Understanding the social and economic contexts surrounding women engaged in street-level prostitution

Self-rated health and quality of life in female sex workers with substance use disorders in Tehran, Iran

BACKGROUND

While self-rated health (SRH) and quality of life (QoL) has been associated with substance use disorders (SUDs) in sex-working populations, little is known about this association in Iran. This study aimed to assess QoL and SRH in Iranian female sex workers (FSWs) in Tehran.

METHOD

FSWs were recruited using convenience sampling methods from substance abuse treatment centers in Tehran that exclusively provided services for women. Participants completed an interviewer-administered demographic questionnaire in Persian and the Iranian version of the Short Form Health Survey (SF-36). Descriptive analyses, means and standard deviations; frequency and percentages, t-test and one-way ANOVA, and Chi-square tests were utilized to analyze the data.

RESULTS

The mean age among 161 participants clinically diagnosed with SUD was 34.09 years (SD 7.97; range: 18-57). The total mean QoL score was 41.03 (SD: 12.92). The highest and lowest mean scores were observed in the physical functioning (52.23) and role emotional (26.64) dimensions, respectively. Significant differences (p < 0.05) in QoL were observed according to education and marital status, and the average QoL score was lower in women who reported permanent marriages and women who were illiterate. The average score of QoL was significantly higher in employed women. Overall, 51.6% of the women rated their health as sub-optimal, with divorced participants and women who were illiterate more likely to rate their health as sub-optimal (p < 0.05).

CONCLUSION

Results emphasize the need for mental, physical, and sexual health screening and gender-specific interventions to improve QoL in this population. Further investigation may elucidate the consequences of poor SRH and QoL on SUD treatment adherence, sexual risk behavior, and morbidity and mortality in FSWs.

Disclosing Sex Trading Histories to Providers: Barriers and Facilitators to Navigation of Social Services Among Women Impacted by Commercial Sexual Exploitation

Sex trafficking and commercial sexual exploitation (CSE) can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, depression, sexually transmitted infections (STIs), and HIV. Consequently, engagement with services that address addiction, mental health, and housing, and provide general advocacy is critically important to women's increased safety, stabilization, and quality of life. The purpose of this study is to identify perceived barriers and facilitators to service access and engagement with social services among women involved in CSE. Drawing from a larger grounded theory study that partnered with an anti-trafficking coalition and a substance use treatment center for women, in-depth, semistructured interviews were conducted with 30 adult women who traded sex as adults and 20 service providers who come into contact with this population. Women engaging in services were sampled through maximum variation sampling (n = 24) and women not engaged with services (n = 6) were recruited through snowball sampling. Providers were recruited through purposive sampling through the coalition (n = 10) and nominations sampling (n = 10). Open and focused coding were conducted. Multiple enhancements to methodological and analytic rigor were taken, including collaboration with multiple key stakeholders, use of nonstigmatizing language, self-reflexivity processes, analytic memo-writing, and member checking. Findings suggest that women experienced judgment when disclosing sex trading in social service intakes, and individual and group sessions from providers and other women in the groups. Although some women saw disclosure as helpful in addressing the complex feelings stemming from sex trading, as well as the desire to help or relate to other women in similar situations, they also identified risk of harm and multiple barriers to disclosing during intake meetings and individual sessions with providers as well as group sessions with providers and other clients. Implications for individual and group practice are discussed.

Factors influencing women's sex work in a Lebanese sample: results of a case-control study

BACKGROUND

Many constituents contribute to the rise of sex work in Lebanon such as the socio-economic situation in the country (poverty, increased unemployment rates, and religious divisions), as well as the political and social instability. Several emotional and psychological factors such as depression, stress, anxiety, low self-esteem, emotional abuse, may force some people to rely on trading sex as a coping strategy for persevering. Therefore, it was deemed interesting to explore and understand factors that are correlated with sex work in Lebanon where no study, to our knowledge, has been written on this critical point. The objective of the study was to assess factors (such as trauma, child abuse, partner abuse, depression, anxiety, and stress) associated with women joining sex work among a sample of the Lebanese population.

METHODS

A case-control study was conducted on a group of women (60 sex workers recruited from a prison for women) involved in sex work matched for age and sex with a control group (60 non-sex workers). Controls were chosen from the same prison population as the sex workers.

RESULTS

A logistic regression was conducted, taking being a sex worker vs not as the dependent variable; independent factors were sociodemographic characteristics, child (psychological, neglect, physical and verbal) and inter partner violence (physical and non-physical), depression, anxiety and stress. Higher anxiety (aOR = 1.08) and higher inter partner physical violence (aOR = 1.02) were altogether related with higher chances of being a sex worker.

CONCLUSION

This study proposes an association between child abuse, inter partner violence, alcohol consumption, anxiety, and sex work. Future research may also need to contemplate other factors not examined here, including parental substance use, personality traits, and many others.

Transactional Sex and HIV Risk among Adolescent School Girls in Ethiopia: Mixed Method Study

Background

Young people in Sub-Saharan Africa are affected by HIV pandemic to a greater extent than elsewhere. Transactional sex among adolescent school girls with older men commonly called "sugar daddies" is one of the major factors fueling the spread of the infection due to the extended sexual network. Thus, this study aimed to assess the magnitude and factors associated with transactional sex among adolescent girls and "sugar daddies" in relation to HIV/AIDS.

Methods

Mixed method cross-sectional study was done among 620 female students in Hawassa town, South Ethiopia, from September 2010 to May 2011. A structured questionnaire and in-depth interview check list were used to collect the quantitative and qualitative data, respectively. Survey participants were selected randomly from five preparatory schools whereas ten in-depth interview participants were recruited by a snowball sampling technique from the same schools. Data were entered using Epi-Info and analyzed by SPSS. A descriptive statistics followed by multivariable logistic regression analyses were conducted to identify factors associated with transactional sex with "sugar daddy". Both crude and adjusted odds ratios with 95% confidence interval were reported. We used OpenCode software for coding and categorizing the in-depth interviews and quotes that represent the informants opinion were used to support the quantitative findings.

Results

A substantial number of female students, 71(11.5%), reported to have had transactional sex with older men. Most of the respondents who dated "sugar daddies" (93%) had multiple sexual partners concurrently and sequentially, and among them, only 22.7% had consistent condom use. Girls who were in older age group [OR (CI) 6.87 (3.48-13.58)], who had lost both parents [OR (CI) 2.99 (1.14-7.84)], had perceived less economic status [OR: 25.41; 95% CI: 7.80-82.76] and engaged in substance abuse [OR (CO) 5.8 (2.1-15.77)] had higher odds of practicing transactional sex with "sugar daddies". In-depth interviewed participants also revealed that they were involved in transactional sex for monetary while having concurrent and subsequent sexual network with their schoolmates and other young partners.

Conclusion

Transactional sex among female students was high, and the sexual network they had with the young men put young people in the network at risk of HIV and other sexually transmitted infections. Therefore, HIV prevention programs shall focus on transactional sex among adolescent school girls to halt transmission of HIV among the generation.

Experiences of Racism and Racial Tensions Among African American Women Impacted by Commercial Sexual Exploitation in Practice: A Qualitative Study

Barriers faced by Black women when navigating commercial sexual exploitation (CSE)-related services remain understudied. This qualitative study explores (a) Black women's experiences of racism when accessing services in CSE-related organizations and (b) the existence and manifestation of racial tensions in practice. In-depth interviews were conducted with 30 adult women who traded sex as adults and 20 CSE-related service providers. Findings suggest that Black women perceive preferential treatment given to White women. Racial tensions between women accessing programs were identified, as well as a promising practice of intergroup dialogue groups addressing racism, privilege, and oppression. Implications are discussed.

Street Level Prostitution: A Systematic Literature Review

The aim of this study was to synthesize research on female street level prostitutes for application in mental health practice and identification of future research needs. The data were from reports conducted in Westernized countries on female street level prostitutes between the years 2000 and 2014. Street level prostitutes are at high risk for HIV/STIs, chronic and acute physical/mental health problems, and violence, but there is a paucity of research on resilience and coping skills. We conclude that street level prostitutes suffer severe health disparities, yet they do not seek health care on a consistent basis. It is important for mental healthcare providers to offer women a safe, non-judgmental environment while providing assessment and referral. Future research on mental health consequences as well as resilience and coping skills would support effective interventions that address the women holistically.

Risk and resiliency factors influencing onset and adolescence-limited commercial sexual exploitation of disadvantaged girls

BACKGROUND

Previous research into age-related variables relevant to girls and young women being involved in commercial sexual exploitation (including prostitution) has not distinguished between its onset and limitation to adolescence and its early onset and persistence into adult life.

AIMS

The aims of this study were to examine variables associated with adolescent versus adult onset of commercial sexual exploitation and identify potential risk and resiliency factors differentiating adolescence-limited sexual exploitation and early-onset-adult persistent exploitation.

METHOD

Interviews with 174 vulnerable mostly African-American women, 23% of whom reported commercial sexual exploitation in adolescence and/or adulthood, yielded data, which were analysed using multinomial logistic regressions.

RESULTS

Adolescent sexual victimisation, younger age at first alcohol/drug use, being a victim of intimate partner violence and sense of stigmatisation of sexual self/others were all variables associated with adolescent onset of commercial sexual exploitation. Educational attainment differentiated adolescence limited from adolescent-adult persistent exploitation; exploitation had ceased by adulthood among over two-thirds of those who completed at least high school education, but only 13% of those exploited into adult life had finished high school.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

As level of education was linked to cessation of exploitation by adulthood, support for vulnerable girls to complete education at least to high school level may be protective.The link between early onset of substance misuse and persistent exploitation suggests that education and support specifically targeted within this field could reduce likelihood of persistent abuse.Work directed at improvement of self-image may also reduce risk of persistent exploitation.

Sex work in trucking milieux: "lot lizards," truckers, and risk

BACKGROUND

Long-haul truckers often engage in risk-laden sexual mixing and drug exchanges with female sex workers while on the road, which increase their vulnerability to sexually transmitted infections/blood borne infections (STI/BBI).

OBJECTIVE

An ethnoepidemiological study of STI/BBI in trucker-centered populations was conducted at four truckstops in the United States. This article reports findings from an analysis of the female sex worker data, which show how mobility and transience, as well as poverty, homelessness, and exposure to violence, have the potential to exacerbate the occupational health risks of female sex workers.

METHODS

Phase 1 involved nonparticipant observation of trucker risk network groups in public and semi-public settings at two Arizona truckstops. Phase 2 was a large-scale ethnoepidemiological study of STI/BBI risk among trucker networks at two Georgia truckstops. Ten sex workers in Phoenix and 29 in Atlanta were interviewed individually or in focus groups. Textual data were analyzed using QSR NVivo 8 and serological data collected from the Georgia sample were analyzed for STIs/HIV.

RESULTS

Infections occur within these populations, where the existence of multiple risks delivered via multiple channels within physical proximity maintains infection and transmission.

CONCLUSIONS

Environmental-level interventions, such as better security at truck stops, and individual-level interventions, such as STI/BBI infection education and testing for FSWs and truckers, can contribute to safer settings for truckers, sex workers, and their sex and drug partners.