Risk and danger among women-who-prostitute in areas where farmworkers predominate

Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model

Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.

Occupational Health and Safety among Female Commercial Sex Workers in Ghana: A Qualitative Study

The topic of occupational health and safety (OHS) has been investigated for many years and continues to be a concept often researched today. Generally speaking, OHS research has been centered around food safety, construction safety, transportation safety, fire safety, drug and alcohol testing, health and medical management, and industrial hygiene, to name a few. However, the concept of OHS concerning female commercial sex workers (FCSWs) has rarely been investigated, often neglected, seldom discussed, and is lacking in sound research. Although regarded as the “oldest profession”, commercial sex work (CSW) has consistently been ignored, disregarded, and under-researched due to the illegality and stigmatization of prostitution. This paper reviews occupational safety and health issues faced by FCSWs in Tema and Accra, Ghana, through in-depth interviews, visits to women’s homes, fieldwork, informal conversations, and observations with FCSWs during the summer of May 2012–July 2012. Facets of OHS that emerged among FCSWs included: sexually transmissible infections, risks associated with harassment and violence from police and clients, alcohol and drug use, irregular hospital visits or lack of hospital visits, immigration issues, legal hazards, and working conditions. We argue that CSW be viewed as an occupation in great need of interventions to reduce workplace risks.

Crack Use Sites and HIV Risk in El Salvador

“The Social Context of Crack Use and Related Sexual Risk in El Salvador” study was designed to increase knowledge of the locations where drugs are consumed in urban San Salvador, the social dynamics within such sites, and their implications for HIV risk and prevention efforts. In-depth interviews with crack smokers reveal several different types of sites where drugs are consumed and risky sex may occur including trances (generally houses where crack is sold and consumed), brothels, motels, drug users' own homes, abandoned buildings, the street, parks, or cantinas. These range from private sites, where site “gatekeepers” strictly control access, to public sites where access is more open. However, even in more public sites there is considerable social interaction, rules regarding site usage, and in some cases gatekeeper control of the site. Social dynamics already normative at drug use sites may support a site-based, peer-led intervention approach.

Sex worker-led structural interventions in India: a case study on addressing violence in HIV prevention through the Ashodaya Samithi collective in Mysore

Background & objectives:

Structural interventions have the capacity to improve the outcomes of HIV/AIDS interventions by changing the social, economic, political or environmental factors that determine risk and vulnerability. Marginalized groups face disproportionate barriers to health, and sex workers are among those at highest risk of HIV in India. Evidence in India and globally has shown that sex workers face violence in many forms ranging from verbal, psychological and emotional abuse to economic extortion, physical and sexual violence and this is directly linked to lower levels of condom use and higher levels of sexually transmitted infections (STIs), the most critical determinants of HIV risk. We present here a case study of an intervention that mobilized sex workers to lead an HIV prevention response that addresses violence in their daily lives.

Methods:

This study draws on ethnographic research and project monitoring data from a community-led structural intervention in Mysore, India, implemented by Ashodaya Samithi. Qualitative and quantitative data were used to characterize baseline conditions, community responses and subsequent outcomes related to violence.

Results:

In 2004, the incidence of reported violence by sex workers was extremely high (> 8 incidents per sex worker, per year) but decreased by 84 per cent over 5 years. Violence by police and anti-social elements, initially most common, decreased substantially after a safe space was established for sex workers to meet and crisis management and advocacy were initiated with different stakeholders. Violence by clients, decreased after working with lodge owners to improve safety. However, initial increases in intimate partner violence were reported, and may be explained by two factors: (i) increased willingness to report such incidents; and (ii) increased violence as a reaction to sex workers’ growing empowerment. Trafficking was addressed through the establishment of a self-regulatory board (SRB). The community's progressive response to violence was enabled by advancing community mobilization, ensuring community ownership of the intervention, and shifting structural vulnerabilities, whereby sex workers increasingly engaged key actors in support of a more enabling environment.

Interpretation & conclusions:

Ashodaya's community-led response to violence at multiple levels proved highly synergistic and effective in reducing structural violence.

Transnational Migration and Global Health: The Production and Management of Risk, Illness, and Access to Care

Globalization, including the global flows of people, is clearly linked to disease transmission and vulnerability to health risks among immigrant populations. Anthropological research on transnational migration and health documents the implications of population movements for health and well-being. Studies of immigrant health reveal the importance of the social, political, and economic production of distress and disease as well as the structures and dynamics that produce particular patterns of access to health services. This review points to underlying political, economic, and social structures that produce particular patterns of health and disease among transnational migrants. Both critical and phenomenological analyses explore ideas of alterity and community, which underlie the production and management of immigrant health. Research on immigrant health underscores the importance of further attention to policies of entitlement and exclusion, which ultimately determine health vulnerabilities and accessibility of health care.

Theoretical sampling and category development in grounded theory

Theoretical sampling is a hallmark of grounded theory methodology, and yet there is little guidance available for researchers on how to implement this process. A review of recently published grounded theory studies in Qualitative Health Research revealed that researchers often indicate that they use theoretical sampling to choose new participants, to modify interview guides, or to add data sources as a study progresses, but few describe how theoretical sampling is implemented in response to emergent findings. In this article, two issues that arose relative to theoretical sampling in an ongoing grounded theory study are discussed. A theoretical sampling guide that was developed by the authors' research team to facilitate systematic decision making and to enhance the audit trail relative to theoretical sampling is described, and an example of how the guide was used to develop a category is presented.

STI/HIV Risks for Mexican Migrant Laborers: Exploratory Ethnographies

The influx of Latino laborers into the U.S. and the confluence of migration-driven factors in an environment ripe for risk-taking have the potential to exacerbate already rising STI/HIV rates among migrants and their social networks at both the home and receiving regions. This paper focuses on Mexican migrant laborers who are among the most marginalized and exploited Latinos in the U.S. This study used ethnographic methods to delineate the sociocultural and spatial contexts and social organization of migrant farmwork, and examined how intertwined individual and environmental factors render migrant farmworkers vulnerable to STI/HIV risks. Findings indicate the presence of a number of factors in the study population of Mexican migrant workers (N = 23)-such as poverty, limited education, physical/social/cultural isolation, long work hours, constant mobility, hazardous work conditions, limited access to health care, low rates of condom use, multipartnering, and use of sexworkers-which increase their risks for STI/HIV transmission. To be successful, prevention efforts need to focus not only on condom education and HIV awareness and testing, but also on reducing migrants' social isolation and understanding their social networks.

Sex workers in agricultural areas: Their drugs, their children

Most research on female sex workers is urban-based, emphasizing economic necessity and risk-taking. Few authors discuss sex workers and their children. The objective of the present study was to ethnographically explore the influence of street life on childrearing by women involved in sex work in agricultural areas of the southeastern USA. Interviews took place with 38 women. Findings suggest that the sampled women followed the usual paths into substance use. Most began using substances before they began sex work, at which time use escalated to crack-cocaine. Children of 32 of the 34 women who were mothers were living separately from their mothers. None the less, mothers took an interest in children's wellbeing, and many visited them whenever possible. Their principal concern was assuring that children were raised in the best way available. One daughter followed her mother into sex work, and a few older children drank moderately. Several children had experienced abuse from persons other than parents, but the long-term effects of this abuse are unknown.

Narrative Constructions of Sexual Violence as Told by Female Rape Survivors in Three Populations of the Southwestern United States: Scripts of Coercion, Scripts of Consent

There is a growing literature on the narrative construction of rape as sexual violence. This is puzzling, since, in certain contexts, violence may stifle narrative production. Researchers of atrocities, for example, propose that the experience of recurring terror disrupts narrative cohesion in reporting lived trauma. Genocidal horror occurs in the context of communities and ethnic groups. Our rape survival data from women of three populations in the southwestern United States reflect traumas of sexual violence against women, experienced within everyday lives. From interviews with 62 female rape survivors, we (1) identify narrative conventions and linguistic devices to show how these women structure accounts of sexual assault that reflect their cultural background; (2) contrast scripts of coercion and consent; (3) examine how the way in which these women describe the coercive actions of the perpetrator(s) contradicts the assumptions of legal discourse; and (4) discuss the narrative production of several women in abusive relationships and compare it to the narrative production (or lack thereof) of persons who experience state-engineered terror.