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Gunn A. Stigma, surveillance, and wounded healing: Promoting a critical ethics of care in research with formerly incarcerated Black women. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3438-3454. [PMID: 35334119 PMCID: PMC9464655 DOI: 10.1002/jcop.22845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Black women experience myriad challenges post incarceration, from managing stigma within social relationships to navigating surveillance when interfacing with service systems. It is these challenges that also make them vulnerable participants in community-based research. With many of potential research harms not falling under the guidance of Institutional Review Boards, it is critical to explore how communities experiencing stigma and surveillance perceive their engagement in research. As such, this study explores how 28 justice-involved Black women experience the research process. Findings reveal that participants view the research context as spaces for reflecting on surveillance and stigma in ways that promote self-recovery. Moreover, they perceive the interview process to allow them to envision identities as wounded healers who use their pasts as mechanisms to help others. The study's implications for anti-oppressive inquiry underscore the need for researchers to employ ethical care and justice frameworks that center compassion, reflexivity, and equity throughout the process.
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Affiliation(s)
- Alana Gunn
- Department of Criminology, Law, and JusticeUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Bungay V, Guta A, Slemon A, Varcoe C, Comber S. The Ethics of Financial Incentivization for Health Research Participation Among Sex Workers in a Canadian Context. QUALITATIVE HEALTH RESEARCH 2022; 32:942-955. [PMID: 35349393 DOI: 10.1177/10497323221089877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research incentivization with sex workers is common, yet limited guidance exists for ethical incentives practice. We undertook a critical qualitative inquiry into how researchers (n = 17), community services staff (n = 17), and sex workers participating in research (n = 53) perceive incentives in a Canadian context. We employed an interpretive thematic approach informed by critical perspectives of relational autonomy for analysis. Four themes illustrate how (un)ethical use of incentives is situated in transactional micro-economies among groups experiencing severe marginalization: i) transactional research economy, ii) incentive type: assumptions and effects, iii) incentive amount: too much too little?, and iv) resistance, trauma, and research-related harm. Paternalistic assumptions about capacities of sex workers to act in their own best interests conflicted with participants' rights and abilities for self-determination; with researchers maintaining ultimate decision-making authority. Power differentials create conditions of harm. Safe, equitable approaches concerning research incentive use must redress relations of power that perpetuate oppression.
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Affiliation(s)
- Vicky Bungay
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Adrian Guta
- School of Social Work, 8637University of Windsor, Windsor, ON, Canada
| | - Allie Slemon
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Colleen Varcoe
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Scott Comber
- Rowe School of Business, 3688Dalhousie University, Halifax, NS, Canada
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Beattie TS, Smilenova B, Krishnaratne S, Mazzuca A. Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003297. [PMID: 32931504 PMCID: PMC7491736 DOI: 10.1371/journal.pmed.1003297] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Shari Krishnaratne
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Canada
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Li JS, Urada LA. Cycle of Perpetual Vulnerability for Women Facing Homelessness near an Urban Library in a Major U.S. Metropolitan Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5985. [PMID: 32824715 PMCID: PMC7459588 DOI: 10.3390/ijerph17165985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Homelessness among women and the multiple vulnerabilities they endure (sexual exploitation/human trafficking, violence, and mental health issues) is a perpetually unresolved issue in the U.S. and globally. METHODS This study is based on qualitative in-depth interviews accompanied by brief socio-demographic surveys conducted among 32 total participants, consisting of cisgender females (n = 17) and cisgender males (n = 15) experiencing homelessness at a large public library. RESULTS Of the women, 35% were White, 35% Latina, 18% African American/Black, and 18% LGBT. Half of all participants said in qualitative interviews that they witnessed violence against women, and/or experienced unwanted harassment/sexual exploitation; one in three described suspected human trafficking. Of the women interviewed, half struggled with mental health symptoms, feelings of hopelessness, and nearly all reported isolation; approximately one-third had substance use issues. Many described an inadequate number of emergency and long-term shelters Available for women facing homelessness; many had to wait or saw other women waiting to get into shelters and faced abuse on the streets in the meantime. CONCLUSION The emergent themes showed that women face a "cycle of perpetual vulnerability" with three relational pathways: iterated trauma from chronic abuse/violence inflicted on them, a state of paralysis due to inadequate availability of supportive services, shelters, and mental health resources to cover all women living on the streets, leaving women susceptible to being a target phenotype for predators.
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Affiliation(s)
- Janny S. Li
- School of Social Work, San Diego State University (SDSU), San Diego, CA 92182, USA;
| | - Lianne A. Urada
- School of Social Work, San Diego State University (SDSU), San Diego, CA 92182, USA;
- Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA
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Ma H, Loke AY. A qualitative study into female sex workers' experience of stigma in the health care setting in Hong Kong. Int J Equity Health 2019; 18:175. [PMID: 31727157 PMCID: PMC6857210 DOI: 10.1186/s12939-019-1084-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background Hong Kong has gained a good reputation for its quality public health care services. However, there is a growing recognition that social stigma is a potential obstacle when female sex workers (FSWs) access health care services. There are a lack of studies focusing on how FSWs experience and cope with stigma when accessing health care services in Hong Kong. Objective This study aims to explore how FSWs experience stigma and develop coping strategies when accessing health care services in Hong Kong. Methods This is a qualitative interview study. Staff of non-governmental organizations (NGOs) that serve sex workers in Hong Kong facilitated the process of recruiting the participants. In-depth individual interviews were conducted with 22 FSWs, focusing on their experiences of stigma and coping strategies when accessing health care services. A directed content analysis approach was adopted to analyze the data. Results The interview data can be grouped into three themes: experience of stigma in the health care setting; coping with the stigma of sex work; and the call for non-judgmental holistic health care. Conclusion This study contributes to an understanding of the experience of stigma and stigma coping strategies of FSWs when accessing health care services in Hong Kong. stigma remains an important issue for a large proportion of FSWs when they seek timely professional help, openly disclose their sex work identity, and receive comprehensive health care services. The study also highlights the need to address multiple healthcare needs of FSWs beyond STDs. Moreover, the study contributes to increasing awareness of, and respect for, the human right of FSWs to receive non-discriminatory health services.
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Affiliation(s)
- Haixia Ma
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, GH 525, Hong Kong, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, GH 525, Hong Kong, China.
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Zhao Y, Fitzpatrick T, Wan B, Day S, Mathews A, Tucker JD. Forming and implementing community advisory boards in low- and middle-income countries: a scoping review. BMC Med Ethics 2019; 20:73. [PMID: 31623624 PMCID: PMC6796331 DOI: 10.1186/s12910-019-0409-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/16/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Community advisory boards (CABs) have expanded beyond high-income countries (HICs) and play an increasing role in low- and middle-income country (LMIC) research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. METHODS We searched five databases (PubMed, Embase, Global Health, Scopus, and Google Scholar) for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. RESULTS Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies (65) were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa (17), China (8), and Thailand (7) having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs (53/88, 60%) focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. CONCLUSIONS Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs.
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Affiliation(s)
- Yang Zhao
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Thomas Fitzpatrick
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- University of Washington School of Medicine, Seattle, USA
| | - Bin Wan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Allison Mathews
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Sinha S. Ethical and Safety Issues in Doing Sex Work Research: Reflections From a Field-Based Ethnographic Study in Kolkata, India. QUALITATIVE HEALTH RESEARCH 2017; 27:893-908. [PMID: 27651071 PMCID: PMC5865471 DOI: 10.1177/1049732316669338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
While much has been said about the risks and safety issues experienced by female sex workers in India, there is a considerable dearth of information about the difficulties and problems that sex work researchers, especially female researchers, experience when navigating the highly political, ideological, and stigmatized environment of the Indian sex industry. As noted by scholars, there are several methodological and ethical issues involved with sex work research, such as privacy and confidentiality of the participants, representativeness of the sample, and informed consent. Yet, there has been reluctance among scholars to comment on their research process, especially with regard to how they deal with the protocols for research ethics when conducting social and behavioral epidemiological studies among female sex workers in India and elsewhere. Drawing on my 7 months of field-based ethnographic research with "flying" or non-brothel-based female sex workers in Kolkata, India, I provide in this article a reflexive account of the problems encountered in implementing the research process, particularly the ethical and safety issues involved in gaining access and acceptance into the sex industry and establishing contact and rapport with the participants. In doing so, it is my hope that future researchers can develop the knowledge necessary for the design of ethical and non-exploitative research projects with sex workers.
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Affiliation(s)
- Sunny Sinha
- Assistant Professor, Marywood University, Scranton, Pennsylvania, USA
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Urada LA, Simmons J, Wong B, Tsuyuki K, Condino-Enrera G, Hernandez LI, Simbulan NP, Raj A. A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study. Int J Public Health 2016; 61:945-957. [PMID: 27600733 DOI: 10.1007/s00038-016-0875-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study evaluated a brief human rights-focused HIV community mobilization intervention for sex workers in the Philippines, a country with one of the fastest rising number of HIV cases worldwide. METHODS Five single-session group interventions to reduce sexual risk and increase HIV testing among 86 sex workers in Manila were evaluated with pre-post-test data via Wilcoxon's signed-ranks and Mann-Whitney tests. The 4-h intervention, Kapihan (August-November, 2013), integrated human rights with HIV skill-building. Demographic data, violence/trafficking victimization, human rights knowledge, and intentions to HIV test and treat were collected. RESULTS Participants were median aged 23; female (69 %); had children (55; 22 % had 3+ children); used drugs (past 3 months: 16 %); sexually/physically abused by clients (66 %); 20 % street sex workers ever took an HIV test. Pre-post-test scores significantly improved in knowledge of HIV (z = -8.895, p < 0.001), reproductive health (z = -3.850, p < 0.001), human rights (z = -4.391, p < 0.001), ethical rights of research participants (z = -5.081, p < 0.001), and intentions to HIV test (z = -4.868, p < 0.001). CONCLUSIONS Integrating human rights into HIV interventions may empower sex workers to address their health and human rights and test for HIV.
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Affiliation(s)
- Lianne A Urada
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA. .,College of Health and Human Services, School of Social Work, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Janie Simmons
- National Development and Research Institutes, Inc., 71 W 23rd St, New York, NY, 10010, USA
| | - Betty Wong
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Kiyomi Tsuyuki
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Gerlita Condino-Enrera
- Woodwater Center for Healing, 8 Nicanor Reyes St, Loyola Heights, Quezon City, Philippines
| | - Laufred I Hernandez
- Department of Behavioral Sciences, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Nymia Pimentel Simbulan
- College of Arts and Science and College of Public Health, University of the Philippines, Manila, Rizal Hall, Padre Faura Street, Ermita, Manila, Philippines
| | - Anita Raj
- Department of Medicine/Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
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Goldenberg SM, Brouwer KC, Jimenez TR, Miranda SM, Mindt MR. Enhancing the Ethical Conduct of HIV Research with Migrant Sex Workers: Human Rights, Policy, and Social Contextual Influences. PLoS One 2016; 11:e0155048. [PMID: 27159157 PMCID: PMC4861265 DOI: 10.1371/journal.pone.0155048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Migrant sex workers are often highly marginalized and disproportionately experience health and social inequities, including high prevalence of HIV, sexually transmitted infections, and human rights violations. In recent years, research involving migrant sex workers has increased, yet many knowledge gaps remain regarding how best to protect research participant rights and welfare. Our objective was to identify key challenges and opportunities related to the responsible conduct of HIV research with migrant sex workers. METHODS Focus groups and interviews conducted with 33 female sex workers ≥18 years old at the Guatemala-Mexico border from June 2013-February 2014 were analyzed. Participants were recruited through community outreach by a local HIV prevention organization to sex work establishments such as bars, hotels, street corners, and truck stops. RESULTS Key themes influencing research engagement for migrant sex workers included researcher mistrust and fear related to research participation, rooted in the social isolation frequently faced by recent migrants; intersecting concerns related to immigration status, fear of criminalization, and compliance with sex work regulations; and perceived benefits and risks of HIV/STI testing for migrants (e.g., immigration implications, stigma) represent potential barriers and opportunities for the responsible conduct of research involving migrant sex workers. CONCLUSIONS Results highlight the intersection between the human rights vulnerabilities of migrant sex workers and barriers to research participation, including social isolation of migrants and policy/legal barriers related to immigration and sex work. Findings illustrate the need for researchers to develop population-tailored procedures to address fears related to immigration and criminalization, and to reinforce positive and non-stigmatizing relationships with migrant sex workers. Community-led efforts to reduce stigma and foster community organization and supports for migrant sex workers are recommended, as are broader policy shifts that move away from punitive legal approaches towards approaches that safeguard and prioritize the human rights of migrant sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, 608–1081 Burrard Street (St. Paul's Hospital), Vancouver, BC, V6Z 1Y6, Canada
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | - Teresita Rocha Jimenez
- Division of Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093–0507, United States of America
| | | | - Monica Rivera Mindt
- HIV Prevention Research Ethics Institute, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, United States of America
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Urada LA, Halterman S, Raj A, Tsuyuki K, Pimentel-Simbulan N, Silverman JG. Socio-structural and behavioral risk factors associated with trafficked history of female bar/spa entertainers in the sex trade in the Philippines. Int J Gynaecol Obstet 2015; 132:55-9. [PMID: 26434671 DOI: 10.1016/j.ijgo.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 06/25/2015] [Accepted: 09/11/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore factors associated with trafficking (deceptive/coercive entry to sex trade) among female bar/spa entertainers who traded sex in the Philippines. METHOD Female bar/spa entertainers who traded sex in the past 6months were recruited from 25bar/spa venues in Metro Manila (April 2009-January 2010) and assessed via cross-sectional survey data collection for HIV-risk-related socio-structural factors associated with deceptive/coercive entry into the sex trade. The study employed hierarchical linear modeling. RESULTS Of 166bar/spa entertainers assessed, 19 (11.4%) reported being deceived/coerced (i.e. trafficked) into their first jobs. Trafficking history was independently associated with current drug use (adjusted odds ratio [AOR] 2.05; 95% confidence interval [CI] 1.00-3.97) decreased availability of condoms at venues for entertainers (AOR 0.18; 95% CI 0.05-0.71) and, conversely, increased peer support for practicing safer sex behaviors (AOR 3.08; 95% CI 1.63-5.09). Those deceived/coerced into their positions were more likely than non-trafficked women to have been recruited by an agency who came to their rural province (AOR 12.07; 95% CI 1.77-82.25) as opposed to getting the job from advertisement (AOR 0.10; 95% CI 0.02-0.65) or a friend/acquaintance (AOR 0.02; 95% CI 0.00-0.48). CONCLUSION The findings have implications for designing interventions to prevent and target trafficked women in the Philippines who may be more vulnerable to substance use and, potentially, HIV infection.
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Affiliation(s)
- Lianne A Urada
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Sonja Halterman
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Anita Raj
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Kiyomi Tsuyuki
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Nymia Pimentel-Simbulan
- Department of Behavioral Sciences, College of Arts and Sciences, University of the Philippines, Manila, Philippines
| | - Jay G Silverman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Fisher CB. Enhancing the Responsible Conduct of Sexual Health Prevention Research Across Global and Local Contexts: Training for Evidence-Based Research Ethics. ETHICS & BEHAVIOR 2014; 25:87-96. [PMID: 29479165 PMCID: PMC5823532 DOI: 10.1080/10508422.2014.948956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The HIV/AIDS pandemic has brought global attention to the ethical challenges of conducting research involving socially vulnerable participants. Such challenges require not only ethical deliberation but also an empirical evidentiary basis for research ethics policies and practices. This need has been addressed through the Fordham University HIV and Drug Abuse Prevention Research Ethics Institute, a National Institute on Drug Abuse-funded program that trains and funds early career scientists in conducting research on HIV/drug abuse research ethics. This article describes the ethical framework guiding Institute training and introduces readers to six empirical articles in this special issue that illuminate and help foster the responsible conduct of research.
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Basta TB, Stambaugh T, Fisher CB. Efficacy of an Educational Intervention to Increase Consent for HIV Testing in Rural Appalachia. ETHICS & BEHAVIOR 2014; 25:125-149. [PMID: 27789935 DOI: 10.1080/10508422.2014.948958] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study sought to assess barriers and enhance readiness to consent to home and Planned Parenthood HIV testing among 60 out-patients from a mental health and substance abuse clinic in rural Appalachia. Testing barriers included not knowing where to get tested, lack of confidentiality, and loss of partners if one tested sero-positive. The intervention yielded lowered HIV stigma, increase in HIV knowledge, and agreement to take the HIV home test. These results are encouraging because they suggest that a brief educational intervention is a critical pathway to the success of the National Institutes on Drug Abuse's Seek, Test, Treat, and Retain initiative in poor rural counties.
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Affiliation(s)
- Tania B Basta
- Department of Social and Public Health, Ohio University
| | | | - Celia B Fisher
- Center for Ethics Education, Department of Psychology, Fordham University
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13
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Brown B, Davtyan M, Fisher CB. Peruvian Female Sex Workers' Ethical Perspectives on Their Participation in an HPV Vaccine Clinical Trial. ETHICS & BEHAVIOR 2014; 25:115-128. [PMID: 27789934 DOI: 10.1080/10508422.2014.950269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined female sex workers' evaluation of ethically relevant experiences of participating in an HPV4 vaccine clinical trial conducted in Lima, Peru (the Sunflower Study). The Sunflower Study provided all participants with HPV testing, treatment for those testing positive, and access to the vaccine for all testing negative. Themes that emerged from content analysis of interviews with 16 former participants included the importance of respectful treatment and access to healthcare not otherwise available and concerns about privacy protections, the potential for HIV stigma, and poststudy abandonment.
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Affiliation(s)
- Brandon Brown
- Program in Public Health, University of California, Irvine
| | - Mariam Davtyan
- Program in Public Health, University of California, Irvine
| | - Celia B Fisher
- Center for Ethics Education, Department of Psychology, Fordham University
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14
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Goldenberg SM, Mindt MR, Jimenez TR, Brouwer KC, Miranda SM, Fisher. CB. Structural and Interpersonal Benefits and Risks of Participation in HIV Research: Perspectives of Female Sex Workers in Guatemala. ETHICS & BEHAVIOR 2014; 25:97-114. [PMID: 27840564 PMCID: PMC5104274 DOI: 10.1080/10508422.2014.950270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study explored perceived benefits and risks of participation in HIV research among 33 female sex workers in Tecun Uman, Guatemala. Stigma associated with sex work and HIV was a critical barrier to research participation. Key benefits of participation included access to HIV/STI prevention and testing, as well as positive and trusting relationships between sex workers and research teams. Control exerted by managers had mixed influences on perceived research risks and benefits. Results underscore the critical need for HIV investigators to develop population-tailored procedures to reduce stigma, engage managers, and reinforce trusting, reciprocal relationships between sex work communities and researchers.
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Affiliation(s)
- Shira M. Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia [608 -1081 Burrard Street (St. Paul's Hospital), Vancouver, BC, CANADA, V6Z 1Y6]
- HIV Prevention Ethics Institute, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
| | - Monica Rivera Mindt
- HIV Prevention Ethics Institute, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
- Department of Psychology, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
| | - Teresita Rocha Jimenez
- Division of Global Public Health, University of California, San Diego [9500 Gilman Drive, La Jolla, CA, USA, 92093-0507]
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California, San Diego [9500 Gilman Drive, La Jolla, CA, USA, 92093-0507]
| | - Sonia Morales Miranda
- Centro de Estudios en Salud, Unidad de VIH, Universidad del Valle de Guatemal [Vista Hermosa III, Guatamala City, GUATEMALA]
| | - Celia B. Fisher.
- HIV Prevention Ethics Institute, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
- Department of Psychology, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
- Center for Ethics Education, Fordham University [441 E. Fordham Road, Bronx, NY, USA, 10458]
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15
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Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand. PLoS One 2014; 9:e100058. [PMID: 24949864 PMCID: PMC4064984 DOI: 10.1371/journal.pone.0100058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. Methods In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work. Results Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. Discussion Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where biomedical HIV prevention trials occur, and where clinical trials in marginalized populations continue.
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Urada LA, Simmons J. A collaborative methodology for investigating the ethical conduct of research on female sex workers in the Philippines. J Empir Res Hum Res Ethics 2014; 9:41-5. [PMID: 24572082 PMCID: PMC4065172 DOI: 10.1525/jer.2014.9.1.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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