrators, which can enhance this risk. While progress has been made in addressing violence by police and clients, little work has been done to understand and prevent violence by intimate partners (IPs) among FSW populations.

METHODS

Samvedana Plus is a multi-level intervention programme that works with FSWs, their IPs, the sex worker community, and the general population, and aims to reduce violence and increase consistent condom use within these 'intimate' relationships. The programme involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The programme will aim to cover 800 FSWs and their IPs living in 47 villages in Bagalkot district, northern Karnataka. The study is designed to assess two primary outcomes: the proportion of FSWs who report: (i) physical or sexual partner violence; and (ii) consistent condom use in their intimate relationship, within the past 6 months. The evaluation will employ a cluster-randomised controlled trial design, with 50 % of the village clusters (n = 24) randomly selected to receive the intervention for the first 24 months and the remaining 50 % (n = 23) receiving the intervention thereafter. Statisticians will be blinded to treatment arm allocation. The evaluation will use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months) and endline (24 months). The evaluation design will involve quantitative and qualitative assessments with (i) all FSWs who report an IP (ii) IPs; and process/ implementation monitoring. Baseline data collection was completed in April 2015, and endline data collection is anticipated in May 2017.

CONCLUSIONS

This is an innovative intervention programme that aims to address violence by IPs as part of HIV prevention programming with FSWs. Reducing violence is expected to reduce vulnerability to HIV acquisition, and help women to work and live without fear of violence.

TRIAL REGISTRATION

Clinical Trials NCT02807259 Jun 24 2016 (retrospectively registered).

Violence, stigma and mental health among female sex workers in China: A structural equation modeling

Intimate partner violence is prevalent among female sex workers (FSWs) in China, and it is significantly associated with mental health problems among FSWs. However, limited studies have explored the mechanisms/process by which violence affects mental health. The purpose of this study was to explore the relationships among partner violence, internalized stigma, and mental health problems among FSWs. Data were collected using a self-administered cross-sectional survey administered to 1,022 FSWs in the Guangxi Zhuang Autonomous Region (Guangxi), China during 2008-2009. We used structural equation modeling to test the hypothesized relationships. Results indicated that violence perpetrated by either stable sexual partners or clients was directly and positively associated with mental health problems. Violence also had an indirect relation to mental health problems through stigma. Results highlight the need for interventions on counseling and care for FSWs who have experienced violence and for interventions to increase FSWs' coping skills and empowerment strategies.

The impact of violence on sex risk and drug use behaviors among women engaged in sex work in Phnom Penh, Cambodia

BACKGROUND

Violence, substance use, and HIV disproportionately impact female entertainment and sex workers (FESW), but causal pathways remain unclear.

METHODS

We examined data from an observational cohort of FESW age 15-29 in Phnom Penh, Cambodia for associations between violence exposure and sexual risk and drug use. Validated measures of physical and sexual violence were assessed at baseline. Self-reported outcomes measured quarterly over the next 12-months included past month sexual partners, consistent condom use by partner type, sex while high, and amphetamine type stimulant (ATS) use. Biomarkers measured quarterly included prostate specific antigen (PSA) and urine toxicology. Generalized estimating equations were fit adjusting for age, education, marital status and sex work venue.

RESULTS

Of 220 women, 48% reported physical or sexual violence in the preceding 12-months. Physical violence was associated with increased number of sex partners (adjusted incidence rate ratio [aIRR] 1.33; 95% CI: 1.04-1.71), greater odds of sex while high (adjusted odds ratio [aOR] 2.42; 95% CI: 1.10-5.33), increased days of ATS use (aIRR 2.74; 95% CI: 1.29-5.84) and increased odds of an ATS+ urine screen (aOR 2.80, 95%CI: 1.38-5.66). Sexual violence predicted decreased odds of consistent condom use with non-paying partners (aOR 0.24; 95% CI: 0.10-0.59) and greater odds of a PSA+ vaginal swab (aOR 1.83; 95% CI: 1.13-2.93).

CONCLUSIONS

Physical and sexual violence are prevalent among Cambodian FESW and associated with subsequent sexual risk and drug use behaviors. Clinical research examining interventions targeting structural and interpersonal factors impacting violence is needed to optimize HIV/AIDS prevention among FESW.

Victimization and HIV Risks Among Croatian Female Sex Workers: Exploring the Mediation Role of Depressiveness and the Moderation Role of Social Support

To assess the association between victimization and HIV vulnerability among Croatian female sex workers (FSWs), a survey involving 157 FSWs recruited from Croatia's two largest urban areas was conducted in 2014. A majority of participants reported direct and indirect victimization, which was found to be significantly associated with condom use at most recent noncommercial sexual intercourse and sexually transmitted infection (STI) diagnosis in the past 12 months. The association between victimization and STI diagnosis was partially mediated by depressiveness and moderated by social support. The buffering role of social support points to the importance of including counseling services in HIV prevention programs in Croatia.

Structural Determinants of Client Perpetrated Violence Among Female Sex Workers in Two Mexico-U.S. Border Cities

Female sex workers (FSWs) are disproportionately affected by both HIV and gender-based violence, such as that perpetrated by clients (CPV). We used a structural determinants framework to assess correlates of physical or sexual CPV in the past 6 months among FSWs in the Mexico/U.S. border cities of Ciudad Juárez and Tijuana. Bivariate and multivariate logistic regression analysis identified individual, client, interpersonal, work environment and macrostructural factors associated with recent CPV. Among 496 FSWs, 5 % experienced recent CPV. Witnessing violence towards other FSWs in one's neighborhood (aOR 5.6, 95 % CI 1.8-17.2), having a majority of foreign (aOR 3.5, 95 % CI 1.4-8.4) or substance using (aOR 4.0, 95 % CI 1.5-10.4) clients, and being a street worker (aOR 3.0, 95 % CI 1.1-7.7) were independently associated with recent CPV. Our findings underscore the vulnerability of FSWs and the need to design policies and interventions addressing macro-level influences on CPV rather than exclusively targeting individual behaviors.

Prevalence and Correlates of Client-Perpetrated Violence against Female Sex Workers in 13 Mexican Cities

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.

Sexual and reproductive health risks amongst female adolescents who use amphetamine-type stimulants and sell sex: a qualitative inquiry in Yunnan, China

BACKGROUND

China, as other Southeast Asian countries, has witnessed an increased use in amphetamine-type stimulants (ATS) amongst urban youth. Amongst female adolescents who both sell sex and use ATS, risk behaviours are compounded resulting in even poorer health outcomes. However, limited knowledge exists on ATS use patterns and ATS-related risk behaviours, particularly in this context. This research aimed to improve the understanding of these issues amongst female adolescents who use ATS and sell sex, and to inform future programming.

METHOD

This study utilised monthly focus group discussions (four in total) with the same study participants in Yunnan, China. From within a drug-treatment programme, female adolescents who reported both a history of drug use and selling sex were purposively enrolled in the study.

RESULTS

Participating adolescent females were aged 17-19 years and were all internal-migrants with low literacy. All reported polydrug use (mainly methamphetamine and heroin, whereas ecstasy and ketamine have been infrequently employed). Being less informed about risks of drug use and lack of sexual and reproductive health knowledge seemed to contribute to problematic drug use, rough and prolonged sexual intercourse, inconsistent condom use and ineffective contraceptive practice. For their income, participants largely relied on selling sex, which was frequently coupled with drug sharing services to clients. However, despite the practices, women did not self-identify as sex workers, and therefore did not think that existing intervention services targeting female sex workers were relevant to them. Moreover, criminalization and stigmatisation of drug use and selling sex impeded their access to care services.

CONCLUSION

Current harm reduction and HIV/sexually transmitted infection (STI) prevention services are unlikely to address the demand of female adolescents engaged in drug use and commercial sex. Our findings highlight that a comprehensive and coordinated harm reduction and sexual and reproductive health response should be conducted involving these most vulnerable adolescents.

Intimate-Partner and Client-Initiated Violence among Female Street-Based Sex Workers in China: Does a Support Network Help?

Background

Globally, female street-based sex workers are vulnerable to gender-based violence. Previous research has shown having a peer social network can reduce sex workers’ risks of victimization. However, mechanisms of how social network impacts violence among female street-based sex workers are still far from clear.

Methods

Our study was based on data abstracted from a paper-and-pencil survey administered among 218 female street-based sex workers in Shanghai, China. We focused on self-reported client-initiated violence and intimate-partner violence in emotional, physical, and sexual forms. Social networks were characterized by the size and sources of financial and psychosocial support (e.g. family, friends, and peers). Multi-variable logistic regression was used to estimate adjusted odds ratios (AOR) of each type of violence exposure by social network structure after the adjustment of age, education, and years in Shanghai.

Results

The street-based female sex workers in our study were primarily rural-to-urban migrants (95.7%) with an average age of 41 years old. 24.3% and 62.8% of the sex workers reported intimate-partner violence and client-initiated violence respectively. Lack of financial support, as defined by having only one individual or none in her peer support system to help financially, was significantly associated with self-reported intimate-partner violence (AOR: 2.5; 95% CI: 1.1–5.9). Respondents who reported client-initiated violence, by contrast, were more likely to report lacked psychosocial support from family (AOR: 2.2, 95% CI: 1.0–4.6) and peers (AOR: 5.1, 95% CI: 2.2–11).

Conclusion

This study is one of the first to systematically analyze the associations between social network and gender-based violence among street-based female sex worker. We reported a high prevalence of both types of gender-based violence and their complex associations with family, friends, and peer support network. Policies with goals to reduce violence against women may apply these findings to leverage social network in the interventions against gender-based violence.

Prevalence and Correlates for Psychosocial Distress Among In-School Adolescents in Zambia

There is scanty information on correlates for psychosocial distress in Zambia. Secondary analysis was conducted using the data collected in 2004 in Zambia during the global school-based health survey to determine the prevalence and correlates for psychosocial distress. Logistic regression analyses were used to estimate magnitudes of associations between exposure factors and the outcome, while the Yates' corrected Chi-squared test was used to compare proportions at the 5% significance level. A total of 2257 students participated in the survey of which 54.2% were males. Males were generally older than females (p < 0.001). Significantly, more females than males were bullied (p = 0.036), involved in a fight (p = 0.019), and consumed alcohol (p = 0.012). Psychosocial distress was detected in 15.7% of the participants (14.4% of males and 16.8% of females). Age <14 years, male gender, parental support for males, and having close friends were protective factors against psychosocial distress. Risk factors for psychosocial distress were being bullied, involvement in a fight, alcohol consumption, being physically active, and parental support. The prevalence of psychosocial distress among adolescents in Zambia appears to be common. There is a need to validate the psychosocial distress indicators that were used in the current study.

Sexual and reproductive health knowledge, contraception uptake, and factors associated with unmet need for modern contraception among adolescent female sex workers in China

OBJECTIVE

In China, policy and social taboo prevent unmarried adolescents from accessing sexual and reproductive health (SRH) services. Research is needed to determine the SRH needs of highly disadvantaged groups, such as adolescent female sex workers (FSWs). This study describes SRH knowledge, contraception use, pregnancy, and factors associated with unmet need for modern contraception among adolescent FSWs in Kunming, China.

METHODS

A cross-sectional study using a one-stage cluster sampling method was employed to recruit adolescents aged 15 to 20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months. A semi-structured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine correlates of low knowledge and unmet need for modern contraception.

RESULTS

SRH knowledge was poor among the 310 adolescents surveyed; only 39% had heard of any long-acting reversible contraception (implant, injection or IUD). Despite 98% reporting not wanting to get pregnant, just 43% reported consistent condom use and 28% currently used another form of modern contraception. Unmet need for modern contraception was found in 35% of adolescents, and was associated with having a current non-paying partner, regular alcohol use, and having poorer SRH knowledge. Past abortion was common (136, 44%). In the past year, 76% had reported a contraception consultation but only 27% reported ever receiving SRH information from a health service.

CONCLUSIONS

This study demonstrated a low level of SRH knowledge, a high unmet need for modern contraception and a high prevalence of unintended pregnancy among adolescent FSWs in Kunming. Most girls relied on condoms, emergency contraception, or traditional methods, putting them at risk of unwanted pregnancy. This study identifies an urgent need for Chinese adolescent FSWs to be able to access quality SRH information and effective modern contraception.

"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

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.

Associations between social support and condom use among commercial sex workers in China: a cross-sectional study

Objective

The aim of this study was to investigate the association between social support and AIDS high-risk behaviors in commercial sex workers (CSWs) in China.

Methods

A cross-sectional study was performed based on a convenience sample. Data were collected through questionnaire interviews including information about social demographic characteristics, the Social Support Rating Scale (SSRS) and AIDS knowledge. Multiple logistic regression was performed to evaluate the association between social support and AIDS high-risk behaviors, specifically condom use during commercial sex.

Results

A total of 581 commercial sex workers from 4 counties in East China participated in the study. The majority of the participants were 15 to 30 years old (79.7%). Sources of individual and family support were mainly provided by their parents (50.3%), relatives and friends (46.3%), spouses (18.4%), respectively. Univariate analysis revealed that marital status, hobbies, smoking habit, individual monthly income and family monthly income were all significantly correlated with current levels of social support being received (P = 0.04, P = 0.00, P = 0.01, P = 0.01, P = 0.01, respectively). Furthermore, Multiple logistic regression analysis indicated that after adjusting for confounding factors, high levels of social support were significantly correlated with increased condom use at the last sexual encounter (P = 0.02, OR = 1.86, 95%CI: 1.10–3.16); and consistently in the past month with clients (P = 0.03, OR = 2.10, 95%CI: 1.09–4.04).

Conclusion

CSWs with high levels of social support are more likely to use condoms during commercial sex. This suggests that increasing social support can potentially reduce AIDS-related high-risk behaviors and accordingly play an important role in AIDS prevention.

Socio-ecological factors associated with depression, suicidal ideation and suicidal attempt among female injection drug users who are sex workers in China

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.

Prevention of domestic violence against women and children in low-income and middle-income countries

PURPOSE OF REVIEW

Violence against women and children is increasingly recognized as an important and urgent public health, social and human rights issue cutting across geographical, socioeconomic and cultural boundaries. There is a large and growing body of literature that demonstrates the negative impact of such violence on the victim's mental and physical health, as well as several other consequences on them, their families and communities. However, this literature for the most part comes from the so-called 'developed countries'. This review, at the opposite, focused on current literature on prevention of domestic/family violence against children and women in low and middle income countries (LMICs).

RECENT FINDINGS

Establishing effective prevention programmes for domestic violence against women and children in LMICs requires an understanding of the sociopolitical, economic and cultural settings and a multilevel collaboration among various stakeholders.

SUMMARY

This review confirms the lack of research in the so-called 'developing countries' and provides suggestions for further research and prevention efforts in this setting.

A systematic review of the correlates of violence against sex workers

We conducted a systematic review in June 2012 (updated September 2013) to examine the prevalence and factors shaping sexual or physical violence against sex workers globally. We identified 1536 (update = 340) unique articles. We included 28 studies, with 14 more contributing to violence prevalence estimates. Lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%. Growing research links contextual factors with violence against sex workers, alongside known interpersonal and individual risks. This high burden of violence against sex workers globally and large gaps in epidemiological data support the need for research and structural interventions to better document and respond to the contextual factors shaping this violence. Measurement and methodological innovation, in partnership with sex work communities, are critical.

Age group differences in HIV risk and mental health problems among female sex workers in Southwest China

HIV risk and mental health problems are prevalent among female sex workers (FSWs) in China. The purpose of this research was to study age group differences in HIV risk and mental health problems in this population. In the current study, we divided a sample of 1022 FSWs into three age groups (≤ 20 years, 21-34 years, and ≥ 35 years). Results showed that among the three groups (1) older FSWs (≥ 35 years) were likely to be socioeconomically disadvantaged (e.g., rural residency, little education, employment in low-paying venues, and low monthly income); (2) older FSWs reported the highest rates of inconsistent, ineffective condom use, and sexually transmitted diseases history; (3) younger FSWs (≤ 20 years) reported the highest level of depression, suicidal thoughts and suicide attempts, regular-partner violence, and substance use; (4) all health-related risks except casual-partner violence were more prevalent among older and younger FSWs than among FSWs aged 21-34 years; and (5) age had a significant effect on all health indicators except suicide attempts after controlling for several key demographic factors. These findings indicate the need for intervention efforts to address varying needs among FSWs in different age groups. Specific interventional efforts are needed to reduce older FSWs' exposure to HIV risk; meanwhile, more attention should be given to improve FSWs' mental health status, especially among younger FSWs.