Female migrant sex workers in Moscow: gender and power factors and HIV risk.

PubMed

Weine, Stevan; Golobof, Alexandra; Bahromov, Mahbat; Kashuba, Adrianna; Kalandarov, Tohir; Jonbekov, Jonbek; Loue, Sana

2013-01-01

This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which researchers conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women's health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies.

Female Migrant Sex Workers in Moscow: Gender and Power Factors and HIV Risk

PubMed Central

Weine, Stevan; Golobof, Alexandra; Bahromov, Mahbat; Kashuba, Adrianna; Kalandarov, Tohir; Jonbekov, Jonbek; Loue, Sana

2013-01-01

This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which we conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women’s health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies. PMID:23421339

Agency, lapse in condom use and relationship intimacy among female sex workers in Jamaica.

PubMed

Bailey, Althea E; Figueroa, John Peter

2018-05-01

This paper explores barriers to consistent condom use among female sex workers in Jamaica in a qualitative study using grounded theory. Multiple perspectives were sought through 44 in-depth interviews conducted with female sex workers, clients, the partners of sex workers and facilitators of sex work. Poverty and lack of education or skills, severely limited support systems as well as childhood abuse served to push the majority of participants into sex work and created vulnerability to HIV and other STIs. Despite these constraints, women found ways to exercise agency, ensure condom use, adopt protective measures and gain economic advantage in various aspects of the Jamaican sex trade. Perceived relationship intimacy between sex workers and their clients and/or their main partners emerged as the main factor contributing to reduced risk perception and inconsistent condom use. Relationship intimacy, with associated trust and affirmation of self, is the most important factor influencing sexual decision-making with respect to lapse in condom use among female sex workers in Jamaica. Study findings provide important insights that can enhance individual psychosocial, interpersonal and community-based interventions as well as inform environmental, structural and policy interventions to reduce risk and vulnerability among female sex workers.

Alcohol and condom use among HIV-positive and HIV-negative female sex workers in Nagaland, India.

PubMed

Nuken, Amenla; Kermode, Michelle; Saggurti, Niranjan; Armstrong, Greg; Medhi, Gajendra Kumar

2013-09-01

This study examines the relationship between alcohol use, HIV status, and condom use among female sex workers in Nagaland, India. We analyzed data from a cross-sectional survey undertaken in 2009, using descriptive and multivariate statistics. Out of 417 female sex workers, one-fifth used alcohol daily and one-tenth were HIV-positive. HIV-positive female sex workers were more likely than HIV-negative female sex workers to consume alcohol daily (30.2% vs. 18.0%). HIV-positive daily alcohol users reported lower condom use at last sex with regular clients compared to HIV-positive non-daily alcohol users (46.2% vs. 79.3%), a relationship not evident among HIV-negative female sex workers. There is a need to promote awareness of synergies between alcohol use and HIV, and to screen for problematic alcohol use among female sex workers in order to reduce the spread of HIV.

Social Support and Sexual Risk Among Establishment-Based Female Sex Workers in Tijuana.

PubMed

Choudhury, Shonali Mona; Toller Erausquin, Jennifer; Park, Kyuwon; Anglade, Debbie

2015-08-01

Social support can affect health outcomes of female sex workers. In this inductive feminist grounded theory study based on 20 in-depth interviews, we explore how establishment-based female sex workers in Tijuana perceive the impact of the connections among women on their lives and health. Participants elected to discuss the importance of social support from mothers, sisters, friends, and co-workers, and the empowering and disempowering aspects of these relationships. In previous studies, scholars demonstrated the efficacy of formal organization of female sex workers in promoting the mitigation of sexual and HIV risk. We show the importance of informal ties with other women. Some participants mentioned competitive relationships, others talked about cooperation and the desire for a venue to learn from one another. Social interactions with other women are especially empowering when female sex workers can openly engage in "woman talk" that may contribute to the mitigation of sexual and HIV risk. © The Author(s) 2015.

Prevalence of sexually transmitted infections in female sex workers in Athens, Greece - 2005.

PubMed

Papadogeorgaki, H; Caroni, C; Frangouli, E; Flemetakis, A; Katsambas, A; Hadjivassiliou, M

2006-01-01

There is little data on the prevalence of STIs in female sex workers, Greek and immigrants, working in Athens, Greece, since most of them work without any form of official license. Our aim was to establish the prevalence of STIs in asymptomatic legal Greek and immigrant female sex workers in Athens, Greece. The study involved an evaluation of gonococcal and chlamydial infection, early infectious syphilis, HIV infection, HSV-2 infection, Hepatitis B and C in 299 female sex workers who applied for an official work permit between May 2005 and October 2005. HSV-2 infection was more common in the Greek sex workers. No difference was found for the other STIs. Prevalence was related to age. A significant association was found between HSV-2 and syphilis. No HIV infection was detected. We concluded that asymptomatic sex workers can be a source of STIs which points out the need for a better health system control in Greece.

Use of dual protection among female sex workers in Swaziland.

PubMed

Yam, Eileen A; Mnisi, Zandile; Mabuza, Xolile; Kennedy, Caitlin; Kerrigan, Deanna; Tsui, Amy; Baral, Stefan

2013-06-01

Female sex workers are at heightened risk of both HIV infection and unwanted pregnancy. Nonbarrier modern contraceptives are highly effective at preventing pregnancy, but offer no HIV protection. A better understanding of sex workers' use of condoms and nonbarrier methods is needed to help them meet their contraceptive and STI protection needs. A 2011 respondent-driven sampling survey collected reproductive health and contraceptive use data from 325 female sex workers in Swaziland. Multinomial logistic regression analysis was used to identify associations between selected characteristics and four outcomes of contraceptive use over the past month: consistent condom use alone; nonbarrier modern contraceptive use (either alone or with inconsistent condom use); dual method use; and inconsistent condom use, other method use or nonuse. Adjusted predicted probabilities were also calculated to determine patterns of association. After adjustments were made for background and behavioral factors, 16% of female sex workers were found to be consistent users of condoms alone; 39% used nonbarrier modern methods (without consistent condom use); 8% were dual method users; and 38% were inconsistent condom users or used other methods or none. Women who reported recent condom failure were less likely than others to be consistent condom users (6% vs. 22%). Consistent use of condoms alone was more common among women who had had no noncommercial partners in the past month than among those who reported two or more such partners (39% vs. 3%). In addition, respondents who had children were more likely than their nulliparous counterparts to report use of nonbarrier methods alone (65% vs. 14%). Inconsistent or no condom use among nonbarrier contraceptive users underscores the need to incorporate HIV prevention into family planning interventions, particularly among female sex workers who have children and noncommercial partners.

Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia.

PubMed

Mazeingia, Yohannes Teka; Olijjira, Lemessa; Dessie, Yadeta

2017-01-01

Female sex workers have been disproportionately affected with HIV and anal sexual experience elevate their vulnerability. Anal intercourse has more risk of HIV transmission than vaginal intercourse for receptors that coupled with low condom and proper lubricant use behavior during anal sex. Besides majority of them did not understand HIV transmission risk of anal intercourse. In Ethiopia, studies on anal sexual experience is almost none existent, so the purpose of this study is to explored anal sexual experience and HIV transmission risk awareness among female sex worker in Dire Dawa, Eastern Ethiopia. Qualitative study with thematic analysis approach was conducted among 18 female sex workers and recruitment of study participants performed until saturation of information. The principal investigator conducted in-depth interviews using local language (Amharic) and it was recorded on audio recorder. Tape recorded data was transcribed and translated to English and entered into open code version 3.4 for coding and theme identification. Data collection conducted simultaneously with data analysis. Female sex workers practiced anal sex for different themes like financial influence, coercion, intentionally, peer pressure and as a sign of intimacy and love. Coercion, negative attitudes, poor awareness about HIV transmission risks of anal sex and protection capacity of condom and proper lubricants are the identified themes for not using condom and proper lubricants during anal sex by female sex workers. Inaccessibility and unavailability of health services for issues related to anal sex was the core reason for female sex workers' misperception and risk anal sexual experience. Female sex workers practiced anal sex without risk reduction approaches and they did not understand exacerbated risk of anal sex to HIV transmission. Stakeholders including ministry of health need to incorporate potential awareness raising tasks and programs about risk of anal sex and methods of risk

Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study.

PubMed

Weldegebreal, Rishan; Melaku, Yohannes Adama; Alemayehu, Mussie; Gebrehiwot, Tesfay Gebregzabher

2015-01-31

Unintended pregnancy is a significant public health concern in the world. Particularly, female sex workers are exposed to the risk of unintended pregnancy, abortion and their consequences. The aim of this study was, therefore, to assess unintended pregnancy and associated factors among female sex workers in Mekelle city, northern Ethiopia. A community based cross-sectional study was conducted among 346 female sex workers from five Kebelles (smallest administrative units in Ethiopia) of Mekelle city from March-April, 2014. Sex workers were selected with simple random sampling technique using sampling frame obtained from urban health extension program. Epi-data version 3.1 was used to enter data and analysis was done using SPSS version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with unintended pregnancy using odds ratio and 95% confidence interval with P-value of 0.05. The magnitude of unintended pregnancy among female sex workers in the past two years was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%), of those who had unintended pregnancies, and 17.1% of all female sex workers. Female sex workers who gave birth and had history of abortion formerly had 3.1 (AOR = 3.07, 95% CI: [1.54, 6.09]) and 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts, respectively. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn't. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn't use. Sex workers who had 60-96 months of duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). High level of unintended pregnancy and a range of associated factors were identified among sex

Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study.

PubMed

Mitchell, Kate M; Prudden, Holly J; Washington, Reynold; Isac, Shajy; Rajaram, Subramanian P; Foss, Anna M; Terris-Prestholt, Fern; Boily, Marie-Claude; Vickerman, Peter

2016-01-01

In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore. A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations. Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use

Entamoeba histolytica Infection in Female Sex Workers: A Matched Case-Control Study in Durango, Mexico.

PubMed

Alvarado-Esquivel, Cosme; Sanchez-Anguiano, Luis Francisco; Hernandez-Tinoco, Jesus; Estrada-Martinez, Sergio; Perez-Alamos, Alma Rosa; Ramos-Nevarez, Agar; Cerrillo-Soto, Sandra Margarita; Guido-Arreola, Carlos Alberto

2017-07-01

Infection with Entamoeba histolytica ( E. histolytica ) can be potentially transmitted by sexual contact. The seroepidemiology of E. histolytica in female sex workers has not been studied. The aim of the study was to determine whether E. histolytica is associated with the occupation of female sex work. In addition, the correlates of E. histolytica seroprevalence in female sex workers were also investigated. We performed an age- and gender-matched case-control study of 187 female sex workers and 374 women without sex work. Cases and controls were tested for the presence of E. histolytica IgG antibodies using a commercially available enzyme-linked immunoassay. Seroprevalence association with the characteristics of female sex workers was determined by bivariate analysis. Anti- E. histolytica IgG antibodies were found in five (2.7%) of 187 female sex workers and in 16 (4.3%) of 374 controls (odds ratios (OR) = 0.61; 95% confidence intervals (CI): 0.22 - 1.70; P = 0.34). Mean optical density of the immunoassay in seropositive cases and controls was 1.35 ± 0.93 and 0.73 ± 0.45, respectively (P = 0.05). Seroprevalence of E. histolytica infection did not vary significantly with age, education, socioeconomic level, or health status of sex workers. Seropositivity to E. histolytica did not correlate with work characteristics such as duration in the occupation, condom use, type of sex, or a history of sexually transmitted diseases, or with behavioral variables such as washing hands before eating, or consumption of untreated water. Results indicate that female sex workers do not have an increased risk for E. histolytica infection in Durango City, Mexico. Further studies to determine the risk of infection with E. histolytica by sexual contact should be conducted.

Entamoeba histolytica Infection in Female Sex Workers: A Matched Case-Control Study in Durango, Mexico

PubMed Central

Alvarado-Esquivel, Cosme; Sanchez-Anguiano, Luis Francisco; Hernandez-Tinoco, Jesus; Estrada-Martinez, Sergio; Perez-Alamos, Alma Rosa; Ramos-Nevarez, Agar; Cerrillo-Soto, Sandra Margarita; Guido-Arreola, Carlos Alberto

2017-01-01

Background Infection with Entamoeba histolytica (E. histolytica) can be potentially transmitted by sexual contact. The seroepidemiology of E. histolytica in female sex workers has not been studied. The aim of the study was to determine whether E. histolytica is associated with the occupation of female sex work. In addition, the correlates of E. histolytica seroprevalence in female sex workers were also investigated. Methods We performed an age- and gender-matched case-control study of 187 female sex workers and 374 women without sex work. Cases and controls were tested for the presence of E. histolytica IgG antibodies using a commercially available enzyme-linked immunoassay. Seroprevalence association with the characteristics of female sex workers was determined by bivariate analysis. Results Anti-E. histolytica IgG antibodies were found in five (2.7%) of 187 female sex workers and in 16 (4.3%) of 374 controls (odds ratios (OR) = 0.61; 95% confidence intervals (CI): 0.22 - 1.70; P = 0.34). Mean optical density of the immunoassay in seropositive cases and controls was 1.35 ± 0.93 and 0.73 ± 0.45, respectively (P = 0.05). Seroprevalence of E. histolytica infection did not vary significantly with age, education, socioeconomic level, or health status of sex workers. Seropositivity to E. histolytica did not correlate with work characteristics such as duration in the occupation, condom use, type of sex, or a history of sexually transmitted diseases, or with behavioral variables such as washing hands before eating, or consumption of untreated water. Conclusions Results indicate that female sex workers do not have an increased risk for E. histolytica infection in Durango City, Mexico. Further studies to determine the risk of infection with E. histolytica by sexual contact should be conducted. PMID:28611864

Mass Media and HIV/AIDS Prevention Among Female Sex Workers in Beijing, China.

PubMed

Xiao, Zhiwen; Li, Xiaoming; Lin, Danhua; Tam, Cheuk Chi

2015-01-01

The current study aimed to identify the sources of HIV prevention information for female sex workers in Beijing and assess the associations between levels of mass media exposure of HIV/AIDS prevention information and HIV/AIDS knowledge as well as condom use-related attitudes, beliefs, and behaviors. Cross-sectional data were collected from 359 female sex workers in Beijing, China. Chi-square tests and one-way ANOVA tests were employed. Female sex workers sampled in Beijing were more likely to obtain HIV/AIDS prevention information from television and street posters than radio and the Internet. However, a higher level of exposure to and a lasting impression on online information were significantly associated with a higher level of condom use self-efficacy and more consistent condom use among the participants. Exposure to HIV/AIDS prevention information delivered by radio, street posters, and the Internet was found to be associated with sexual communication about HIV or condom use with sexual partners. Overall, this study provides preliminary evidence of the utility of various mass media outlets in delivering HIV/AIDS prevention information among female sex workers in China. Future studies are needed to systematically examine the effectiveness of mass media-based prevention education on HIV/AIDS related attitudes and behaviors among female sex workers and other populations in China.

Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers

PubMed Central

Kerr, T; Strathdee, S A; Shoveller, J; Montaner, J S; Tyndall, M W

2009-01-01

Objective To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution. Design Prospective observational study. Setting Vancouver, Canada during 2006-8. Participants Female sex workers 14 years of age or older (inclusive of transgender women) who used illicit drugs (excluding marijuana) and engaged in street level sex work. Main outcome measure Self reported gender based violence. Results Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aORphysicalviolence) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aORrape) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aORclientviolence) 2.13, 1.26 to 3.62; aORphysicalviolence 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aORclientviolence 1.50, 1.08 to 2.57); prior assault by police (aORclientviolence 3.45, 1.98 to 6.02; aORrape 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aORphysicalviolence 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aORclientviolence 2.13, 1.26 to 3.62). Conclusions Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender

Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers.

PubMed

Shannon, Kate; Kerr, T; Strathdee, S A; Shoveller, J; Montaner, J S; Tyndall, M W

2009-08-11

To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution. Prospective observational study. Vancouver, Canada during 2006-8. Female sex workers 14 years of age or older (inclusive of transgender women) who used illicit drugs (excluding marijuana) and engaged in street level sex work. Self reported gender based violence. Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aOR(physicalviolence)) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aOR(rape)) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aOR(clientviolence)) 2.13, 1.26 to 3.62; aOR(physicalviolence) 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aOR(clientviolence) 1.50, 1.08 to 2.57); prior assault by police (aOR(clientviolence) 3.45, 1.98 to 6.02; aOR(rape) 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aOR(physicalviolence) 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aOR(clientviolence) 2.13, 1.26 to 3.62). Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender based violence against street based female sex workers. Socio

High burden of STI and HIV in male sex workers working as internet escorts for men in an observational study: a hidden key population compared with female sex workers and other men who have sex with men.

PubMed

Verhaegh-Haasnoot, Amanja; Dukers-Muijrers, Nicole H T M; Hoebe, Christian J P A

2015-07-29

Male sex work in the western countries has changed, including now a subculture of male sex workers who have paid sex with men arranged for via the internet. The men involved in this subculture do not easily identify themselves as sex workers nor as homosexual, and are therefore missed by regular health care and public health interventions. These male sex workers may form a hidden key population for sexually transmitted infections (STIs) and HIV, bridging towards other persons outside this context. This clinic-based observational study included consultations by male sex workers (n = 212), female sex workers (n = 801) and in men having sex with men who did not report being paid for sexual contacts (MSM, n = 2703) who received STI and HIV testing and counselling at our clinic during the study period. In this study we compare the consultations in male sex workers to those in in female sex workers and MSM. Demographic characteristics and sexual behaviour of the male sex workers, female sex workers and MSM were compared using chi-square tests and non-parametric tests. Using univariate and multivariate regression analyses, determinants for STI positivity in male sex workers were evaluated. Male sex workers tested positive for STI (including HIV) in 40 % of the consultations; female sex workers and MSM respectively in 9 and 14 % of the consultations. A new HIV infection was found in 8 % of the consultations of male sex workers. Male sex workers were a young population of migrant sex workers from Eastern Europe. They reported more often to also have sex contacts with women and other sex workers. Male sex workers are at a higher risk for one or more new STI than female sex workers and other MSM, even after correction for age, ethnicity, known HIV positivity and behavioural variables. Male sex workers form a hidden key population that impacts the transmission of STI and HIV within the MSM population and, possibly, to the heterosexual population. They require specific targeted

Determinants of condom use in female sex workers in Surabaya, Indonesia.

PubMed

Joesoef, M R; Kio, D; Linnan, M; Kamboji, A; Barakbah, Y; Idajadi, A

2000-04-01

In the developing world condom use among sex workers and their clients plays a dominant role in the transmission of HIV/STD. In Surabaya, Indonesia, data from the 1993 STD prevalence survey in female sex workers (brothels, street, massage parlours, barber shops, call-girl houses, and nightclubs) reveal that only 5% (33/692) of the brothel workers and 14% (25/177) of the street walkers had condoms in their possession at the time of the interview. During the last paid sexual intercourse, sex workers from the brothels, streets, and nightclubs used condoms infrequently (14%, 20%, and 25%, respectively). Sex workers from massage parlours, barber shops, and call girls were about 5 to 3 times more likely to use condoms than sex workers from nightclubs (adjusted odds ratio of 3.5, 4.9, and 4.2, respectively); thus condom promotion programmes should be targeted at sex workers at brothels, streets, and nightclubs. Programmes should include: (1) free distribution of condoms to sex establishments at the initial stage, and condom social marketing at later stages; (2) penalties, including legal sanctions, against any sex establishments that do not consistently use condoms; (3) participation of brothel owners and madams in encouraging sex workers to consistently have clients use condoms during sexual intercourse; and (4) establishment of sentinel surveillance to monitor STD/HIV and condom-use compliance.

Vulnerability on the streets: female sex workers and HIV risk.

PubMed

Pyett, P M; Warr, D J

1997-10-01

In-depth interviews were conducted with 24 purposively selected female sex workers who were perceived to be vulnerable to risks associated with their lifestyle and occupation. Brothel workers were found to be considerably less exposed to risk than the women working on the streets. Client resistance was the major obstacle to women maintaining safe sex practices. Physical threats and coercion from clients, the absence of legal protection for street workers, the workers' extreme social isolation and lack of community support added to the difficulties experienced by women in their attempts to insist on condoms for all sex services. Youth, homelessness and heavy drug use had contributed to women being at times even more vulnerable because they had less capacity to manage situations of potential violence or STD risk. Whether through sex work or in their private relationships, HIV remains a risk for some of these women. This study highlights the dangers associated with illegal sex work. While decriminalization of prostitution would reduce some of the dangers to which women were exposed and increase women's capacity to insist on safe sex practices, it is also important for community education programmes to address men's failure to accept responsibility for condom use when seeking the services of sex workers.

Cisgender male and transgender female sex workers in South Africa: gender variant identities and narratives of exclusion.

PubMed

Samudzi, Zoe; Mannell, Jenevieve

2016-01-01

Sex workers are often perceived as possessing 'deviant' identities, contributing to their exclusion from health services. The literature on sex worker identities in relation to health has focused primarily on cisgender female sex workers as the 'carriers of disease', obscuring the experiences of cisgender male and transgender sex workers and the complexities their gender identities bring to understandings of stigma and exclusion. To address this gap, this study draws on 21 interviews with cisgender male and transgender female sex workers receiving services from the Sex Workers Education and Advocacy Taskforce in Cape Town, South Africa. Our findings suggest that the social identities imposed upon sex workers contribute to their exclusion from public, private, discursive and geographic spaces. While many transgender female sex workers described their identities using positive and empowered language, cisgender male sex workers frequently expressed shame and internalised stigma related to identities, which could be described as 'less than masculine'. While many of those interviewed felt empowered by positive identities as transgender women, sex workers and sex worker-advocates, disempowerment and vulnerability were also linked to inappropriately masculinised and feminised identities. Understanding the links between gender identities and social exclusion is crucial to creating effective health interventions for both cisgender men and transgender women in sex work.

Poverty as a contextual factor affecting sexual health behavior among female sex workers in India.

PubMed

Dasgupta, Satarupa

2013-06-01

A thorough understanding of the environmental and structural factors that precipitate unsafe sexual practices is necessary for HIV/AIDS-prevention research among high-risk population groups like commercial sex workers. I examined how poverty contextualizes sexual health behavior, including condom compliance among commercial female sex workers in a red light district in Calcutta, India. For my research I did an ethnographic study and conducted in-depth interviews of 37 commercial female sex workers. I found that poverty, instead of serving as a catalyst for poor health choices among sex workers, acted as an impetus for pursuing safe sex practices and remaining healthy. The results indicate that sex work, poverty, and health do not always have a paradoxical relationship.

Resilience in work-related stress among female sex workers in Hong Kong.

PubMed

Yuen, Winnie Wing-Yan; Wong, William Chi-Wai; Holroyd, Eleanor; Tang, Catherine So-Kum

2014-09-01

The literature on positive psychology and resilience demonstrates that individuals utilize their personal strengths and environmental resources to facilitate positive adaptation. Using a qualitative approach, we investigated how these frameworks operated as self-protective strategies for female sex workers to maintain their psychological and physical well-being under stressful socioeconomic and work-related conditions. Twenty-three female sex workers in Hong Kong participated in in-depth interviews. We used the grounded theory approach for data analysis. The informants reported negative feelings in response to financial burden, clients' demands, threats to physical health, and stigma. Some female sex workers showed their resilience by being able to rationalize their role, believe their ability to make a change in life, and stay optimistic. They adopted strategies including emotional regulation and acceptance of their responsibility and limits to cope with stressful life events. The results help us understand the role of positive psychology and resilience in this vulnerable population. © The Author(s) 2014.

Stigma and sex work from the perspective of female sex workers in Hong Kong.

PubMed

Wong, William C W; Holroyd, Eleanor; Bingham, Amie

2011-01-01

While the stigma surrounding sex work is both well documented and easily recognised, few studies examine stigma in this context from the perspective of the sex workers themselves. In this article we report on a study using a modified grounded theory approach to analyse a series of semi-structured interviews with 49 female sex workers in Hong Kong, in order to examine the ways in which this group experiences and negotiates the stigma which arises from their employment in the sex industry. Sex workers in Hong Kong were subject to various stigmatising forces in their daily lives in their interactions with the public, the police and their families. These processes could have a negative impact on the sex workers' health, both through obvious manifestations such as physical or verbal abuse and through more subtle processes such as those which generated or perpetuated vulnerability and those which compelled the sex workers to conceal their identities and withdraw themselves from social networks. These findings are situated in the context of broader research surrounding sex work, drawing attention to the consequences of stigma on health and their interaction with health-service providers, before briefly discussing possible means of overcoming stigma-related barriers to providing adequate healthcare for this marginalised group. © 2010 The Authors. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Perspectives on condom breakage: a qualitative study of female sex workers in Bangalore, India.

PubMed

Gurav, Kaveri; Bradley, Janet; Chandrashekhar Gowda, G; Alary, Michel

2014-01-01

A qualitative study was conducted to obtain a detailed understanding of two key determinants of condom breakage - 'rough sex' and poor condom fit - identified in a recent telephone survey of female sex workers, in Bangalore, India. Transcripts from six focus-group discussions involving 35 female sex workers who reported condom breakage during the telephone survey were analysed. Rough sex in different forms, from over-exuberance to violence, was often described by sex workers as a result of clients' inebriation and use of sexual stimulants, which, they report, cause tumescence, excessive thrusting and sex that lasts longer than usual, thereby increasing the risk of condom breakage. Condom breakage in this setting is the result of a complex set of social situations involving client behaviours and power dynamics that has the potential to put the health and personal lives of sex workers at risk. These findings and their implications for programme development are discussed.

[Analysis of the risky behaviors among HIV positive female sex workers].

PubMed

Wang, Jue; Jia, Manhong; Luo, Hongbing; Li, Youfang; Song, Lijun; Mei, Jingyuan; Ma, Yanling; Yang, Yanling; Lu, Ran; Wang, Ling; Zhang, Renzhong; Pan, Songfeng; Li, Zhiqing; Lu, Lin

2015-11-01

To analyze the characteristics of risky behaviors among different age groups of HIV positive female sex workers, and to explore the strengthening of their management. From January to June 2014, 22 814 female sex workers were investigated and tested HIV in 117 sentinel surveillance sites in Yunnan Province, and 181 were confirmed to be HIV antibody positive, who accepted questionnaire surveys. According to the age, the participants were divided into the < 35 years old age group and ≥ 35 years old age group. The demographic characteristics, knowledge about HIV/AIDS and related risk behaviors characteristics of the two groups were obtained via questionnaire surveys among 181 HIV positive female sex workers, and in-depth qualitative interviews were conducted from among 12 HIV positive sex workers. HIV antibody positive rate was 0.8% (181), the age of the 181 subjects were (35.83 ± 9.17) years old, 76 cases (42.0%) were < 35 years old, and 105 cases (58.0%) were ≥ 35 years old. The differences of marital status, workplace class, the last work site among two groups were statistically significant (χ(2) = 20.80, 28.32, 7.83; P < 0.001, P < 0.001, P = 0.020, respectively). Among 181 HIV, the proportion of AIDS awareness was 95.6% (173); the proportion of drug use among ≥ 35 years old age group was 51.4% (54), which was higher than that in < 35 years old age group (34.2%, 26/76) (χ(2) = 5.30, P = 0.021). 96.7% (175) received condom promotion or HIV counseling and testing in the past year. The proportion of continuing to engage in sexual services over 5 years after HIV infection was 48.5% (51/105) and the proportion of receiving antiretroviral treatment was 69.5% (73/105) in ≥ 35 years old age group, which were higher than those in the < 35 age group (30.2% (23/76), 52.6% (40/76); χ(2) = 12.26, 5.36; P = 0.002, 0.021, respectively). In-depth interviews among 12 HIV positive female sex workers found that regular clients, not consistent use of condoms were the main

Prevalence and correlates of non-disclosure of HIV serostatus to sex partners among HIV-infected female sex workers and HIV-infected male clients of female sex workers in India.

PubMed

Saggurti, Niranjan; Raj, Anita; Mahapatra, Bidhubhusan; Cheng, Debbie M; Coleman, Sharon; Bridden, Carly; Battala, Madhusudana; Silverman, Jay G; Pardeshi, Manoj H; Samet, Jeffrey H

2013-01-01

This study examines non-disclosure of HIV serostatus to sex partners among HIV-infected adults involved with transactional sex in Mumbai, India. Surveys were conducted with HIV-infected female sex workers (n = 211) and infected male clients (n = 205) regarding HIV knowledge, awareness of sex partners' HIV serostatus, alcohol use, transactional sex involvement post-HIV diagnosis and non-disclosure of HIV serostatus. Gender-stratified multiple logistic regression models were used for analysis. Non-disclosure of one's serostatus to all sex partners was reported by almost three-fifths of females and two-fifths of males. Predictors of non-disclosure included lack of correct knowledge about HIV and no knowledge of sex partners' HIV serostatus. Among females, recent alcohol consumption also predicted non-disclosure. Among males, 10 + paid sexual partners in the year following HIV diagnosis predicted non-disclosure. Secondary HIV prevention efforts in India require greater focus on HIV disclosure communication and integrated alcohol and sexual risk reduction.

Prevalence and Correlates of Non-Disclosure of HIV Serostatus to Sex partners among HIV-Infected Female Sex Workers and HIV-infected Male Clients of Female Sex Workers in India

PubMed Central

Raj, Anita; Mahapatra, Bidhubhusan; Cheng, Debbie M.; Coleman, Sharon; Bridden, Carly; Battala, Madhusudana; Silverman, Jay G.; Pardeshi, Manoj H.; Samet, Jeffrey H.

2013-01-01

This study examines non-disclosure of HIV serostatus to sex partners among HIV-infected adults involved with transactional sex in Mumbai, India. Surveys were conducted with HIV-infected female sex workers (n = 211) and infected male clients (n = 205) regarding HIV knowledge, awareness of sex partners’ HIV serostatus, alcohol use, transactional sex involvement post-HIV diagnosis and non-disclosure of HIV serostatus. Gender-stratified multiple logistic regression models were used for analysis. Non-disclosure of one’s serostatus to all sex partners was reported by almost three-fifths of females and two-fifths of males. Predictors of non-disclosure included lack of correct knowledge about HIV and no knowledge of sex partners’ HIV serostatus. Among females, recent alcohol consumption also predicted non-disclosure. Among males, 10 + paid sexual partners in the year following HIV diagnosis predicted non-disclosure. Secondary HIV prevention efforts in India require greater focus on HIV disclosure communication and integrated alcohol and sexual risk reduction. PMID:22810892

Depression and key associated factors in female sex workers and women living with HIV/AIDS in the Dominican Republic.

PubMed

Rael, Christine T; Davis, Alissa

2017-04-01

Little is known about the mental health of female sex workers and women living with HIV/AIDS in the Dominican Republic, which impedes HIV prevention, testing, and treatment. This project estimates the prevalence of depression and identifies key contributing factors to this outcome in female sex workers, women living with HIV/AIDS, and a comparison group. Participants were female sex workers (N = 349), women living with HIV/AIDS (N = 213), and a comparison group of HIV-negative women who were not sex workers (N = 314) from the Dominican Republic. Participants completed questionnaires assessing demographic characteristics and depression. Female sex workers and women living with HIV/AIDS completed additional questionnaires ascertaining HIV or sex work-related internalized stigma. Depression was prevalent among female sex workers (70.2%), women living with HIV/AIDS (81.1%), and the comparison group (52.2%). Adjusted logistic regressions showed that internalized stigma was associated with depression for female sex workers (OR = 2.73; 95% CI = 1.95-3.84) and women living with HIV/AIDS (OR = 3.06; 95% CI = 1.86-5.05). Permanent income was associated with this outcome for female sex workers (OR = 0.08; 95% CI = 0.01-0.80) and the comparison group (OR = 0.04; 95% CI = 0.00-0.45).

Diversity among clients of female sex workers in India: comparing risk profiles and intervention impact by site of solicitation. implications for the vulnerability of less visible female sex workers.

PubMed

Suryawanshi, Dipak; Bhatnagar, Tarun; Deshpande, Sucheta; Zhou, Weiwei; Singh, Pankaj; Collumbien, Martine

2013-01-01

It seems generally accepted that targeted interventions in India have been successful in raising condom use between female sex workers (FSWs) and their clients. Data from clients of FSWs have been under-utilised to analyse the risk environments and vulnerability of both partners. The 2009 Integrated Biological and Behavioural Assessment survey sampled clients of FSWs at hotspots in Andhra Pradesh, Maharashtra and Tamil Nadu (n=5040). The risk profile of clients in terms of sexual networking and condom use are compared across usual pick-up place. We used propensity score matching (PSM) to estimate the average treatment effect on treated (ATT) of intervention messages on clients' consistent condom use with FSW. Clients of the more hidden sex workers who solicit from home or via phone or agents had more extensive sexual networks, reporting casual female partners as well as anal intercourse with male partners and FSW. Clients of brothel-based sex workers, who were the least educated, reported the fewest number/categories of partners, least anal sex, and lowest condom use (41%). Consistent condom use varied widely by state: 65% in Andhra Pradesh, 36% in Maharashtra and 29% in Tamil Nadu. Exposure to intervention messages on sexually transmitted infections was lowest among men frequenting brothels (58%), and highest among men soliciting less visible sex workers (70%). Exposure had significant impact on consistent condom use, including among clients of home-based sex workers (ATT 21%; p=0.001) and among men soliciting other more hidden FSW (ATT 17%; p=0.001). In Tamil Nadu no impact could be demonstrated. Commercial sex happens between two partners and both need to be, and can be, reached by intervention messages. Commercial sex is still largely unprotected and as the sex industry gets more diffuse a greater focus on reaching clients of sex workers seems important given their extensive sexual networks.

Condom utilization and sexual behavior of female sex workers in Northwest Ethiopia: A cross-sectional study.

PubMed

Tamene, Masresha Molla; Tessema, Gizachew Assefa; Beyera, Getahun Kebede

2015-01-01

Sexually transmitted infections are among the most important public health problems in the world. People who indulge in unsafe sex, such as female sex workers are the most at risk population groups due to multiple sexual partners and inconsistent condom use. The aim of this study was to assess condom utilization and sexual behavior of female sex workers in Gondar town, Northwest Ethiopia. A quantitative cross-sectional study triangulated with qualitative method was conducted from March 20 - April 10, 2014 in Gondar town. The quantitative data were collected through interviewing 488 female sex workers while in-depth interview was administered to collect qualitative data from 10 female sex workers. The collected data were entered into EPI-INFO version 3.5.3 and exported to SPSS version 20.0 software for analysis. Logistic regression analysis was done to determine the association between condom utilization and independent variables. This study revealed that less than half (47.7%) of the respondents utilized condom with any type of client. Secondary education or above, perceiving themselves at risk of HIV/AIDS infection, having awareness that sexually transmitted infections could increase HIV infection, being tested for HIV/AIDS in the last 12 months, and having lower number of clients in a month were positively associated with condom utilization. This finding depicted that condom utilization was low among female sex workers. Thus, developing and implementing target oriented behavioral change and communication strategies are needed to prevent the risk of acquiring HIV/AIDS and other sexually transmitted infections in female sex workers.

Female sex workers' empowerment strategies amid HIV-related socioeconomic vulnerabilities in Cameroon.

PubMed

Cange, Charles W; LeBreton, Matthew; Saylors, Karen; Billong, Serge; Tamoufe, Ubald; Fokam, Pamella; Baral, Stefan

2017-10-01

Research has consistently demonstrated that female sex workers use a variety of empowerment strategies to protect one another and their families. This study examines the strategies Cameroonian sex workers employ to do so. In-depth interviews and focus-group discussions were conducted with 100 sex workers. Coded texts were analysed for recurring themes. Sex workers reported being concerned with physical violence and sexual assault and demands from authorities for bribes to avoid fines and/or imprisonment. Women described strategies such as 'looking out for' each other when faced with security threats. Many reported staying in sex work to provide for their children through education and other circumstances to allow them to lead a better life. Sex worker mothers reported not using condoms when clients offered higher pay, or with intimate partners, even when they understood the risk of HIV transmission to themselves. Concern for their children's quality of life took precedence over HIV-related risks, even when sex workers were the children's primary carers. A sex worker empowerment programme with a focus on family-oriented services could offer an effective and novel approach to increasing coverage of HIV prevention, treatment and care in Cameroon.

Alcohol consumption and high risk sexual behaviour among female sex workers in Uganda.

PubMed

Mbonye, Martin; Rutakumwa, Rwamahe; Weiss, Helen; Seeley, Janet

2014-01-01

Alcohol consumption has been associated with high risk sexual behaviour among key populations such as female sex workers. We explored the drivers of alcohol consumption and its relationship to high risk sexual behaviour. Participants were drawn from a cohort of 1027 women selected from 'hot spots' in the suburbs of Kampala city. We conducted 3 in-depth interviews with 40 female sex workers between 2010 and 2011. Data were analysed thematically, focusing on alcohol use within the context of sex work. Alcohol consumption was very high with only seven women reporting that they did not drink. Alcohol consumption was driven by the emotional and economic needs of the participants, but also promoted by clients who encouraged consumption. Many sex workers only started drinking alcohol when they joined sex work on the advice of more experienced peers, as a way to cope with the job. Alcohol was blamed for unsafe sex, acts of violence and poor decision making which increased sexual and physical violence. Alcohol was reported to affect medication adherence for HIV-positive women who forgot to take medicine. The findings suggest that the drivers of alcohol consumption are multifaceted in this group and require both individual and structural interventions. Alcohol reduction counselling can be supportive at the individual level and should be an integral part of HIV prevention programmes for female sex workers and others such as patrons in bars. The counselling should be addressed in a sensitive manner to bar owners and managers.

Female street sex workers in Hong Kong: moving beyond sexual health.

PubMed

Wong, William C W; Holroyd, Eleanor A; Gray, Ann; Ling, Davina C

2006-05-01

For many years, the sex industry in Hong Kong has appeared to be an integral and ever-expanding component of the city's sociocultural and economic structure. Accordingly, the physical and psychological health of sex workers is becoming an increasing concern for the workers themselves, the public, and government policy. A cross-sectional survey on the quality of life (World Health Organization Quality of Life [WHOQOL]) of female sex workers (FSWs) in Hong Kong was used to investigate the physical and psychological well-being of street FSWs, and the results were compared with those of non-sex-working Hong Kong women after adjusting for age, educational level, marital status, and health status. The 89 FSWs surveyed scored significantly lower on QOL--WHOQOL-BREF (HK)--measures compared with the non-sex-working women. One common aspect among these sex workers was their negative view of themselves and of life. Many sex workers were at risk of being abused while at work, and many women worked without legal protection. Most of the women surveyed engaged in sex work to support their families. Because their income was often insufficient, some of their needs, especially those concerning health, were often neglected. The low WHOQOL-BREF (HK) scores in FSWs indicate feelings of helplessness and entrapment, which may well result in detrimental effects on sex workers' health, self-esteem, and confidence when asserting their basic rights, such as access to healthcare and safety. The conclusion highlights the vulnerability of this population to apparent weaknesses in Hong Kong's current healthcare system.

Prevalence of HIV Among U.S. Female Sex Workers: Systematic Review and Meta-analysis

PubMed Central

Noble, Meredith; Salo, Kathryn; Tregear, Stephen J.

2016-01-01

Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10 years. The pooled estimate of HIV prevalence was 17.3 % (95 % CI 13.5–21.9 %); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32 %) and statistical heterogeneity was substantial (I2 = 0.89, Q = 123; p < 0.001). Although the variance across the 14 studies was high, prevalence was generally high (10 % or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high. PMID:26914165

HIV risk practices by female sex workers according to workplace.

PubMed

Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann; Souza Júnior, Paulo Roberto Borges de

2014-06-01

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues.

HIV risk practices by female sex workers according to workplace

PubMed Central

Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann; de Souza, Paulo Roberto Borges

2014-01-01

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues. PMID:25119937

Diversity among Clients of Female Sex Workers in India: Comparing Risk Profiles and Intervention Impact by Site of Solicitation. Implications for the Vulnerability of Less Visible Female Sex Workers

PubMed Central

Suryawanshi, Dipak; Bhatnagar, Tarun; Deshpande, Sucheta; Zhou, Weiwei; Singh, Pankaj; Collumbien, Martine

2013-01-01

Background It seems generally accepted that targeted interventions in India have been successful in raising condom use between female sex workers (FSWs) and their clients. Data from clients of FSWs have been under-utilised to analyse the risk environments and vulnerability of both partners. Methods The 2009 Integrated Biological and Behavioural Assessment survey sampled clients of FSWs at hotspots in Andhra Pradesh, Maharashtra and Tamil Nadu (n=5040). The risk profile of clients in terms of sexual networking and condom use are compared across usual pick-up place. We used propensity score matching (PSM) to estimate the average treatment effect on treated (ATT) of intervention messages on clients’ consistent condom use with FSW. Results Clients of the more hidden sex workers who solicit from home or via phone or agents had more extensive sexual networks, reporting casual female partners as well as anal intercourse with male partners and FSW. Clients of brothel-based sex workers, who were the least educated, reported the fewest number/categories of partners, least anal sex, and lowest condom use (41%). Consistent condom use varied widely by state: 65% in Andhra Pradesh, 36% in Maharashtra and 29% in Tamil Nadu. Exposure to intervention messages on sexually transmitted infections was lowest among men frequenting brothels (58%), and highest among men soliciting less visible sex workers (70%). Exposure had significant impact on consistent condom use, including among clients of home-based sex workers (ATT 21%; p=0.001) and among men soliciting other more hidden FSW (ATT 17%; p=0.001). In Tamil Nadu no impact could be demonstrated. Conclusion Commercial sex happens between two partners and both need to be, and can be, reached by intervention messages. Commercial sex is still largely unprotected and as the sex industry gets more diffuse a greater focus on reaching clients of sex workers seems important given their extensive sexual networks. PMID:24023877

Criminalization, legalization or decriminalization of sex work: what female sex workers say in San Francisco, USA.

PubMed

Lutnick, Alexandra; Cohan, Deborah

2009-11-01

Sex work is a criminal offence in San Francisco, USA, and sex work advocates have so far unsuccessfully campaigned for decriminalizing it. Some groups argue that the decriminalization movement does not represent the voices of marginalized sex workers. Using qualitative and quantitative data from the Sex Worker Environmental Assessment Team Study, we investigated the perspectives and experiences of a range of female sex workers regarding the legal status of sex work and the impact of criminal law on their work experiences. Forty women were enrolled in the qualitative phase in 2004 and 247 women in the quantitative phase in 2006-07. Overall, the women in this study seemed to prefer a hybrid of legalization and decriminalization. The majority voiced a preference for removing statutes that criminalize sex work in order to facilitate a social and political environment where they had legal rights and could seek help when they were victims of violence. Advocacy groups need to explore the compromises sex workers are willing to make to ensure safe working conditions and the same legal protections afforded to other workers, and with those who are most marginalized to better understand their immediate needs and how these can be met through decriminalization.

Determinants of condom breakage among female sex workers in Karnataka, India.

PubMed

Bradley, Janet; Rajaram, S; Alary, Michel; Isac, Shajy; Washington, Reynold; Moses, Stephen; Ramesh, B M

2011-12-29

Condoms are effective in preventing the transmission of HIV and other sexually transmitted infections, when properly used. However, recent data from surveys of female sex workers (FSWs) in Karnataka in south India, suggest that condom breakage rates may be quite high. It is important therefore to quantify condom breakage rates, and examine what factors might precipitate condom breakage, so that programmers can identify those at risk, and develop appropriate interventions. We explored determinants of reported condom breakage in the previous month among 1,928 female sex workers in four districts of Karnataka using data from cross-sectional surveys undertaken from July 2008 to February 2009. Using stepwise multivariate logistic regression, we examined the possible determinants of condom breakage, controlling for several independent variables including the district and client load. Overall, 11.4% of FSWs reported at least one condom break in the previous month. FSWs were much more likely to report breakage if under 20 years of age (AOR 3.43, p = 0.005); if divorced/ separated/widowed (AOR 1.52, p = 0.012); if they were regular alcohol users (AOR 1.63, p = 0.005); if they mostly entertained clients in lodges/rented rooms (AOR 2.99, p = 0.029) or brothels (AOR 4.77, p = 0.003), compared to street based sex workers; if they had ever had anal sex (AOR 2.03, p = 0.006); if the sex worker herself (as opposed to the client) applied the condom at last use (AOR 1.90, p < 0.001); if they were inconsistent condom users (AOR 2.77, p < 0.001); and if they had never seen a condom demonstration (AOR 2.37, p < 0.001). The reported incidence of condom breakage was high in this study, and this is a major concern for HIV/STI prevention programs, for which condom use is a key prevention tool. Younger and more marginalized female sex workers were most vulnerable to condom breakage. Special effort is therefore required to seek out such women and to provide information and skills on correct

Determinants of condom breakage among female sex workers in Karnataka, India

PubMed Central

2011-01-01

Background Condoms are effective in preventing the transmission of HIV and other sexually transmitted infections, when properly used. However, recent data from surveys of female sex workers (FSWs) in Karnataka in south India, suggest that condom breakage rates may be quite high. It is important therefore to quantify condom breakage rates, and examine what factors might precipitate condom breakage, so that programmers can identify those at risk, and develop appropriate interventions. Methods We explored determinants of reported condom breakage in the previous month among 1,928 female sex workers in four districts of Karnataka using data from cross-sectional surveys undertaken from July 2008 to February 2009. Using stepwise multivariate logistic regression, we examined the possible determinants of condom breakage, controlling for several independent variables including the district and client load. Results Overall, 11.4% of FSWs reported at least one condom break in the previous month. FSWs were much more likely to report breakage if under 20 years of age (AOR 3.43, p = 0.005); if divorced/ separated/widowed (AOR 1.52, p = 0.012); if they were regular alcohol users (AOR 1.63, p = 0.005); if they mostly entertained clients in lodges/rented rooms (AOR 2.99, p = 0.029) or brothels (AOR 4.77, p = 0.003), compared to street based sex workers; if they had ever had anal sex (AOR 2.03, p = 0.006); if the sex worker herself (as opposed to the client) applied the condom at last use (AOR 1.90, p < 0.001); if they were inconsistent condom users (AOR 2.77, p < 0.001); and if they had never seen a condom demonstration (AOR 2.37, p < 0.001). Conclusions The reported incidence of condom breakage was high in this study, and this is a major concern for HIV/STI prevention programs, for which condom use is a key prevention tool. Younger and more marginalized female sex workers were most vulnerable to condom breakage. Special effort is therefore required to seek out such women and to

Police violence and sexual risk among female and transvestite sex workers in Serbia: qualitative study.

PubMed

Rhodes, Tim; Simic, Milena; Baros, Sladjana; Platt, Lucy; Zikic, Bojan

2008-07-30

To explore female and transvestite sex workers' perceptions of risk in the sex work environment in Serbia. Qualitative interview study. Street based locations for sex work in Belgrade and Pancevo, Serbia. 31 female and transvestite sex workers. Violence, including police violence, was reported as a primary concern in relation to risk. Violence was linked to unprotected sex and the reduced capacity for avoiding sexual risk. Participants reported that coerced sex was routinely provided to the police in exchange for freedom from detainment, arrest, or fine, and was enforced by the perceived threat of violence, sometimes realised. Accounts contained multiple instances of physical and sexual assault, presented as abuses of police authority, and described policing as a form of moral punishment. This was largely through non-physical means but was also enforced through physical violence, especially towards transvestite and Roma sex workers, whose experience of police violence was reported as relentless and brutal and connected with broader social forces of discrimination in this setting, especially towards Roma. Preventing violence towards sex workers, which can link with vulnerability to sexually transmitted infections, is a priority in Serbia. This requires monitoring perpetrators of violence, providing legal support to sex workers, and creating safer environments for sex work.

Prevalence and correlates of sexual risk among male and female sex workers in Tijuana, Mexico.

PubMed

Katsulis, Yasmina; Durfee, Alesha

2012-01-01

We investigated prevalence and correlates of sexual risk behaviours among male and female sex workers in Tijuana, Mexico, the busiest border crossing area on the US - Mexico border, analysing survey data from a purposive, cross-sectional sample of male and female sex workers who worked in a range of indoor and outdoor settings. Logistic regression was used to determine factors that were associated with sexual risk-taking, defined as failing to use a condom with last client. In bivariate regression models, gender, work setting (e.g., indoor vs. outdoor), poverty, engaging in survival sex, marital status and perceived drug addiction were correlated with sexual risk. When controlling for work location, housing insecurity, poverty, survival sex, marital status and perceived drug addiction, male sex workers were still 10 times more likely than female sex workers (FSW) to engage in sex without a condom during their last encounter with a client. And, although FSW were significantly more likely than males to have used a condom with a client, they were significantly less likely than males to have used a condom with their regular partner. Future research should further examine how gender shapes sexual risk activities in both commercial and non-commercial relationships.

Prevalence of HIV Among U.S. Female Sex Workers: Systematic Review and Meta-analysis.

PubMed

Paz-Bailey, Gabriela; Noble, Meredith; Salo, Kathryn; Tregear, Stephen J

2016-10-01

Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10 years. The pooled estimate of HIV prevalence was 17.3 % (95 % CI 13.5-21.9 %); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32 %) and statistical heterogeneity was substantial (I(2) = 0.89, Q = 123; p < 0.001). Although the variance across the 14 studies was high, prevalence was generally high (10 % or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high.

Acceptability of a microenterprise intervention among female sex workers in Chennai, India.

PubMed

Sherman, Susan G; Srikrishnan, A K; Rivett, Katharine A; Liu, Su-Hsun; Solomon, Suniti; Celentano, David D

2010-06-01

Female sex workers have been central in India's HIV epidemic since it was first diagnosed among them in 1989. Female sex workers' risk of HIV is primarily economically motivated. The Pi pilot study examined the feasibility and association of a microenterprise intervention, the tailoring of canvas bags, on sexual risk behaviors among female sex workers (N = 100) in Chennai. Women were randomized to an intervention or control arm. Between-group comparisons at baseline and at six-month follow-up were performed. Multivariate linear regression with bootstrapping was conducted to estimate the intervention effect. At baseline, women were a median of 35 years old, 61% were married and they had an average of two children. Intervention participants reported a significantly lower number of sex partners and significant increases in income at the 6-month follow-up compared to control participants. In a multivariate model, intervention participants had a significantly lower number of paying clients per month at follow-up compared to control participants. By graduation, 75% of intervention arm participants had made at least one sellable canvas bag and 6 months after the study's end, 60% have continued involvement in bag production. The pilot study demonstrated that microenterprise interventions are successful in both providing FSWs with licit income opportunities and was associated with reductions in HIV risk behaviors.

Predictive factors of unprotected sex for female sex workers: first study in French Guiana, the French territory with the highest HIV prevalence.

PubMed

Parriault, Marie-Claire; Basurko, Célia; Melle, Astrid Van; Gaubert-Maréchal, Emilie; Rogier, Stéphanie; Couppié, Pierre; Nacher, Mathieu

2015-07-01

French Guiana is the French territory that is most affected by HIV. AIDS incidence is much higher than in mainland France and sex work seems to be an important driver of the epidemic. The objective of this study was to describe consistent condom use among female sex workers with their clients and their intimate partners and to identify determinants of non-use of condoms. An HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey was conducted in 2009-2010 among sex workers in French Guiana. A total of 477 sex workers were interviewed. Female sex workers were more likely to use condoms with their clients (97%) than with their intimate partners (45%). The factors associated with non-consistent condom use with the intimate partner were having had an abortion, feeling at risk for HIV, not evaluating one's own risk for HIV, living as a couple, being Dominican, and not feeling comfortable asking intimate partners to use condoms. Although a high proportion of female sex workers declared using condoms with commercial partners, there is still room for improvement in the prevention of transmission with both commercial and intimate partners. © The Author(s) 2014.

The Use of Female Commercial Sex Workers' Services by Latino Day Laborers

ERIC Educational Resources Information Center

Galvan, Frank H.; Ortiz, Daniel J.; Martinez, Victor; Bing, Eric G.

2009-01-01

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was used. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day…

From violence to sex work: agency, escaping violence, and HIV risk among establishment-based female sex workers in Tijuana, Mexico.

PubMed

Choudhury, Shonali M; Anglade, Debbie; Park, Kyuwon

2013-01-01

Violence experienced by female sex workers has been found to affect the HIV risk and quality of life of these women. Research on this topic has dealt with female sex workers and current experiences of violence with partners, clients, and in the workplace. In this study, we used feminist constructivist grounded theory to explore perceptions of violence among establishment-based female sex workers in Tijuana, Mexico. A key concept that emerged from 20 semi-structured in-depth interviews was "escaping violence with a romantic partner by becoming independent through sex work." The women also emphasized the negative impact of violence in the workplace but felt that achieving separation from a violent partner gave them strength to protect their lives and health. Interventions to help these women protect themselves from HIV infection and improve their quality of life should aim to build upon their strengths and the agency they have already achieved. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Is Work-Family Balance a Possibility? The Case of Kenyan Female Teachers in Urban Public Schools

ERIC Educational Resources Information Center

Muasya, Gladys

2016-01-01

Young mothers in Kenyan public schools experience a high level of work-family conflict. Currently, there are no formal family-friendly policies, despite declining levels of extended family support and rising cost of hiring domestic workers. A total of 375 female teachers from three towns and Nairobi city filled open-ended surveys to examine the…

Police violence and sexual risk among female and transvestite sex workers in Serbia: qualitative study

PubMed Central

Simić, Milena; Baroš, Sladjana; Platt, Lucy; Žikić, Bojan

2008-01-01

Objective To explore female and transvestite sex workers’ perceptions of risk in the sex work environment in Serbia. Design Qualitative interview study. Setting Street based locations for sex work in Belgrade and Pancevo, Serbia. Participants 31 female and transvestite sex workers. Results Violence, including police violence, was reported as a primary concern in relation to risk. Violence was linked to unprotected sex and the reduced capacity for avoiding sexual risk. Participants reported that coerced sex was routinely provided to the police in exchange for freedom from detainment, arrest, or fine, and was enforced by the perceived threat of violence, sometimes realised. Accounts contained multiple instances of physical and sexual assault, presented as abuses of police authority, and described policing as a form of moral punishment. This was largely through non-physical means but was also enforced through physical violence, especially towards transvestite and Roma sex workers, whose experience of police violence was reported as relentless and brutal and connected with broader social forces of discrimination in this setting, especially towards Roma. Conclusion Preventing violence towards sex workers, which can link with vulnerability to sexually transmitted infections, is a priority in Serbia. This requires monitoring perpetrators of violence, providing legal support to sex workers, and creating safer environments for sex work. PMID:18667468

Exploring dynamics of anal sex among female sex workers in Andhra Pradesh.

PubMed

Tucker, Saroj; Krishna, Rama; Prabhakar, Parimi; Panyam, Swarup; Anand, Pankaj

2012-01-01

The anal sex among heterosexual couples is on the rise as reported in many scientific studies. Considering that unprotected anal sex has higher risk of human immunodeficiency virus (HIV) transmission than the vaginal sex, we undertook a study to understand the anal sex practices among Female Sex Workers (FSW). The study was conducted among FSW attending 11 randomly selected sexually transmitted infection (STI) clinics in Bill and Melinda Gates supported targeted interventions in Andhra Pradesh. A structured questionnaire was administered to the 555 FSW attending these clinics by project clinic counselors. Informed consent was obtained from all the study participants. Engaging in anal sex was self reported by 22% of sex workers, though demand from clients was reported to be much higher (40%). The reasons for anal sex practices included more money (61%), clout/influence of the client (45%), risk of losing client (27%), and forced sex (1.2%). Factors associated with anal sex were higher number of clients, higher duration of sex work, higher income, and older age group. Associated risks perceived by FSW were bleeding and injury to anal canal (98%) while only 28% associated it with higher HIV transmission risk. Reported Condom and lubricant use was about 88% and 39% respectively. The study shows that there is frequent anal sex, inconsistent condom and infrequent lubricant usage, economic and physical coercion, and low awareness of STI/HIV transmission risk among FSW, which have serious implications for HIV prevention programmes. There is a need to focus on anal sex education and use of lubricants along with condoms during anal sex in FSW-targeted interventions in AP.

Suicidal Behavior Among Female Sex Workers in Goa, India: The Silent Epidemic

PubMed Central

Wayal, Sonali; Cowan, Frances; Mabey, David; Copas, Andrew; Patel, Vikram

2009-01-01

Objectives. We sought to study suicidal behavior prevalence and its association with social and gender disadvantage, sex work, and health factors among female sex workers in Goa, India. Methods. Using respondent-driven sampling, we recruited 326 sex workers in Goa for an interviewer-administered questionnaire regarding self-harming behaviors, sociodemographics, sex work, gender disadvantage, and health. Participants were tested for sexually transmitted infections. We used multivariate analysis to define suicide attempt determinants. Results. Nineteen percent of sex workers in the sample reported attempted suicide in the past 3 months. Attempts were independently associated with intimate partner violence (adjusted odds ratio [AOR] = 2.70; 95% confidence interval [CI] = 1.38, 5.28), violence from others (AOR = 2.26; 95% CI = 1.15, 4.45), entrapment (AOR = 2.76; 95% CI = 1.11, 6.83), regular customers (AOR = 3.20; 95% CI = 1.61, 6.35), and worsening mental health (AOR = 1.05; 95% CI = 1.01, 1.11). Lower suicide attempt likelihood was associated with Kannad ethnicity, HIV prevention services, and having a child. Conclusions. Suicidal behaviors among sex workers were common and associated with gender disadvantage and poor mental health. India's widespread HIV-prevention programs for sex workers provide an opportunity for community-based interventions against gender-based violence and for mental health services delivery. PMID:19443819

Time to unsafe sexual practice among cross-border female sex workers in Metemma Yohannes, North West Ethiopia.

PubMed

Gezie, Lemma Derseh; Taye, Belaynew Wassie; Ayele, Tadesse Awoke

2015-07-28

Because of the nature of their work, female sex workers are at risk of sexually transmitted diseases. Cross-border areas are places where this situation becomes worse. In Ethiopia, there has been a serious scarcity of studies on the time at which unsafe sexual practice starts and on factors which determine the practice among female sex workers there. Therefore, this study aimed to fill this identified gap. A total of 467 women who had been sex workers at least for three months prior to the resumption of the study were included. A structured and pre-tested questionnaire was used to collect data from July-August, 2010. Descriptive statistics was used to explore the data, and the Extended Cox-Regression model was employed to identify the predictors of time-to-unsafe sexual practice. The study participants were followed for 6, 643 person-months. The overall incidence density of unsafe sexual practice was 44.71 persons per 1000 persons-months. The hazard of unsafe sexual practice increased by 3.0 % every month (p-value =0.040) due to problem-drinking. Those female sex workers with familiarized clients had a two-fold hazard of practicing unsafe sex compared to their counterparts (AHR = 1.94 95 % CI 1.49, 2.53). The predominant sexual client type and the work place of sex workers were the other significant predictors of unsafe sexual practice. The incidence of unsafe sexual practice was found to be high among sex workers in the cross-border area. Time-to-unsafe sexual practice was significantly associated with female sex workers' status of familiarity with their clients, predominant sexual client type, their work place, and the interaction term of time and problem-drinking. Interventions need to be made on these controllable social and behavioral characteristics to help sex workers extend the duration of their safe sexual practice beyond the time they will quit sex work.

Pornography, Sexual Enhancement Products, and Sexual Risk of Female Sex Workers and their Clients in Southern India.

PubMed

Bradley, Janet; Rajaram, Subramanian Potty; Isac, Shajy; Gurav, Kaveri; Ramesh, B M; Gowda, Chandrashekhar; Moses, Stephen; Alary, Michel

2016-05-01

Despite their large numbers, and important role in the HIV epidemic in India, male clients of female sex workers (FSWs) are a difficult to reach population and little is known about their sexual behaviors. Using data from an integrated behavioral and biological assessment of 684 clients in Bangalore in 2012, we examined factors associated with their reports of having sex with three or more different female sex workers in the last month, and anal sex with sex workers. We included sociodemographic and sexual behavior factors and, for the first time in client studies in India, included data on the use of pornography and sexual enhancement products (SEPs) such as pills, oils, and sprays, in our multivariable analyses of client risk. Seventy-eight percent of clients had seen pornographic material and 8% reported ever having used SEPs. The profiles of men practicing the two risk behaviors examined were quite different. Travel in the past year, drunkenness in the past month, young age at first commercial sex, non-use of condoms at last sex, and finding sex workers in public places (but not use of pornography and SEPs) were independently associated with multiple partnering. Sex with a man or transsexual, being a white collar worker, seeking out FSWs at home, pornography and SEP use, and condom use at last FSW sex, were all independently associated with anal sex with an FSW. More research is needed to better understand the links between pornography and SEPs, and HIV risk behaviors, and HIV prevention programs need to be cognizant of the importance of ensuring that condom use is adequately promoted and supported in the context of anal sex in female sex worker-client interactions.

Structural Violence in Health Care: Lived Experience of Street-Based Female Commercial Sex Workers in Kathmandu.

PubMed

Basnyat, Iccha

2017-01-01

Thirty-five in-depth, semi-structured interviews were conducted with female, street-based, commercial sex workers in Kathmandu, Nepal. The framework of structural violence guided this study in identifying the structural context that impacts the female sex workers' lives and may cause harm to their health. Structural violence in health care was revealed through thematic analysis as (a) discrimination, (b) forced choice, and (c) limitations to health information sources. Lived experiences highlight how the sex workers engaged with structural limitations in health care access, services, and utilization. Structural violence conveys a message about who is entitled to health care and what a society emphasizes and expects regarding acceptable health behavior. Examining the structural violence highlighted how the sex workers negotiated, understood, and engaged with structural limitations in health care access, services, and utilization. © The Author(s) 2015.

Sexually transmitted diseases and condom use among female freelance and brothel-based sex workers in Singapore.

PubMed

Wong, M L; Chan, R K; Chua, W L; Wee, S

1999-11-01

Most studies in Asia exclude freelance female sex workers because of difficulties in access and the illegality of their work. Data are lacking on their risk behaviors. To compare sexually transmitted disease (STD) rates, condom use, and health screening behavior between freelance and brothel-based sex workers in Singapore. This is a cross-sectional survey of 111 free-lance sex workers arrested from November 1996 to March 1997 for illicit prostitution and 333 randomly selected brothel-based sex workers. All were tested for STDs. STDs were significantly more prevalent among freelance than brothel-based sex workers (34.8% vs. 24.0%). Inconsistent condom use was significantly higher among freelance than brothel-based sex workers and was significantly associated with younger age, decreasing number of clients, and perception of non-condom use among peers. Educational programs to promote condom use should target freelance sex workers and their clients.

Opportunities for Woman-Initiated HIV Prevention Methods among Female Sex Workers in Southern China

PubMed Central

Weeks, Margaret R.; Liao, Susu; Abbott, Maryann; He, Bin; Zhou, Yuejiang; Jiang, Jingmei; Wei, Liu; Yu, Wang

2010-01-01

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women’s knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China. PMID:17599276

Female sex workers use power over their day-to-day lives to meet the condition of a conditional cash transfer intervention to incentivize safe sex.

PubMed

Cooper, Jan E; Dow, William H; de Walque, Damien; Keller, Ann C; McCoy, Sandra I; Fernald, Lia C H; Balampama, Marianna P; Kalolella, Admirabilis; Packel, Laura J; Wechsberg, Wendee M; Ozer, Emily J

2017-05-01

Female Sex Workers are a core population in the HIV epidemic, and interventions such as conditional cash transfers (CCTs), effective in other health domains, are a promising new approach to reduce the spread of HIV. Here we investigate how a population of Tanzanian female sex workers, though constrained in many ways, experience and use their power in the context of a CCT intervention that incentivizes safe sex. We analyzed 20 qualitative in-depth interviews with female sex workers enrolled in a randomized-controlled CCT program, the RESPECT II pilot, and found that while such women have limited choices, they do have substantial power over their work logistics that they leveraged to meet the conditions of the CCT and receive the cash award. It was through these decisions over work logistics, such as reducing the number of workdays and clients, that the CCT intervention had its greatest impact on modifying female sex workers' behavior. Copyright © 2017. Published by Elsevier Ltd.

Sexual and physical violence against female sex workers in Kenya: a qualitative enquiry.

PubMed

Okal, Jerry; Chersich, Matthew F; Tsui, Sharon; Sutherland, Elizabeth; Temmerman, Marleen; Luchters, Stanley

2011-05-01

Few studies in Africa provide detailed descriptions of the vulnerabilities of female sex workers (FSW) to sexual and physical violence, and how this impacts on their HIV risk. This qualitative study documents FSW's experiences of violence in Mombasa and Naivasha, Kenya. Eighty-one FSW who obtained clients from the streets, transportation depots, taverns, discos and residential areas were recruited through local sex workers trained as peer counsellors to participate in eight focus-group discussions. Analysis showed the pervasiveness of sexual and physical violence among FSW, commonly triggered by negotiation around condoms and payment. Pressing financial needs of FSW, gender-power differentials, illegality of trading in sex and cultural subscriptions to men's entitlement for sex sans money underscore much of this violence. Sex workers with more experience had developed skills to avoid threats of violence by identifying potentially violent clients, finding safer working areas and minimising conflict with the police. Addressing violence and concomitant HIV risks and vulnerabilities faced by FSW should be included in Kenya's national HIV/AIDS strategic plan. This study indicates the need for multilevel interventions, including legal reforms so that laws governing sex work promote the health and human rights of sex workers in Kenya.

'Female condoms give women greater control': a qualitative assessment of the experiences of commercial sex workers in Swaziland.

PubMed

Mathenjwa, Thulile; Maharaj, Pranitha

2012-10-01

To explore commercial sex workers' experiences with the female condom in Swaziland. This is a qualitative study that draws on two focus group discussions and ten individual in-depth interviews with female commercial sex workers in Lavumisa, Swaziland. The findings suggest that the majority of female sex workers prefer to use the female condom with their clients because it offers them greater control over the sexual encounter. Other factors that facilitate its use include the absence of side effects, the enhancement of sexual pleasure and protection against the risk of STIs (including HIV). In addition, the women reported that the female condom is stronger and more resistant to breakage than the male condom. Moreover, the female condoms can be inserted well in advance of sexual intercourse. Difficulties of insertion, partner objection and limited product availability were some of the barriers to the use of the device. There was also a tendency to reuse the female condoms because of lack of product availability and privacy to insert it. Although female condom use involves negotiation with clients, the fact that it offers sex workers an independent method of protection gives them more power and also, increases their ability to control their sexual and reproductive health.

Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia.

PubMed

Mooney, Alyssa; Kidanu, Aklilu; Bradley, Heather M; Kumoji, Evelyn Kuor; Kennedy, Caitlin E; Kerrigan, Deanna

2013-08-23

Although reported condom use between female sex workers and their clients is high in Ethiopia, condom use with regular, non-paying partners remains low, posing a substantial risk of HIV infection to sex workers, their partners and the general population. Previous studies have identified the synergistic effects of substance abuse, violence and HIV risk, but few have examined these inter-relationships among female sex workers and their regular, non-paying partners. This study explored the associations between work-related violence, alcohol abuse and inconsistent condom use among establishment-based female sex workers and their regular, non-paying partners in Adama City, Ethiopia. A cross-sectional survey was conducted with 350 establishment-based female sex workers, aged 15-35, at 63 bars, hotels and nightclubs. Multivariate logistic regression analysis was conducted to test the association between work-related violence and condom use with regular, non-paying partners, controlling for age, overall income, education and sex workers' total number of sexual partners in the past week. Alcohol abuse was explored as an effect modifier. Respondents reported a high prevalence of work-related violence (59%) and alcohol abuse (51%). Work-related violence was statistically significantly associated with unprotected sex with regular, non-paying partners among those who abused alcohol (OR: 6.34, 95% CI: 2.43-16.56) and among those who did not (OR: 2.98, 95% CI: 1.36-6.54). Alcohol abuse was not associated with inconsistent condom use within these partnerships, though it may strengthen the effect of work-related violence on unprotected sex. Findings suggest violence against establishment-based female sex workers is associated with HIV risk within regular, non-paying partnerships. Qualitative work is needed to better understand the links between a violent work environment and condom use with regular, non-paying partners and how interventions can be implemented in this context to

Sex with sex workers among latino day laborers in Suburban Maryland.

PubMed

Bianchi, Fernanda T; Reisen, Carol A; Gonzales, Felisa A; Arroyo, Juan C; Zea, Maria Cecilia; Poppen, Paul J

2013-07-01

Using the structural-environmental conceptual framework, this study employed mixed methods to address the question of whether sex with female sex workers contributes to HIV risk among male immigrant Latino day laborers in suburban Maryland. Because contextual factors can greatly affect HIV risk for both sex workers and their clients, this study investigated the organizational structure of sex work, factors that predicted men's hiring of sex workers, sexual behaviors performed with sex workers, and the use of condoms. Qualitative research was conducted to inform the development of a quantitative survey, but also provided crucial descriptions about the motivations, locations, arrangements, and sexual activities related to sex work. Key informant interviews (N = 10), in-depth interviews with day laborers (N = 10) and Latina female sex workers (N = 4), and two focus groups with day laborers (N = 11) were conducted, and a quantitative survey administered via Audio-enhanced Computer-assisted Self-interviewing (N = 174). Condom use was nearly universal in encounters with female sex workers, thus indicating that the sex workers were not an important source of HIV transmission in this context. Logistic regression was performed to test a model predicting sex with sex workers. Latino day laborers who reported more immigrant stress and who did not have a partner in the U.S. were more likely to have had sex with a sex worker, as were men who reported binge drinking. Structural and social conditions influenced the hiring of sex workers. Further research is warranted to better understand the interrelationships among these circumstances and to inform the development of programs to address them.

Sex with Sex Workers among Latino Day Laborers in Suburban Maryland

PubMed Central

Reisen, Carol A.; Gonzales, Felisa A.; Arroyo, Juan C.; Zea, Maria Cecilia; Poppen, Paul J.

2016-01-01

Using the structural-environmental conceptual framework, this study employed mixed methods to address the question of whether sex with female sex workers contributes to HIV risk among male immigrant Latino day laborers in suburban Maryland. Because contextual factors can greatly affect HIV risk for both sex workers and their clients, this study investigated the organizational structure of sex work, factors that predicted men’s hiring of sex workers, sexual behaviors performed with sex workers, and the use of condoms. Qualitative research was conducted to inform the development of a quantitative survey, but also provided crucial descriptions about the motivations, locations, arrangements, and sexual activities related to sex work. Key informant interviews (N= 10), in-depth interviews with day laborers (N= 10) and Latina female sex workers (N = 4), and two focus groups with day laborers (N= 11) were conducted, and a quantitative survey administered via Audio-enhanced Computer-assisted Self-interviewing (N = 174). Condom use was nearly universal in encounters with female sex workers, thus indicating that the sex workers were not an important source of HIV transmission in this context. Logistic regression was performed to test a model predicting sex with sex workers. Latino day laborers who reported more immigrant stress and who did not have a partner in the U.S. were more likely to have had sex with a sex worker, as were men who reported binge drinking. Structural and social conditions influenced the hiring of sex workers. Further research is warranted to better understand the interrelationships among these circumstances and to inform the development of programs to address them. PMID:23070528

Syphilis infection among female sex workers in Colombia.

PubMed

Mejia, Alfredo; Bautista, Christian T; Leal, Luis; Ayala, Claudia; Prieto, Franklyn; de la Hoz, Fernando; Alzate, Martha L; Acosta, Jacqueline; Sanchez, Jose L

2009-04-01

To study the epidemiology of Treponema pallidum (syphilis) among female sex workers (FSW) in Santa Fe de Bogotá, Colombia. A cross-sectional study was conducted. Participants were interviewed using a standardized questionnaire, which collected socio-demographic characteristics and risk behavior information. Blood samples were screened for syphilis using the VDRL test and the MHATP assay. The prevalence of syphilis was 10.3% (53/514). Adjusted risk factors significantly associated with syphilis were: age (linear increase), education (primary or no education), monthly income (sex work (>or=4 years), number of clients per week (>or=22), main workplace (street), inconsistent (never) condom use in sex work, previous STI history, and use of illegal drugs. Effective health education programs for improving the level of knowledge of STI and the promotion of consistent condom use activities along with other appropriate harm reduction activities are urgently required among FSW in Colombia.

Vaginal douching and sexually transmitted infections among female sex workers: a cross-sectional study in three provinces in China.

PubMed

Li, Jing; Jiang, Ning; Yue, Xiaoli; Gong, Xiangdong

2015-05-01

Though vaginal douching is a common practice among female sex workers that could increase the risk of HIV and adverse reproductive health outcomes, it has drawn limited attention. From November 2010 to January 2011, a convenience sample of female sex workers was recruited in three cities in China. Face-to-face interviews were conducted to gather socio-demographic and behavioural information. Blood samples were collected for syphilis serological tests. Endo-cervical swabs were collected and tested for Neisseria gonorrhoeae and Chlamydia trachomatis by polymerase chain reaction. A logistic regression model was used to determine factors associated with vaginal douching and the association between vaginal douching and sexually transmitted infection. A total of 1032 eligible female sex workers were enrolled. The overall prevalence of any sexually transmitted infection (syphilis, Chlamydia trachomatis or Neisseria gonorrhoeae) and vaginal douching with disinfectant were 23.4% and 23.1%, respectively. Factors independently associated with douching practice included study sites, venue types, ethnicity, having regular partner and sexually transmitted infection history. No significant association was found between vaginal douching and current sexually transmitted infection. Vaginal douching with disinfectant after sex with clients seemed to be a prevalent practice among female sex workers in China. Prevention programmes targeting female sex workers should incorporate components about the adverse health outcomes associated with vaginal douching. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China.

PubMed

Davis, Alissa; Meyerson, Beth E; Aghaulor, Blessing; Brown, Katherine; Watson, Adisyn; Muessig, Kathryn E; Yang, Ligang; Tucker, Joseph D

2016-10-14

Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

A Qualitative Exploration of Barriers to Condom Use among Female Sex Workers in China

PubMed Central

Ciyong, Lu; Hui, Wang; Lingyao, Hong; Xueqing, Deng

2012-01-01

Background Sex workers in China continue to engage in unprotected sex acts that put them at risk for contracting HIV (Human Immunodeficiency Virus) and other STIs (Sexually Transmitted Infections). The purpose of this study was to explore women’s work history, the context of sex work, condom use, HIV testing services, and potential barriers to condom use in a sample of FSWs (female sex workers) in Guangzhou, China. Methodology/Principal Findings In-depth, semi-structured, face-to-face interviews were conducted with 24 FSWs in Guangzhou, China. Informants were recruited using a purposive sampling technique. Qualitative data were coded and analyzed using NVivo 8.0. The majority of respondents were internal economic migrants who had entered the sex industry in pursuit of greater financial reward. Most women in the study were married or had steady boyfriends, and were young, with secondary education and limited knowledge about HIV and STIs. Most were not satisfied with their current living conditions and expressed a desire to leave the sex industry. Women reported that they were more likely to use condoms during sex acts with commercial partners than with non-commercial partners. The potential stigma of being seen as a sex worker prevented many from accessing HIV testing. Three key factors put these FSWs at risk for HIV and STIs: unreasonable trust toward clients, stereotypes and assumptions about customers, and financial incentives. Conclusions/Significance These findings suggest that social and economic factors play an important role in shaping sexual decision-making among female sex workers in Guangzhou. We argue that greater insight into and attention to these factors could enhance the success of HIV prevention efforts. PMID:23056452

Correlates of Suicidal Ideation and Attempt Among Female Sex Workers in China

PubMed Central

HONG, YAN; LI, XIAOMING; FANG, XIAOYI; ZHAO, RAN

2007-01-01

The purpose of this study was to explore the factors associated with suicidal ideation and attempt among female sex workers (FSWs) in China. A cross-sectional survey was administered among 454 FSWs in a rural county of Guangxi, China. About 14% of FSWs had thought of suicide and 8% had attempted suicide in the past 6 months. Multiple logistic regression analyses indicated that those FSWs who were dissatisfied with life, abused alcohol, were deceived or forced into commercial sex, and had stable sexual partners were more likely to report suicidal ideation. Female sex workers who had multiple stable partners, experienced sexual coercion, and worried about an inability to make enough money were more likely to report a suicide attempt. These FSWs who entered commercial sex because of financial needs or who were influenced by the peers were less likely to report a suicide attempt. Our data suggested that the rates of suicidal ideation and attempts were high among FSWs in China, and there were multiple factors associated with their suicidality. Future health education and promotion efforts among FSWs need to take into consideration substance abuse, interpartner conflict, and psychological stress. PMID:17469002

Demographic, migration status, and work-related changes in Asian female sex workers surveyed in Sydney, 1993 and 2003.

PubMed

Pell, C; Dabbhadatta, J; Harcourt, C; Tribe, K; O'Connor, C

2006-04-01

To compare demography, sexual health awareness, migration and workplace conditions of Asian female sex workers in Sydney in 1993 and 2003. A Chinese interpreter and a Thai-speaking health education officer (HEO) were used to administer a questionnaire survey to Thai- and Chinese-speaking sex workers attending sexual health clinics in 1993. A follow-up survey, which included some women contacted at work as well as clinic attenders, was administered by Thai- and Chinese-speaking HEOs in 2003. Ninety-one female sex workers were surveyed in 1993 and 165 in 2003. Median age increased (26 years vs. 33 years, p=0.000), as did numbers of Chinese- versus Thai-speakers (1993, 25.3% Chinese vs. 2003, 58.2% Chinese, p=0.000). In 2003, the women reported more years of schooling and better English skills. Fewer reported previous sex work (48.4% vs. 17.6%, p=0.000). Numbers currently or ever on a contract decreased sharply (27.5% vs. 9.1%, p=0.000) and the majority were apparently working legally. Condom use at work for vaginal (51.6% vs. 84.8%) and oral sex (39.6% vs. 66.1%) increased significantly (p=0.001). Chinese-speaking sex workers were less informed about HIV transmission and safer sex practices than were Thai sex workers. Drug and alcohol use was low. Positive changes have occurred in the conditions of Asian female sex workers surveyed over 10 years in Sydney. Maintaining current levels of health service delivery will ensure continued improvements in health and workplace conditions and address inequalities between language groups.

A cross-sectional evaluation of the prevalence and associations of HIV among female sex workers in the Gambia.

PubMed

Peitzmeier, Sarah; Mason, Krystal; Ceesay, Nuha; Diouf, Daouda; Drame, Fatou; Loum, Jaegan; Baral, Stefan

2014-03-01

To determine HIV prevalence among female sex workers in the Gambia and HIV risk factors, we accrued participants (n = 251) through peer-referral and venue-based recruitment. Blood samples were screened for HIV and participants were administered a questionnaire. Bivariate and multivariate logistic regression identified factors associated with HIV status. Forty respondents (15.9%) were HIV-positive: 20 (8.0%) were infected with HIV-1 only, 10 (4.0%) with HIV-2 only, and 10 (4.0%) with both HIV-1 and HIV-2; 12.5% (n = 5/40) knew their status. Condom usage at last sex was 97.1% (n = 170/175) with new clients and 44.2% (n = 53/120) with non-paying partners. Having a non-paying partner, living with relatives or friends, having felt scared to walk in public, selling sex in multiple locations, and recent depressive symptoms were positively associated with HIV under multivariate regression. Female sex workers have a higher prevalence of HIV compared to the general Gambian population. Interventions should be rights-based, promote safer sex practices and regular testing for female sex workers and linkage to HIV treatment and care with adherence support for those living with HIV. In addition, service providers should consider non-paying partners of female sex workers, improve knowledge and availability of condoms and lubricant, and address safety and mental health needs.

Effects of government registration on unprotected sex among female sex workers in Tijuana, Mexico

PubMed Central

Sirotin, Nicole; Strathdee, Steffanie A.; Lozada, Remedios; Abramovitz, Daniela; Semple, Shirley J.; Bucardo, Jesús; Patterson, Thomas L.

2010-01-01

Background Sex work is partially regulated in Tijuana, but little is known of its health effects. A recent behavioral intervention among female sex workers (FSWs) decreased incidence of HIV/STIs by 40%. We evaluated effects of sex worker regulation on condom use among FSWs randomized to this intervention. Methods FSWs aged ≥18 years who reported unprotected sex with ≥1 client in the last 2 months and whether they were registered with Tijuana’s Municipal Health Department underwent a brief, theory-based behavioral intervention to increase condom use. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, C. trachomatis and N. gonorrhoeae. Negative binomial regression was used to determine the effect of registration on numbers of unprotected sex acts and cumulative HIV/STI incidence. Results Of 187 women, 83 (44%) were registered. Lack of registration was associated with higher rates of unprotected sex (rate ratio: 1.7, 95% CI: 1.2–2.3), compared to FSWs who were registered, after controlling for potential confounders. Conclusions Registration predicted increased condom use among FSWs enrolled in a behavioral intervention. Public health programs designed to improve condom use among FSWs may benefit from understanding the impact of existing regulation systems on HIV risk behaviors. PMID:20956076

Effects of government registration on unprotected sex amongst female sex workers in Tijuana; Mexico.

PubMed

Sirotin, Nicole; Strathdee, Steffanie A; Lozada, Remedios; Abramovitz, Daniela; Semple, Shirley J; Bucardo, Jesús; Patterson, Thomas L

2010-11-01

Sex work is partially regulated in Tijuana, but little is known of its health effects. A recent behavioural intervention amongst female sex workers (FSWs) decreased incidence of HIV/STIs by 40%. We evaluated effects of sex worker regulation on condom use amongst FSWs randomized to this intervention. FSWs aged ≥18 years who reported unprotected sex with ≥1 client in the last 2 months and whether they were registered with Tijuana's Municipal Health Department underwent a brief, theory-based behavioural intervention to increase condom use. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, Chlamydia trachomatis and Neisseria gonorrhoeae. Negative binomial regression was used to determine the effect of registration on numbers of unprotected sex acts and cumulative HIV/STI incidence. Of 187 women, 83 (44%) were registered. Lack of registration was associated with higher rates of unprotected sex (rate ratio: 1.7, 95% CI: 1.2-2.3), compared to FSWs who were registered, after controlling for potential confounders. Registration predicted increased condom use amongst FSWs enrolled in a behavioural intervention. Public health programmes designed to improve condom use amongst FSWs may benefit from understanding the impact of existing regulation systems on HIV risk behaviours. Copyright © 2010 Elsevier B.V. All rights reserved.

Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences

PubMed Central

Urada, Lianne A.; Morisky, Donald E.; Pimentel-Simbulan, Nymia; Silverman, Jay G.; Strathdee, Steffanie A.

2012-01-01

Background Social and structural influences of condom negotiation among female sex workers (FSWs) remain understudied. This study assesses environmental and individual factors associated with condom negotiation among FSWs at high risk for acquiring HIV in a large urban setting of Metro Manila, Philippines. Methods Female bar/spa workers (N = 498), aged 18 and over, underwent interview-led surveys examining their sexual health practices in the context of their risk environments. Data were collected from April 2009-January 2010 from 54 venues. Multiple logistic regressions were conducted to assess socio-behavioral factors (e.g., age, education, length of time employed as an entertainer, and alcohol/drug use) and socio-structural factors (e.g., venue-level peer/manager support, condom rule/availability, and sex trafficking) associated with condom negotiation, adjusting for individuals nested within venues. Results Of 142 FSWs who traded sex in the previous 6 months (included in the analysis), 24% did not typically negotiate condom use with venue patrons. Factors in the physical environment - trafficked/coerced into work (AOR = 12.92, 95% CI = 3.34–49.90), economic environment - sex without a condom to make more money (AOR = 1.52, 95% CI 1.01–2.30), policy environment - sex without a condom because none was available (AOR = 2.58, 95% CI = 1.49–4.48), and individual risk - substance use (AOR = 2.36, 95% CI = 1.28–4.35) were independently associated with FSWs' lack of condom negotiation with venue patrons. Conclusions Factors in the physical, economic, and policy environments, over individual (excepting substance use) and social level factors, were significantly associated with these FSWs' condom negotiations in the Philippines. Drawing upon Rhodes' risk environment framework, these results highlight the need for policies that support safer sex negotiations among sex workers in the context of their risk environments. Interventions

"One country, two systems": Sociopolitical implications for female migrant sex workers in Hong Kong

PubMed Central

Wong, William CW; Holroyd, Eleanor; Chan, Emily Y; Griffiths, Sian; Bingham, Amie

2008-01-01

Background Under the "two countries, one system" policy implemented by China to manage the return of Hong Kong's sovereignty, Hong Kong has maintained a comparatively prosperous economy within the Asian region. This has resulted in an environment which fosters migration from the mainland to Hong Kong, due largely to proximity, higher earning potential, common language, and a relaxing of border control measures. However not all mainland China citizens are equally able to access these new migration schemes and indeed a number of women such as sex workers are either migrating and/or working illegally and without occupational, legal and health protection within Hong Kong. Discussion Female migrant sex workers are exposed to a number of significant threats to their health, however their illegal status contributes to even greater vulnerability. The prevailing discourses which view these women as either "trafficked women" or as "illegal immigrants" do not adequately account for the complex situations which result in such women's employment in Hong Kong's sex industry. Rather, their position can best be understood within the broader frameworks provided by migration literature and the concept of "structural violence". This allows for a greater understanding of the socio-political issues which are systematically denying migrant sex workers adequate access to health care and other opportunities for social advancement. When these issues are taken into account, it becomes clear that the current relevant legislation regarding both immigration and sex work is perpetuating the marginalised and vulnerable status of migrant sex workers. Unless changes are made, structural barriers will remain in place which impede the ability of migrant sex workers to manage their own health needs and status. Conclusion Female migrant sex workers in Hong Kong are extremely vulnerable to a number of occupational health and safety hazards which have significantly detrimental effects on their health

Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland.

PubMed

Fonner, Virginia A; Kerrigan, Deanna; Mnisi, Zandile; Ketende, Sosthenes; Kennedy, Caitlin E; Baral, Stefan

2014-01-01

Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR] = 2.25, 95% confidence interval [CI]: 1.30-3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36-4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13-3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33-0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland.

Social Cohesion, Social Participation, and HIV Related Risk among Female Sex Workers in Swaziland

PubMed Central

Fonner, Virginia A.; Kerrigan, Deanna; Mnisi, Zandile; Ketende, Sosthenes; Kennedy, Caitlin E.; Baral, Stefan

2014-01-01

Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR]  = 2.25, 95% confidence interval [CI]: 1.30–3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36–4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13–3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33–0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland. PMID:24498125

[HIV epidemic among female sex workers in Guinea: prevalence, associated risk factors, vulnerability and trend from 2001 to 2007].

PubMed

Diallo, B L; Alary, M; Barry, A; Rashed, S

2010-08-01

Estimate the associations between potential risk factors and HIV prevalence, as well as the trends from 2001 through 2007 of these indicators. Describe the vulnerability of female sex workers to in Guinea. Female sex workers in Guinea were interviewed in 2001 (n = 339) and 2007 (n = 598) and then screened for HIV. This was a nationwide survey using a unique protocol. Associations between potential risk factors and HIV prevalence were tested, and their trends from 2001 through 2007 estimated, after adjustment using Generalized Estimating Equations. In 2001, HIV was associated with illiteracy (PR = 1.41; p = 0.2), and with genital ulcer symptom (PR = 1.89; p = 0.001). In 2007, it was associated with illiteracy (RP = 1, p = 0.03), and with older age (PR for 10 years = 1.29; p = 0.004). The profile of illiterate female sex workers included low price per sexual encounter in both 2001 and 2007, greater number of clients, and lesser exposure to HIV/Aids counselling in 2001. From 2001 to 2007, increases were noted for the number of clients by female sex workers (p < 0.0001), price per sexual encounter (p < 0.0001), condom use (p < 0.0001) and exposure to HIV/Aids counselling (p < 0.0001); decreases were noted for symptoms of sexually transmitted diseases (p < 0.0001) and HIV prevalence among female sex workers aged less than 20 years (p = 0.005). From 2001 through 2007, condom use and exposure to HIV/Aids counselling increased in Guinea while symptoms of sexually transmitted diseases and HIV prevalence declined. Nevertheless, illiterate female sex workers remained highly vulnerable. Copyright 2010 Elsevier Masson SAS. All rights reserved.

High Seroprevalence of Toxoplasma Gondii Infection in Female Sex Workers: A Case-Control Study

PubMed Central

Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Hernández-Tinoco, Jesús; Arreola-Cháidez, Emilio; López, Juan; Salcido-Meraz, Karla Itzel; Estrada-Martínez, Sergio; Navarrete-Flores, José Antonio; Pérez-Álamos, Alma Rosa; Hernández-Ochoa, Marcia; Rábago-Sánchez, Elizabeth; Liesenfeld, Oliver

2015-01-01

Through an age- and sex-matched case-control study, we sought to determine whether female sex workers have an increased risk of Toxoplasma gondii exposure and to determine the sociodemographic, work, clinical, and behavioral characteristics of these workers associated with T. gondii exposure. Female workers (n = 136) and controls (n = 272) were examined with enzyme-linked immunoassays (EIA) for the presence of anti-Toxoplasma IgG and IgM antibodies. IgM positive sera were additionally tested with enzyme linked-fluorescence immunoassay (ELFA). Anti-T. gondii IgG antibodies were found in 21 (15.44%) of 136 cases and in 10 (3.67%) of 272 controls (OR = 4.05; 95% CI: 1.84–8.89; P = 0.0001). Anti-T. gondii IgG levels higher than 150 IU/ml were found in 13 (9.6%) of 136 cases and in 8 (2.9%) of 272 controls (P = 0.007). Anti-T. gondii IgM antibodies were found in two cases and in six controls by EIA, but all were negative by ELFA. T. gondii seropositivity was associated with being born out of Durango State (OR = 10.47; 95% CI: 2.9–36.8; P < 0.01), injuries during sex work (OR = 6.30; 95% CI: 1.1–33.7; P = 0.03), and soil contact (OR = 4.11; 95% CI: 1.2–14.0; P = 0.02). This is the first report of an association of T. gondii infection and female sex workers. PMID:26716017

Epidemic Impacts of a Community Empowerment Intervention for HIV Prevention among Female Sex Workers in Generalized and Concentrated Epidemics

PubMed Central

Wirtz, Andrea L.; Pretorius, Carel; Beyrer, Chris; Baral, Stefan; Decker, Michele R.; Sherman, Susan G.; Sweat, Michael; Poteat, Tonia; Butler, Jennifer; Oelrichs, Robert; Semini, Iris; Kerrigan, Deanna

2014-01-01

Introduction Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. Methods We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5–65% in Kenya and Ukraine; 10–70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012–2016 and, compared to status quo when all interventions are held constant. Results Optimistic but feasible coverage (65%–70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. Discussion A community empowerment approach to HIV prevention and

Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.

PubMed

Wirtz, Andrea L; Pretorius, Carel; Beyrer, Chris; Baral, Stefan; Decker, Michele R; Sherman, Susan G; Sweat, Michael; Poteat, Tonia; Butler, Jennifer; Oelrichs, Robert; Semini, Iris; Kerrigan, Deanna

2014-01-01

Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant. Optimistic but feasible coverage (65%-70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a

Gender relations and risks of HIV transmission in South India: the discourse of female sex workers' clients.

PubMed

Aubé-Maurice, Joanne; Clément, Michèle; Bradley, Janet; Lowndes, Catherine M; Gurav, Kaveri; Alary, Michel

2012-01-01

In South India, where the majority of the country's cases of HIV are concentrated, transmission of infection occurs mainly within networks composed of female sex workers, their clients and the other sexual partners of the latter. This study aims to determine how gender relations affect the risks of HIV transmission in this region. Semi-structured interviews were carried out with 30 clients and analysed qualitatively. Results show that clients perceive sexual relations with female sex workers as a vice involving loss of control and contact with women at the bottom of the social ladder. Paradoxically, this sometimes allows them to conform to the masculine ideal, in giving sexual satisfaction to a woman, in a context of incompatibility between the idealised and actual masculine and feminine archetypes. Attitudes to condoms, affected by various facets of the client-female sex worker relationship, are indicators of the link between this relationship and the risks of contracting HIV. The results suggest that there is a need for expanding targeted HIV prevention towards clients and female sex workers alongside more general interventions on gender issues, particularly among young people, focusing on the structural elements moulding current relations between men and women, with particular consideration of local cultural characteristics.

Motivators and barriers to HIV testing among street-based female sex workers in St. Petersburg, Russia.

PubMed

King, Elizabeth J; Maman, Suzanne; Dudina, Victoria I; Moracco, Kathryn E; Bowling, J Michael

2017-07-01

Female sex workers are particularly susceptible to HIV-infection in Russia. However, a dearth of information exists on their utilisation of HIV services. A mixed-methods, cross-sectional study was conducted to examine motivators and barriers to HIV testing among street-based sex workers in St. Petersburg, Russia. The health belief model was the theoretical framework for the study. Twenty-nine sex workers participated in in-depth interviews, and 139 sex workers completed interviewer-administered surveys between February and September 2009. Barriers to getting an HIV test were fear of learning the results, worrying that other people would think they were sick, and the distance needed to travel to obtain services. Motivators for getting tested were protecting others from infection, wanting to know one's status and getting treatment if diagnosed. Logistic regression analysis demonstrated that knowing people living with HIV [aOR = 6.75, 95% CI (1.11, 41.10)] and length of time since start of injection drug use [aOR = 0.30, 95% CI (0.09, 0.97)] were significantly associated with recently getting tested. These results are important to consider when developing public health interventions to help female sex workers in Russia learn their HIV status and get linked to care and treatment services if needed.

Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru.

PubMed

Kohler, Pamela K; Campos, Pablo E; Garcia, Patricia J; Carcamo, Cesar P; Buendia, Clara; Hughes, James P; Mejia, Carolina; Garnett, Geoff P; Holmes, King K

2016-04-01

This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues. © The Author(s) 2015.

Female sex workers and the social context of workplace violence in Tijuana, Mexico.

PubMed

Katsulis, Yasmina; Lopez, Vera; Durfee, Alesha; Robillard, Alyssa

2010-09-01

Gender-based violence in the workplace impacts the physical and emotional wellbeing of sex workers and may lead to other health problems, such as PTSD and depression, drug abuse, and a greater likelihood of sexually transmitted infections. This study examines the social context of workplace violence and risk avoidance in the context of legal regulations meant to reduce harms associated with the industry. Ethnographic research, including 18 months of extended field observations and interviews with 190 female sex workers, is used to illustrate how sex workers in Tijuana, Mexico, experience and manage workplace violence. Multiple subthemes emerge from this analysis, including deciding where to work, working with a third party, avoiding theft, and dealing with police. These findings support the idea that the risk of violence is part of a larger "hierarchy of risk" that can result in a "tradeoff" of harms.

Factors associated with establishment-based female sex workers accessing health care services in Shanghai.

PubMed

Pan, Rong; Mao, Limin; He, Na; Zhang, Jing; Chen, Kun; Liao, Cuiqin; Tang, Xian; Gong, Xiangzhen; Blaxland, Megan; de Wit, John

2015-01-01

Female sex workers are a priority population for HIV prevention and health promotion in China. This paper examines the patterns of and factors associated with the utilisation of HIV-related and general health services by establishment-based sex workers in Hongkou District, Shanghai. Participants were recruited through a three-stage sampling strategy and invited to self-complete a brief survey in 2012. The median age of the 400 participants included in the analyses was 33 years (range = 18-52 years old), with over three-quarters being married at the time of the survey. Participants were mostly internal migrants, more than half had lived in Shanghai for six months or longer and nearly two-thirds were working in an establishment with a total of less than five female sex workers. Routine physical examination and HIV testing were the most commonly accessed health services in the previous 12 months. Altogether, 347 women (86.8%) had actively sought, including 157 women had obtained, free health services mainly from local Community Health Service Centres (CHSCs) in the previous 12 months. The active seeking of free, largely CHSC-provided health services was associated with a longer duration of residence in Shanghai (adjusted odds ratio [AOR] = 2.55, 95% CI = 1.32-4.93; p < 0.01) and having tested for HIV in the previous 12 months (AOR = 3.68, 95% CI = 1.84-7.38; p < 0.001). Conversely, a higher annual income (AOR = 0.41, 95% CI = 0.21-0.80; p < 0.01), working in a larger establishment (AOR = 0.40, 95% CI = 0.20-0.79; p < 0.01) and knowing that HIV can be transmitted through blood transfusion with unscreened blood (AOR = 0.21, 95% CI = 0.05-0.91; p < 0.05) were associated with not actively seeking such services. Free, community-based health services are highly demanded by establishment-based female sex workers in Shanghai. Scaling-up of free and integrated health services provided by community-based health service providers in metropolitan areas in China and beyond holds

Effects of implementing the act of prohibition on sex trafficking on female sex workers' sexually transmitted infections.

PubMed

Jung, Minsoo

2017-01-01

This study investigated the effect of implementing the act of prohibition on sex trafficking (PST) on sexually transmitted disease (STD) infections among South Korean female sex workers (FSWs) working at prostitution blocks. Research data were collected twice through the Korean government-sanctioned survey for female sex workers (1st wave = 1,083; 2nd wave = 926). We examined the associations among health behavior, working conditions, and the effect of PST act via hierarchical logistic regression analyses using propensity score matching. After adjusted covariates, the risk probability was 0.288 times lower among FSWs who had remained in prostitute blocks after the PST act enforcement compared to FSWs who had worked before the PST. Similarly, the risk probability for a gonorrhea infection was 0.219 times lower among FSWs who had remained in prostitute blocks after the PST act compared to FSWs who had worked before the PST. Therefore, this study showed that, besides already known factors, the implementation and establishment of the PST Act was a strong factor that suppressed STD infections among FSWs.

Psychological Stressors in the Context of Commercial Sex Among Female Sex Workers in China

PubMed Central

Zhang, Chen; Hong, Yan; Li, Xiaoming; Qiao, Shan; Zhou, Yuejiao; Su, Shaobing

2014-01-01

Because of the illegality and stigma associated with female sex workers (FSW) in China, data were limited regarding their psychological stressors examined through the lens of occupational health. Analyzing qualitative data from 16 gatekeepers and 38 FSW, we explored these stressors in the context of commercial sex in China. We found that FSW faced a continuum of stressors that resulted from poverty, limited employment, lack of social protection, violence perpetrated by clients, and limited social support from peers and stable partners. We call for empowerment and a structural approach to address the needs of FSW to improve their psychological well-being. PMID:24180467

HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions.

PubMed

Parriault, Marie-Claire; van Melle, Astrid; Basurko, Célia; Gaubert-Marechal, Emilie; Macena, Raimunda Hermelinda Maia; Rogier, Stéphanie; Kerr, Ligia Regina Franco Sansigolo; Nacher, Mathieu

2015-08-01

The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. One third (31.5%) of the interviewed had never tested for HIV. Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, to be 30 or older, feeling at risk of HIV, not evaluating one's own risk towards HIV, and living in Oiapoque. These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.

Looking beyond legality: understanding the context of female sex workers in greater Cairo, Egypt.

PubMed

Kabbash, I A; Abdul-Rahman, I; Shehata, Y A

2013-01-01

Data on demographic, social and behavioural characteristics of female sex workers in greater Cairo are very scarce. A cross-sectional study was conducted with 431 randomly selected sex workers after mapping of sites where they gather. Data collection was performed by direct interviewing using a questionnaire sheet covering sociodemographic data and sexual history with paying and non-paying partners. More than one half of participants (52.7%) were aged < 30 years. Only 39.3% were exclusively working as sex workers while the rest had other jobs beside sex work. Almost 70% were responsible for deperidants. The age of first selling sex was < 15 years for 4.7% of the women and 15-25 years for 58.7%. Unwanted pregnancies were experienced by 36.2% and 34.8% had had an abortion. Many participants had ever been arrested by the police (71.2%). The study has provided some useful background data for further studies in this very sensitive area of research.

Substance Use and HIV Among Female Sex Workers and Female Prisoners: Risk Environments and Implications for Prevention, Treatment, and Policies

PubMed Central

Strathdee, Steffanie A.; West, Brooke S.; Reed, Elizabeth; Moazan, Babak; Azim, Tasnim; Dolan, Kate

2015-01-01

Female sex workers (FSWs) and female prisoners experience elevated HIV prevalence relative to the general population because of unprotected sex and unsafe drug use practices, but the antecedents of these behaviors are often structural in nature. We review the literature on HIV risk environments for FSWs and female prisoners, highlighting similarities and differences in the physical, social, economic, and policy/legal environments that need to be understood to optimize HIV prevention, treatment, and policy responses. Sex work venues, mobility, gender norms, stigma, debt, and the laws and policies governing sex work are important influences in the HIV risk environment among FSWs, affecting their exposure to violence and ability to practice safer sex and safer drug use behaviors. Female prisoners are much more likely to have a drug problem than do male prisoners and have higher HIV prevalence, yet are much less likely to have access to HIV prevention and treatment and access to drug treatment in prison. Women who trade sex or are imprisoned and engage in substance use should not be considered in separate silos because sex workers have high rates of incarceration and many female prisoners have a history of sex work. Repeated cycles of arrest, incarceration, and release can be socially and economically destabilizing for women, exacerbating their HIV risk. This dynamic interplay requires a multisectoral approach to HIV prevention and treatment that appreciates and respects that not all women are willing, able, or want to stop sex work or drug use. Women who engage in sex work, use drugs, or are imprisoned come from all communities and deserve sustained access to HIV prevention and treatment for substance use and HIV, helping them and their families to lead healthy and satisfying lives. PMID:25978477

Substance Use and HIV Among Female Sex Workers and Female Prisoners: Risk Environments and Implications for Prevention, Treatment, and Policies.

PubMed

Strathdee, Steffanie A; West, Brooke S; Reed, Elizabeth; Moazen, Babak; Moazan, Babak; Azim, Tasnim; Dolan, Kate

2015-06-01

Female sex workers (FSWs) and female prisoners experience elevated HIV prevalence relative to the general population because of unprotected sex and unsafe drug use practices, but the antecedents of these behaviors are often structural in nature. We review the literature on HIV risk environments for FSWs and female prisoners, highlighting similarities and differences in the physical, social, economic, and policy/legal environments that need to be understood to optimize HIV prevention, treatment, and policy responses. Sex work venues, mobility, gender norms, stigma, debt, and the laws and policies governing sex work are important influences in the HIV risk environment among FSWs, affecting their exposure to violence and ability to practice safer sex and safer drug use behaviors. Female prisoners are much more likely to have a drug problem than do male prisoners and have higher HIV prevalence, yet are much less likely to have access to HIV prevention and treatment and access to drug treatment in prison. Women who trade sex or are imprisoned and engage in substance use should not be considered in separate silos because sex workers have high rates of incarceration and many female prisoners have a history of sex work. Repeated cycles of arrest, incarceration, and release can be socially and economically destabilizing for women, exacerbating their HIV risk. This dynamic interplay requires a multisectoral approach to HIV prevention and treatment that appreciates and respects that not all women are willing, able, or want to stop sex work or drug use. Women who engage in sex work, use drugs, or are imprisoned come from all communities and deserve sustained access to HIV prevention and treatment for substance use and HIV, helping them and their families to lead healthy and satisfying lives.

HIV-related risk perception among female sex workers in Nigeria

PubMed Central

Ankomah, Augustine; Omoregie, Godpower; Akinyemi, Zacch; Anyanti, Jennifer; Ladipo, Olaronke; Adebayo, Samson

2011-01-01

Background Over one-third of sex workers in Nigeria are infected with human immunodeficiency virus (HIV), yet there is a lack of understanding of sex workers’ own perception of sexual risk-taking. Applying the theory of cognitive dissonance, this paper examined the personal HIV risk perception of brothel-based sex workers. Methods The study is based on 24 focus group discussions held among brothel-based sex workers in four geographically and culturally dispersed cities in Nigeria. Results It was found that sex workers underestimated their risk of infection and rationalized, defended, or justified their behaviors, a typical psychological response to worry, threat, and anxiety arising from the apparent discrepancies between beliefs and behaviors. To reduce dissonance, many sex workers had a strong belief in fatalism, predestination, and faith-based invulnerability to HIV infection. Many believed that one will not die of acquired immune deficiency syndrome if it is not ordained by God. The sex workers also had a high level of HIV-related stigma. Conclusion From these findings, most sex workers considered risk reduction and in particular condom use as far beyond their control or even unnecessary, as a result of their strong beliefs in fatalism and predestination. Therefore, one critical area of intervention is the need to assist sex workers to develop accurate means of assessing their personal vulnerability and self-appraisal of HIV-related risk. PMID:22096411

Sampling studies to estimate the HIV prevalence rate in female commercial sex workers.

PubMed

Pascom, Ana Roberta Pati; Szwarcwald, Célia Landmann; Barbosa Júnior, Aristides

2010-01-01

We investigated sampling methods being used to estimate the HIV prevalence rate among female commercial sex workers. The studies were classified according to the adequacy or not of the sample size to estimate HIV prevalence rate and according to the sampling method (probabilistic or convenience). We identified 75 studies that estimated the HIV prevalence rate among female sex workers. Most of the studies employed convenience samples. The sample size was not adequate to estimate HIV prevalence rate in 35 studies. The use of convenience sample limits statistical inference for the whole group. It was observed that there was an increase in the number of published studies since 2005, as well as in the number of studies that used probabilistic samples. This represents a large advance in the monitoring of risk behavior practices and HIV prevalence rate in this group.

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

PubMed

Hail-Jares, Katie; Chang, Ruth C F; Choi, Sugy; Zheng, Huang; He, Na; Huang, Z Jennifer

2015-01-01

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. 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. 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). 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

Government crackdown of sex work in China: responses from female sex workers and implications for their health.

PubMed

Huang, Yingying; Pan, Suiming

2014-01-01

The Chinese Government periodically enforces anti-prostitution laws through regular police presence in red light districts and through the arrests of brothel managers and sex workers. One of the most intense crackdowns on prostitution occurred throughout China in 2010. Using the 'structure-agency' framework and ethnographic approach, this paper examines the influence of the 2010 government anti-prostitution crackdown on female sex workers (FSWs). We observed 10 red light districts (6 cities and 2 counties) and interviewed 107 FSWs, 26 managers and 37 outreach workers working with FSWs. The findings describe variations in police practices and diverse strategies adopted by FSWs in response to police actions. The strategies include: soliciting sex outside of establishments in less visible channels, increasing the mobility and flexibility of sex work, changing sexual practices, sharing knowledge of how to identify policemen disguised as male clients and building personal relationships with local police. Our study suggests that, rather than disappearing as a result of crackdowns, the terms and content of sex work changed as a result of the FSWs' responses to police practices. Some of these responses potentially increased the health risks associated with sex work, but others laid the foundation for an effective response to police practices.

Government crackdown of sex work in China: Responses from female sex workers and implications for their health

PubMed Central

Huang, Yingying; Pan, Suiming

2015-01-01

The Chinese Government periodically enforces anti-prostitution laws through regular police presence in red light districts and through the arrests of brothel managers and sex workers. One of the most intense crackdowns on prostitution occurred throughout China in 2010. Using the ‘structure-agency’ framework and ethnographic approach, this paper examines the influence of the 2010 government anti-prostitution crackdown on female sex workers (FSWs). We observed 10 red light districts (6 cities and 2 counties) and interviewed 107 FSWs, 26 managers and 37 outreach workers working with FSWs. The findings describe variations in police practices and diverse strategies adopted by FSWs in response to police actions. The strategies include: soliciting sex outside of establishments in less visible channels, increasing the mobility and flexibility of sex work, changing sexual practices, sharing knowledge of how to identify policemen disguised as male clients and building personal relationships with local police. Our study suggests that, rather than disappearing as a result of crackdowns, the terms and content of sex work changed as a result of the FSWs’ responses to police practices. Some of these responses potentially increased the health risks associated with sex work, but others laid the foundation for an effective response to police practices. PMID:25226069

Female sex work in Yangon, Myanmar.

PubMed

Talikowski, Luke; Gillieatt, Sue

2005-01-01

Myanmar (Burma), with an upper estimate of 400,000 people living with HIV/AIDS, faces a dangerous and potentially devastating epidemic. Female sex workers in the country are one of the most affected populations, with high prevalence rates of both HIV and sexually transmitted infections (STIs). A qualitative study was undertaken in Yangon at the end of 2002 to investigate the social and demographic features contributing to the transmission of HIV among female sex workers in urban Myanmar. Twenty-seven key informants from the government, non-government organisations (NGOs), international non-government organisations (INGOs), private sector and the United Nations system agencies and 25 women currently working in the sex trade were interviewed. The sex trade in Yangon is rapidly growing and is characterised by a high degree of complexity. The number of female sex workers is estimated to be between 5,000 and 10,000 and there are approximately 100 brothels operating in various townships around the city. Nearly one-third of the women in the study reported previous imprisonment for offences related to sex work as well as fear of harassment, sexual exploitation, violence and gang rape. Almost half reported using condoms with clients at all times. Contradicting views exist as to the level of awareness about STIs and HIV among Yangon sex workers, with the majority never having been tested for HIV. Only one-quarter of women were regular patients of the limited number of STI clinics operated by INGOs. Female sex workers in Myanmar remain a highly marginalised group almost inaccessible due to a variety of legal, political, cultural and social factors and are particularly vulnerable to HIV and STIs. It is important to encourage partnerships between INGOs by promoting service coordination and information sharing to increase the availability of services for sex workers and to build political support for an unpopular cause.

Negative trust and depression among female sex workers in Western China: The mediating role of thwarted belongingness.

PubMed

Chen, Hong; Li, Xu; Li, Bingbing; Huang, Ailong

2017-10-01

Female sex workers are at high risk for depression in China but they are understudied and underserved. Based on cognitive models of depression, dysfunctional beliefs about oneself and others may act as vulnerability factors for depression. However, the association between negative trust and depression is still under debate. The present study aimed to test the hypothesis that negative trust positively relates to depression through thwarted belongingness among female sex workers. Four hundred and fifty-seven participants completed measures of negative trust, thwarted belongingness, and depression. Stepwise multiple linear regression analyses showed that both negative trust and thwarted belongingness significantly positively predicted depression, and thwarted belongingness was positively predicted by negative trust. The results from the mediation analysis suggest that thwarted belongingness might be an underlying mechanism linking negative trust and depression. Psychological interventions could focus on helping female sex workers form and strengthen meaningful social connectedness (the behavioral/observable indicators of the constructs of thwarted belongingness). Copyright © 2017. Published by Elsevier B.V.

Differing HIV vulnerability among female sex workers in a high HIV burden Indian state.

PubMed

Mamulwar, Megha; Godbole, Sheela; Bembalkar, Shilpa; Kamble, Pranil; Dulhani, Nisha; Yadav, Rajesh; Kadu, Chitra; Kumar, Pradeep; Lalikar, Shivraj; Acharya, Shrikala; Gangakhedkar, Raman; Risbud, Arun; Venkatesh, Srinivas

2018-01-01

The HIV sentinel surveillance [HSS] conducted in 2010-11 among female sex workers [FSW] in the state of Maharashtra, India provided an opportunity to assess characteristics of different types of FSWs and their HIV risk. It is important for India's National AIDS Control Program, to understand the differences in vulnerability among these FSW, in order to define more specific and effective risk reduction intervention strategies. Therefore, we analyzed data from HSS with the objective of understanding the HIV vulnerability among different types of FSW in Maharashtra. Cross sectional data collected as a part of HSS among FSWs in year 2010-11 from 21 sentinel sites in the state of Maharashtra were analyzed to understand the vulnerability and characteristics of different types of female sex workers based on their place of solicitation using multinomial logistic regression. While the HIV prevalence was 6.6% among all FSWs, it was 9.9% among brothel based [BB], 9% among street based [SB] and 3.1% and 3.7% among home based [HB], and bar based [Bar-B] sex workers respectively. SB FSWs were least likely to be located in HIV low burden districts [ANC] [ARRR: 0.61[95% CI: 0.49, 0.77

Typology of older female sex workers and sexual risks for HIV infection in China: a qualitative study

PubMed Central

Hao, Chun; Sherman, Susan G.; Jiang, Baofa; Li, Xiaojing; Xu, Yongfang; Jiang, Zhenxia; Zang, Chunpeng

2013-01-01

The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. The objectives of this study were to investigate the reasons for women's entry into sex work during their thirties and to develop typology of older women sex workers. Semi-structured in-depth interviews with sixty-three older women sex workers and six focus groups interviews with stakeholders were conducted in three cities in China in 2012. Data were analysed inductively using constant comparative method. The mean age of participants was 43 years old and the mean age of entry into sex work was 39 years old. The primary reasons for entry into sex work include heavy economic burdens, limited employment opportunities, and the appealing nature of sex work. Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. The development of effective HIV interventions needs to consider older women sex workers unique characteristics and target factors that impede safer sex practices. PMID:23998493

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

PubMed Central

Hail-Jares, Katie; Chang, Ruth C. F.; Choi, Sugy; Zheng, Huang; He, Na; Huang, Z. Jennifer

2015-01-01

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

Pregnancy Intentions and Safer Pregnancy Knowledge Among Female Sex Workers in Port Elizabeth, South Africa.

PubMed

Rao, Amrita; Baral, Stefan; Phaswana-Mafuya, Nancy; Lambert, Andrew; Kose, Zamakayise; Mcingana, Mfezi; Holland, Claire; Ketende, Sosthenes; Schwartz, Sheree

2016-07-01

To assess the association between human immunodeficiency virus (HIV) and pregnancy intentions and safer conception knowledge among female sex workers in Port Elizabeth, South Africa. This cross-sectional study recruited female sex workers in Port Elizabeth using respondent-driven sampling and completed an interviewer-administered questionnaire alongside HIV testing and counseling. In this secondary analysis, robust Poisson regression was used to model prevalence ratios for positive fertility intentions in this cross-sectional study. Knowledge of safer conception methods by HIV status was compared using Fisher exact tests. Overall 391 women were represented in the analyses. More than 50% had a prior HIV diagnosis, and an additional 12% were diagnosed with HIV during the study. Approximately half (n=185) of the women reported future pregnancy intentions. In univariate analysis, a prior HIV diagnosis was negatively associated with pregnancy intentions as compared with HIV-negative women (prevalence ratio 0.68, 95% confidence interval 0.55-0.85). Only parity remained independently associated with future pregnancy intentions in multivariate regression after controlling for HIV status, age, race, relationship status, and years selling sex. Knowledge of safer conception methods such as timed sex without a condom, preexposure prophylaxis, or self-insemination was low and similar between those with and without future pregnancy plans. Pregnancy intentions did not significantly vary according to HIV status. Fertility intentions were high, however, and knowledge of safer conception methods low, suggesting a need to provide female sex workers with advice around options to conceive safely in the context of high HIV prevalence.

Beyond exploitation: towards a nuanced understanding of agency for adolescent female sex workers - evidence from Zanzibar and Morogoro.

PubMed

Van Bavel, Hannelore

2017-01-01

This study examines how young women sex workers exercise agency when entering prostitution, coping with occupational health problems and accessing healthcare services. It was conducted at two sites in Tanzania: Morogoro on Tanzania's mainland and Stone Town on Zanzibar Island. A total of 19 in-depth interviews were conducted with female sex workers who were 18-years old or younger at the time of entry into prostitution and 12 key informant interviews with sex workers who were 19 or older at the time of entry into prostitution. Eight key informant interviews were held with the peer educators and staff of ZAYEDESA, a sex worker organization on Zanzibar. The findings show that agency is more constrained for adolescent sex workers compared to adult sex workers. However, younger sex workers find coping strategies to navigate within the constraints that compromise their agency, reflecting different positions on the agency spectrum, ranging from reconciliation, via negotiation, to actual individual or collective agency. Adolescent sex worker agency is often severely compromised; however, it is still present and should not be ignored. Rather, it should inspire the design and implementation of harm reduction and rehabilitative interventions that address the needs of young sex workers in their particular situation.

Commercial sex venues, syphilis and methamphetamine use among female sex workers.

PubMed

Kang, Dianming; Liao, Meizhen; Jiang, Zhenxia; Zhang, Xijiang; Mao, Wenwen; Zhang, Ning; Tao, Xiaorun; Huang, Tao; Bi, Zhenqiang; Aliyu, Muktar; Wu, Pingsheng; Jiang, Baofa; Jia, Yujiang

2011-06-01

The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission.

Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya.

PubMed

Parcesepe, Angela M; L'Engle, Kelly L; Martin, Sandra L; Green, Sherri; Suchindran, Chirayath; Mwarogo, Peter

2016-12-01

Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence.

Violence in contract work among female sex workers in Andhra Pradesh, India.

PubMed

George, Annie; Sabarwal, Shagun; Martin, P

2011-12-01

Female sex workers (FSWs) are vulnerable to physical and sexual violence at work. This article examines the prevalence of recent physical and sexual violence victimization and associations of type of sex work among a large sample of young FSWs. We used data from a cross-sectional survey on sex trafficking and sex work in southern India that included 1138 FSWs aged 18-25 years residing in 3 districts of Andhra Pradesh state. The independent variable was organization of sex work. FSWs on contract at sex work establishments outside their home district were classified as contract workers, as compared with women who worked autonomously within their home district. Using logistic regression models adjusted for sociodemographic factors, we assessed the relation between contract/ non-contract sex work and various forms of violence experienced by FSWs. Results indicate a high prevalence of work-related physical and sexual violence; 50% FSWs reported physical violence, and 77% reported sexual violence. FSWs performing contract work were at increased risk of physical and sexual violence at work, compared with women engaged in sex work in their home districts. The findings that contract work outside the home district increases the vulnerabilities faced by FSWs in India suggest that violence and disease prevention services aimed at FSWs would be more effective if organization of sex work--as contract or noncontract--is taken into account.

Female commercial sex worker perspective on susceptibility of HIV-AIDS in Yogyakarta

NASA Astrophysics Data System (ADS)

Mahmudah, Nurul; Dasuki, Djaswadi; Kurniawati, Herlin Fitriani

2017-08-01

Commercial sex worker is one of the groups with the highest level of susceptibility against HIV infection. They are 13,5 fold more prone to a living with HIV infection than the female of non commercial sex workers. Moreover, these commercial sex workers are also stigmatized with social sanction and discrimination against people with HIV-AIDS. The society mostly avoid them, deject them, isolate them, insult them, despise them, distrust them, and even go against the existence of those suffering from or infected by HIV-AIDS. Thus, stigmatizing and discrimination are basicly highly prohibited since they can incur higher social problems. It is also vital to handle the spread of HIV-AIDS in the society as soon as possible in the attempt of fighting against the spread of the disease. Hence, being broad minded, tolerant, and caring towards them as well as working hand in hand with the community are expected to diminish, minimize, and even eradicate the outbreak of HIV-AIDS. Caring towards those suffering from the infection without stigmatizing them and discriminating them will be one of the first measurements to take to improve what is needed to prevent the prevalence and spread of the disease. Thus, the primary objective of this research is to know the perception of female commercial sex workers on the susceptibility of HIV-AIDS in Yogyakarta. The research participants were selected from three localizations in Yogyakarta namely Pasar Kembang, Bongsuwung, and Giwangan. It is revealed that the participants had a good perception on the susceptibility of AIDS infection as seen from the fact there are free avalaible condoms for them to use everytime they have a sexual intercourse with the clients. All participants were aware of their high susceptibility against the infection of STIs/HIV/AIDS and thus they want to save their skin from those diseases. Also they had a good knowledge that having an intercourse without condom may get them infected.

Migration status, work conditions and health utilization of female sex workers in three South African cities.

PubMed

Richter, Marlise; Chersich, Matthew F; Vearey, Jo; Sartorius, Benn; Temmerman, Marleen; Luchters, Stanley

2014-02-01

Intersections between migration and sex work are underexplored in southern Africa, a region with high internal and cross-border population mobility, and HIV prevalence. Sex work often constitutes an important livelihood activity for migrant women. In 2010, sex workers trained as interviewers conducted cross-sectional surveys with 1,653 female sex workers in Johannesburg (Hillbrow and Sandton), Rustenburg and Cape Town. Most (85.3%) sex workers were migrants (1396/1636): 39.0% (638/1636) internal and 46.3% (758/1636) cross-border. Cross-border migrants had higher education levels, predominately worked part-time, mainly at indoor venues, and earned more per client than other groups. They, however, had 41% lower health service contact (adjusted odds ratio = 0.59; 95% confidence interval = 0.40-0.86) and less frequent condom use than non-migrants. Police interaction was similar. Cross-border migrants appear more tenacious in certain aspects of sex work, but require increased health service contact. Migrant-sensitive, sex work-specific health care and health education are needed.

A pragmatic intervention to promote condom use by female sex workers in Thailand.

PubMed Central

Ford, N.; Koetsawang, S.

1999-01-01

An overview is presented of a multifaceted intervention to promote consistent condom use by female commercial sex workers in Thailand, in the context of the government's 100% condom use policy for preventing spread of human immunodeficiency virus (HIV) infection. The project is described with reference to a succession of stages including pre-programme needs assessment, intervention design, implementation and evaluation. The key elements of the intervention were video scenarios and discussions coordinated by health personnel, and video-depicted open-ended narratives aimed at helping sex workers to explore their personal and work-related dilemmas and concerns. A core objective was to enhance sex workers' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection. The intervention was evaluated using a combination of qualitative (process evaluation) and quantitative (outcome) methods. The outcome evaluation was undertaken using a pretest, post-test intervention and control group quasi-experimental design. There were significant increases in consistent condom use among the intervention groups but not among the controls. Pragmatic stability is advocated for the Thai sex industry and recommendations are offered for good quality HIV prevention activities. PMID:10612884

Organizational policy recommendations for control of STI/HIV among female sex workers in China: regular examination of workers in social hygiene clinics.

PubMed

Morisky, Donald E; Urada, Lianne A

2011-06-01

This article aims to address female sex workers at high risk for contracting HIV in China by recommending evidence-based socio-structural interventions and policies at the national level that have yielded effective outcomes in other countries. National governments such as the Philippines and Hong Kong have utilized the Social Hygiene Clinic (SHC) model. A similar national policy can be highly effective in China. Evidence-based research study results indicate significant reductions in STI and consistent condom use among female sex workers in both China and the Philippines. Consistent condom use in both countries continues to be significantly associated with interpersonal- and venue-level factors. Individuals who had higher appointment-keeping ratios in the Philippines had higher rates of consistent condom use (OR = 2.7, 95% CI = 1.6-3.7) and significantly lower rates of STI (OR = 0.43, 95% CI = 0.26-0.57). By beginning with provinces, which already have a good relationship between establishment venues and the local Health Department, China can develop city ordinances and establishment regulations that begin to require regular examinations of female sex workers and entertainers in the local STI clinic.

Understanding out-migration among female sex workers in South India

PubMed Central

Banandur, Pradeep; Ramnaik, Satyanarayana; Manhart, Lisa E.; Buzdugan, Raluca; Mahapatra, Bidhubhushan; Isac, Shajy; Halli, Shiva S; Washington, Reynold G; Moses, Stephen; Blanchard, James F

2012-01-01

BACKGROUND Migrant sex workers are known to be vulnerable to HIV. There is substantial female sex worker (FSW) mobility between the borders of Maharashtra and Karnataka, but little programming emphasis on migrant FSWs in India. We sought to understand the individual/cultural, structural and contextual determinants of migration among FSWs from Karnataka. METHODS A cross sectional face-to-face interview of 1567FSWs from 142 villages in 3 districts of northern Karnataka, India was conducted from January–June 2008. Villages having 10+FSWs, a large number of whom were migrant, were selected following mapping of FSWs. Multinomial logistic regression was conducted to identify characteristics associated with migrant (travelled for ≥2weeks outside the district past year) and mobile (travelled for <2weeks outside the district past year) FSWs; adjusting for age and district. RESULTS Compared to non-migrants, migrant FSWs were more likely to be brothel than street-based (AOR 5.7; 95%CI 1.6–20.0), have higher income from sex work (AOR 42.2; 12.6–142.1), speak >2languages (AOR 5.6%; 2.6–12.0), have more clients (AORper client 2.9; 1.2–7.2) and have more sex acts/day (AORper sex act 3.5; 1.3–9.3). Mobile FSWs had higher income from sex work (AOR=13.2; 3.9–44.6) relative to non-migrants, but not as strongly as for migrant FSWs. CONCLUSION Out-migration of FSWs in Karnataka was strongly tied to sex work characteristics; thus, the structure inherent in sex work should be capitalized on when developing HIV preventive interventions. The important role of FSWs in HIV epidemics, coupled with the potential for rapid spread of HIV with migration, requires the most effective interventions possible for mobile and migrant FSWs. PMID:23001264

[Characteristics of social supportive network serving the older female sex workers in Qingdao].

PubMed

Xu, Y Q; Li, Y F; Jiang, Z X; Zhang, X J; Yuan, X; Zhang, N; Li, X F; Jiang, B F

2016-02-01

To overview the status of social support on older female sex workers (OFSWs) in Qingdao and to better understand the characteristics of this egocentric social support networks. Ucinet 6 software was used to analyze the characteristics of egocentric social networks which involving 400 OFSWs who were recruited by respondent-driven sampling (RDS) method in Qingdao during March 2014 to June. Structural equation model (SEM) was used for data analysis, fitted test and estimation. A total of 400 OFSWs of Qingdao nominated 1 617 social supportive members, and the average size of egocentric social networks of OFSWs was (4.0 ± 1.5). Among all the alter egos (social support network members of the egos), 613 were female sex workers fellows, accounted for the most important part of all the social ties (37.91%). Characteristics of small size and non-relative relationships were seen more obviously among OFSWs with non-local registration and the ratings of emotional support (4.42±2.38) was significantly lower than the tangible support (5.73 ± 1.69) (P<0.05). Result of the SEM showed that homogeneity, joint strength and the network structure were significantly related to the ratings of average support. The total standard effects of which were 0.110, 0.925 and -0.069 respectively. It seemed that homogeneity can affect the degree of support, both directly and indirectly. OFSWs in Qingdao tended to ask for social support from friends who were also female sex workers. Stronger the joint strength between egos and alters, greater the homogeneity between the two was seen. Tighter relations among the alter egos, higher degree of average social support of the egos were acquired.

History of sex trafficking, recent experiences of violence, and HIV vulnerability among female sex workers in coastal Andhra Pradesh, India

PubMed Central

Gupta, Jhumka; Reed, Elizabeth; Kershaw, Trace; Blankenship, Kim M.

2011-01-01

Synopsis Findings from female sex workers in southern India indicate that women who enter sex work via trafficking are exposed to unique HIV vulnerabilities. Objectives To estimate the prevalence of sex trafficking as a mode of entry into sex work, and to examine associations between sex trafficking and recent violence experiences and HIV vulnerability among female sex workers (FSWs). Methods In a cross-sectional study in 2006 in coastal Andhra Pradesh, India, 812 FSWs were recruited via respondent-driven sampling to take part in an oral survey of their experiences in sex work. Results One in 5 (19.3%) FSWs met the UN definition of sex trafficking. Women trafficked into sex work were more likely than other FSWs to report recent violence experiences (adjusted odds ratio [AOR], 1.93; 95% confidence interval [CI], 1.32–2.81), more clients per week (AOR, 1.63; 95% CI, 1.11–2.41), and more days of sex work per week (AOR, 1.76; 95% CI, 1.18–2.63), and were less likely to report use of FSW-focused services (AOR, 0.60; 95% CI, 0.42–0.86). No significant differences emerged regarding HIV knowledge or consistent condom use. Conclusion There was a high prevalence of sex trafficking. A history of sex trafficking was associated with a greater vulnerability to recent violence and HIV risk behaviors, underscoring the need for increased attention to the public health needs of trafficked populations. PMID:21620402

Behaviour change and associated factors among female sex workers in Kenya.

PubMed

Nyagero, Josephat; Wangila, Samuel; Kutai, Vincent; Olango, Susan

2012-01-01

Initiatives aimed at behaviour change of key populations such as the female sex workers (FSWs) are pivotal in reducing the transmission of HIV. An 8-year implementation research to establish the predictor factors of behaviour change among FSWs in Kenya was initiated by the African Medical Research Foundation (AMREF) with Sida and DfID support. This cross-sectional survey interviewed 159 female sex workers (FSWs) identified through snowball procedure. The measurement of behaviour change was based on: the consistent use of condoms with both regular and non regular clients, reduced number of clients, routine checks for STIs, and involvement in alternative income generating activities. The adjusted odds ratios at 95% confidence interval computed during binary logistic regression analysis were used to determine the behaviour change predictor factors. Most FSWs (84%) had participated in AMREF's integrated intervention programme for at least one year and 59.1% had gone through behaviour change. The adjusted odds ratio showed that the FSWs with secondary education were 2.23 times likely to change behaviour, protestants were 4.61 times, those in sex work for >4 years were 2.36 times, FSWs with good HIV prevention knowledge were 4.37 times, and those engaged in alternative income generating activities were 2.30 times more likely to change their behaviour compared to respective counterparts. Behaviour change among FSWs was possible and is associated with the level of education, religious affiliation, number of years in sex work and one's level of HIV prevention knowledge. A re-orientation on the peer education programme to focus on HIV preventive measures beyond use of condoms is emphasized.

Sexually transmitted diseases among female commercial sex workers in Finote Selam town, northwest Ethiopia: a community-based cross-sectional study.

PubMed

Anteneh, Zelalem Alamrew; Agumas, Yirdaw Amare; Tarekegn, Molalign

2017-01-01

Female commercial sex workers (FCSWs) are considered a high-risk group for acquiring sexually transmitted diseases (STDs), yet the reported prevalence varies in studies around the world. The aim of this study was to determine the magnitude and associated factors of STDs among female sex workers. A community-based cross-sectional study was conducted among female sex workers in Finote Selam town. A total of 389 sex workers were studied using census method. Data were collected using an interview with structured questionnaires. The data were entered and analyzed by using SPSS version 20 software package. The findings of this study showed that the overall prevalence of STDs was 20.6%. The reported prevalence of genital discharge, ulcer, and bubo was 15.9%, 15.2%, and 11.6%, respectively. In the multivariable logistic regression analysis, respondents who did not use a condom were about four times at higher risk of STDs than those who were using a condom consistently (adjusted odds ratio [AOR] = 4.07; 95% confidence interval [CI]: 1.812, 9.139). Respondents who experienced condom breakages were more than 12 times more likely to report STDs than those who never experienced condom breakages (AOR = 12.291, 95% CI: 5.701, 26.495). The findings of this study showed that one in five commercial sex workers in Finote Selam town had STDs. Sex without a condom and condom breakage during sexual intercourse showed a significant association with STDs. Therefore, the Woreda Health Office in collaboration with nongovernmental organizations in the area should work on safe sex promotion to enhance consistent condom use and reduce condom breakage through continuous education among commercial sex workers.

Sexually transmitted infections: prevalence, knowledge and treatment practices among female sex workers in a cosmopolitan city in Nigeria.

PubMed

Sekoni, Adekemi O; Odukoya, Oluwakemi O; Onajole, Adebayo T; Odeyemi, Kofoworola A

2013-03-01

Sexually transmitted infections constitute economic burden for developing countries, exposure to causative agents is an occupational hazard for female sex workers. Targeted interventions for this population can reduce the incidence and prevalence of sexually transmitted infections including human immunodeficiency virus, but barriers exists which can hinder effective implementation of such programs. This descriptive cross sectional study sought to assess the prevalence, knowledge and treatment practices of sexually transmitted infections among brothel based female sex workers. Three hundred and twenty three consenting female sex workers were surveyed using pre tested, interviewer administered questionnaires. More than half of the respondents (54.2%) had poor knowledge of symptoms of sexually transmitted infections. Only 13.9% were aware that sexually transmitted infections could be asymptomatic. The self reported prevalence of symptomatic sexually transmitted infections was 36.5%. About half of those with sexually transmitted infectionss sought treatment in a hospital or health centre while 32.5% from a patent medicine vendor. Most respondents (53.8%) mentioned the perceived quality of care as the main reason for seeking treatment in their chosen place. More of the respondents with good knowledge of sexually transmitted infections reported symptoms compared to those with fair and poor knowledge. The knowledge of sexually transmitted infections among these female sex workers is poor and the prevalence is relatively high. Efforts to improve knowledge promote and encourage preventive as well as effective treatment practices must be made for this population.

Environmental–Structural Interventions to Reduce HIV/STI Risk Among Female Sex Workers in the Dominican Republic

PubMed Central

Kerrigan, Deanna; Moreno, Luis; Rosario, Santo; Gomez, Bayardo; Jerez, Hector; Barrington, Clare; Weiss, Ellen; Sweat, Michael

2006-01-01

Objectives. We assessed the effectiveness of 2 environmental–structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic. Methods. Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention–postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings. Results. Significant increases in condom use with new clients (75.3%–93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%–28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%–16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers’ verbal rejections of unsafe sex (50.0%–79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments’ ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22). Conclusions. Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers. PMID:16317215

The influence of power, poverty and agency in the negotiation of condom use for female sex workers in mainland China.

PubMed

Choi, Susanne Y P; Holroyd, Eleanor

2007-01-01

This paper analyses barriers to consistent condom use in the context of transactional sex among female sex workers in mainland China. It reveals how differences in socioeconomic profile and organisational hierarchies amongst different groups of sex workers create different barriers to condom use. Data was collected by means of field observation of entertainment venues and in-depth interviews. Findings suggest that, compared with other sex workers, street-walkers are less likely to use condoms with their clients, hold highly disadvantaged socioeconomic profiles and work in isolation. Major barriers to condom use link to economic deprivation and threats of violence from clients. For the women working in entertainment venues, drunkenness of clients, pricing mechanisms and familiarity with clients pose barriers to condom use. Yet within all these constraints women are not powerless and instead find ways to exercise agency and gain personal protection and economic advantage. In the newly emerging China, both structural hierarchies of work and individual agency inform condom use by female sex workers. Future HIV intervention programmes need to take these factors into account in order to meet the needs of different groups of women sex workers.

Women's voices: attitudes and behaviors of female Ghanaian sex workers regarding HIV prevention and AIDS-related stigma.

PubMed

Raingruber, Bonnie; Uwazie, Ernest; Bowie, Sylvester

2010-08-01

Attitudes and behaviors of sex workers have a pivotal influence on the spread of AIDS. A qualitative descriptive study was undertaken to elicit Ghanaian female sex workers' perspectives regarding effective methods of HIV prevention, sources of AIDS-related stigma, and challenges associated with sex work. Women described that: (1) sex work is hard; (2) they felt God would protect their health; (3) staying safe is both a gift and a priority; (4) sex work allows for autonomy; and (5) AIDS-related stigma is very real. To design effective prevention programs it is necessary to consider the culture and perspectives of those who will be served.

Combination HIV prevention for female sex workers: what is the evidence?

PubMed

Bekker, Linda-Gail; Johnson, Leigh; Cowan, Frances; Overs, Cheryl; Besada, Donela; Hillier, Sharon; Cates, Willard

2015-01-03

Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide. Copyright © 2015 Elsevier Ltd. All rights reserved.

Human papillomavirus infection in female sex workers in Lima, Peru.

PubMed

Montano, Silvia M; Hsieh, Evelyn J; Calderón, Martha; Ton, Thanh G N; Quijano, Eberth; Solari, Vicky; Zunt, Joseph R

2011-02-01

To determine the prevalence and risk factors for human papillomavirus (HPV) infection in female sex workers (FSW) in Lima, Peru. Cross-sectional study of 87 FSW. Information regarding demographics, sex work practices, and genital and blood specimens was collected. Forty-four (50.6%) of 87 FSW had HPV detected in cervical swabs. The prevalence of coinfection by two or more HPV types was 39.1%. Thirty-one (35.6%) were infected by at least one high-risk HPV type, representing 70.5% of women with HPV infection. HPV infection was associated with younger age but not with any demographic or sexual characteristics. Our study confirms the high prevalence of HPV infection in FSW reported by other groups and suggests that brothel-based FSW may be at lower risk for acquiring high-risk HPV infection.

Efficacy of a Brief Behavioral Intervention to Promote Condom Use Among Female Sex Workers in Tijuana and Ciudad Juarez, Mexico

PubMed Central

Mausbach, Brent; Lozada, Remedios; Staines-Orozco, Hugo; Semple, Shirley J.; Fraga-Vallejo, Miguel; Orozovich, Prisci; Abramovitz, Daniela; de la Torre, Adela; Amaro, Hortensia; Martinez, Gustavo; Magis-Rodríguez, Carlos; Strathdee, Steffanie A.

2008-01-01

Objectives. We examined the efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico. Methods. We randomized 924 female sex workers 18 years or older without known HIV infection living in Tijuana and Ciudad Juarez who had recently had unprotected sex with clients to a 30-minute behavioral intervention or a didactic control condition. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia. Results. We observed a 40% decline in cumulative sexually transmitted illness incidence (P = .049) in the intervention group. Incidence density for the intervention versus control groups was 13.8 versus 24.92 per 100 person-years for sexually transmitted illnesses combined (P = .034) and 0 versus 2.01 per 100 person-years for HIV (P < .001). There were concomitant increases in the number and percentage of protected sex acts and decreases in the number of unprotected sex acts with clients (P < .05). Conclusions. This brief behavioral intervention shows promise in reducing HIV and sexually transmitted illness risk behaviors among female sex workers and may be transferable to other resource-constrained settings. PMID:18799768

HIV Stigma Mediates the Association Between Social Cohesion and Consistent Condom Use Among Female Sex Workers Living with HIV in the Dominican Republic.

PubMed

Carrasco, Maria Augusta; Nguyen, Trang Q; Barrington, Clare; Perez, Martha; Donastorg, Yeycy; Kerrigan, Deanna

2018-07-01

Evidence indicates that social cohesion is a successful strategy to improve consistent condom use (CCU) among female sex workers. However, the individual and layered or combined effect that various types of overlapping stigmas may have on CCU between female sex workers living with HIV and their clients and steady partners has not been analyzed. Drawing on the Abriendo Puertas cohort of female sex workers living with HIV in the Dominican Republic, we used structural equation modeling to test the hypothesis that both HIV stigma and sex work stigma mediate the association between social cohesion and CCU and that they have a layered effect. The results indicated that HIV stigma mediated the association between social cohesion and CCU with clients and partners, while sex work-related stigma did not. There was no evidence of a layered HIV stigma and sex work stigma effect, which may be due to methodological limitations to handle highly correlated latent variables. Findings highlight the need to address internalized HIV stigma within the context of community-based approaches to enhance their HIV prevention impact. This will help to reduce the risk of HIV re-infection with a new distinct HIV viral strain, STI infection, and onward HIV transmission among female sex workers living with HIV.

The relationship between health worker stigma and uptake of HIV counseling and testing and utilization of non-HIV health services: the experience of male and female sex workers in Kenya.

PubMed

Nyblade, Laura; Reddy, Aditi; Mbote, David; Kraemer, John; Stockton, Melissa; Kemunto, Caroline; Krotki, Karol; Morla, Javier; Njuguna, Stella; Dutta, Arin; Barker, Catherine

2017-11-01

The barrier HIV-stigma presents to the HIV treatment cascade is increasingly documented; however less is known about female and male sex worker engagement in and the influence of sex-work stigma on the HIV care continuum. While stigma occurs in all spheres of life, stigma within health services may be particularly detrimental to health seeking behaviors. Therefore, we present levels of sex-work stigma from healthcare workers (HCW) among male and female sex workers in Kenya, and explore the relationship between sex-work stigma and HIV counseling and testing. We also examine the relationship between sex-work stigma and utilization of non-HIV health services. A snowball sample of 497 female sex workers (FSW) and 232 male sex workers (MSW) across four sites was recruited through a modified respondent-driven sampling process. About 50% of both male and female sex workers reported anticipating verbal stigma from HCW while 72% of FSW and 54% of MSW reported experiencing at least one of seven measured forms of stigma from HCW. In general, stigma led to higher odds of reporting delay or avoidance of counseling and testing, as well as non-HIV specific services. Statistical significance of relationships varied across type of health service, type of stigma and gender. For example, anticipated stigma was not a significant predictor of delay or avoidance of health services for MSW; however, FSW who anticipated HCW stigma had significantly higher odds of avoiding (OR = 2.11) non-HIV services, compared to FSW who did not. This paper adds to the growing evidence of stigma as a roadblock in the HIV treatment cascade, as well as its undermining of the human right to health. While more attention is being paid to addressing HIV-stigma, it is equally important to address the key population stigma that often intersects with HIV-stigma.

Profile of female sex workers in a Chinese county: does it differ by where they came from and where they work?

PubMed

Fang, Xiaoyi; Li, Xiaoming; Yang, Hongmei; Hong, Yan; Zhao, Ran; Dong, Baiqing; Liu, Wei; Zhou, Yuejiao; Liang, Shaoling; Stanton, Bonita

2007-01-01

Since the 1980s, informal or clandestine sex work in the service or entertainment industry has spread from municipalities to small towns in most areas of China. Despite recognition of the important role of female sex workers in HIV and STD epidemics in China, limited data are available regarding their individual characteristics and the social and environmental context of their work. Furthermore, most existing studies on commercial sex in China have been conducted in large cities or tourist attractions. Using data from 454 female sex workers in a rural Chinese county, the current study was designed to explore the individual profiles of commercial sex workers and to examine whether the profile and sexual risk behaviour differ by where the female sex workers came from and where they work. The sample in the current study was different from previous studies in a number of key individual characteristics. However, similarly to previous studies, the subjects in the current study were driven into commercial sex by poverty or limited employment opportunities, lived a stressful life, were subject to sexual harassment and related violence, and engaged in a number of health-compromising behaviours including behaviours that put them at risk of HIV/STD infection and depression. The findings of the current study underscore the urgent need for effective HIV/STD prevention, intervention and mental health promotion programs among female sex workers in China. The data in the current study suggest a strong association of individual profile with the economic conditions of work sites and residence status (in-province residency vs. out-of-province residency), which suggests that such efforts must take the social and cultural contextual factors of working environment (and sexual risks) into consideration.

Profile of female sex workers in a Chinese county: Does it differ by where they came from and where they work?

PubMed Central

Fang, Xiaoyi; Li, Xiaoming; Yang, Hongmei; Hong, Yan; Zhao, Ran; Dong, Baiqing; Liu, Wei; Zhou, Yuejiao; Liang, Shaoling; Stanton, Bonita

2007-01-01

Since the 1980s, informal or clandestine sex work in the service or entertainment industry has spread from municipalities to small towns in most areas of China. Despite recognition of the important role of female sex workers in HIV and STD epidemics in China, limited data are available regarding their individual characteristics and social and environmental context of their work. Furthermore, most existing studies on commercial sex in China have been conducted in large cities or tourist attractions. Using data from 454 female sex workers in a rural Chinese county, the current study was designed to explore the individual profile of commercial sex workers and to examine whether the profile and sexual risk behavior differ by where the female sex workers came from and where they work. The sample in the current study was different from previous studies in a number of key individual characteristics. However, similar to previous studies, the sample in the current study were driven into commercial sex by poverty or limited employment opportunities, lived in a stressful life, were subject to sexual harassment and related violence, and engaged in a number of health-compromising behaviors including behaviors that put them at risk of HIV/STD infection and depression. The findings of the current study underscore the urgent needs for effective HIV/STD prevention intervention and mental health promotion program among female sex workers in China. The data in the current study suggest a strong association of individual profile with the economic conditions of work sites and residence status (in-province residency versus out-province residence) which suggests that such efforts must take the social and cultural contextual factors of their working environment (and sexual risks) into consideration. PMID:18270499

Narratives of Violence, Pathology, and Empowerment: Mental Health Needs Assessment of Home-Based Female Sex Workers in Rural India.

PubMed

Sardana, Srishti; Marcus, Marina; Verdeli, Helen

2016-08-01

This study explores the narratives of psychological distress and resilience among a group of female sex workers who use residential spaces to attend to clients in rural India. The narratives reflect the lived experiences of these women. They describe the women's reasons for opting into sex work; guilt, shame, and stigma related to their sex worker status; experiences with intimate partner and domestic violence; health-related problems; communication with their family members about their sex worker status; mental health referral practices among the women; and elements of resilience and strength that they experience within themselves and within their community of fellow sex workers. The article also offers elements of our own experiences of recruiting the women to participate in the focus group, training local outreach workers in conducting focus group discussions, and forging a collaboration with a local community-based organization to highlight important barriers, challenges, and strategies for planning a group-based discussion to explore the mental health needs of home-based sex workers. © 2016 Wiley Periodicals, Inc.

Exploring the impact of underage sex work among female sex workers in two Mexico-US border cities.

PubMed

Goldenberg, Shira M; Rangel, Gudelia; Vera, Alicia; Patterson, Thomas L; Abramovitz, Daniela; Silverman, Jay G; Raj, Anita; Strathdee, Steffanie A

2012-05-01

Although sex work and younger age increase HIV vulnerability, empirical data regarding the impacts of underage sex work are lacking. We explored associations between features of the risk environment, sex work, and drug use history, and underage sex work entry among 624 female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico. Forty-one percent (n = 253) of women began sex work as minors, among whom HIV and any STI/HIV prevalence were 5.2 and 60.7%. Factors independently associated with increased odds of underage sex work were inhalants as the first drug used, forced first injection, number of drug treatment attempts, and recent receptive syringe sharing. Number of recent condom negotiation attempts with steady partners and depression as a reason for first injecting were negatively associated with underage entry. These results underscore the importance of efforts to prevent underage sex work and the wider factors contributing to HIV risk among vulnerable youth and underage FSWs.

Demography and sex work characteristics of female sex workers in India

PubMed Central

Dandona, Rakhi; Dandona, Lalit; Kumar, G Anil; Gutierrez, Juan Pablo; McPherson, Sam; Samuels, Fiona; Bertozzi, Stefano M

2006-01-01

Background The majority of sex work in India is clandestine due to unfavorable legal environment and discrimination against female sex workers (FSWs). We report data on who these women are and when they get involved with sex work that could assist in increasing the reach of HIV prevention activities for them. Methods Detailed documentation of demography and various aspects of sex work was done through confidential interviews of 6648 FSWs in 13 districts in the Indian state of Andhra Pradesh. The demography of FSWs was compared with that of women in the general population. Results A total of 5010 (75.4%), 1499 (22.5%), and 139 (2.1%) street-, home-, and brothel-based FSWs, respectively, participated. Comparison with women of Andhra Pradesh revealed that the proportion of those aged 20–34 years (75.6%), belonging to scheduled caste (35.3%) and scheduled tribe (10.5%), illiterate (74.7%), and of those separated/divorced (30.7%) was higher among FSWs (p < 0.001). The FSWs engaged in sex work for >5 years were more likely to be non-street-based FSWs, illiterate, living in small urban towns, and to have started sex work between 12–15 years of age. The mean age at starting sex work (21.7 years) and gap between the first vaginal intercourse and the first sexual intercourse in exchange for money (6.6 years) was lower for FSWs in the rural areas as compared with those in large urban areas (23.9 years and 8.8 years, respectively). Conclusion These data highlight that women struggling with illiteracy, lower social status, and less economic opportunities are especially vulnerable to being infected by HIV, as sex work may be one of the few options available to them to earn money. Recommendations for actions are made for long-term impact on reducing the numbers of women being infected by HIV in addition to the current HIV prevention efforts in India. PMID:16615869

Leaving sex work: barriers, facilitating factors and consequences for female sex workers in northern Thailand.

PubMed

Manopaiboon, C; Bunnell, R E; Kilmarx, P H; Chaikummao, S; Limpakarnjanarat, K; Supawitkul, S; St Louis, M E; Mastro, T D

2003-02-01

Factors facilitating or inhibiting women's ability to leave sex work are still poorly characterized, and little is known about women's lives after they leave the profession. This paper presents findings from a qualitative study about factors affecting women's ability to leave sex work and influencing their lives after leaving. We interviewed 42 current and former female sex workers (FSWs) drawn from a cohort study of 500 FSWs in northern Thailand. All but one of the participants had quit sex work at least once. The majority experienced one or more quit-re-entry-quit cycles. Women's ability and decisions to leave sex work were determined primarily by four factors: economic situation, relationship with a steady partner, attitudes towards sex work and HIV/AIDS experience. Economic concerns, ranging from survival needs to materialistic desires, had the strongest influence. Most women perceived their risk for HIV infection to be lower after leaving sex work, but three of the 17 HIV-infected women acquired infection after having left, presumably from their steady partners. Prevention efforts should guide women as they transition out of commercial sex work. Interventions aimed at assisting women wanting to leave sex work need to address the role of economic factors.

Love, power, resilience and vulnerability: relationship dynamics between female sex workers in Ghana and their intimate partners.

PubMed

Onyango, Monica Adhiambo; Adu-Sarkodie, Yaw; Adjei, Rose Odotei; Agyarko-Poku, Thomas; Kopelman, Carol Hunsberger; Green, Kimberly; Wambugu, Samuel; Clement, Nana Fosua; Wondergem, Peter; Beard, Jennifer

2018-04-19

Little is known about female sex workers' daily lives or emotional relationships. Using relational-cultural theory, this study explored the relationship dynamics between sex workers and their intimate partners in Kumasi, Ghana. We collected qualitative data from 37 male intimate partners through 24 in-depth interviews and two focus group discussions (FGDs) with 13 male partners. We also conducted three FGDs with 20 women involved in sex work. Relationships between sex workers and their intimate partners were mutual, reciprocal and transactional. Male partners provided protection for financial support, a place to sleep and intimacy. Both men and women described their relationships in terms of friendship, love and a hopeful future. Women were reluctant to quit sex work because they depended on it for income. Most respondents did not use condoms in these romantic relationships, citing trust, love, faithfulness and commitment. Both men and women described high levels of violence in their relationships. The context of sex work heightens vulnerability but also appears to facilitate resilience and creative coping strategies. The relational dynamics between sex workers and their intimate partners in Ghana merit further exploration to examine the extent to which women involved in sex work hold and exert power within these relationships.

HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review.

PubMed

Tokar, Anna; Broerse, Jacqueline E W; Blanchard, James; Roura, Maria

2018-02-20

HIV testing uptake continues to be low among Female Sex Workers (FSWs). We synthesizes evidence on barriers and facilitators to HIV testing among FSW as well as frequencies of testing, willingness to test, and return rates to collect results. We systematically searched the MEDLINE/PubMed, EMBASE, SCOPUS databases for articles published in English between January 2000 and November 2017. Out of 5036 references screened, we retained 36 papers. The two barriers to HIV testing most commonly reported were financial and time costs-including low income, transportation costs, time constraints, and formal/informal payments-as well as the stigma and discrimination ascribed to HIV positive people and sex workers. Social support facilitated testing with consistently higher uptake amongst married FSWs and women who were encouraged to test by peers and managers. The consistent finding that social support facilitated HIV testing calls for its inclusion into current HIV testing strategies addressed at FSW.

Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya.

PubMed

White, Darcy; Wilson, Kate S; Masese, Linnet N; Wanje, George; Jaoko, Walter; Mandaliya, Kishorchandra; Richardson, Barbra A; Kinuthia, John; Simoni, Jane M; McClelland, R Scott

2016-10-01

Studies of alcohol use and sexual behavior in African populations have primarily been cross-sectional, used nonvalidated measures of alcohol use, or relied on self-reported sexual risk endpoints. Few have focused on human immunodeficiency virus (HIV)-positive women. Longitudinal data were collected from a cohort of HIV-positive Kenyan female sex workers. At enrollment and annual visits, participants were asked about past-year alcohol use using the Alcohol Use Disorders Identification Test (AUDIT). The primary endpoint was detection of prostate-specific antigen (PSA) in vaginal secretions at quarterly examinations. Associations between hazardous/harmful alcohol use (AUDIT score ≥7), PSA detection, and secondary measures of sexual risk were evaluated using generalized estimating equations with a log binomial regression model. A total of 405 women contributed 2750 vaginal samples over 606 person-years of follow-up. Hazardous/harmful alcohol use was reported at 16.6% of AUDIT assessments and was associated with higher risk of PSA detection (relative risk 1.50; 95% confidence interval, 1.11-2.01) relative to no alcohol use. This association was attenuated and no longer statistically significant, after adjusting for age, work venue, intimate partner violence, depression, and partnership status (adjusted relative risk, 1.13; 95% confidence interval, 0.82-1.56). In exploratory analyses, alcohol use was associated with self-report of unprotected sex and with sexually transmitted infection acquisition. Although hazardous/harmful alcohol use was not associated with detection of PSA in adjusted analysis, associations with secondary outcomes suggest that alcohol use is at least a marker of sexual risk behavior.

A Framework for Sexual Decision-Making Among Female Sex Workers in Jamaica.

PubMed

Bailey, Althea; Figueroa, J Peter

2016-05-01

The Jamaican government has provided targeted HIV and sexually transmitted infection prevention, treatment, and other services for female sex workers (FSW) since 1989. HIV prevalence among FSW declined from 20 to 12% between 1989 and 1994, then to 9% in 2005, 5% in 2008, and 4.1% in 2011. This article distills the literature and two decades of experience working with FSW in Jamaica. Drawing on the constant comparative method, we put forward an innovative conceptual framework for explaining sexual decision-making and risk behaviors within both transactional and relational sexual situations. This framework helps fill the gaps in existing models that focus on individual behaviors. The model identifies interactions between environmental and structural elements of sex work, and three individual-level factors: risk perception, perceived relationship intimacy, and perceived control, as the four primary mediating factors influencing sexual decision-making among FSW. We propose that other factors such as violence, socioeconomic vulnerability, and policy/legal frameworks influence sexual decision-making through these primary mediating factors. This conceptual model may offer a useful framework for planning and evaluating prevention interventions among sex workers. However, it remains to be tested in order to establish its value.

A comparison of respondent-driven and venue-based sampling of female sex workers in Liuzhou, China

PubMed Central

Weir, Sharon S; Merli, M Giovanna; Li, Jing; Gandhi, Anisha D; Neely, William W; Edwards, Jessie K; Suchindran, Chirayath M; Henderson, Gail E; Chen, Xiang-Sheng

2012-01-01

Objectives To compare two methods for sampling female sex workers (FSWs) for bio-behavioural surveillance. We compared the populations of sex workers recruited by the venue-based Priorities for Local AIDS Control Efforts (PLACE) method and a concurrently implemented network-based sampling method, respondent-driven sampling (RDS), in Liuzhou, China. Methods For the PLACE protocol, all female workers at a stratified random sample of venues identified as places where people meet new sexual partners were interviewed and tested for syphilis. Female workers who reported sex work in the past 4 weeks were categorised as FSWs. RDS used peer recruitment and chain referral to obtain a sample of FSWs. Data were collected between October 2009 and January 2010. We compared the socio-demographic characteristics and the percentage with a positive syphilis test of FSWs recruited by PLACE and RDS. Results The prevalence of a positive syphilis test was 24% among FSWs recruited by PLACE and 8.5% among those recruited by RDS and tested (prevalence ratio 3.3; 95% CI 1.5 to 7.2). Socio-demographic characteristics (age, residence and monthly income) also varied by sampling method. PLACE recruited fewer FSWs than RDS (161 vs 583), was more labour-intensive and had difficulty gaining access to some venues. RDS was more likely to recruit from areas near the RDS office and from large low prevalence entertainment venues. Conclusions Surveillance protocols using different sampling methods can obtain different estimates of prevalence and population characteristics. Venue-based and network-based methods each have strengths and limitations reflecting differences in design and assumptions. We recommend that more research be conducted on measuring bias in bio-behavioural surveillance. PMID:23172350

Predictors of Sexually Transmitted Infections among Female Sex Workers (FSWs) in a City of Northern India

PubMed Central

Shukla, Pallavi; Masood, Jamal; Singh, J. V.; Singh, V. K.; Gupta, Abhishek; Krishna, Asuri

2015-01-01

Introduction: Sexually transmitted infections (STIs) and Reproductive tract infections RTIs are important public health problems in India. The prevalence of these infections is considerably higher among high risk groups (HRGs) ranging from 20-30%. It is high time that a study should be conducted to explore different factors and conditions responsible for the practice of unsafe sex among female sex workers (FSWs) in Uttar Pradesh (UP) and the impact of this on social life and health of FSWs. As Lucknow provides a comprehensive opportunity in terms of tourism, occupation, and economy, it becomes a potential hub for sex work. Studying FSW in Lucknow can thus be considered as a yardstick for the entire FSW population of UP population. The present study was thus planned with the objective of knowing the STI prevalence and its determinants among FSWs. Materials and Methods: A cross-sectional descriptive study was conducted on FSWs registered with Targeted Intervention-Non-government Organization (TI-NGO), registered with Uttar Pradesh State Acquired Immuno Deficiency Syndrome (AIDS) Control Society (UPSACS) of Lucknow city. Total 288 subjects were studied. Results: The average age of FSWs was 31 years. FSWs were mostly Hindus and illiterate. The overall prevalence of STI as per Syndromic diagnosis was found to be 35.8%. However, the percentage of FSWs with STI was higher in street-based (50.6%) than home-based (29.8%). Majority (42.7%) of sex workers with STI had non-regular partners only while majority (52.4%) of sex workers without any STI had only regular partners. Condom usage with regular partners was poor. However, with the non-regular partners the condom usage was better. On multivariate analysis being single, having sex work as a sole means of earning, duration of sex work > 2 years, having pallor, and giving in to client's demand for unsafe sex were found to be significant in causing STI. Conclusions: Prevalence of STI among the female sex workers as per

Predictors of Sexually Transmitted Infections among Female Sex Workers (FSWs) in a City of Northern India.

PubMed

Shukla, Pallavi; Masood, Jamal; Singh, J V; Singh, V K; Gupta, Abhishek; Krishna, Asuri

2015-01-01

Sexually transmitted infections (STIs) and Reproductive tract infections RTIs are important public health problems in India. The prevalence of these infections is considerably higher among high risk groups (HRGs) ranging from 20-30%. It is high time that a study should be conducted to explore different factors and conditions responsible for the practice of unsafe sex among female sex workers (FSWs) in Uttar Pradesh (UP) and the impact of this on social life and health of FSWs. As Lucknow provides a comprehensive opportunity in terms of tourism, occupation, and economy, it becomes a potential hub for sex work. Studying FSW in Lucknow can thus be considered as a yardstick for the entire FSW population of UP population. The present study was thus planned with the objective of knowing the STI prevalence and its determinants among FSWs. A cross-sectional descriptive study was conducted on FSWs registered with Targeted Intervention-Non-government Organization (TI-NGO), registered with Uttar Pradesh State Acquired Immuno Deficiency Syndrome (AIDS) Control Society (UPSACS) of Lucknow city. Total 288 subjects were studied. The average age of FSWs was 31 years. FSWs were mostly Hindus and illiterate. The overall prevalence of STI as per Syndromic diagnosis was found to be 35.8%. However, the percentage of FSWs with STI was higher in street-based (50.6%) than home-based (29.8%). Majority (42.7%) of sex workers with STI had non-regular partners only while majority (52.4%) of sex workers without any STI had only regular partners. Condom usage with regular partners was poor. However, with the non-regular partners the condom usage was better. On multivariate analysis being single, having sex work as a sole means of earning, duration of sex work > 2 years, having pallor, and giving in to client's demand for unsafe sex were found to be significant in causing STI. Prevalence of STI among the female sex workers as per Syndromic diagnosis was found to be 35.8%. Unemployment, anemia

Structural and Interpersonal Benefits and Risks of Participation in HIV Research: Perspectives of Female Sex Workers in Guatemala

PubMed Central

Goldenberg, Shira M.; Mindt, Monica Rivera; Jimenez, Teresita Rocha; Brouwer, Kimberly C.; Miranda, Sonia Morales; Fisher., Celia B.

2016-01-01

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. PMID:27840564

Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers.

PubMed

Mutua, Gaudensia; Sanders, Eduard; Mugo, Peter; Anzala, Omu; Haberer, Jessica E; Bangsberg, David; Barin, Burc; Rooney, James F; Mark, David; Chetty, Paramesh; Fast, Patricia; Priddy, Frances H

2012-01-01

Little is known about safety of and adherence to intermittent HIV PrEP regimens, which may be more feasible than daily dosing in some settings. We present safety and adherence data from the first trial of an intermittent PrEP regimen among Kenyan men who have sex with men (MSM) and female sex workers (FSW). MSM and FSW were randomized to daily oral FTC/TDF or placebo, or intermittent (Monday, Friday and within 2 hours after sex, not to exceed one dose per day) oral FTC/TDF or placebo in a 2:1:2:1 ratio; volunteers were followed monthly for 4 months. Adherence was assessed with the medication event monitoring system (MEMS). Sexual activity data were collected via daily text message (SMS) queries and timeline followback interviews with a one-month recall period. Sixty-seven men and 5 women were randomized into the study. Safety was similar among all groups. Median MEMS adherence rates were 83% [IQR: 63-92] for daily dosing and 55% [IQR:28-78] for fixed intermittent dosing (p = 0.003), while adherence to any post-coital doses was 26% [IQR:14-50]. SMS response rates were low, which may have impaired measurement of post-coital dosing adherence. Acceptability of PrEP was high, regardless of dosing regimen. Adherence to intermittent dosing regimens, fixed doses, and in particular coitally-dependent doses, may be more difficult than adherence to daily dosing. However, intermittent dosing may still be appropriate for PrEP if intracellular drug levels, which correlate with prevention of HIV acquisition, can be attained with less than daily dosing and if barriers to adherence can be addressed. Additional drug level data, qualitative data on adherence barriers, and better methods to measure sexual activity are necessary to determine whether adherence to post-coital PrEP could be comparable to more standard regimens. ClinicalTrials.gov NCT00971230.

Viral hepatitis in female sex workers using the Respondent-Driven Sampling

PubMed Central

de Matos, Marcos André; França, Divânia Dias da Silva; Carneiro, Megmar Aparecida dos Santos; Martins, Regina Maria Bringel; Kerr, Lígia Regina Franco Sansigolo; Caetano, Karlla Antonieta Amorim; Pinheiro, Raquel Silva; de Araújo, Lyriane Apolinário; Mota, Rosa Maria Salani; de Matos, Marcia Alves Dias; Motta-Castro, Ana Rita Coimbra; Teles, Sheila Araújo

2017-01-01

ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6–23.4) and 0.7% (95%CI 0.1–1.5), respectively. Only 28% (95%CI 21.1–36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil. PMID:28678904

Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico.

PubMed

Goldenberg, Shira M; Gallardo Cruz, Manuel; Strathdee, Steffanie A; Nguyen, Lucie; Semple, Shirley J; Patterson, Thomas L

2010-05-01

Tijuana, situated adjacent to San Diego, CA on the US-Mexico border, is experiencing an emerging HIV epidemic, with prevalence among female sex workers (FSWs) having risen in recent years from <1% to 6%. Comparable data on FSWs' clients are lacking. We explored correlates of unprotected sex with FSWs among male clients in Tijuana. In 2008, males from San Diego (N = 189) and Tijuana (N = 211) aged 18 or older who had paid or traded for sex with a FSW in Tijuana during the past 4 months were recruited in Tijuana's red light district. Participants underwent psychosocial interviews, and were tested for HIV, syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), and Chlamydia (Chlamydia trachomatis). Of 394 men, median age was 36 years, 42.1% were married, and 39.3% were unemployed. Ethnic composition was 13.2% white, 79.4% Hispanic, and 7.4% black or other. Half (50.3%) reported unprotected vaginal or anal sex with FSWs in Tijuana in the past 4 months. High proportions reported using drugs during sex (66%), and 36% reported frequenting the same FSW. Factors independently associated with unprotected sex with FSWs were using drugs during sex, visiting the same FSW, being married, and being unemployed. FSWs' clients represent a sexually transmitted infections/HIV transmission "bridge" through unprotected sex with FSWs, wives, and other partners. Tailored interventions to promote consistent condom use are needed for clients, especially within the context of drug use and ongoing relations with particular FSWs.

Client retention and health among sex workers in Nairobi, Kenya.

PubMed

Izugbara, Chimaraoke O

2012-12-01

It is still a small body of research that directly addresses female sex workers' relationships with their regular commercial male partners. I used ethnographic data from Nairobi, Kenya to interrogate motivations and strategies for recruiting and retaining regular male clients among female sex workers (FSWs). Regular commercial male partners, popularly called customer care, wera or wesh by Nairobi's FSWs, played diverse roles in their lives. Client retention enabled sex workers to manage the risk of reduced marriage prospects, guaranteed them steady work, livelihoods, and incomes, and prevented their victimization and harassment. To retain clients, sex workers obliged them a great deal, pretended they had quit prostitution, and sometimes resorted to magical practices. However, these strategies were also accompanied by risks that reinforced the vulnerability of sex workers. Lack of critical attention to sex workers' practices for managing perceived risks in their particular type of work may hamper current programmatic efforts to make their job safer.

Workplace violence among female sex workers who use drugs in Vancouver, Canada: does client-targeted policing increase safety?

PubMed

Prangnell, Amy; Shannon, Kate; Nosova, Ekaterina; DeBeck, Kora; Milloy, M-J; Kerr, Thomas; Hayashi, Kanna

2018-02-01

Workplace violence, by clients or predators, poses serious negative health consequences for sex workers. In 2013, the Vancouver (British Columbia), Canada Police Department changed their guidelines with the goal of increasing safety for sex workers by focusing law enforcement on clients and third parties, but not sex workers. We sought to examine the trends and correlates of workplace violence among female sex workers (FSW) before and after the guideline change, using data collected from prospective cohorts of persons who use illicit drugs in Vancouver, Canada. Among 259 FSW, 21.0% reported workplace violence at least once during the study period between 2008 and 2014. There was no statistically significant change in rates of workplace violence after the guideline change. In our multivariable analysis, daily heroin use was independently associated with workplace violence. The 2013 policing guideline change did not appear to have resulted in decreased reports of workplace violence. Increased access to opioid agonist therapies may reduce workplace violence among drug-using FSW.

Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon

PubMed Central

Tihnje, Mbah Abena; Vukugah, Thomas Achombwom; Tarkang, Elvis Enowbeyang; Mbu, Robinson Enow

2018-01-01

Introduction The purpose of this study was to examine the relationship between socio-demographic characteristics, risky sexual behaviour, alcohol use and transactional sex among female bar workers in Yaounde, Cameroon. Materials and methods A cross-sectional survey was conducted among a representative sample of 410 female bar workers, recruited through a modified version of venue-based cluster sampling technique from May to June 2017. Transactional sex was defined as having received money/gifts in exchange for sex with any sexual partner in the past 12 months. Logistic regression models were performed to identify the factors associated with transactional sex. The level of statistical significance was set at p< = 0.05. Results About 14.9% (n = 61) of respondents reported to have engaged in transactional sex, 83.7% (n = 338) had multiple sexual partners at the time of the study, 14.4% (n = 55) had sex with one or more of their male customers in the past 6 months. Almost 73.4% (n = 301) reported alcohol use. Of these, 37.2% (n = 112) were frequent alcohol consumers. About 17.6% (n = 72) reported to have had unprotected sex under the influence of alcohol in the past 6 months. Multivariate logistic regression analysis showed that those who engaged in transactional sex were more likely to have had sex with a male customer in the past 6 months (aOR = 7.34; 95% CI, 3.63–16.98), had sex under the influence of alcohol in the past 6 months (aOR = 2.42; 95% CI, 1.18–4.96) and frequent alcohol consumers (aOR = 2.06; 95%CI, 1.04–4.10). Respondents who had their last sexual intercourse 4 weeks or more prior to the study (aOR = 0.26; 95% CI, 0.08–0.84) were less likely to have engaged in transactional sex. Conclusions Our study concludes that female bar workers are exposed to male customers and engage in risky sexual practices including transaction sex. Most of them also consume alcohol which increases their risk of HIV and STI acquisition. They are a high-risk group that

Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon.

PubMed

Akoku, Derick Akompab; Tihnje, Mbah Abena; Vukugah, Thomas Achombwom; Tarkang, Elvis Enowbeyang; Mbu, Robinson Enow

2018-01-01

The purpose of this study was to examine the relationship between socio-demographic characteristics, risky sexual behaviour, alcohol use and transactional sex among female bar workers in Yaounde, Cameroon. A cross-sectional survey was conducted among a representative sample of 410 female bar workers, recruited through a modified version of venue-based cluster sampling technique from May to June 2017. Transactional sex was defined as having received money/gifts in exchange for sex with any sexual partner in the past 12 months. Logistic regression models were performed to identify the factors associated with transactional sex. The level of statistical significance was set at p< = 0.05. About 14.9% (n = 61) of respondents reported to have engaged in transactional sex, 83.7% (n = 338) had multiple sexual partners at the time of the study, 14.4% (n = 55) had sex with one or more of their male customers in the past 6 months. Almost 73.4% (n = 301) reported alcohol use. Of these, 37.2% (n = 112) were frequent alcohol consumers. About 17.6% (n = 72) reported to have had unprotected sex under the influence of alcohol in the past 6 months. Multivariate logistic regression analysis showed that those who engaged in transactional sex were more likely to have had sex with a male customer in the past 6 months (aOR = 7.34; 95% CI, 3.63-16.98), had sex under the influence of alcohol in the past 6 months (aOR = 2.42; 95% CI, 1.18-4.96) and frequent alcohol consumers (aOR = 2.06; 95%CI, 1.04-4.10). Respondents who had their last sexual intercourse 4 weeks or more prior to the study (aOR = 0.26; 95% CI, 0.08-0.84) were less likely to have engaged in transactional sex. Our study concludes that female bar workers are exposed to male customers and engage in risky sexual practices including transaction sex. Most of them also consume alcohol which increases their risk of HIV and STI acquisition. They are a high-risk group that need to be targeted with HIV prevention interventions.

Exploring the impact of underage sex work among female sex workers in two Mexico-U.S. border cities

PubMed Central

Goldenberg, Shira M; Rangel, Gudelia; Vera, Alicia; Patterson, Thomas L; Abramovitz, Daniela; Silverman, Jay G; Raj, Anita; Strathdee, Steffanie A

2011-01-01

Although sex work and younger age increase HIV vulnerability, empirical data regarding the impacts of underage sex work are lacking. We explored associations between features of the risk environment, sex work and drug use history, and underage sex work entry among 624 female sex workers(FSWs) in Tijuana and Ciudad Juarez, Mexico. Forty-one percent (n=253) of women began sex work as minors, among whom HIV and any STI/HIV prevalence were 5.2% and 60.7%. Factors independently associated with increased odds of underage sex work were inhalants as the first drug used, forced first injection, number of drug treatment attempts, and recent receptive syringe-sharing. Number of recent condom negotiation attempts with steady partners and depression as a reason for first injecting were negatively associated with underage entry. These results underscore the importance of efforts to prevent underage sex work and the wider factors contributing to HIV risk among vulnerable youth and underage FSWs. PMID:22012147

Oral and cervical human papillomavirus infection among female sex workers in Japan.

PubMed

Matsushita, Kaori; Sasagawa, Toshiyuki; Miyashita, Michiko; Ishizaki, Azumi; Morishita, Atsushi; Hosaka, Norimitsu; Saikawa, Kunikazu; Hoshina, Shinji; Bi, Xiuqiong; Ichimura, Hiroshi

2011-01-01

It has been reported recently that oral human papillomavirus (HPV) infection is associated with oropharyngeal squamous cell carcinomas. The aim of this study was to determine the prevalence of HPV infection and HPV types in the oral cavity and cervix of female sex workers in Japan. Oral and cervical swabs were taken from 196 female sex workers who visited a clinic for regular medical checkups in 2007, and genomic DNA was extracted from those specimens. The HPV L1 gene was amplified by polymerase chain reaction (PCR) using original and modified GP5(+)/6(+) primers, and genotyping was performed using the Kurabo GeneSquare Microarray or by sequencing cloned PCR products. HPV DNA was detected in the oral cavity of 12 (6.1%) women, with HPV-56 being the most common type (7/12). Likewise, HPV DNA was detected in the cervix of 103 (52.6%) women, with HPV-52 (30/103, 29.1%), followed by HPV-16 (24.3%) and HPV-56 (18.4%), being the most common. Of the 12 women with oral HPV infection, only two were infected with the concordant HPV genotype in the cervix. These findings suggest that oral HPV infection occurs independently of cervical HPV infection in this population, and that oral HPV infection may play a role in HPV transmission in Japan.

The promise and peril of pre-exposure prophylaxis (PrEP): using social science to inform prep interventions among female sex workers.

PubMed

Syvertsen, Jennifer L; Robertson Bazzi, Angela M; Scheibe, Andrew; Adebajo, Sylvia; Strathdee, Steffanie A; Wechsberg, Wendee M

2014-09-01

Advances in biomedical interventions to prevent HIV offer great promise in reducing the number of new infections across sub- Saharan Africa, particularly among vulnerable populations such as female sex workers. Several recent trials testing pre-exposure prophylaxis (PrEP) have demonstrated efficacy, although others have been stopped early for futility. Given the importance and complexities of social and behavioural factors that influence biomedical approaches to prevention, we discuss several key areas of consideration moving forward, including trial participation, adherence strategies, social relationships, and the structural factors that shape PrEP interest, use, and potential effectiveness among female sex workers in sub-Saharan Africa. Our review highlights the importance of involving social scientists in clinical and community-based research on PrEP. We advocate for a shift away from a singular "re-medicalization" of the HIV epidemic to that of a "reintegration" of interdisciplinary approaches to prevention that could benefit female sex workers and other key populations at risk of acquiring HIV.

Acceptability of three novel HIV prevention methods among Puerto Rican male and transgender female sex workers

PubMed Central

Giguere, Rebecca; Frasca, Timothy; Dolezal, Curtis; Febo, Irma; Cranston, Ross D.; Mayer, Kenneth; McGowan, Ian; Carballo-Diéguez, Alex

2017-01-01

Male and transgender female (TGF) sex workers need HIV-prevention methods they can control and incorporate easily in their work. We explored acceptability of the use of the HIV self test with clients, oral pre-exposure prophylaxis (PrEP), and rectal microbicide gel among 12 male and TGF sex workers in Puerto Rico. At baseline, we measured likelihood of use of each method. Five sex workers also completed a 12-week study of rectal microbicide placebo gel use prior to receptive anal intercourse with clients and explored in interviews how each method could be incorporated into their work. Most were interested in a rectal microbicide gel and able to use it covertly with clients. Challenges to using the HIV self test with clients included breach of confidentiality and violent situations. They expressed some interest in oral PrEP, but had concerns about side effects. Rectal microbicides may work well for this population. PMID:27048236

Police-related experiences and HIV risk among female sex workers in Andhra Pradesh, India.

PubMed

Erausquin, Jennifer Toller; Reed, Elizabeth; Blankenship, Kim M

2011-12-01

Research suggests experiences with police are related to human immunodeficiency virus (HIV) sexual risk among women working as sex workers. However, little is known about the links between specific police-related behaviors and HIV vulnerability. We examine whether 5 police-related experiences are associated with measures of HIV risk and violence among a sample of female sex workers (FSWs) in Andhra Pradesh, India, and consider the implications for HIV prevention. FSWs at least 18 years of age (n = 835) were recruited through respondent-driven sampling for a cross-sectional survey conducted as part of Avahan, the India AIDS Initiative. Using logistic regression models adjusted for age, age at start of sex work, and sex work venue, we assessed police-related experiences reported by FSWs in relation to HIV risk behaviors and violence. Results showed having sex with police to avoid trouble, giving gifts to police to avoid trouble, having police take condoms away, experiencing a workplace raid, and being arrested were associated with sexually transmitted infection symptoms, inconsistent condom use, acceptance of more money for sex without a condom, and experience of client violence. These findings suggest a need for interventions targeting police-FSW interactions to reduce HIV vulnerability among FSWs.

Police-Related Experiences and HIV Risk Among Female Sex Workers in Andhra Pradesh, India

PubMed Central

Reed, Elizabeth; Blankenship, Kim M.

2011-01-01

Research suggests experiences with police are related to human immunodeficiency virus (HIV) sexual risk among women working as sex workers. However, little is known about the links between specific police-related behaviors and HIV vulnerability. We examine whether 5 police-related experiences are associated with measures of HIV risk and violence among a sample of female sex workers (FSWs) in Andhra Pradesh, India, and consider the implications for HIV prevention. FSWs at least 18 years of age (n = 835) were recruited through respondent-driven sampling for a cross-sectional survey conducted as part of Avahan, the India AIDS Initiative. Using logistic regression models adjusted for age, age at start of sex work, and sex work venue, we assessed police-related experiences reported by FSWs in relation to HIV risk behaviors and violence. Results showed having sex with police to avoid trouble, giving gifts to police to avoid trouble, having police take condoms away, experiencing a workplace raid, and being arrested were associated with sexually transmitted infection symptoms, inconsistent condom use, acceptance of more money for sex without a condom, and experience of client violence. These findings suggest a need for interventions targeting police–FSW interactions to reduce HIV vulnerability among FSWs. PMID:22043036

HIV testing behaviors among female sex workers in Southwest China.

PubMed

Hong, Yan; Zhang, Chen; Li, Xiaoming; Fang, Xiaoyi; Lin, Xiuyun; Zhou, Yuejiao; Liu, Wei

2012-01-01

Despite the recognized importance of HIV testing in prevention, care and treatment, HIV testing remains low in China. Millions of female sex workers (FSW) play a critical role in China's escalating HIV epidemic. Limited data are available regarding HIV testing behavior among this at-risk population. This study, based on a cross-sectional survey of 1,022 FSW recruited from communities in Southwest China, attempted to address the literature gap. Our data revealed that 48% of FSW ever took HIV testing; older age, less education, working in higher-income commercial sex venues and better HIV knowledge were associated with HIV testing. Those who never took HIV testing were more likely to engage in high-risk behaviors including inconsistent condom use with clients and stable partners. A number of psychological and structural barriers to testing were also reported. We call for culturally appropriate interventions to reduce HIV risks and promote HIV testing for vulnerable FSW in China.

A border context of violence: Mexican female sex workers on the U.S.-Mexico border.

PubMed

Cepeda, Alice; Nowotny, Kathryn M

2014-12-01

Female sex workers (FSW) represent a population confronted with an array of intersecting social problems. We explore the case of FSW in Nuevo Laredo and Ciudad Juarez to understand the everyday violence associated with sex work within the unique context of Mexico. Life history interviews were conducted with 109 FSW revealing violent acts by clients and other sex industry employees (bar owners, police, other FSW). The risk of violence by different types of persons associated with the sex work industry varied by venue and geographic area. Moreover, the violence was shaped by the social structural constraints of dominant gender ideologies. © The Author(s) 2014.

Violence as a Barrier for HIV Prevention among Female Sex Workers in Argentina

PubMed Central

Pando, María A.; Coloccini, Romina S.; Reynaga, Elena; Rodriguez Fermepin, Marcelo; Gallo Vaulet, Lucia; Kochel, Tadeusz J.; Montano, Silvia M.; Avila, María M.

2013-01-01

Background Violence against female sex workers (FSWs) has been increasingly reported as an important determinant of HIV infection risk. This study explores the frequency of different violent experiences (sexual abuse, rejection, beating and imprisonment) among FSWs in Argentina and its association with condom use and HIV and T. pallidum prevalence. Methods A convenience sample of 1255 FSWs was included in a cross-sectional study conducted between October 2006 and November 2009. Results Sexual abuse was reported by 24.1% (219/907) of women. A total of 34.7% (42/1234) reported rejection experiences, 21.9% (267/1215) reported having been beaten and 45.4% (561/1236) stated having been arrested because of their sex work activity. There was a higher frequency of inconsistent condom use with clients among FSWs who had experienced sexual abuse, rejection, and police detention. A higher frequency of HIV and T. pallidum infection was detected among FSWs who reported having been arrested by the police. Conclusion The study shows for the first time the frequency of different violent situations among FSWs in Argentina. The association between violence against sex workers, condom use and STI prevalence demonstrated here calls for measures to reduce stigma and violence against FSWs. Such violent experiences may increase vulnerability to STI through coerced unprotected sex. PMID:23342092

The first community-based sexually transmitted disease/HIV intervention trial for female sex workers in China.

PubMed

Wu, Zunyou; Rou, Keming; Jia, Manhong; Duan, Song; Sullivan, Sheena G

2007-12-01

This study was the first community-based intervention to test feasibility and effectiveness of an intervention targeting sex workers in China. Prospective, community-based, pre/post-intervention trial. Thirty establishments in Chengjiang, 34 in Ruili and 23 in Longchuan were selected for the study. The study participants were female sex workers. Out-reach workers visited the establishments to conduct intervention activities over 6 weeks. The activities included lectures, discussion, video and audio cassettes, and distribution of educational folders and condoms. Pre- and post-intervention cross-sectional surveys assessed changes in sexually transmitted disease (STD)/AIDS knowledge and condom use. After the intervention, knowledge of the three HIV transmission routes increased from 25 to 88% (P < 0.01), knowledge that condoms can reduce the risk of STD/HIV infection increased from 56 to 94% (P < 0.01). Condom use at last sex and in the last three sexual encounters increased from 61 to 85% (P < 0.01) and from 41 to 70%, respectively. Multivariate analyses indicated that the intervention was an independent factor (P < 0.01) for these changes. The intervention programme was effective at increasing HIV/AIDS knowledge and condom use rates among sex workers in the community and should be expanded.

Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in Northern Mexico

PubMed Central

Morris, Meghan D.; Lemus, Hector; Wagner, Karla D.; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A.

2012-01-01

Aims To identify factors associated with time to initiation of (1) sex work prior to injecting drugs, (2) injection drug use, and (3) concurrent sex work and injection drug use (i.e., initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Design Parametric survival analysis of baseline data for time to initiation event. Setting Tijuana and Ciudad Juarez situated on the Mexico-U.S. border. Participants 575 FSW-IDUs aged ≥18. Measurements Interview-administered surveys assessing context of sex work and injection drug use initiation. Findings Nearly half (n=256) initiated sex work prior to beginning to inject, a third (n=163) initiated injection first, and a quarter (n=136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Conclusions Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one third initiate injection drug use before beginning sex work, and one quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. PMID:22775475

Motivations for entry into sex work and HIV risk among mobile female sex workers in India.

PubMed

Saggurti, Niranjan; Verma, Ravi K; Halli, Shiva S; Swain, Suvakanta N; Singh, Rajendra; Modugu, Hanimi Reddy; Ramarao, Saumya; Mahapatra, Bidhubhusan; Jain, Anrudh K

2011-09-01

This paper assesses the reasons for entry into sex work and its association with HIV risk behaviours among mobile female sex workers (FSWs) in India. Data were collected from a cross-sectional survey conducted in 22 districts across four high HIV prevalence states in India during 2007-2008. Analyses were limited to 5498 eligible mobile FSWs. The reasons given by FSWs for entering sex work and associations with socio-demographic characteristics were assessed. Reported reasons for entering sex work include poor or deprived economic conditions; negative social circumstances in life; own choice; force by an external person; and family tradition. The results from multivariate analyses indicate that those FSWs who entered sex work due to poor economic conditions or negative social circumstances in life or force demonstrated elevated levels of current inconsistent condom use as well as in the past in comparison with those FSWs who reported entering sex work by choice or family tradition. This finding indicates the need for a careful assessment of the pre-entry contexts among HIV prevention interventions since these factors may continue to hinder the effectiveness of efforts to reduce the spread of HIV/AIDS in India and elsewhere.

'You already drank my beer, I can decide anything': using structuration theory to explore the dynamics of alcohol use, gender-based violence and HIV risk among female sex workers in Tanzania.

PubMed

Leddy, Anna M; Kerrigan, Deanna; Kennedy, Caitlin E; Mbwambo, Jessie; Likindikoki, Samuel; Underwood, Carol R

2018-03-16

Female sex workers experience high rates of gender-based violence and HIV. Alcohol has been shown to facilitate women's risk of both gender-based violence and HIV; however, little research has explored how aspects of the sex work environment shape this risk. Drawing on structuration theory, this study explored how social conduct is patterned across time and space within the sex work environment to influence alcohol consumption, gender-based violence and HIV risk among female sex workers. Qualitative in-depth interviews were conducted with 24 female sex workers enrolled in an ongoing community randomised controlled trial of a combination HIV prevention intervention in Iringa, Tanzania. Data were analysed using both inductive and deductive approaches. Findings reveal how routine interactions between female sex workers and their clients occur at three moments of time and space during the sex exchange process to facilitate alcohol consumption and increase women's risk of gender-based violence and HIV. Findings also highlight how sex workers utilise collective agency to address aspects of the sex work environment that place them at risk of alcohol abuse, gender-based violence and HIV. Implications for future interventions to prevent gender-based violence and HIV among female sex workers in Tanzania and similar contexts are discussed.

HIV susceptibility among clients of female sex workers in Indonesia: a qualitative inquiry.

PubMed

Mwanri, Lillian; Fauk, Nelsensius Klau; Kustanti, Christina Yeni; Ambarwati, Atik; Merry, Maria Silvia

2018-02-15

Background: The spread of HIV infection among men in Indonesia continues to increase every year. Clients of female sex workers (FSWs) are a group at higher risk of acquiring HIV infection due to their frequent engagement in sexual acts with sex workers. This study aimed to identify factors of susceptibility to HIV infection among clients of FSWs. Methods: A qualitative inquiry using one-on-one in-depth interviews was conducted in the Belu and Malaka districts of Indonesia from January to April 2017. The study participants (n =42) were the clients of FSWs recruited using the snowball sampling technique. The inclusion criteria were: being a client of FSWs and being aged 18 years or more. Data were analysed using a framework analysis. Results: Findings were grouped into two main emerging themes that included behavioural and socioeconomic factors. Behavioural factors that mediated HIV susceptibility among clients of FSWs were: frequent engagement in unsafe sex with multiple sex workers; low perceptions of the relevance of available HIV and AIDS services and limited access to these services; and HIV stigma or fear of being labelled as HIV positive. Socioeconomic factors included: participants' economic situation; and individuals' household responsibility and ability to afford FSWs services. Conclusions: The study results indicate the need to reformulate and improve HIV and AIDS-related services, including increasing the level of availability of HIV service points and the dissemination of knowledge and information about HIV and AIDS and condom use and making them accessible to both FSWs and their clients in Belu and Malaka districts.

A Border Context of Violence: Mexican Female Sex Workers on the U.S.–Mexico Border

PubMed Central

Cepeda, Alice; Nowotny, Kathryn M.

2018-01-01

Female sex workers (FSW) represent a population confronted with an array of intersecting social problems. We explore the case of FSW in Nuevo Laredo and Ciudad Juarez to understand the everyday violence associated with sex work within the unique context of Mexico. Life history interviews were conducted with 109 FSW revealing violent acts by clients and other sex industry employees (bar owners, police, other FSW). The risk of violence by different types of persons associated with the sex work industry varied by venue and geographic area. Moreover, the violence was shaped by the social structural constraints of dominant gender ideologies. PMID:25409891

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African American Female Sex Workers

PubMed Central

Buttram, Mance E.; Surratt, Hilary L.; Kurtz, Steven P.

2014-01-01

Research among sexual minorities has traditionally examined problems such as substance use, HIV risk, mental health problems, and victimization. Among sexual minority street-based female sex workers, these vulnerabilities can be magnified. Grounded in theories of resilience, this study examines risk and protective factors associated with a high level of personal mastery among a vulnerable population of women. Data are drawn from baseline interviews from street-based African American female sex workers enrolled in a randomized intervention trial in Miami, Florida. We compare sexual minority (N=197) and heterosexual (N=365) women on measures of risk and protective factors; among sexual minority women we present logistic regression analyses which reveal that severe mental distress and HIV transmission risk are associated with low levels of personal mastery, while protective factors of transportation access and social support are associated with high levels of personal mastery. These findings suggest that these protective factors may potentially facilitate the development of personal mastery and represent beneficial avenues for intervention efforts. PMID:25530691

Individual, interpersonal, and social-structural correlates of involuntary sex exchange among female sex workers in two Mexico-U.S. border cities.

PubMed

Goldenberg, Shira M; Rangel, Gudelia; Staines, Hugo; Vera, Alicia; Lozada, Remedios; Nguyen, Lucie; Silverman, Jay G; Strathdee, Steffanie A

2013-08-15

To investigate individual, interpersonal, and social-structural factors associated with involuntary sex exchange among female sex workers (FSWs) along the Mexico-U.S. border. In 2010 to 2011, 214 FSWs from Tijuana (n = 106) and Ciudad Juarez (n = 108) aged ≥ 18 years who reported lifetime use of heroin, cocaine, crack, or methamphetamine, having a stable partner, and having sold/traded sex in the past month completed quantitative surveys and HIV/sexually transmitted infection testing. Logistic regression was used to identify correlates of involuntary sex exchange among FSWs. Of 214 FSWs, 31 (14.5%) reported involuntary sex exchange These women were younger at sex industry entry [adjusted odds ratio (AOR): 0.84/1-year increase, 95% confidence interval (CI): 0.72 to 0.97] and were significantly more likely to service clients whom they perceived to be HIV/sexually transmitted infection-infected (AOR: 12.41, 95% CI: 3.15 to 48.91). In addition, they were more likely to have clients who used drugs (AOR: 7.88, 95% CI: 1.52 to 41.00), report poor working conditions (AOR: 3.27, 95% CI: 1.03 to 10.31), and report a history of rape (AOR: 4.46, 95% CI: 1.43 to 13.91). Involuntary sex exchange is disproportionate among FSWs who begin to exchange sex at a younger age, and these women experience elevated risk of violence and HIV/STIs related to their clients' behaviors and their working conditions. These data suggest the critical need for evidence-based approaches to preventing sexual exploitation of women and girls and to reducing harm among current sex workers. Multilevel interventions for all females who exchange sex and their clients that target interpersonal and social-structural risks (eg, measures to improve safety and reduce exploitation within the workplace) are needed.

Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in northern Mexico.

PubMed

Morris, Meghan D; Lemus, Hector; Wagner, Karla D; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A

2013-01-01

To identify factors associated with time to initiation of (i) sex work prior to injecting drugs initiation; (ii) injection drug use prior to sex work initiation; and (iii) concurrent sex work and injection drug use (i.e. initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Parametric survival analysis of baseline data for time to initiation event. Tijuana and Ciudad Juarez situated on the Mexico-US border. A total of 557 FSW-IDUs aged ≥18 years. Interview-administered surveys assessing context of sex work and injection drug use initiation. Nearly half (n = 258) initiated sex work prior to beginning to inject, a third (n = 163) initiated injection first and a quarter (n = 136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one-third initiate injection drug use before beginning sex work and one-quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Threats during sex work and association with mental health among young female sex workers in Hong Kong.

PubMed

Mo, Phoenix K H; Mak, Winnie W S; Kwok, Yvonne T Y; Xin, Meiqi; Chan, Charlie W L; Yip, Louise W M

2018-08-01

Young female sex workers (YFSWs) are confronted with significant threats during sex work. The present cross-sectional study examined different levels of threats (i.e., threats to life and health, threats to humanity, threats to control of work and financial security, and the threats to future) experienced by 87 YFSWs (age 16-25) in Hong Kong, and identified their association with mental health (i.e., psychological well-being) together with other factors, including childhood trauma, self-efficacy, hope, and social support. Results showed that the participants encountered a significant number of threats. More than half reported that they had a condom removed by clients during sex (51.7%); or have been humililated by clients (51.7%). Because of sex work, about a quarter (25.3%) have had sexually transmitted disease, and respectively 10.3% and 12.6% have had abortion and unplanned pregnancy. The majority have had friends found out that they engaged in sex work (72.4%). They also showed a high level of worry about the various threats. Multiple linear regression analysis showed that childhood trauma (β = -.26) and worry about threats during sex work (β = -.22) were significantly negative predictors, while self-efficacy (β = .20) and hope (β = .27) were significantly positive predictors of mental health. Future services should improve YFSWs' skills to minimize potential threats during female sex work, address the structural correlates and relieve their worries, and empower them with more hope and self-efficacy in choosing clients.

Determinants of Heterosexual Adolescents Having Sex with Female Sex Workers in Singapore

PubMed Central

Ng, Junice Y. S.; Wong, Mee-Lian

2016-01-01

Objectives We assessed the proportion of and socio-ecological factors associated with ever having had sex with female sex workers (FSWs) among heterosexual adolescents. We also described the characteristics of the adolescents who reported inconsistent condom use with FSWs. Methods This is a cross-sectional study (response rate: 73%) of 300 heterosexually active male adolescents of 16 to 19 years attending a national STI clinic in Singapore between 2009 and 2014. We assessed the ecological factors (individual, parental, peer, school and medial influences) and sexual risk behaviors using a self-reported questionnaire. Poisson regression was used to obtain the adjusted prevalence ratios (aPR) and confidence intervals (CI). Results The proportion of heterosexual male adolescents who had ever had sex with FSWs was 39%. Multivariate analysis showed that significant factors associated with ever having had sex with FSWs were sex initiation before 16 years old (aPR 1.79 CI: 1.30–2.46), never had a sexually active girlfriend (aPR 1.75 CI 1.28–2.38), reported lower self-esteem score (aPR 0.96 CI: 0.93–0.98), higher rebelliousness score (aPR 1.03 CI: 1.00–1.07) and more frequent viewing of pornography (aPR 1.47 CI: 1.04–2.09). Lifetime inconsistent condom use with FSWs was 30%. Conclusions A significant proportion of heterosexual male adolescents attending the public STI clinic had ever had sex with FSWs. A targeted intervention that addresses different levels of influence to this behavior is needed. This is even more so because a considerable proportion of adolescents reported inconsistent condom use with FSWs, who may serve as a bridge of STI transmission to the community. National surveys on adolescent health should include the assessment of frequency of commercial sex visits and condom use with FSWs for long-term monitoring and surveillance. PMID:26808561

Male sex workers who sell sex to men also engage in anal intercourse with women: evidence from Mombasa, Kenya.

PubMed

Mannava, Priya; Geibel, Scott; King'ola, Nzioki; Temmerman, Marleen; Luchters, Stanley

2013-01-01

To investigate self-report of heterosexual anal intercourse among male sex workers who sell sex to men, and to identify the socio-demographic characteristics associated with practice of the behavior. Two cross-sectional surveys of male sex workers who sell sex to men in Mombasa, Kenya. Male sex workers selling sex to men were invited to participate in surveys undertaken in 2006 and 2008. A structured questionnaire administered by trained interviewers was used to collect information on socio-demographic characteristics, sexual behaviors, HIV and STI knowledge, and health service usage. Data were analyzed through descriptive and inferential statistics. Bivariate logistic regression, after controlling for year of survey, was used to identify socio-demographic characteristics associated with heterosexual anal intercourse. From a sample of 867 male sex workers, 297 men had sex with a woman during the previous 30 days - of whom 45% did so with a female client and 86% with a non-paying female partner. Within these groups, 66% and 43% of male sex workers had anal intercourse with a female client and non-paying partner respectively. Factors associated with reporting recent heterosexual anal intercourse in bivariate logistic regression after controlling for year of survey participation were being Muslim, ever or currently married, living with wife only, living with a female partner only, living with more than one sexual partner, self-identifying as basha/king/bisexual, having one's own children, and lower education. We found unexpectedly high levels of self-reported anal sex with women by male sex workers, including selling sex to female clients as well as with their own partners. Further investigation among women in Mombasa is needed to understand heterosexual anal sex practices, and how HIV programming may respond.

Children of female sex workers and drug users: a review of vulnerability, resilience and family-centred models of care.

PubMed

Beard, Jennifer; Biemba, Godfrey; Brooks, Mohamad I; Costello, Jill; Ommerborn, Mark; Bresnahan, Megan; Flynn, David; Simon, Jonathon L

2010-06-23

Injection drug users and female sex workers are two of the populations most at risk for becoming infected with HIV in countries with concentrated epidemics. Many of the adults who fall into these categories are also parents, but little is known about the vulnerabilities faced by their children, their children's sources of resilience, or programmes providing services to these often fragile families. This review synthesizes evidence from disparate sources describing the vulnerabilities and resilience of the children of female sex workers and drug users, and documents some models of care that have been put in place to assist them. A large literature assessing the vulnerability and resilience of children of drug users and alcoholics in developed countries was found. Research on the situation of the children of sex workers is extremely limited. Children of drug users and sex workers can face unique risks, stigma and discrimination, but both child vulnerability and resilience are associated in the drug use literature with the physical and mental health of parents and family context. Family-centred interventions have been implemented in low- and middle-income contexts, but they tend to be small, piecemeal and struggling to meet demand; they are poorly documented, and most have not been formally evaluated. We present preliminary descriptive data from an organization working with pregnant and new mothers who are drug users in Ukraine and from an organization providing services to sex workers and their families in Zambia. Because parents' drug use or sex work is often illegal and hidden, identifying their children can be difficult and may increase children's vulnerability and marginalization. Researchers and service providers, therefore, need to proceed with caution when attempting to reach these populations, but documentation and evaluation of current programmes should be prioritized.

Sexual and reproductive health outcomes among female sex workers in Johannesburg and Pretoria, South Africa: Recommendations for public health programmes.

PubMed

Slabbert, Mariette; Venter, Francois; Gay, Cynthia; Roelofsen, Corine; Lalla-Edward, Samanta; Rees, Helen

2017-07-04

The sexual and reproductive health (SRH) status of female sex workers is influenced by a wide range of demographic, behavioural and structural factors. These factors vary considerably across and even within settings. Adopting an overly standardised approach to sex worker programmes may compromise its impact on some sub-groups in local areas. Records of female sex workers attending clinic-, community-, or hotel-based health services in Johannesburg (n = 1422 women) and Pretoria (n = 408 women), South Africa were analysed. We describe the population's characteristics and identified factors associated with sexual and reproductive health outcomes, namely HIV status; previous symptomatic sexually transmitted infection (STI); modern contraceptive use and number of child dependents. The women in Johannesburg were less likely than those in Pretoria to have HIV (42.2% vs 52.9%), or previous symptomatic STIs (44.3% vs. 8.3%), and were 1.4 fold less likely to have child dependents (20.1% vs. 15.3%). About 43% of women in Johannesburg were Zimbabwean and 40% in Pretoria. Of concern, only about 15% of women in both sites were using modern contraceptives. Johannesburg women were also more likely to access health services at a hotel (85.0% vs. 80.6%) or clinic (5.7% vs. 0.5%), to have completed secondary education (57.1% vs. 36.0%), and moved house more than twice during the past year (19.6 vs. 2.0%). In both cities, risk of HIV rose rapidly with age (23.8%-58.2% vs. 22.0%-64.8%). Of interest, HIV prevalence was considerably higher in those with consistent condom use with one's main partner than inconsistent users. Sex worker populations are heterogeneous. Local health programmes must prioritise services that reflect the variety and complexity of sex worker needs and behaviours, and should be designed in consultation with sex workers. Segmenting sex worker populations according to age, country of origin and place of service delivery, and training healthcare providers

Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy

PubMed Central

Strathdee, Steffanie A.; Shoveller, Jean; Rusch, Melanie; Kerr, Thomas; Tyndall, Mark W.

2009-01-01

Objectives. We investigated the relationship between environmental–structural factors and condom-use negotiation with clients among female sex workers. Methods. We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of “hot spots” for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental–structural factors and being pressured by a client into unprotected sexual intercourse. Results. In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73). Conclusions. Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental–structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties. PMID:19197086

HIV knowledge, risk perception, and safer sex practices among female sex workers in Port Moresby, Papua New Guinea

PubMed Central

Bruce, Eunice; Bauai, Ludwina; Sapuri, Mathias; Kaldor, John M; Fairley, Christopher K; Keogh, Louise A

2011-01-01

Sex workers are considered a high-risk group for sexually transmitted infections, including human immunodeficiency virus (HIV), and are often targeted by prevention interventions with safer sex messages. The purpose of this study was to explore the extent to which knowledge of HIV and perception of risk influence safer sex practices among female sex workers (FSWs) in Port Moresby, Papua New Guinea. FSWs (n = 174) were recruited from 19 sites to participate in the study. Qualitative data were collected using semistructured interviews with FSWs (n = 142) through focus group discussions and (n = 32) individual interviews. In addition, quantitative data were collected from all FSWs using a short structured, demographic questionnaire. Data were analyzed using recurring themes and calculations of confidence intervals. Despite some common misperceptions, overall, most FSWs were basically aware of the risks of HIV and informed about transmission and prevention modalities but used condoms inconsistently. Most reported using condoms ‘sometimes’, almost one-sixth ‘never’ used condoms, only a fraction used condoms ‘always’ with clients, and none used condoms ‘always’ with regular sexual partners (RSPs). Among these FSWs, being knowledgeable about the risks, transmission, and prevention of HIV did not translate into safe sex. The findings suggest that certain contextual barriers to safer sex practices exist. These barriers could heighten HIV vulnerability and possibly may be responsible for infection in FSWs. Specific interventions that focus on improving condom self-efficacy in FSWs and simultaneously target clients and RSPs with safer sex messages are recommended. PMID:21445375

Predictors of unprotected sex among female sex workers in Madagascar: comparing semen biomarkers and self-reported data.

PubMed

Gallo, Maria F; Steiner, Markus J; Hobbs, Marcia M; Weaver, Mark A; Hoke, Theresa Hatzell; Van Damme, Kathleen; Jamieson, Denise J; Macaluso, Maurizio

2010-12-01

Research on the determinants of condom use and condom non-use generally has relied on self-reported data with questionable validity. We identified predictors of recent, unprotected sex among 331 female sex workers in Madagascar using two outcome measures: self-reports of unprotected sex within the past 48 h and detection of prostate-specific antigen (PSA), a biological marker of recent semen exposure. Multivariable logistic regression revealed that self-reported unprotected sex was associated with three factors: younger age, having a sipa (emotional partner) in the prior seven days, and no current use of hormonal contraception. The sole factor related to having PSA detected was prevalent chlamydial infection (adjusted odds ratio, 4.5; 95% confidence interval, 2.0-10.1). Differences in predictors identified suggest that determinants of unprotected sex, based on self-reported behaviors, might not correlate well with risk of semen exposure. Caution must be taken when interpreting self-reported sexual behavior measures or when adjusting for them in analyses evaluating interventions for the prevention of HIV/STIs.

Syphilis among middle-aged female sex workers in China: a three-site cross-sectional study.

PubMed

Liu, Hongjie; Dumenci, Levent; Morisky, Donald E; Xu, Yongfang; Li, Xiaojing; Jiang, Baofa

2016-05-10

This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China. A cross-sectional study with respondent-driven sampling (RDS). A multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014. 1245 middle-aged female sex workers who were over 35 years old (about 400 per study site). Unprotected commercial sex, and syphilis and HIV infection were biologically tested and measured. The RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases. In contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Psychological Fears among Low-Paid Female Sex Workers in Southwest China and Their Implications for HIV Prevention

PubMed Central

Qiao, Shan; Li, Xiaoming; Zhang, Chen; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhenzhu; Stanton, Bonita

2014-01-01

Commercial sex plays a critical role in rapidly increasing heterosexual transmission of HIV in China. Low-paid female sex workers (FSWs) are especially vulnerable to HIV/AIDS. Because of the illegality and stigma associated with sex work, FSWs may constantly live with fears in their daily life. Based on cross-sectional study of 794 low-paid FSWs in China we described their psychological fears related to commercial sex and examined the associations between fears and HIV-related behaviors. Fear of HIV infection was significantly associated with consistent use of condoms with clients. However, fear of breaching sex worker identity significantly prevented the FSWs from consistently using condoms with clients and taking HIV tests. Fear of being arrested by the police was positively associated with consistent use of condoms but negatively associated with accessing HIV prevention services. Our findings underlined the importance of examining the triadic interaction of behavioral, psychological and environmental factors in HIV prevention interventions among low-paid FSWs. PMID:25330242

Psychological fears among low-paid female sex workers in southwest China and their implications for HIV prevention.

PubMed

Qiao, Shan; Li, Xiaoming; Zhang, Chen; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhenzhu; Stanton, Bonita

2014-01-01

Commercial sex plays a critical role in rapidly increasing heterosexual transmission of HIV in China. Low-paid female sex workers (FSWs) are especially vulnerable to HIV/AIDS. Because of the illegality and stigma associated with sex work, FSWs may constantly live with fears in their daily life. Based on cross-sectional study of 794 low-paid FSWs in China we described their psychological fears related to commercial sex and examined the associations between fears and HIV-related behaviors. Fear of HIV infection was significantly associated with consistent use of condoms with clients. However, fear of breaching sex worker identity significantly prevented the FSWs from consistently using condoms with clients and taking HIV tests. Fear of being arrested by the police was positively associated with consistent use of condoms but negatively associated with accessing HIV prevention services. Our findings underlined the importance of examining the triadic interaction of behavioral, psychological and environmental factors in HIV prevention interventions among low-paid FSWs.

An assessment of sex work in Swaziland: barriers to and opportunities for HIV prevention among sex workers.

PubMed

Chipamaunga, Shalote; Muula, Adamson S; Mataya, Ronald

2010-10-01

The HIV situation in virtually all southern African countries is a generalised epidemic. Despite the fact that almost all adult age and social groups have high HIV prevalence estimates, sex workers are disproportionally affected, with prevalence estimates higher than the general population. In a qualitative study of 61 male and female sex workers in Swaziland, we found that while poverty drove many into sex work, others reported motivations of pleasure or "sensation seeking", and freedoms from the burden of marriage as perceived benefits of sex work. We also found that penile-vaginal sex was not universal in male-female sexual encounters; and motivation by sex workers for non-condom use included intention to earn more money from unprotected sex, desire for sexual pleasure, and not having time to use condoms. Many sex workers expressed doubts over an alternative lifestyle, even if that change afforded them money to meet their daily necessities. The findings from this study suggest that treating sex workers as a homogenous group that is driven into, or maintain sex work only because of poverty may be problematic, and could hamper HIV-relevant interventions aimed at reducing their vulnerability to sexually transmitted infections.

Shorter Ground Contact Time and Better Running Economy: Evidence From Female Kenyan Runners.

PubMed

Mooses, Martin; Haile, Diresibachew W; Ojiambo, Robert; Sang, Meshack; Mooses, Kerli; Lane, Amy R; Hackney, Anthony C

2018-06-25

Mooses, M, Haile, DW, Ojiambo, R, Sang, M, Mooses, K, Lane, AR, and Hackney, AC. Shorter ground contact time and better running economy: evidence from female Kenyan runners. J Strength Cond Res XX(X): 000-000, 2018-Previously, it has been concluded that the improvement in running economy (RE) might be considered as a key to the continued improvement in performance when no further increase in V[Combining Dot Above]O2max is observed. To date, RE has been extensively studied among male East African distance runners. By contrast, there is a paucity of data on the RE of female East African runners. A total of 10 female Kenyan runners performed 3 × 1,600-m steady-state run trials on a flat outdoor clay track (400-m lap) at the intensities that corresponded to their everyday training intensities for easy, moderate, and fast running. Running economy together with gait characteristics was determined. Participants showed moderate to very good RE at the first (202 ± 26 ml·kg·km) and second (188 ± 12 ml·kg·km) run trials, respectively. Correlation analysis revealed significant relationship between ground contact time (GCT) and RE at the second run (r = 0.782; p = 0.022), which represented the intensity of anaerobic threshold. This study is the first to report the RE and gait characteristics of East African female athletes measured under everyday training settings. We provided the evidence that GCT is associated with the superior RE of the female Kenyan runners.

Policing the epidemic: High burden of workplace violence among female sex workers in conflict-affected northern Uganda.

PubMed

Muldoon, Katherine A; Akello, Monica; Muzaaya, Godfrey; Simo, Annick; Shoveller, Jean; Shannon, Kate

2017-01-01

Sex workers in sub-Saharan Africa experience a high burden of HIV with a paucity of data on violence and links to HIV risk among sex workers, and even less within conflict-affected environments. Data are from a cross-sectional survey of female sex workers in Gulu, northern Uganda (n = 400). Logistic regression was used to determine the specific association between policing and recent physical/sexual violence from clients. A total of 196 (49.0%) sex workers experienced physical/sexual violence by a client. From those who experienced client violence the most common forms included physical assault (58.7%), rape (38.3%), and gang rape (15.8%) Police harassment was very common, a total of 149 (37.3%) reported rushing negotiations with clients because of police presence, a practice that was significantly associated with increased odds of client violence (adjusted odds ratio: 1.61, 95% confidence intervals: 1.03-2.52). Inconsistent condom use with clients, servicing clients in a bar, and working for a manager/pimp were also independently associated with recent client violence. Structural and community-led responses, including decriminalisation, and engagement with police and policy stakeholders, remain critical to addressing violence, both a human rights and public health imperative.

Predictors of Sexual Risk Reduction Among Mexican Female Sex Workers Enrolled in a Behavioral Intervention Study

PubMed Central

Strathdee, Steffanie A.; Mausbach, Brent; Lozada, Remedios; Staines-Orozco, Hugo; Semple, Shirley J.; Abramovitz, Daniela; Fraga-Vallejo, Miguel; de la Torre, Adela; Amaro, Hortensia; Martínez-Mendizábal, Gustavo; Magis-Rodríguez, Carlos; Patterson, Thomas L.

2009-01-01

Objective We recently showed efficacy of an intervention to increase condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, situated on the Mexico–United States border. We determined whether increases in condom use were predicted by social cognitive theory and injection drug user status among women randomized to this intervention. Methods Four hundred nine HIV-negative FSWs aged ≥18 years having unprotected sex with clients within the prior 2 months received a brief individual counseling session integrating motivational interviewing and principles of behavior change (ie, HIV knowledge, self-efficacy for using condoms, and outcome expectancies). Results Increases in self-efficacy scores were associated with increases in percent condom use (P = 0.008), whereas outcome expectancies were not. Female sex workers who inject drugs (FSW-IDUs) increased condom use with clients but not to the same extent as other FSWs (P = 0.09). Change in HIV knowledge was positively associated with change in percent condom use among FSW-IDUs (P = 0.03) but not noninjection drug users. Conclusions Increases in self-efficacy significantly predicted increased condom use among FSWs, consistent with social cognitive theory. Increased HIV knowledge was also important among FSW-IDUs, but their changes in condom use were modest. Enhanced interventions for FSW-IDUs are needed, taking into account realities of substance use during sexual transactions that can compromise safer sex negotiation. PMID:19384101

Indigenous HIV Prevention Beliefs and Practices Among Low-Earning Chinese Sex Workers as Context for Introducing Female Condoms and Other Novel Prevention Options.

PubMed

Dunn, Jennifer; Zhang, Qingning; Weeks, Margaret R; Li, Jianghong; Liao, Susu; Li, Fei

2017-07-01

New interventions to reduce HIV and sexually transmitted infections (STI) among female sex workers are introduced into the context of women's existing prevention beliefs and practices. These indigenous practices affected implementation of our program to introduce female condoms to women in sex-work establishments in southern China. We used ethnographic field observations and in-depth interviews to document common prevention methods women reported using to protect themselves before and during intervention implementation. Individual, sex-work establishment, and other contextual factors, including sources of information and social and economic pressures to use or reject prevention options, shaped their perceptions and selection of these methods and affected adoption of female condoms as an additional tool. Efforts to improve uptake of effective prevention methods among low-income sex workers require attention to the context and spectrum of women's HIV/STI prevention practices when introducing innovations such as female condoms, microbicides, pre-exposure prophylaxis pills, and others, as they become available.

Differentiated Typology of Sex Work and Implication for HIV Prevention Programs among Female Sex Workers in Nepal.

PubMed

Mishra, Shiva Raj; Neupane, Sanjeev Raj

2015-01-01

Sex work in exchange for kind and cash has long been practiced in Nepal. The HIV prevention program in Nepal is focused mainly on these two typologies of sex work. There might be more typologies of sex work beyond streets and establishments seeking research and programmatic attention. The objective of the study is to explore the differentiated typologies of sex work. This is a cross-sectional study conducted using a qualitative technique. Researchers carried out eight Focus Group Discussions with female sex workers (FSWs) (n = 50) in different places of Tanahu district. Data were analyzed using a deductive thematic analysis approach. We identified a more differentiated typology of sex work. Private contact-based sex work and the covert sex work on the cruising areas along the major highways were common. Sex work has become easier to operate with the advent of new technologies such as cell phone. With limited role of facilitation by brokers and pimps, now FSWs are better off and have longer duration of relationship with clients. Soft prostitution was common, as FSWs complemented their income through sex work. The conventional mode of peer and outreach educational approach needs to be further strengthened and modified according to the changing typology of sex work. HIV testing sites need to be further expanded to cruising areas along the highways.

Differentiated Typology of Sex Work and Implication for HIV Prevention Programs among Female Sex Workers in Nepal

PubMed Central

Mishra, Shiva Raj; Neupane, Sanjeev Raj

2015-01-01

Background: Sex work in exchange for kind and cash has long been practiced in Nepal. The HIV prevention program in Nepal is focused mainly on these two typologies of sex work. There might be more typologies of sex work beyond streets and establishments seeking research and programmatic attention. The objective of the study is to explore the differentiated typologies of sex work. Methods: This is a cross-sectional study conducted using a qualitative technique. Researchers carried out eight Focus Group Discussions with female sex workers (FSWs) (n = 50) in different places of Tanahu district. Data were analyzed using a deductive thematic analysis approach. Results: We identified a more differentiated typology of sex work. Private contact-based sex work and the covert sex work on the cruising areas along the major highways were common. Sex work has become easier to operate with the advent of new technologies such as cell phone. With limited role of facilitation by brokers and pimps, now FSWs are better off and have longer duration of relationship with clients. Soft prostitution was common, as FSWs complemented their income through sex work. Conclusion: The conventional mode of peer and outreach educational approach needs to be further strengthened and modified according to the changing typology of sex work. HIV testing sites need to be further expanded to cruising areas along the highways. PMID:25785259

Sex work and its associations with alcohol and methamphetamine use among female bar and spa workers in the Philippines.

PubMed

Urada, Lianne A; Strathdee, Steffanie A; Morisky, Donald E; Schilling, Robert F; Simbulan, Nymia P; Estacio, Leonardo R; Raj, Anita

2014-03-01

To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.

Participatory mapping of sex trade and enumeration of sex workers using capture-recapture methodology in Diego-Suarez, Madagascar.

PubMed

Kruse, Natalie; Behets, Frieda M-T F; Vaovola, Georgine; Burkhardt, Gillian; Barivelo, Texina; Amida, X; Dallabetta, Gina

2003-08-01

Capture-recapture methodology has been employed to estimate the size of hidden or difficult-to-reach human populations such as sex workers, homeless persons, and intravenous drug users. This study took place in the context of efforts to improve the quality of curative and preventive services for sexually transmitted infections offered to sex workers in Diego-Suarez, Madagascar in partnership with sex workers. The goal of this study was to better understand sex-trading practices, map out sex work sites, and estimate the size of a mobile sex-worker population in Diego-Suarez, Madagascar using methods that can be reproduced in other resource-poor settings. Forty sex workers were trained to function as field researchers. Key informants in designated neighborhoods were identified and interviewed. Basic maps of sex-trade sites were designed by hand. The number of sex workers in Diego-Suarez was estimated using capture-recapture methodology. An educational brochure was used to "capture" sex workers during a first phase, and "recapture" 2 weeks later. Most sex trade was street based and mobile. Capture-recapture methods estimated a total of 2684 sex workers (95% CI: 2588-2780) in Diego-Suarez, or approximately 12% of the 15- to 49-year-old female population in the city. Geographic mapping and capture-recapture proved to be low-cost and relatively easy to use techniques for counting a hard-to-reach population, such as female street-based sex workers. Sex workers can be capable fieldworkers, and their active participation in research concerning sex work should be considered whenever possible. A high proportion of women of reproductive age were found to engage in sex work, indicating that there is an urgent need to scale up sexually transmitted infection and HIV prevention activities targeting sex workers, their sexual partners, and the general population.

Debe cuidarse en la calle: Normative influences on condom use among the steady male partners of female sex workers in the Dominican Republic

PubMed Central

Barrington, Clare; Kerrigan, Deanna

2014-01-01

Encouragement to use condoms reflects the injunctive norm, or idea that you should use condoms. In our previous research with the regular male partners of female sex workers in the Dominican Republic, we found that encouragement to use condoms with female sex workers from individuals in their personal social networks was not directly associated with condom use. In the current study, we used qualitative interviews to further explore the influence of social network norms on men's sexual risk behaviours. We interviewed eleven steady male partners of female sex workers; participants completed two interviews to achieve greater depth. We analysed data using analytic summaries and systematic thematic coding. All men perceived that the prevailing injunctive norm was that they should use condoms with sex workers. Men received encouragement to use condoms but did not articulate a link between this encouragement and condom use. Additionally, men who did not use condoms lied to their friends to avoid social sanction. Findings highlight that the influence of a pro-condom injunctive norm is not always health promoting and can even be negative. HIV prevention efforts seeking to promote condom use should address the alignment between injunctive and descriptive norms to strengthen their collective influence on behaviour. PMID:24555440

Love, Trust, and HIV Risk Among Female Sex Workers and Their Intimate Male Partners.

PubMed

Syvertsen, Jennifer L; Bazzi, Angela Robertson; Martinez, Gustavo; Rangel, M Gudelia; Ulibarri, Monica D; Fergus, Kirkpatrick B; Amaro, Hortensia; Strathdee, Steffanie A

2015-08-01

We examined correlates of love and trust among female sex workers and their noncommercial male partners along the Mexico-US border. From 2011 to 2012, 322 partners in Tijuana and Ciudad Juárez, Mexico, completed assessments of love and trust. Cross-sectional dyadic regression analyses identified associations of relationship characteristics and HIV risk behaviors with love and trust. Within 161 couples, love and trust scores were moderately high (median 70/95 and 29/40 points, respectively) and correlated with relationship satisfaction. In regression analyses of HIV risk factors, men and women who used methamphetamine reported lower love scores, whereas women who used heroin reported slightly higher love. In an alternate model, men with concurrent sexual partners had lower love scores. For both partners, relationship conflict was associated with lower trust. Love and trust are associated with relationship quality, sexual risk, and drug use patterns that shape intimate partners' HIV risk. HIV interventions should consider the emotional quality of sex workers' intimate relationships.

Correlates of Mental Depression Among Female Sex Workers in Southern India.

PubMed

Patel, Sangram Kishor; Saggurti, Niranjan; Pachauri, Saroj; Prabhakar, Parimi

2015-11-01

Mental health is an integral part of overall health status but has been a largely neglected issue in the developing world especially among female sex workers (FSWs). This study examines the prevalence and correlates of major depression among FSWs in southern India. Major depression was assessed using Patient Health Questionnaire-2 depression scale data from a cross-sectional Behavioral Tracking Survey, 2010-2011 conducted among FSWs (n = 1986) in Andhra Pradesh, a state in southern India. Almost two-fifths of FSWs (39%) reported major depression. Multivariate logistic regression analysis shows a significant association between major depression and the following characteristics for FSWs: low autonomy, alcohol use, experience of violence, police arrest, inconsistent condom use with clients, mobility for sex work, and being HIV positive or not wanting to disclose HIV status. Research and advocacy efforts are needed to ensure that the mental health issues of marginalized groups are appropriately addressed in HIV prevention programs. © 2015 APJPH.

'Health is wealth and wealth is health'--perceptions of health and ill-health among female sex workers in Savannakhet, Laos.

PubMed

Phrasisombath, Ketkesone; Thomsen, Sarah; Sychareun, Vanphanom; Faxelid, Elisabeth

2013-01-02

Female sex workers (FSWs) are vulnerable to sexually transmitted infections (STIs) and other types of health problems and they also encounter socio-economic difficulties. Efforts to develop effective health intervention programs for FSWs have been hampered by a lack of information on why FSWs do not seek or delay seeking treatment for STIs. To further understand their reasons, our study applied a qualitative approach to explore perceptions of health and ill-health among FSWs in Savannakhet province in Laos. Fifteen in-depth interviews were conducted with FSWs in Savannakhet province. Latent content analysis was used for analysis. Sex workers' definitions of health and wealth are intertwined. Thus, good health was described as strongly related to wealth, and wealth was needed in order to be healthy. This is explained in two sub-themes: health is necessary for work and income and ill-health creates social and economic vulnerability. Female sex workers' beliefs and perceptions about health and ill-health were dominated by their economic need, which in turn was influenced by expectations and demands from their families.

Individual, Interpersonal, and Social-Structural Correlates of Involuntary Sex Exchange Among Female Sex Workers in Two Mexico–U.S. Border Cities

PubMed Central

Goldenberg, S.M.; Rangel, G.; Staines, H.; Vera, A.; Lozada, R.; Nguyen, L.; Silverman, J.G.; Strathdee, S.A.

2013-01-01

Objective To investigate individual, interpersonal, and social-structural factors associated with involuntary sex exchange among female sex workers (FSWs) along the Mexico–U.S. border. Methods In 2010–2011, 214 FSWs from Tijuana (n=106) and Ciudad Juarez (n=108) aged ≥18 who reported lifetime use of heroin, cocaine, crack, or methamphetamine, having a stable partner, and having sold/traded sex in the past month completed quantitative surveys and HIV/STI testing. Logistic regression was used to identify correlates of involuntary sex exchange among FSWs. Results Of 214 FSWs, 31 (14.5%) reported involuntary sex exchange. These women were younger at sex work entry (Adjusted odds ratio [AOR]: 0.84/1 year increase, 95% CI: 0.72–0.97) and were significantly more likely to service clients whom they perceived to be HIV/STI-infected (AOR: 12.41, 95% CI: 3.15–48.91). Additionally, they were more likely to have clients who used drugs (AOR: 7.88, 95% CI: 1.52–41.00), report poor working conditions (AOR: 3.27, 95% CI: 1.03–10.31), and report a history of rape (AOR: 4.46, 1.43–13.91).] Conclusions Involuntary sex exchange is disproportionate among FSWs who begin to exchange sex at a younger age, and these women experience elevated risk of violence and HIV/STIs related to their clients’ behaviors and their working conditions. These data suggest the critical need for evidence-based approaches to preventing sexual exploitation of women and girls and to reducing harm among current sex workers. Multi-level interventions for sex workers and their clients that target interpersonal and social-structural risks (e.g., measures to improve safety and reduce exploitation within the workplace) are needed. PMID:23614997

Risk and risk management for Australian sex workers.

PubMed

Harris, Margaret; Nilan, Pam; Kirby, Emma

2011-03-01

In this article, we address the experiences of female sex workers in urban Australia through analysis of interviews using a feminist approach. Although many previous studies have been conducted, our focus was on the voices of sex workers in an area that was rapidly gentrifying, leading to local community tensions. Intensive analysis of interview transcripts was employed to derive thematic codes for understanding how the women viewed and managed everyday risk in sex work. They were well aware of the health risks associated with sex work. For women working on premises, domain separation between sex work and other life domains was an important management strategy for maintaining self-esteem. For women working on the street, instincts honed by years of dangerous work provided a measure of safety. Our findings have implications for health and other agencies dealing with sex workers in situations in which community pressure is exerted to move sex workers away from the area.

Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh.

PubMed

Haseen, F; Chawdhury, F A H; Hossain, M E; Huq, M; Bhuiyan, M U; Imam, H; Rahman, D M M; Gazi, R; Khan, S I; Kelly, R; Ahmed, J; Rahman, M

2012-08-01

A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.

The job satisfaction of female sex workers working in licensed brothels in Victoria, Australia.

PubMed

Bilardi, Jade E; Miller, Amanda; Hocking, Jane S; Keogh, Louise; Cummings, Rosey; Chen, Marcus Y; Bradshaw, Catriona S; Fairley, Christopher K

2011-01-01

Previous studies have examined sex workers' attitudes to work but not their levels of job satisfaction compared with other occupations. The job satisfaction levels and standards of living of sex workers in licensed brothels in Victoria were compared with Australian women. Responses to a questionnaire that included questions about sex work and their "most likely alternative job." Survey data was compared with identical questions from the Households, Income and Labour Dynamics in Australia Survey. A structured survey was undertaken with sex workers in Victoria attending a a sexual health service. Of the 112 sex workers who agreed to participate in the study, 85 (76%) completed the survey. The median years women had been working as sex workers was three (range 0.1-18). The main reasons women started sex work was because "they needed the money" (69%), were attracted to the flexible hours (44%) or had a particular goal in mind (43%). The two biggest concerns women had about sex work were their safety (65%) and the risk of sexually transmitted infections (65%). When compared with the median job satisfaction scores of Australian women working in sex workers' "most likely alternative jobs," 50% of sex workers reported a higher median satisfaction score for sex work in relation to hours worked, 47% in relation to flexibility, 43% in relation to total pay, 26% in relation to job security, 19% in relation to the work itself, and 25% in relation to overall job satisfaction. Women reported that they primarily do sex work for financial gain although a significant minority prefer it to other work they would be likely to do. These results should be interpreted in the context that the presence of personality disorders that are common among sex workers were not measured in this study. © 2010 International Society for Sexual Medicine.

Barriers to free antiretroviral treatment access for female sex workers in Chennai, India.

PubMed

Chakrapani, Venkatesan; Newman, Peter A; Shunmugam, Murali; Kurian, Abraham K; Dubrow, Robert

2009-11-01

India's National AIDS Control Organization (NACO) provides free first-line antiretroviral treatment (ART) at government centers for people living with HIV. To assist in developing policies and programs to ensure equity in ART access, we explored barriers to ART access among female sex workers (FSWs) living with HIV in Chennai. Between August and November 2007, we conducted three focus group discussions and two key informant interviews. Data were explored using framework analysis to identify categories and derive themes. We found interrelated barriers at the family/social, health care system/programmatic, and individual levels. Major barriers included fear of adverse consequences of disclosure of HIV status due to stigma and discrimination associated with HIV and sex work, lack of family support, negative experiences with health care providers, lack of adequate counseling services at government centers and by outreach workers employed by nongovernmental organizations (NGOs), perceived biased treatment of FSWs who are not referred by NGOs, lack of adequate knowledge about ART, and fatalism. Barriers can be addressed by: creating effective measures to reduce stigma associated with HIV/AIDS and sex work at the familial, societal, and health care system levels; incorporating information about ART into targeted interventions among FSWs; training counselors at government hospitals and NGO outreach workers on treatment issues; improving infrastructure and staffing levels at government centers to allow adequate time and privacy for counseling; and implementing government mass media campaigns on ART availability. Finally, it is crucial that NACO begin monitoring ART coverage of FSWs and other marginalized populations to ensure equitable ART access.

Recruitment of Caribbean female commercial sex workers at high risk of HIV infection

PubMed Central

Deschamps, Marie Marcelle; Zorrilla, Carmen D.; Morgan, Cecilia A.; Donastorg, Yeycy; Metch, Barbara; Madenwald, Tamra; Joseph, Patrice; Severe, Karine; Garced, Sheyla; Perez, Marta; Escamilia, Gina; Swann, Edith; Pape, Jean William

2014-01-01

Objective To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. Methods A prospective cohort study was conducted in 2009–2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man in the previous 6 months. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. Results HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8–9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3–1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. Conclusions This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial. PMID:24096973

Foster care history and HIV infection among drug-using African American female sex workers.

PubMed

Surratt, Hilary L; Kurtz, Steven P

2012-05-01

Foster care has been associated with increased HIV risk behaviors among youth, yet long-term association with HIV infection has not been examined. This study explored the associations between foster placement, victimization, mental health, onset of sex work and HIV infection among highly vulnerable female sex workers. 562 drug-involved African American women were enrolled into an intervention study to increase health services utilization and reduce HIV risk. Seventeen percent reported a history of foster placement. Foster history was associated with significantly lower educational attainment, higher victimization, and more severe mental health problems. Women with foster histories reported significantly earlier entry into paid sex work, with some 62% active in the sex trade before age 18. Multivariate analyses found that foster care was independently associated with HIV seropositivity, and that early sex work partially mediated this association. The potential long-term health vulnerabilities associated with foster placement are understudied and warrant additional research.

Safer sex negotiation and its association with condom use among clients of female sex workers in Bangladesh.

PubMed

Kamal, S M Mostafa; Hassan, Che Hashim; Salikon, Roslan Hj

2015-03-01

This study examines safer sex negotiation and its association with condom use among clients of female sex workers (FSWs) in Bangladesh. Data were collected from 484 FSWs living in Dhaka city following a convenient sampling procedure. Overall, 47% of the clients were suggested to use condom during last sexual intercourse and 21% did so. Both bivariate and multivariable binary logistic regression analyses yielded significantly increased risk of negotiation for safer sex with clients among FSWs with higher education. The power bargaining significantly (P < .001) increased the risk of condom use by 2.15 times (95% confidence interval = 1.28-3.59). The odds of condom use were significantly higher among the FSWs with higher education, unmarried, hotel-based, and among those with higher level of HIV/AIDS-related knowledge. The Bangladeshi FSWs have little control over their profession. HIV prevention programs should aim to encourage FSWs through information, education, and communication program to insist on condom use among clients. © 2013 APJPH.

Reasons for non- use of condoms and self- efficacy among female sex workers: a qualitative study in Nepal.

PubMed

Ghimire, Laxmi; Smith, W Cairns S; van Teijlingen, Edwin R; Dahal, Rashmi; Luitel, Nagendra P

2011-09-26

Heterosexual contact is the most common mode of transmission of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) in Nepal and it is largely linked to sex work. We assessed the non-use of condoms in sex work with intimate sex partners by female sex workers (FSWs) and the associated self-efficacy to inform the planning of STI/HIV prevention programmes in the general population. This paper is based on a qualitative study of Female Sex Workers (FSWs) in Nepal. In-depth interviews and extended field observation were conducted with 15 FSWs in order to explore issues of safe sex and risk management in relation to their work place, health and individual behaviours. The main risk factor identified for the non-use of condoms with intimate partners and regular clients was low self efficacy. Non-use of condoms with husband and boyfriends placed them at risk of STIs including HIV. In addition to intimidation and violence from the police, clients and intimate partners, clients' resistance and lack of negotiation capacity were identified as barriers in using condoms by the FSWs. This study sheds light on the live and work of FSWs in Nepal. This information is relevant for both the Government of Nepal and Non Governmental Organisations (NGO) to help improve the position of FSWs in the community, their general well-being and to reduce their risks at work.

Anal sex and associated HIV-related sexual risk factors among female sex workers in Andhra Pradesh, India.

PubMed

Patra, Rajesh Kumar; Mahapatra, Bidhubhusan; Kovvali, Dolly; Proddutoor, Laxminarayana; Saggurti, Niranjan

2012-11-01

This study aims to understand the correlates of anal sex practices among female sex workers (FSWs) and examine the association of anal sex with HIV-related sexual risk factors in Andhra Pradesh, India. A cross-sectional behavioural survey was conducted in 2011 among 795 FSWs aged 18 years or older. Probability-based cluster sampling was used to select respondents from sex work hotspots. One-quarter (23%) of FSWs had practiced anal sex in the last year. The odds of practicing anal sex were higher among FSWs aged 35 years or more than in those aged less than 25 years (adjusted odds ratio (AOR): 2.05, P<0.05), in those formerly married compared to those currently married (AOR: 1.88, P<0.01), in those having an income only from sex work compared to those having additional sources of income (AOR: 1.54, P<0.05), those reporting heavy alcohol consumption compared to those who did not (AOR: 2.80, P<0.01) and those who experienced violence compared to those who had not (AOR: 2.80, P<0.01). FSWs practicing anal sex were more likely to experience sexually transmissible infection (STI) related symptoms than those practicing only vaginal sex. There was no association between anal sex practice and condom use. Anal sex is associated with STI symptoms, a factor for HIV risk. HIV intervention programmes need to educate FSWs about the risks associated with anal sex.

"It's all about making a life": poverty, HIV, violence, and other vulnerabilities faced by young female sex workers in Kumasi, Ghana.

PubMed

Onyango, Monica Adhiambo; Adu-Sarkodie, Yaw; Agyarko-Poku, Thomas; Asafo, Mabel Kissiwah; Sylvester, Joy; Wondergem, Peter; Green, Kimberly; Wambugu, Samuel; Brennan, Alana T; Beard, Jennifer

2015-03-01

This study aimed to identify social, economic, structural, and individual-level vulnerabilities of female adolescents who sell sex in Kumasi, Ghana. Twenty-four in-depth interviews and 4 focus group discussions were conducted with female sex workers of age 18-20 years who had been involved in sex work for at least 2 years. Total sample size was 48. One-third of participants started sex work before age 15. Knowledge of HIV was accurate and most reported having intentions to use condoms consistently with clients; however, factors such as higher payments, drug and/or alcohol use, fear of violence, and police harassment affected condom use. They perceived violence and rape at the hands of clients as their greatest risk. They also reported abuse and exploitation by police. Respondents voiced strong concerns that girls and teens involved in sex work are at higher risk of unsafe sex, exploitation, and abuse than their older and more experienced counterparts. Unprotected sex with boyfriends was also common. The pathway to sex work followed a similar pattern for many study participants who left their rural homes for Kumasi in search of economic opportunity. While adolescents who sell sex appear to be abundant in Kumasi, they have been missed by HIV prevention and harm reduction programming. The findings from this study informed the design and implementation of a young female sex worker peer educator pilot program. Key elements of that program are presented, and recommendations for future program evaluation are made.

Sex worker incarceration in the People's Republic of China.

PubMed

Tucker, J D; Ren, X

2008-02-01

Tens of thousands of commercial sex workers in China are administratively detained each year in female re-education through labor (RTL) centres for moral education and vocational training. Recent increases in syphilis and heterosexual HIV make tailored HIV prevention efforts for sex workers increasingly important in many regions of China. However, RTL centres focused on detaining commercial sex workers have not traditionally been linked to sexually transmitted infections (STI)/HIV programmes. The stigma of being incarcerated and selling sex complicates STI/HIV prevention for these women. Incarcerated sex workers represent a particularly marginalized HIV risk group that has been excluded from domestic and international HIV programmes to date. Although several laws and administrative decrees provide a legal mandate for sex worker STI/HIV testing, treatment and rights, there is still substantial variation in how laws are implemented. Creating devoted medical services and legal aid for incarcerated sex workers is important in curbing the spread of heterosexual HIV and other STIs in China. Recent legal and social developments suggest that China's RTL system will be transformed in the near future, gaining momentum for reform that could improve the sexual and human rights of incarcerated sex workers.

Overlapping HIV and sex-work stigma among female sex workers recruited to 14 respondent-driven sampling surveys across Zimbabwe, 2013.

PubMed

Hargreaves, J R; Busza, J; Mushati, P; Fearon, E; Cowan, F M

2017-06-01

HIV stigma can inhibit uptake of HIV testing and antiretroviral therapy as well as negatively affect mental health. Efforts to reduce discrimination against people living with HIV (LWH) have contributed to greater acceptance of the infection. Female sex workers (FSW) LWH may experience overlapping stigma due to both their work and HIV status, although this is poorly understood. We examined HIV and sex-work stigma experienced by FSW LWH in Zimbabwe. Using the SAPPH-IRe cluster-randomised trial baseline survey, we analysed the data from 1039 FSW self-reporting HIV. The women were recruited in 14 sites using respondent-driven sampling. We asked five questions to assess internalised and experienced stigma related to working as a sex worker, and the same questions were asked in reference to HIV. Among all FSW, 91% reported some form of sex-work stigma. This was not associated with sociodemographic or sex-work characteristics. Rates of sex-work stigma were higher than those of HIV-related stigma. For example, 38% reported being "talked badly about" for LWH compared with 77% for their involvement in sex work. Those who reported any sex-work stigma also reported experiencing more HIV stigma compared to those who did not report sex-work stigma, suggesting a layering effect. FSW in Zimbabwe experience stigma for their role as "immoral" women and this appears more prevalent than HIV stigma. As HIV stigma attenuates, other forms of social stigma associated with the disease may persist and continue to pose barriers to effective care.

Causes of maternal and child mortality among Cambodian sex workers and their children: a cross sectional study.

PubMed

Willis, Brian; Onda, Saki; Stoklosa, Hanni Marie

2016-11-21

To reach global and national goals for maternal and child mortality, countries must identify vulnerable populations, which includes sex workers and their children. The objective of this study was to identify and describe maternal deaths of female sex workers in Cambodia and causes of death among their children. A convenience sample of female sex workers were recruited by local NGOs that provide support to sex workers. We modified the maternal mortality section of the 2010 Cambodia Demographic and Health Survey and collected reports of all deaths of female sex workers. For each death we ask the 'sisterhood' methodology questions to identify maternal deaths. For child deaths we asked each mother who reported the death of a child about the cause of death. We also asked all participants about the cause of deaths of children of other female sex workers. We interviewed 271 female sex workers in the four largest Cambodian cities between May and September 2013. Participants reported 32 deaths of other female sex workers that met criteria for maternal death. The most common reported causes of maternal deaths were abortion (n = 13;40%) and HIV (n = 5;16%). Participants report deaths of 8 of their children and 50 deaths of children of other female sex workers. HIV was the reported cause of death for 13 (36%) children under age five. This is the first report of maternal deaths of sex workers in Cambodia or any other country. This modification of the sisterhood methodology has not been validated and did not allow us to calculate maternal mortality rates so the results are not generalizable, however these deaths may represent unrecognized maternal deaths in Cambodia. The results also indicate that children of sex workers in Cambodia are at risk of HIV and may not be accessing treatment. These issues require additional studies but in the meantime we must assure that sex workers in Cambodia and their children have access to quality health services.

National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries.

PubMed

Reeves, Aaron; Steele, Sarah; Stuckler, David; McKee, Martin; Amato-Gauci, Andrew; Semenza, Jan C

2017-03-01

Sex workers are disproportionately affected by HIV compared with the general population. Most studies of HIV risk among sex workers have focused on individual-level risk factors, with few studies assessing potential structural determinants of HIV risk. In this Article, we examine whether criminal laws around sex work are associated with HIV prevalence among female sex workers. We estimate cross-sectional, ecological regression models with data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation from the US State Department's Country Reports on Human Rights Practices and country-specific legal documents; the rule of law and gross-domestic product per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injecting drug use among sex workers. Although data from two countries include male sex workers, the numbers are so small that the findings here essentially pertain to prevalence in female sex workers. Countries that have legalised some aspects of sex work (n=17) have significantly lower HIV prevalence among sex workers than countries that criminalise all aspects of sex work (n=10; β=-2·09, 95% CI -0·80 to -3·37; p=0·003), even after controlling for the level of economic development (β=-1·86; p=0·038) and the proportion of sex workers who are injecting drug users (-1·93; p=0·026). We found that the relation between sex work policy and HIV among sex workers might be partly moderated by the effectiveness and fairness of enforcement, suggesting legalisation of some aspects of sex work could reduce HIV among sex workers to the greatest extent in countries where enforcement is fair and effective. Our findings suggest that the legalisation of some aspects of sex work might help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair. European Centre for Disease Prevention and Control. Copyright �

Reframing the Interpretation of Sex Worker Health: A Behavioral–Structural Approach

PubMed Central

Tuminez, Astrid S.

2011-01-01

Expanding sexually transmitted infection (STI) epidemics in many parts of Asia increase the importance of effective human immunodeficiency virus (HIV)/STI prevention programs for female sex workers. Designing sex worker health research and programs demands a well-stated conceptual approach, especially when one is interpreting the relationship between local policy environments and sex worker health. However, the core principles of the 2 most common conceptual approaches used in sex worker health programs—abolitionism and empowerment—have frequently divergent assumptions and implications. The abolitionist approach sees major aspects of the sex industry as fundamentally coercive and exploitative of women and supports dismantling all or parts of the sex sector. The empowerment approach strengthens sex workers’ agency and rights in order to build collective self-efficacy and have women invested in implementing their own HIV/STI prevention programs. This review compares these approaches using implication analysis and empirical cases from Asia. The misperception of an unresolvable gap between the 2 approaches ignores common ground that forms the basis of a new behavioral–structural conceptual framework. Explicitly accounting for the interaction between female sex worker behaviors and larger structures and policies, a behavioral–structural approach may provide a solid foundation for sex work research and programs. PMID:22043033

The price of sex: condom use and the determinants of the price of sex among female sex workers in eastern Zimbabwe.

PubMed

Elmes, Jocelyn; Nhongo, Kundai; Ward, Helen; Hallett, Timothy; Nyamukapa, Constance; White, Peter J; Gregson, Simon

2014-12-01

Higher prices for unprotected sex threaten the high levels of condom use that contributed to the decline in Zimbabwe's human immunodeficiency virus (HIV) epidemic. To improve understanding of financial pressures competing against safer sex, we explore factors associated with the price of commercial sex in rural eastern Zimbabwe. We collected and analyzed cross-sectional data on 311 women, recruited during October-December 2010, who reported that they received payment for their most-recent or second-most-recent sex acts in the past year. Zero-inflated negative binomial models with robust standard errors clustered on female sex worker (FSW) were used to explore social and behavioral determinants of price. The median price of sex was $10 (interquartile range [IQR], $5-$20) per night and $10 (IQR, $5-$15) per act. Amounts paid in cash and commodities did not differ significantly. At the most-recent sex act, more-educated FSWs received 30%-74% higher payments. Client requests for condom use significantly predicted protected sex (P < .01), but clients paid on average 42.9% more for unprotected sex. Within a work environment where clients' preferences determine condom use, FSWs effectively use their individual capital to negotiate the terms of condom use. Strengthening FSWs' preferences for protected sex could help maintain high levels of condom use. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

The Price of Sex: Condom Use and the Determinants of the Price of Sex Among Female Sex Workers in Eastern Zimbabwe

PubMed Central

Elmes, Jocelyn; Nhongo, Kundai; Ward, Helen; Hallett, Timothy; Nyamukapa, Constance; White, Peter J.; Gregson, Simon

2014-01-01

Background. Higher prices for unprotected sex threaten the high levels of condom use that contributed to the decline in Zimbabwe's human immunodeficiency virus (HIV) epidemic. To improve understanding of financial pressures competing against safer sex, we explore factors associated with the price of commercial sex in rural eastern Zimbabwe. Methods. We collected and analyzed cross-sectional data on 311 women, recruited during October–December 2010, who reported that they received payment for their most-recent or second-most-recent sex acts in the past year. Zero-inflated negative binomial models with robust standard errors clustered on female sex worker (FSW) were used to explore social and behavioral determinants of price. Results. The median price of sex was $10 (interquartile range [IQR], $5–$20) per night and $10 (IQR, $5–$15) per act. Amounts paid in cash and commodities did not differ significantly. At the most-recent sex act, more-educated FSWs received 30%–74% higher payments. Client requests for condom use significantly predicted protected sex (P < .01), but clients paid on average 42.9% more for unprotected sex. Conclusions. Within a work environment where clients' preferences determine condom use, FSWs effectively use their individual capital to negotiate the terms of condom use. Strengthening FSWs' preferences for protected sex could help maintain high levels of condom use. PMID:25381377

HIV prevalence and characteristics of sex work among female sex workers in Hargeisa, Somaliland, Somalia.

PubMed

Kriitmaa, Kelsi; Testa, Adrienne; Osman, Mohamed; Bozicevic, Ivana; Riedner, Gabriele; Malungu, Jacqueline; Irving, Greg; Abdalla, Ismail

2010-07-01

To measure prevalence of HIV and syphilis and describe characteristics of sex work among female sex workers (FSWs) in Hargeisa, Somaliland, Somalia. A cross-sectional survey recruited 237 FSWs using respondent-driven sampling (RDS). A face-to-face, structured interview using handheld-assisted personal interviewing (HAPI) on personal digital assistants (PDAs) was completed and blood collected for serological testing. FSWs 15-19 years old accounted for 6.9% of the population; 20-24 year-old constituted an additional 18.0%. The majority (86.6%) never attended school. International (59.0%) and interzonal (10.7%) migration was common. Most (95.7%) reported no other source of income; 13.8% had five or more clients in the last 7 days. A minority (38.4%) had heard of STIs, even fewer (6.9%) held no misconceptions about HIV. Only 24% of FSW reported using a condom at last transactional sex, and 4% reported ever been tested for HIV. HIV prevalence was 5.2% and syphilis prevalence was 3.1%. Sex work in Hargeisa, Somaliland, Somalia, is characterized by high numbers of sexual acts and extremely low knowledge of HIV. This study illustrates the need for targeted HIV prevention interventions focusing on HIV testing, risk-reduction awareness raising, and review of condom availability and distribution mechanisms among FSWs and males engaging with FSWs.

An action agenda for HIV and sex workers.

PubMed

Beyrer, Chris; Crago, Anna-Louise; Bekker, Linda-Gail; Butler, Jenny; Shannon, Kate; Kerrigan, Deanna; Decker, Michele R; Baral, Stefan D; Poteat, Tonia; Wirtz, Andrea L; Weir, Brian W; Barré-Sinoussi, Françoise; Kazatchkine, Michel; Sidibé, Michel; Dehne, Karl-Lorenz; Boily, Marie-Claude; Strathdee, Steffanie A

2015-01-17

The women, men, and transgender people who sell sex globally have disproportionate risks and burdens of HIV in countries of low, middle, and high income, and in concentrated and generalised epidemic contexts. The greatest HIV burdens continue to be in African female sex workers. Worldwide, sex workers still face reduced access to needed HIV prevention, treatment, and care services. Legal environments, policies, police practices, absence of funding for research and HIV programmes, human rights violations, and stigma and discrimination continue to challenge sex workers' abilities to protect themselves, their families, and their sexual partners from HIV. These realities must change to realise the benefits of advances in HIV prevention and treatment and to achieve global control of the HIV pandemic. Effective combination prevention and treatment approaches are feasible, can be tailored for cultural competence, can be cost-saving, and can help to address the unmet needs of sex workers and their communities in ways that uphold their human rights. To address HIV in sex workers will need sustained community engagement and empowerment, continued research, political will, structural and policy reform, and innovative programmes. But such actions can and must be achieved for sex worker communities everywhere. Copyright © 2015 Elsevier Ltd. All rights reserved.

Innovative approaches to cervical cancer screening for sex trade workers: an international scoping review.

PubMed

Thulien, Naomi S

2014-03-01

Female sex trade workers are among those at highest risk for developing and dying of cervical cancer, and yet many-particularly the most marginalized-are less likely than other women to be screened. This review summarizes global findings on innovative approaches to cervical cancer screening for female sex trade workers, highlights current gaps in the delivery of cervical cancer screening for female sex trade workers globally, and suggests areas for future research and policy development. A scoping review of peer-reviewed publications and grey literature was conducted. Medline (OVID), PubMed, EMBASE, and SCOPUS were searched for relevant studies written in English. There were no limitations placed on dates. Grey literature was identified by hand searching and through discussion with health care providers and community outreach workers currently working with sex trade workers. Twenty-five articles were deemed suitable for review. Articles detailing innovative ways for female sex trade workers to access cervical cancer screening were included. Articles about screening for sexually transmitted infections were also included if the findings could be generalized to screening for cervical cancer. Articles limited to exploring risk factors, knowledge, awareness, education, prevalence, and incidence of cervical cancer among sex trade workers were excluded from the review. Successful screening initiatives identified in the studies reviewed had unconventional hours of operation, understood the difference between street-based and venue-based sex trade workers, and/or used peers for outreach. Two significant gaps in health care service delivery were highlighted in this review: the limited use of unorthodox hours and the nearly exclusive practice of providing sexually transmitted infection screening for female sex trade workers without cervical cancer screening. In addition, although street-based (as opposed to venue-based) sex trade workers are likely at higher risk for

Prevalence of HIV, human papillomavirus type 16 and herpes simplex virus type 2 among female sex workers in Guinea and associated factors.

PubMed

Aho, Joséphine; Koushik, Anita; Coutlée, François; Diakité, Soumaïla Laye; Rashed, Sélim

2014-03-01

Female sex workers are at high risk for HIV infection. Sexually transmitted infections are known to be co-factors for HIV infection. Our aims were (1) to assess the prevalence of HIV and other sexually transmitted infections in this population; (2) to determine the association between sociodemographic characteristics, behavioural variables, and variables related to HIV prevention and HIV infection. A cross-sectional study was conducted in Conakry, Guinea, among a convenience sample of 223 female sex workers. A questionnaire on sociodemographic characteristics, risk factors, and exposure to prevention was administered. Screening for HIV, herpes simplex virus type 2, human papillomavirus type 16, Neisseria gonorrhoeae, and Chlamydia trachomatis was performed. Prevalences of HIV, herpes simplex virus type 2, human papillomavirus type 16, N. gonorrhoeae, and C. trachomatis were 35.3%, 84.1%, 12.2%, 9.0%, and 13.6%, respectively. Having a child, lubricant use, and human papillomavirus type 16 infection were associated with HIV infection. Interventions that promote screening and treatment of sexually transmitted infections are needed in order to achieve successful interventions to prevent HIV among female sex workers in resource-limited settings.

Pragati: an empowerment programme for female sex workers in Bangalore, India.

PubMed

Euser, Sjoerd M; Souverein, Dennis; Rama Narayana Gowda, Pushpalatha; Shekhar Gowda, Chandra; Grootendorst, Diana; Ramaiah, Rajendra; Barot, Snehal; Kumar, Sunil; Jenniskens, Françoise; Kumar, Shiv; Den Boer, Jeroen W

2012-11-27

To describe the effects of a broad empowerment programme among female sex workers (FSWs) in Bangalore, India, which seeks to develop the capacities of these women to address the issues that threaten their lives and livelihoods. This study is based on a comprehensive, on-going HIV-prevention and empowering programme, known as Pragati, which reaches out to approximately 10,000-12,000 FSWs in Bangalore each year. The programme has been designed in collaboration with the sex worker community and provides a personalised set of services, which include STI prevention and treatment services, crisis-response facilities, de-addiction services, and microfinance support all of which have been tailored to adequately fulfil each woman's needs. During the period examined by this study, the programme reached out to 20,330 individual FSWs [median (IQR) age 28 (24-35) years]. The programme's personal records of the participating FSWs were used for this descriptive study. Between 2005 and 2010, the number of participating FSWs increased from 2,307 to 13,392. These women intensified their contact with the programme over time: the number of programme contacts increased from 10,351 in 2005 to 167,709 in 2010. Furthermore, data on the effects of crisis-response facilities, de-addiction and microfinance services, condom distribution schemes, and STI diagnosis and treatment showed an accumulating involvement of the participating FSWs in these programme services. This programme, which focuses on social and economic empowerment among FSWs, is successful in reaching and involving the target population.

Levels of advertised unprotected vaginal and oral sex by independent indoor female sex workers in West Yorkshire, UK.

PubMed

Eccles, Claire; Clarke, Janette

2014-02-01

To assess the proportion of independent indoor female sex workers (FSW) in West Yorkshire, UK who advertise unprotected sex, and to investigate any association with cost, location and provision of anal sex. Data on whether independent indoor FSW (defined as those not advertising via an escort agency or through a parlour) advertised unprotected sexual services, along with demographic data, were collected from 462 advertisement profiles of FSW in West Yorkshire from the website http://www.adultwork.com. Independent t test and χ(2) statistics were used to test the association between advertised unprotected vaginal and oral sex, and FSW age, cost of services, location and whether they advertised anal sex. Unprotected vaginal sex was advertised by 8% of FSW, and unprotected oral sex by 74% of FSW. FSW advertising unprotected vaginal sex were more likely to live in Wakefield and Bradford than in Leeds, had significantly lower hourly rates, and were more likely to advertise anal sex. Advertised condom use for vaginal and oral sex by independent indoor FSW in West Yorkshire was significantly lower than reported rates of protected sex found in previous studies based in London and the south of England. The advertisement of unprotected vaginal sex is associated with factors such as lower hourly rates and the advertisement of higher risk anal sex, which may signify greater economic need. FSW offering unprotected sex therefore represent an at-risk target group for health promotion.

Reasons for non- use of condoms and self- efficacy among female sex workers: a qualitative study in Nepal

PubMed Central

2011-01-01

Background Heterosexual contact is the most common mode of transmission of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) in Nepal and it is largely linked to sex work. We assessed the non-use of condoms in sex work with intimate sex partners by female sex workers (FSWs) and the associated self-efficacy to inform the planning of STI/HIV prevention programmes in the general population. Methods This paper is based on a qualitative study of Female Sex Workers (FSWs) in Nepal. In-depth interviews and extended field observation were conducted with 15 FSWs in order to explore issues of safe sex and risk management in relation to their work place, health and individual behaviours. Results The main risk factor identified for the non-use of condoms with intimate partners and regular clients was low self efficacy. Non-use of condoms with husband and boyfriends placed them at risk of STIs including HIV. In addition to intimidation and violence from the police, clients and intimate partners, clients' resistance and lack of negotiation capacity were identified as barriers in using condoms by the FSWs. Conclusion This study sheds light on the live and work of FSWs in Nepal. This information is relevant for both the Government of Nepal and Non Governmental Organisations (NGO) to help improve the position of FSWs in the community, their general well-being and to reduce their risks at work. PMID:21943102

Assessing reported condom use among female sex workers in southern India through examination of condom availability.

PubMed

Bradley, Janet; Moses, Stephen; Blanchard, James F; Rajaram, S; Ramesh, B M; Verma, Supriya; Alary, Michel

2010-02-01

A key indicator of success of HIV prevention programmes is the number of female sex worker (FSW) sex acts protected by condoms. This measure usually relies on FSW reports, which may be biased. We examined condom availability data in five Karnataka districts to estimate the proportion of FSW sex acts potentially protected by condoms. Financial, programme, population, condom and contraceptive data were obtained from governmental and non-governmental sources, surveys and HIV prevention programmes. Sexual behaviour data were obtained from general population and FSW surveys. We examined four scenarios in a sensitivity analysis, each one assuming different proportions of available condoms that might have been used by sex workers. Possible condom use rates for all FSW sex acts ranged from 3%-36% in 2004 to 56%-96% in 2008. The two most realistic scenarios that discounted the number of private sector condoms that might have been bought for sex acts other than with FSWs showed that 16-24% of FSW sex acts could have been protected by condoms in 2004 rising to 77-85% in 2008. These data suggest that condom availability in these Karnataka districts in 2004 was low in relation to the number of FSW sex acts, but rose substantially over the ensuing 4 years. Condom availability data can be useful for triangulation with other available data, such as self-reported condom use, to provide a range of possibilities regarding the number of FSW sex acts protected by condoms.

Risks, benefits and survival strategies-views from female sex workers in Savannakhet, Laos

PubMed Central

2012-01-01

Background Female sex workers (FSWs) are vulnerable to sexually transmitted infections (STIs) and encounter socio-economic and health problems, including STIs/HIV, unintended pregnancy and complications from unsafe abortion, stigma, violence, and drug addiction. Reducing risks associated with sex work requires an understanding of the social and cultural context in which sex workers live and work. This study aimed to explore the working environment and perceived risks among FSWs in Savannakhet province in Laos. Methods Five focus group discussions (FGDs) and seven interviews were conducted with FSWs in Kaysone Phomvihan district in Laos. Latent content analysis was used to analyze the transcribed text. Results The results revealed that the FSWs were aware of risks but they also talked about benefits related to their work. The risks were grouped into six categories: STIs/HIV, unintended pregnancy, stigma, violence, being cheated, and social and economic insecurity. The reported benefits were financial security, fulfilling social obligations, and sexual pleasure. The FSWs reported using a number of strategies to reduce risks and increase benefits. Conclusions The desire to be self-sufficient and earn as much money as possible put the FSWs in disadvantaged and vulnerable situations. Fear of financial insecurity, obligations to support one’s family and the need to secure the future influenced FSWs’ decisions to have safe or unsafe sex. The FSWs were, however, not only victims. They also had some control over their lives and working environment, with most viewing their work as an easy and good way of earning money. PMID:23164407

Prevalence of lifetime abortion and methods of contraception among female sex workers in Bogota, Colombia.

PubMed

Bautista, Christian T; Mejía, Alfredo; Leal, Luis; Ayala, Claudia; Sanchez, Jose L; Montano, Silvia M

2008-03-01

The primary objective was to estimate the lifetime prevalence of abortion and the secondary objective was to describe the use of contraceptive methods among female sex workers (FSW) in Bogota, Colombia. A cross-sectional survey was conducted among FSW. Information on sociodemographic characteristics, contraceptive methods, number of abortions, reasons for abortions and sexual practices was collected. A total of 514 FSW were enrolled. Of these, 264 (53%) had a lifetime abortion. Age, years in sex work and a previous sexually transmitted infection were associated with abortion. A total of 89 FSW(17%) reported no contraception method. Oral contraceptives, use of condoms, female sterilization and intrauterine device insertion were the most common methods of contraception. Women who were poorer, who initiated sex work at a younger age and who reported use of illegal drugs were associated with inconsistent contraception. A high lifetime prevalence of abortion and inconsistent contraception was found among FSW in Bogota. There is a need for effective and practical contraceptive methods of family health planning among FSW in Colombia.

The Female Sex Work Industry in a District of India in the Context of HIV Prevention

PubMed Central

Buzdugan, Raluca; Halli, Shiva S.; Hiremath, Jyoti M.; Jayanna, Krishnamurthy; Raghavendra, T.; Moses, Stephen; Blanchard, James; Scambler, Graham; Cowan, Frances

2012-01-01

HIV prevalence in India remains high among female sex workers. This paper presents the main findings of a qualitative study of the modes of operation of female sex work in Belgaum district, Karnataka, India, incorporating fifty interviews with sex workers. Thirteen sex work settings (distinguished by sex workers' main places of solicitation and sex) are identified. In addition to previously documented brothel, lodge, street, dhaba (highway restaurant), and highway-based sex workers, under-researched or newly emerging sex worker categories are identified, including phone-based sex workers, parlour girls, and agricultural workers. Women working in brothels, lodges, dhabas, and on highways describe factors that put them at high HIV risk. Of these, dhaba and highway-based sex workers are poorly covered by existing interventions. The paper examines the HIV-related vulnerability factors specific to each sex work setting. The modes of operation and HIV-vulnerabilities of sex work settings identified in this paper have important implications for the local programme. PMID:23346389

The Female Sex Work Industry in a District of India in the Context of HIV Prevention.

PubMed

Buzdugan, Raluca; Halli, Shiva S; Hiremath, Jyoti M; Jayanna, Krishnamurthy; Raghavendra, T; Moses, Stephen; Blanchard, James; Scambler, Graham; Cowan, Frances

2012-01-01

HIV prevalence in India remains high among female sex workers. This paper presents the main findings of a qualitative study of the modes of operation of female sex work in Belgaum district, Karnataka, India, incorporating fifty interviews with sex workers. Thirteen sex work settings (distinguished by sex workers' main places of solicitation and sex) are identified. In addition to previously documented brothel, lodge, street, dhaba (highway restaurant), and highway-based sex workers, under-researched or newly emerging sex worker categories are identified, including phone-based sex workers, parlour girls, and agricultural workers. Women working in brothels, lodges, dhabas, and on highways describe factors that put them at high HIV risk. Of these, dhaba and highway-based sex workers are poorly covered by existing interventions. The paper examines the HIV-related vulnerability factors specific to each sex work setting. The modes of operation and HIV-vulnerabilities of sex work settings identified in this paper have important implications for the local programme.

Alcohol and sexual risk behavior among migrant female sex workers and male workers in districts with high in-migration from four high HIV prevalence states in India.

PubMed

Verma, Ravi K; Saggurti, Niranjan; Singh, Ajay K; Swain, Suvakanta N

2010-08-01

This paper examines the association between alcohol use and sexual risk in two critical migrant populations living within the same geographical areas--migrant men and female sex-workers (FSWs). Data are drawn from two independent surveys of migrant FSWs and male workers in 14 districts of four high HIV prevalent Indian states. In the paper we have examined the independent effects of degree of mobility and alcohol use prior to sex on HIV risk behaviors. Nearly two-thirds of FSWs and a similar proportion of male migrant workers, as well as nine out of ten clients of FSWs consume alcohol. More than half of the FSWs and their clients consumed alcohol prior to sex. The practice of alcohol use prior to sex among both FSWs and their clients has a significant association with inconsistent condom use during paid as well as unpaid sex, and these effects are independent of degree of mobility. The results suggest a need for developing an in-depth understanding of the role of alcohol in accentuating HIV risk particularly among migrant populations who move frequently from one place another.

Occupational and demographic factors associated with drug use among female sex workers at the China-Myanmar border.

PubMed

Hail-Jares, Katie; Choi, Sugy; Duo, Lin; Luo, Zhi; Huang, Z Jennifer

2016-04-01

Within the last decade, the use of amphetamine type stimulants (ATS) has swelled in Myanmar. Regionally, female sex workers have reported turning to ATS for occupational reasons. In doing so, drug-using female sex workers (FSW) face compounded risks for HIV and other sexually transmitted infections (STI). Here, we examine the factors that impact FSW drug use in Muse, a town along the China-Myanmar border. In 2012, 101 FSW were recruited from entertainment venues and brothels along the Myanmar-Chinese border. Participants participated in a self-administered behavioral survey covering demographics, drug use, sex work, and risk behaviors. Bivariate and regression analyses were conducted in SPSS. Thirty four percent of respondents indicated current drug use. ATS derivatives were the most commonly used drugs (87.5%) with injection drug use being nearly non-existent in the sample. Drug using FSWs were older, had engaged in sex work longer, had more Chinese clients, and were more likely to have a previous boyfriend who had used drugs. They were also 3.5 times more likely to report a STI. Client condom use, HIV testing rates, and familiarity with public health resources did not statistically differ by drug use status. More research is needed to examine how romantic and professional sexual relationships push-and-pull FSW into using drugs. Our results suggest that diverse safer sex strategies, beyond client condom use, should be promoted with drug using FSWs, including strategies that acknowledge the impact of ATS use. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Understanding STI Risk and Condom Use Patterns by Partner Type Among Female Sex Workers in Peru.

PubMed

Kinsler, Janni J; Blas, Magaly M; Cabral, Alejandra; Carcamo, Cesar; Halsey, Neal; Brown, Brandon

2014-01-01

While brothel-based sex work is regulated by the Peruvian government, there is little data on STI risk factors reported by female sex workers (FSW). This study compared high risk behaviors among 120 Peruvian FSW from government regulated brothels with both clients and non-commercial partners. Our study found that 12% of FSW reported unprotected vaginal sex with clients (compared to 75% with non-commercial partners), and 42% reported unprotected anal sex with clients (compared to 87% with non-commercial partners). Group differences were observed in the expectation to have oral sex (32% for partners vs 60% for clients; p<0.01), and a history of anal sex (65% for partners vs 32% for clients; p<0.01) and both vaginal and anal sex with the same partners (46% for partners vs 25% for clients; p<0.001). These findings suggest that FSW constitute an important bridge population for STI/HIV transmission in Peru.

Mobile phones and sex work in South India: the emerging role of mobile phones in condom use by female sex workers in two Indian states.

PubMed

Navani-Vazirani, Sonia; Solomon, Davidson; Gopalakrishnan; Heylen, Elsa; Srikrishnan, Aylur Kailasom; Vasudevan, Canjeevaram K; Ekstrand, Maria L

2015-01-01

The aim of this study was to examine female sex workers' solicitation of clients using mobile phones and the association between this and condom use with clients. Cross-sectional data were utilised to address the study's aim, drawing on data collected from female sex workers in Calicut, Kerala, and Chirala, Andhra Pradesh. Use of mobile phone solicitation was reported by 46.3% (n = 255) of Kerala participants and 78.7% (n = 464) of those in Andhra Pradesh. Kerala participants reporting exclusive solicitation using mobile phones demonstrated 1.67 times higher odds (95% CI: 1.01-2.79) of inconsistent condom use than those reporting non-use of mobile phones for solicitation. However, those reporting exclusive solicitation through mobile phones in Andhra Pradesh reported lower odds of inconsistent condom use (OR: 0.03; 95% CI: 0.01-0.26) than those not using mobile phones for solicitation. Findings indicate that solicitation of clients using mobile phones facilitates or hampers consistency in condom use with clients depending on the context, and how mobile phones are incorporated into solicitation practices. Variations in sex work environments, including economic dependence on sex work or lack thereof may partially account for the different effects found.

Peer outreach work as economic activity: implications for HIV prevention interventions among female sex workers.

PubMed

George, Annie; Blankenship, Kim M

2015-01-01

Female sex workers (FSWs) who work as peer outreach workers in HIV prevention programs are drawn from poor socio-economic groups and consider outreach work, among other things, as an economic activity. Yet, while successful HIV prevention outcomes by such programs are attributed in part to the work of peers who have dense relations with FSW communities, there is scant discussion of the economic implications for FSWs of their work as peers. Using observational data obtained from an HIV prevention intervention for FSWs in south India, we examined the economic benefits and costs to peers of doing outreach work and their implications for sex workers' economic security. We found that peers considered their payment incommensurate with their workload, experienced long delays receiving compensation, and at times had to advance money from their pockets to do their assigned peer outreach work. For the intervention these conditions resulted in peer attrition and difficulties in recruitment of new peer workers. We discuss the implications of these findings for uptake of services, and the possibility of reaching desired HIV outcomes. Inadequate and irregular compensation to peers and inadequate budgetary outlays to perform their community-based outreach work could weaken peers' relationships with FSW community members, undermine the effectiveness of peer-mediated HIV prevention programs and invalidate arguments for the use of peers.

Perceived stigma of purchasing sex among Latino and non-Latino male clients of female sex workers in Tijuana, Mexico

PubMed Central

Pitpitan, Eileen V.; Strathdee, Steffanie A.; Semple, Shirley J.; Wagner, Karla D.; Chavarin, Claudia V.; Earnshaw, Valerie A.; Patterson, Thomas L.

2013-01-01

HIV prevention efforts must be comprehensive in their understanding of the factors involved in HIV risk. Male clients, who have received less research attention than female sex workers (FSWs), may experience stigma as a function of purchasing sex. Perceived stigma may be related to poor psychological outcomes, risky psychosexual characteristics, and higher drug and sexual risk behavior among male clients of FSWs. However, perceived stigma of purchasing sex may differ between clients of different ethnic groups. In the present study, we examine the correlates of perceived stigma of purchasing sex among Latino vs. non-Latino male clients of FSWs in Tijuana, Mexico. Using time-location sampling, we recruited 375 male clients (323 Latino, 52 non-Latino) in Tijuana who completed a computerized survey on various measures. We measured perceived stigma of purchasing sex using three items we developed for this study. Using linear regression analyses we found that perceived stigma was associated with greater guilt, a greater feeling of escape from everyday life, and more negative condom attitudes among Latino clients. This was not found among non-Latino clients. Features of Latino culture, like machismo, and how they may relate to stigma of purchasing sex are discussed. PMID:23979714

Perceived stigma of purchasing sex among Latino and non-Latino male clients of female sex workers in Tijuana, Mexico.

PubMed

Pitpitan, Eileen V; Strathdee, Steffanie A; Semple, Shirley J; Wagner, Karla D; Chavarin, Claudia V; Earnshaw, Valerie A; Patterson, Thomas L

2015-02-01

HIV prevention efforts must be comprehensive in their understanding of the factors involved in HIV risk. Male clients, who have received less research attention than female sex workers (FSWs), may experience stigma as a function of purchasing sex. Perceived stigma may be related to poor psychological outcomes, risky psychosexual characteristics, and higher drug and sexual risk behavior among male clients of FSWs. However, perceived stigma of purchasing sex may differ between clients of different ethnic groups. In the present study, we examine the correlates of perceived stigma of purchasing sex among Latino versus non-Latino male clients of FSWs in Tijuana, Mexico. Using time-location sampling, we recruited 375 male clients (323 Latino, 52 non-Latino) in Tijuana who completed a computerized survey on various measures. We measured perceived stigma of purchasing sex using three items we developed for this study. Using linear regression analyses we found that perceived stigma was associated with greater guilt, a greater feeling of escape from everyday life, and more negative condom attitudes among Latino clients. This was not found among non-Latino clients. Features of Latino culture, like machismo, and how they may relate to stigma of purchasing sex are discussed.

Can variation in HIV/STD-related risk be explained by individual SES? Findings from female sex workers in a rural Chinese county

PubMed Central

Fang, Xiaoyi; Li, Xiaoming; Yang, Hongmei; Hong, Yan; Stanton, Bonita; Zhao, Ran; Dong, Baiqing; Liu, Wei; Zhou, Yuejiao; Liang, Shaoling

2007-01-01

Low socioeconomic status (SES) has been linked to HIV and sexually transmitted disease (STD) at a macro level because the majority of new cases of HIV infection in the world have been reported in underdeveloped or developing countries. However, empirical data on the relationship between individual SES and HIV/STD related risk have been mixed. Employing quantitative data from 454 female sex workers, this study was designed to examine the profile of the study sample in terms of their individual SES, HIV/STD-related sexual risk across work locations with different social, cultural and economic conditions; and examine the relationship between work location and HIV-related risk behaviors, controlling for individual SES. We have shown in the current study that both SES and HIV/STD-related risk behaviors significantly differed by work location. However, the difference in individual SES was not sufficient to explain the difference of HIV/STD-related risk across the work locations. The findings underscore the need for effective prevention intervention efforts targeting female sex workers in rural area. Based on the findings, we also suggest that HIV/STD intervention efforts among female sex workers should take the social and cultural contextual factors of their working environment (and sexual risks) into consideration. PMID:18350430

Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar.

PubMed

Hoke, Theresa H; Feldblum, Paul J; Damme, Kathleen Van; Nasution, Marlina D; Grey, Thomas W; Wong, Emelita L; Ralimamonjy, Louisette; Raharimalala, Leonardine; Rasamindrakotroka, Andry

2007-10-01

To assess whether individual clinic-based counselling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion. In two public dispensaries in Madagascar, a total of 901 sex workers were randomly allocated between two alternative male and female condom promotion peer education only, or peer education supplemented with individual clinic-based counselling. Participants were followed for 12 months. Every 2 months they made clinic visits, where they were interviewed on condom use. Peer educators counselled all participants on condom use as they accompanied their assigned participants to study visits. Participants assigned to receive the supplemental intervention were counselled by a trained clinician following study interviews. Participants were tested and treated for chlamydia, gonorrhoea and trichomoniasis every 6 months. We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence. Use of protection with clients and non-paying partners was assessed by study arm, site, and visit. There was no statistically significant association between study arm and aggregated STI prevalence. No substantial differences in levels of reported protection were noted between study groups. This study found little evidence for gains from more thorough clinical counselling on male and female condom use. These findings suggest that less clinically intensive interventions such as peer education could be suitable for male and female condom promotion in populations already exposed to barrier method promotion.

Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study

PubMed Central

Merghati-Khoei, Effat

2018-01-01

Objectives In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. Methods A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. Results We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. Conclusions Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS. PMID:29631351

Pragati: an empowerment programme for female sex workers in Bangalore, India

PubMed Central

Euser, Sjoerd M.; Souverein, Dennis; Rama Narayana Gowda, Pushpalatha; Shekhar Gowda, Chandra; Grootendorst, Diana; Ramaiah, Rajendra; Barot, Snehal; Kumar, Sunil; Jenniskens, Françoise; Kumar, Shiv; Den Boer, Jeroen W.

2012-01-01

Objectives To describe the effects of a broad empowerment programme among female sex workers (FSWs) in Bangalore, India, which seeks to develop the capacities of these women to address the issues that threaten their lives and livelihoods. Design This study is based on a comprehensive, on-going HIV-prevention and empowering programme, known as Pragati, which reaches out to approximately 10,000–12,000 FSWs in Bangalore each year. The programme has been designed in collaboration with the sex worker community and provides a personalised set of services, which include STI prevention and treatment services, crisis-response facilities, de-addiction services, and microfinance support all of which have been tailored to adequately fulfil each woman's needs. During the period examined by this study, the programme reached out to 20,330 individual FSWs [median (IQR) age 28 (24–35) years]. The programme's personal records of the participating FSWs were used for this descriptive study. Results Between 2005 and 2010, the number of participating FSWs increased from 2,307 to 13,392. These women intensified their contact with the programme over time: the number of programme contacts increased from 10,351 in 2005 to 167,709 in 2010. Furthermore, data on the effects of crisis-response facilities, de-addiction and microfinance services, condom distribution schemes, and STI diagnosis and treatment showed an accumulating involvement of the participating FSWs in these programme services. Conclusion This programme, which focuses on social and economic empowerment among FSWs, is successful in reaching and involving the target population. PMID:23195516

Dangerous subtlety: relationship-related determinants of consistency of condom use among female sex workers and their regular, non-commercial partners in Hai Phong, Viet Nam.

PubMed

Hoffman, Leah; Nguyen, Ha Thi Thu; Kershaw, Trace S; Niccolai, Linda M

2011-10-01

Research indicates female sex workers use condoms more consistently with their clients than with regular, non-commercial partners (partners). The purpose of this study was to better understand the relationship between couple communication and HIV risk behavior by examining (1) sex worker-partner divergence on communication measures and (2) the association between intra-couple communication divergence and consistent condom use. In this cross-sectional study, 50 sex workers and their partners in Hai Phong, Viet Nam were separately asked about their relationships and condom use. When asked about HIV risk communication in their relationship, sex workers reported significantly higher HIV communication content than their partners (p < 0.001). Higher communication divergence between partners was associated with a decreased likelihood of consistent condom use (OR 0.54 95% CI 0.30, 0.97). Sex workers urgently need interventions that build their communication skills and address their risk behavior in non-commercial relationships.

Sex workers talk about sex work: six contradictory characteristics of legalised sex work in Melbourne, Australia.

PubMed

Begum, Sufia; Hocking, Jane S; Groves, Jan; Fairley, Christopher K; Keogh, Louise A

2013-01-01

Despite research suggesting that legal sex work is safe and that emotional risks and social stigma are of greater concern than health risks, much research on sex work has focused on health risks. Given the legalisation of sex work in Victoria, Australia, it is timely to look beyond health. Three focus groups were conducted with a total of 14 female sex workers on their experience of legal sex work, both positive and negative, and the social acceptability of their profession. Thematic analysis was used to identify the key ways that sex workers described sex work. Women saw legal sex work as safer than illegal sex work, but still not socially acceptable. However, they also described six contradictory elements of sex work, which was seen as: financially rewarding and entrapping; empowering and demeaning; increasing some opportunities while reducing others; flexible and demanding; offering both intimacy and competition; and leading to a 'double life'. While legalisation has improved the safety of sex work, stigma and discrimination persist.

High risk of HIV in non-brothel based female sex workers in India

PubMed Central

Dandona, Rakhi; Dandona, Lalit; Gutierrez, Juan Pablo; Kumar, Anil G; McPherson, Sam; Samuels, Fiona; Bertozzi, Stefano M

2005-01-01

Background Heterosexual contact is the most common mode of HIV transmission in India that is largely linked to sex work. We assessed the non-use of condoms in sex work and with regular sex partners by female sex workers (FSWs), and identified its associations that could assist in planning HIV prevention programmes. Methods Detailed documentation of various aspects of sex work, and sexual behaviour with regular sex partners, was done through confidential interviews for 6648 FSWs in 13 districts in the Indian state of Andhra Pradesh. Multivariate analysis was done to understand condom non-use with clients. Results 5010 (75.4%), 1499 (22.5%), and 139 (2.1%) FSWs were street-, home-, and brothel-based, respectively. Of the total 6648 FSWs, 6165 (92.7%) had penetrative vaginal/anal sex with at least one client in the last 15 days, and of these 2907 (47.2%; 95% CI 41.2–53.2%) reported non-use of condom with at least one of her last three clients. Lack of knowledge that HIV could be prevented (odds ratio 5.01; 95% CI 4.38–5.73), no access to free condoms (odds ratio 3.45; 95% CI 2.99–3.98), being street-based as compared with brothel-based (odds ratio 3.36; 95% CI 1.87–6.04), and no participation in FSW support groups (odds ratio 2.02; 95% CI 1.50–2.70) were the most significant predictors of condom non-use with clients. Other associations included lower social support, lower income, age >24 years, illiteracy, and living in medium-size urban or rural areas. Of the 2582 who had penetrative sex with regular sex partner within the last 7 days, 2428 (94%; 95% CI 92.1–95.9%) had not used condom at last sex, and 1032 (41.8%) had neither used condom consistently with clients nor with regular sex partner. Conclusion About half the FSWs do not use condom consistently with their clients in this Indian state putting them at high risk of HIV infection. Non-brothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher risk of HIV

High risk of HIV in non-brothel based female sex workers in India.

PubMed

Dandona, Rakhi; Dandona, Lalit; Gutierrez, Juan Pablo; Kumar, Anil G; McPherson, Sam; Samuels, Fiona; Bertozzi, Stefano M

2005-08-20

Heterosexual contact is the most common mode of HIV transmission in India that is largely linked to sex work. We assessed the non-use of condoms in sex work and with regular sex partners by female sex workers (FSWs), and identified its associations that could assist in planning HIV prevention programmes. Detailed documentation of various aspects of sex work, and sexual behaviour with regular sex partners, was done through confidential interviews for 6,648 FSWs in 13 districts in the Indian state of Andhra Pradesh. Multivariate analysis was done to understand condom non-use with clients. 5,010 (75.4%), 1,499 (22.5%), and 139 (2.1%) FSWs were street-, home-, and brothel-based, respectively. Of the total 6,648 FSWs, 6,165 (92.7%) had penetrative vaginal/anal sex with at least one client in the last 15 days, and of these 2,907 (47.2%; 95% CI 41.2-53.2%) reported non-use of condom with at least one of her last three clients. Lack of knowledge that HIV could be prevented (odds ratio 5.01; 95% CI 4.38-5.73), no access to free condoms (odds ratio 3.45; 95% CI 2.99-3.98), being street-based as compared with brothel-based (odds ratio 3.36; 95% CI 1.87-6.04), and no participation in FSW support groups (odds ratio 2.02; 95% CI 1.50-2.70) were the most significant predictors of condom non-use with clients. Other associations included lower social support, lower income, age >24 years, illiteracy, and living in medium-size urban or rural areas. Of the 2582 who had penetrative sex with regular sex partner within the last 7 days, 2428 (94%; 95% CI 92.1-95.9%) had not used condom at last sex, and 1032 (41.8%) had neither used condom consistently with clients nor with regular sex partner. About half the FSWs do not use condom consistently with their clients in this Indian state putting them at high risk of HIV infection. Non-brothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher risk of HIV infection as compared with brothel-based FSWs. With

Occupational safety and HIV risk among female sex workers in China: A mixed-methods analysis of sex-work harms and mommies

PubMed Central

Yi, Huso; Zheng, Tiantian; Wan, Yanhai; Mantell, Joanne E.; Park, Minah; Csete, Joanne

2013-01-01

Female sex workers (FSWs) in China are exposed to multiple work-related harms that increase HIV vulnerability. Using mixed-methods, we explored the social-ecological aspects of sexual risk among 348 FSWs in Beijing. Sex-work harms were assessed by property stolen, being underpaid or not paid at all, verbal and sexual abuse, forced drinking; and forced sex more than once. The majority (90%) reported at least one type of harm, 38% received harm protection from ‘mommies’ (i.e., managers) and 32% reported unprotected sex with clients. In multivariate models, unprotected sex was significantly associated with longer involvement in sex work, greater exposure to harms, and no protection from mommies. Mommies’ protection moderated the effect of sex-work harms on unprotected sex with clients. Our ethnography indicated that mommies played a core role in sex-work networks. Such networks provide a basis for social capital; they are not only profitable economically, but also protect FSWs from sex-work harms. Effective HIV prevention interventions for FSWs in China must address the occupational safety and health of FSWs by facilitating social capital and protection agency (e.g., mommies) in the sex-work industry. PMID:22375698

Oral sex practices, oral human papillomavirus and correlations between oral and cervical human papillomavirus prevalence among female sex workers in Lima, Peru.

PubMed

Brown, B; Blas, M M; Cabral, A; Carcamo, C; Gravitt, P E; Halsey, N

2011-11-01

Few data exist on oral human papillomavirus (HPV) prevalence in female sex workers (FSWs). Information regarding oral sex practices of 185 Peruvian FSWs, 18-26 years of age, was obtained via survey and compared with HPV testing results of oral rinse samples. Oral HPV prevalence was 14/185 (7.6%); four (28.9%) HPV genotypes were carcinogenic. One hundred and eighty-two participants reported having had oral sex; 95% reported condom use during oral sex with clients and 9.5% with partners. Women who had oral sex more than three times with their partners in the past month were more likely to have oral HPV than women who had oral sex three times or less (P = 0.06). Ten (71.4%) women with oral HPV were HPV-positive at the cervix; conversely 8.3% of women with cervical HPV were HPV-positive in the oral cavity. The prevalence of oral HPV was relatively low, considering the high rates of oral sex practiced by these women.

Male and female Ethiopian and Kenyan runners are the fastest and the youngest in both half and full marathon.

PubMed

Knechtle, Beat; Nikolaidis, Pantelis T; Onywera, Vincent O; Zingg, Matthias A; Rosemann, Thomas; Rüst, Christoph A

2016-01-01

In major marathon races such as the 'World Marathon Majors', female and male East African runners particularly from Ethiopia and Kenya are the fastest. However, whether this trend appears for female and male Ethiopians and Kenyans at recreational level runners (i.e. races at national level) and in shorter road races (e.g. in half-marathon races) has not been studied yet. Thus, the aim of the present study was to examine differences in the performance and the age of female and male runners from East Africa (i.e. Ethiopians and Kenyans) between half- and full marathons. Data from 508,108 athletes (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) originating from 126 countries and competing between 1999 and 2014 in all road-based half-marathons and marathons held in one country (Switzerland) were analysed using Chi square (χ(2)) tests, mixed-effects regression analyses and one-way analyses of variance. In half-marathons, 48 women (0.038 %) and 63 men (0.019 %) were from Ethiopia and 80 women (0.063 %) and 134 men (0.040 %) from Kenya. In marathons, three women (0.029 %) and 15 men (0.034 %) were from Ethiopia and two women (0.019 %) and 33 men (0.075 %) from Kenya. There was no statistically significant association between the nationality of East Africans and the format of a race. In both women and men, the fastest race times in half-marathons and marathons were achieved by East African runners (p < 0.001). Ethiopian and Kenyan runners were the youngest in both sexes and formats of race (p < 0.001). In summary, women and men from Ethiopia and Kenya, despite they accounted for <0.1 % in half-marathons and marathons, achieved the fastest race times and were the youngest in both half-marathons and marathons. These findings confirmed in the case of half-marathon the trend previously observed in marathon races for a better performance and a younger age in East African runners from Ethiopia and Kenya.

Behavioral and psychosocial correlates of anal sex among male clients of female sex workers in Tijuana, Mexico.

PubMed

Semple, Shirley J; Strathdee, Steffanie A; Pitpitan, Eileen V; Chavarin, Claudia; Patterson, Thomas L

2015-05-01

Most studies of heterosexual sex risk practices have focused on condomless vaginal sex despite evidence that condomless anal sex has a significantly higher risk of HIV transmission. The present study focused on male clients' anal sex practices with female sex workers (FSWs) in Tijuana, Mexico, where an HIV epidemic is growing among high-risk groups. Logistic regression analyses were used to identify psychosocial and behavioral correlates of anal sex among male clients. Our sample of HIV-negative men (N = 400) was predominantly Latino (87.5 %), born in Mexico (78.8 %), never married (36.8 %) or in a regular or common-law marriage (31.5 %), and employed (62.8 %), with an average age and education of 37.8 and 9.2 years, respectively. Eighty-nine percent identified as heterosexual and 11 % as bisexual. By design, 50 % of the sample resided in Tijuana and the other 50 % in San Diego County. Nearly half (49 %) reported at least one incident of anal sex with a FSW in Tijuana in the past 4 months; of those participants, 85 % reported that one or more of their anal sex acts with FSWs had been without a condom. In a multivariate model, anal sex with a FSW in the past 4 months was associated with bisexual identification, methamphetamine use with FSWs, repeat visits to the same FSW, higher scores on perceived stigma about being a client of FSWs, and sexual compulsivity. Prevention programs are needed that address the behavioral and psychosocial correlates of heterosexual anal sex in order to reduce HIV/STI transmission risk among male clients, FSWs, and their sexual network members.

Immigration status and HIV-risk related behaviors among female sex workers in South America.

PubMed

Bautista, Christian T; Mosquera, Carlos; Serra, Margarita; Gianella, Alberto; Avila, Maria M; Laguna-Torres, Victor; Carr, Jean K; Montano, Silvia M; Sanchez, José L

2008-03-01

This study compares immigrant (i.e., foreigner) with non-immigrant (i.e., local/native) HIV-related risk behaviors among female sex workers (FSW) in South America. A total of 1,845 FSW were enrolled in Argentina, Bolivia, Ecuador, and Uruguay. According to their nationality, 10.1% of participants were immigrant FSW. Immigrant FSW were more likely to be younger in Argentina; to work in a disco/bar in Bolivia; to be single and use illegal drugs in Ecuador; and to work in a brothel, consume alcohol, and have sex with foreign clients in Uruguay. HIV-related sexual and drug use behaviors were more common among immigrant FSW in Bolivia, Ecuador, and Uruguay. Country-specific HIV/STI prevention and control programs should be developed for immigrant FSW populations in South America.

Social Influence and Individual Risk Factors of HIV Unsafe Sex among Female Entertainment Workers in China

PubMed Central

Yang, Xiushi; Xia, Guomei; Li, Xiaoming; Latkin, Carl; Celentano, David

2010-01-01

Female entertainment workers in China are at increased sexual risk of HIV, but causes of their unprotected sex remain poorly understood. We develop a model that integrates information-motivation-behavioral skills (IMB) with social influences and test the model in a venue-based sample of 732 female entertainment workers in Shanghai. Most IMB and social influence measures are statistically significant in bivariate relationships to condom use; only HIV prevention motivation and behavioral self-efficacy remain significant in the multiple regressions. Self-efficacy in condom use is the most proximate correlate, mediating the relationship between information and motivation and condom use. Both peer and venue supports are important, but their influences over condom use are indirect and mediated through prevention motivation and/or self-efficacy. Behavioral intervention is urgently needed and should take a multi-level approach, emphasizing behavioral skills training and promoting a supportive social/working environment. PMID:20166789

Sex workers as safe sex advocates: Sex workers protect both themselves and the wider community from HIV.

PubMed

Bates, Julie; Berg, Rigmor

2014-06-01

Since the advent of HIV, significant changes have made the Australian sex industry one of the safest in the world. Creating this safety has been in large part due to the ability of sex workers to act as safe sex advocates through peer-based health promotion; to negotiate with sex business owners; and to inform and participate in the development of government policy. Empowerment of sex workers through legislative reform and government funding of sex worker organizations has been central to the prevention of HV transmission, as has been the development of genuine partnership between sex worker organizations, government departments and those working in public health. The paper describes these responses in some detail and explores some of the current issues facing sex workers in Australia.

Sexual HIV risk among substance-using female commercial sex workers in Durban, South Africa.

PubMed

Carney, Tara; Petersen Williams, Petal M; Plüddemann, Andreas; Parry, Charles D H

2015-01-01

This study examined data collected from a sample of female sex workers (FSWs) during the first two years of a brief risk-reduction intervention for vulnerable populations that focused on substance use and HIV risk-related behaviours (2007-2009) as part of a rapid assessment and response evaluation study. In 2007, in collaboration with a local non-governmental organisation (NGO), an initiative was begun to roll out targeted harm reduction strategies for drug-using street based FSWs in Durban, South Africa. Data were collected on demographic characteristics, substance use and HIV risk behaviours to tailor these harm reduction strategies with participants. Over the first two years of the intervention, data were collected from 646 FSWs: 428 who reported being at low risk for HIV and 218 who reported being at high risk for HIV (defined as engaging in unprotected sex with sexual partners in the past 90 days). FSWs who had previously been diagnosed with HIV or a sexually transmitted disease (STD) were significantly less likely to report engaging in unprotected sex. Those who used over-the-counter or prescription (OTC/PRE) drugs reported engaging in unprotected sex significantly more often than FSWs who did not use these substances, while those who used heroin were less likely to report unprotected sex. The findings are encouraging in that those who are aware of their HIV status are less likely to engage in risky sexual behaviour, and therefore HIV testing and counselling is recommended. It indicates the need to identify strategies to encourage the likelihood of all FSWs, particularly those who are HIV-positive, to use condoms. It also encourages further research to investigate specific substances as possible predictors of high risk behaviours in high-risk populations of sex workers.

Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers.

PubMed

Deuba, Keshab; Anderson, Sarah; Ekström, Anna Mia; Pandey, Satish Raj; Shrestha, Rachana; Karki, Deepak Kumar; Marrone, Gaetano

2016-08-01

Sex workers face stigma, discrimination, and violence across the globe and are almost 14 times more likely to be HIV-infected than other women in low- and middle-income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions to be sustainable, it is important to understand micro-level social and structural factors that influence sexual behaviours of sex workers. This study assessed the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers (FSWs) in Nepal. This quantitative study included 610 FSWs who were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai Highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioural information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills), and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex. The HIV prevalence was 1%; this is presumably representative, with a large sample of FSWs in Nepal. The prevalence of unprotected sex with clients was high (24%). For each additional adverse physical, social, and economic condition, the probability of non-use of condoms with clients increased substantially: one problem = 12% (p<0.005), two problems = 19% (p<0.001), and three to five problems = 38% (p<0.001). Interactions between two or more adverse conditions linked to physical, social, and economic environments increased the risk of unprotected sex among Nepalese FSWs. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

HIV-infected female sex workers' high risk behavior and attitude changes in Kaiyuan City, Yunnan Province, China.

PubMed

Ding, Guo Wei; Hsi, Jenny H; Liu, Hui Xin; Su, Ying Ying; Wang, Jun Jie; Bai, Jun; Wang, Gui Xiang; Wang, Hai Bo; Dong, Rui Ling; Wang, Ning

2014-06-01

To investigate the attitude and sexual behavior status and change among HIV positive female workers in entertainment sites in Kaiyuan city, Yunnan province, China. The key information should be applied in the integrated intervention program in future. A cohort survey among HIV positive female workers was conducted during 12 months, between 2010 and 2012. All the risk sexual behavior and attitude were collected for assessment for the potential secondary transmission to sexual partners. Of 99 HIV positive women who sell sex in Kaiyuan city, 99 participated in the survey at baseline, 80, 80, 75, and 75 at 3-, 6-, 9-, and 12-month follow-ups. The percentage of participants who reported consistently used condoms in the last one month ranged between 94.5% and 95.5%. The client volume in the last one month, income per sex and age group were significant related with non-insistent condom use with their clients. It was suggested that integrated intervention program package should include 100 percent condom use promotion for the HIV positive FSW with all sexual partners, and also, include socially support involved. Copyright © 2014 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Trapped in circle of threats: violence against sex workers in Thailand.

PubMed

Ratinthorn, Ameporn; Meleis, Afaf; Sindhu, Siriorn

2009-03-01

Most researchers studying sex work have focused on the risks of sexually transmitted diseases, predominantly HIV, for sex workers, their clients, and subsequent partners. Violence against these women often goes undocumented and unnoticed. Consequently, few researchers have addressed violence against sex workers, and these few have generated limited evidence about the nature of violence from the sex-worker perspective--especially the street sex worker perspective. In this study, we used qualitative methods to explore characteristics of violence against street sex workers and how violence influences personal and societal health risks. The participants were 28 female street sex workers. The data were collected through in-depth interviews with 23 women, one focus group with 5 women, and observations of these women in their working and social environment. The results revealed that violence against sex workers can be clustered into three categories, threat to their life and health, threat to control of work and financial security, and finally, threat to humanity. Because they are disadvantaged, and engage in illegal employment, theses women were trapped in a circle of threats. To reduce violence, sex work should be decriminalized along with strategies to decrease poverty and social inequality. A special agency needs to be established to protect the rights and safety of sex workers.

Sex Workers, Fem Queens, and Cross-Dressers: Differential Marginalizations and HIV Vulnerabilities Among Three Ethnocultural Male-to-Female Transgender Communities in New York City.

PubMed

Hwahng, Sel Julian; Nuttbrock, Larry

2007-12-01

This article describes 3 distinct ethnocultural male-to-female transgender communities in New York City: the low-income African American/Black and Latina(o) House Ball community; low-income, often undocumented immigrant Asian sex workers; and middle-class White cross-dressers. These communities are highly socially isolated from each other and are more connected to their ethnocultural contexts than to an abstract and shared transgender identity. Whereas previous research either has viewed male-to-female transgender people as one monolithic group or has separated them into abstract racial categories unconnected to their communities and lifestyles, this article positions them within specific social networks, cultures, neighborhoods, and lifestyles. With regard to HIV vulnerabilities, violence, and rape, House Ball community members seemed to engage in the riskiest form of survival sex work, whereas Asian sex workers seemed to engage in moderate-risk survival sex work. White cross-dressers seemed to engage in very low-risk recreational sex work.

Sex Workers, Fem Queens, and Cross-Dressers: Differential Marginalizations and HIV Vulnerabilities Among Three Ethnocultural Male-to-Female Transgender Communities in New York City

PubMed Central

Hwahng, Sel Julian; Nuttbrock, Larry

2008-01-01

This article describes 3 distinct ethnocultural male-to-female transgender communities in New York City: the low-income African American/Black1 and Latina(o) House Ball community; low-income, often undocumented immigrant Asian sex workers; and middle-class White cross-dressers. These communities are highly socially isolated from each other and are more connected to their ethnocultural contexts than to an abstract and shared transgender identity. Whereas previous research either has viewed male-to-female transgender people as one monolithic group or has separated them into abstract racial categories unconnected to their communities and lifestyles, this article positions them within specific social networks, cultures, neighborhoods, and lifestyles. With regard to HIV vulnerabilities, violence, and rape, House Ball community members seemed to engage in the riskiest form of survival sex work, whereas Asian sex workers seemed to engage in moderate-risk survival sex work. White cross-dressers seemed to engage in very low-risk recreational sex work.2 PMID:19079558

Transactional sex risk across a typology of rural and urban female sex workers in Indonesia: a mixed methods study.

PubMed

Puradiredja, Dewi Ismajani; Coast, Ernestina

2012-01-01

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n=310), in-depth interviews (n=11), key informant interviews (n=5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.34 95% CI 0.13-0.90, p=0.029). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study's typology.

Transactional Sex Risk across a Typology of Rural and Urban Female Sex Workers in Indonesia: A Mixed Methods Study

PubMed Central

Puradiredja, Dewi Ismajani; Coast, Ernestina

2012-01-01

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n = 310), in-depth interviews (n = 11), key informant interviews (n = 5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.34 95% CI 0.13–0.90, p = 0.029). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study's typology. PMID:23285205

Drug-related behaviors independently associated with syphilis infection among female sex workers in two Mexico-US border cities.

PubMed

Loza, Oralia; Patterson, Thomas L; Rusch, Melanie; Martínez, Gustavo A; Lozada, Remedios; Staines-Orozco, Hugo; Magis-Rodríguez, Carlos; Strathdee, Steffanie A

2010-08-01

To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1 : 8) were identified by logistic regression. Setting Tijuana and Ciudad Juarez, two Mexican cities on the US border that are situated on major drug trafficking routes and where prostitution is quasi-legal. A total of 914 FSWs aged > or =18 years without known human immunodeficiency virus (HIV) infection who had had recent unprotected sex with clients. Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 31.4% had clients in the last 6 months who injected drugs, and 68.6% reported having clients from the United States. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.08), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65) and having any US clients (AOR: 2.85; 95% CI: 1.43, 5.70). Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were associated more closely with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use.

Mental Health and Functioning of Female Sex Workers in Chittagong, Bangladesh.

PubMed

Hengartner, Michael P; Islam, Md Nazrul; Haker, Helene; Rössler, Wulf

2015-01-01

To examine the mental health and functioning of female sex workers (FSW) in Chittagong, Bangladesh, a population that has commonly been neglected in mental health policy and research. We included 259 women in the study (M age: 23.2 years; range: 11-48). The comprehensive Composite International Diagnostic Interview was used to assess their 12-month prevalence rates of DSM-IV mental disorders, and a comprehensive questionnaire was adapted to explore various factors, such as socio-demographics, working and living conditions, or experiences of abuse. On average, participants began their commercial sex work at 18.5 years old (range: 10-45). Their main motives for sex work were coercion (49.4%) and the necessity to financially support families (54.8%). In total, 224 FSW (86.5%) wanted to quit commercial sex work. A mental disorder within the past 12 months was reported by 100 FSW (38.6%), with drug abuse clearly being the most prevalent diagnosis (15.4%). Sexual, physical, and emotional abuse were very common among the FSW, and substance use disorders (SUD) were significantly more prevalent in persons who experienced emotional abuse (OR = 2.2). Prevalence rates of any mental disorder and SUD were higher in women who did sex work to support their family, whereas mood disorders were more frequent in those who needed the money to pay debts. Participants with any disorder were significantly older than those without (M age: 24.4 vs. 22.5 years) and had started significantly later in the sex business (M age: 19.7 vs. 17.7 years). Our study revealed that FSW in Chittagong are very vulnerable and highly impaired, as expressed by high rates of abuse and mental disorders. Coercion is very common and many FSW are required to work in the sex business because they need the money to support their families. FSW are a very marginalized population, especially in the developing countries where awareness for mental health is low and the availability of mental health services

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs.

PubMed

Wilson, David

2015-06-01

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection "Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers" highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Sex differences in injury patterns among workers in heavy manufacturing.

PubMed

Taiwo, Oyebode A; Cantley, Linda F; Slade, Martin D; Pollack, Keshia M; Vegso, Sally; Fiellin, Martha G; Cullen, Mark R

2009-01-15

The objective of the study was to determine if female workers in a heavy manufacturing environment have a higher risk of injury compared with males when performing the same job and to evaluate sex differences in type or severity of injury. By use of human resources and incident surveillance data for the hourly population at 6 US aluminum smelters, injuries that occurred from January 1, 1996, through December 21, 2005, were analyzed. Multivariate logistic regression, adjusted for job, tenure, and age category, was used to calculate odds ratios and 95% confidence intervals for female versus male injury risk for all injuries, recordable injuries, and lost work time injuries. The analysis was repeated for acute injuries and musculoskeletal disorder-related injuries separately. Female workers in this industry have a greater risk for sustaining all forms of injury after adjustment for age, tenure, and standardized job category (odds ratio = 1.365, 95% confidence interval: 1.290, 1.445). This excess risk for female workers persisted when injuries were dichotomized into acute injuries (odds ratio = 1.2) and musculoskeletal disorder-related injuries (odds ratio = 1.1). This study provides evidence of a sex disparity in occupational injury with female workers at higher risk compared with their male counterparts in a heavy manufacturing environment.

HIV-related risk behaviors among female sex workers in Ho Chi Minh City, Vietnam.

PubMed

Nemoto, Tooru; Iwamoto, Mariko; Colby, Donn; Witt, Samantha; Pishori, Alefiyah; Le, Mai Nhung; Vinh, Dang Thi Nhat; Giang, Le Truong

2008-10-01

This study quantitatively and qualitatively described HIV risk behaviors among Vietnamese female sex workers (FSWs) who work at three distinct venues in Ho Chi Minh City: street, massage parlors, and bars/clubs. Although 35% of the participants had never been tested for HIV, 18% of street and 7% of bar/club FSWs reported being positive. Almost all massage parlor FSWs had never used a condom for oral sex. Inconsistent condom use for vaginal sex with customers was more prevalent among bar/club FSWs (85%) than massage parlor (72%) and street FSWs (68%). Many participants reported difficulties in negotiating condom use with customers because of economic pressure, maintaining relationships, and lack of bargaining power. Bar/club FSWs revealed a difficult situation where drinking is part of their work. Thirty percent of street FSWs had injected drugs and reported addiction to heroin in relation to their helpless condition as FSWs. Street FSWs had the lowest levels of self-esteem and norms toward practicing safe sex and the highest levels of economic pressure. This study recommends future HIV prevention programs for FSWs in Vietnam that target their specific risk behaviors and work environments.

Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

PubMed Central

Parcesepe, Angela M; L’Engle, Kelly L; Martin, Sandra L; Green, Sherri; Suchindran, Chirayath; Mwarogo, Peter

2016-01-01

Objectives Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya. Methods In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status. Results FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early. Conclusions Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated. PMID:27217378

Peer Outreach Work as Economic Activity: Implications for HIV Prevention Interventions among Female Sex Workers

PubMed Central

George, Annie; Blankenship, Kim M.

2015-01-01

Female sex workers (FSWs) who work as peer outreach workers in HIV prevention programs are drawn from poor socio-economic groups and consider outreach work, among other things, as an economic activity. Yet, while successful HIV prevention outcomes by such programs are attributed in part to the work of peers who have dense relations with FSW communities, there is scant discussion of the economic implications for FSWs of their work as peers. Using observational data obtained from an HIV prevention intervention for FSWs in south India, we examined the economic benefits and costs to peers of doing outreach work and their implications for sex workers’ economic security. We found that peers considered their payment incommensurate with their workload, experienced long delays receiving compensation, and at times had to advance money from their pockets to do their assigned peer outreach work. For the intervention these conditions resulted in peer attrition and difficulties in recruitment of new peer workers. We discuss the implications of these findings for uptake of services, and the possibility of reaching desired HIV outcomes. Inadequate and irregular compensation to peers and inadequate budgetary outlays to perform their community-based outreach work could weaken peers’ relationships with FSW community members, undermine the effectiveness of peer-mediated HIV prevention programs and invalidate arguments for the use of peers. PMID:25775122

Risk reduction and perceived collective efficacy and community support among female sex workers in Tamil Nadu and Maharashtra, India: the importance of context.

PubMed

Guha, Mohua; Baschieri, Angela; Bharat, Shalini; Bhatnagar, Tarun; Sane, Suvarna Sanjay; Godbole, Sheela V; S, Saravanamurthy P; Mainkar, Mandar Keshav; Williams, Joseph; Collumbien, Martine

2012-10-01

Empowering sex workers to mobilise and influence the structural context that obstructs risk reduction efforts is now seen an essential component of successful HIV prevention programmes. However, success depends on local programme environments and history. The authors analysed data from the Integrated Behavioural and Biological Assessment Round I cross-sectional survey among female sex workers in Tamil Nadu and Maharashtra. The authors used propensity score matching to estimate the impact of participation in intervention activities on reduction of risk (consistent condom use) and vulnerability (perceived collective efficacy and community support). Background levels of risk and vulnerability as well as intervention impact varied widely across the different settings. The effect size ATT of attending meetings/trainings on consistent condom use was as high as 21% in Tamil Nadu (outside of Chennai) where overall use was lowest at 51%. Overall, levels of perceived collective efficacy were low at the time of the survey; perceived community support was high in Tamil Nadu and especially in Chennai (93%) contrasting with 33% in Mumbai. Consistent with previous research, the context of Mumbai seems least conducive to vulnerability reduction, yet self-help groups had a significant impact on consistent condom use (ATT=10%) and were significantly associated with higher collective efficacy (ATT=31%). Significant risk reduction can be achieved by large-scale female sex worker interventions, but the impact depends on the history of programming, the complexity of the context in which sex work happens and pre-existing levels of support sex workers perceive from their peers.

Partner Violence and Psychosocial Distress among Female Sex Workers in China

PubMed Central

Hong, Yan; Zhang, Chen; Li, Xiaoming; Liu, Wei; Zhou, Yuejiao

2013-01-01

Background Despite recognized vulnerability of female sex workers (FSW), most data on this population are focused on their HIV and STI prevalence; studies on their experience of partner violence and psychosocial distress are limited, especially FSW in China. Methods and Findings A cross-sectional survey was administered among 1,022 FSW recruited from 9 different types of commercial sex venues in Southwest China. Partner violence scales were adapted from WHO's Women's Health and Domestic Violence scale and psychosocial distress was measured by five indicators, including alcohol intoxication, drug use, suicidal behavior, depression, and loneliness. Random effects modeling was used to control for cluster effects. Findings: About 58% of FSW ever experienced violence from their stable partners, and 45% suffered it from their clients. Partner violence was strongly associated with each of the five measures of psychosocial distress, even after controlling for potential confounders. Conclusion This study is one of the first to examine the association between partner violence and psychosocial distress among FSW in China. The high prevalence of violence experience and distress in this population suggests urgency for intervention. The public health programs targeting FSW should go beyond the focus on HIV/STI prevention and care for the fundamental health and human rights of millions of FSW in China. PMID:23626798

Condom Use Among Female Sex Workers in China: Role of Gatekeepers

PubMed Central

YANG, HONGMEI; LI, XIAOMING; STANTON, BONITA; FANG, XIAOYI; ZHAO, RAN; DONG, BAIQING; LIU, WEI; LIANG, SHAOLING; ZHOU, YUEJIAO; HONG, YAN

2007-01-01

Objective The objective of this study was to assess the potential role of gatekeepers of establishments in promoting condom use among female sex workers (FSWs) in China. Goals The goals of this study were to explore FSWs’ perceptions of gatekeeper attitudes and support for condom use, and to assess their association with FSWs’ practice, communication, intention, proper use, knowledge of correct use, and perceptions related to condom use. Study The authors conducted a cross-sectional study among 454 establishment-based FSWs in one Chinese county. Results Perceived gatekeeper support for condom use was low among FSWs. Perceived support was positively associated with condom use communication with sexual partners, condom use frequency and intention, but not associated with proper condom use among FSWs. Perceived support was significantly associated with most condom use-related perceptions (e.g., self-efficacy of condom use, barriers to condom use, and perceived peer condom use) among FSWs. Conclusions Healthcare professionals should work with gatekeepers to create a supportive local environment for condom use in sex work establishments. Gatekeepers need to clearly articulate their support for condom use to the FSWs. Training and skill acquisition regarding correct use of condoms among FSWs will be necessary. PMID:16118607

Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities.

PubMed

Semple, Shirley J; Pitpitan, Eileen V; Chavarin, Claudia V; Strathdee, Steffanie A; Mendoza, Doroteo V; Aarons, Gregory A; Patterson, Thomas L

2017-12-01

This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.

Sex workers and AIDS in Pakistan. NCIH's Women's Reproductive Health Initiative.

PubMed

Khalji, T

1997-01-01

A recent study interviewing several sex workers and health care providers in Lahore's red light district found that sex workers seem to prefer curative care over preventive health measures. That preference, together with the lack of acknowledgement of any kind of commercial sex work, has led to an increase in the incidence of HIV infection and other sexually transmitted diseases (STDs). The commercial sex business is thriving in Lahore, but the stigma of female sexuality has hampered widespread awareness of the causes and treatment of AIDS. Many prostitutes take medication used by a colleague or use herbal concoctions to treat STDs. Language and culture are two of several obstacles to educating these women. Sex workers in Lahore's red light district have neither regular gynecological examinations nor general medical check-ups. Donor assistance for education and HIV/STD prevention interventions among sex workers is lacking.

Estimating the number of sex workers in South Africa: rapid population size estimation.

PubMed

Konstant, Tracey L; Rangasami, Jerushah; Stacey, Maria J; Stewart, Michelle L; Nogoduka, Coceka

2015-02-01

Although recognized as a vulnerable population, there is no national population size estimate for sex workers in South Africa. A rapid sex worker enumeration exercise was undertaken in twelve locations across the country based on principles of participatory mapping and Wisdom of the Crowd. Sites with a range of characteristics were selected, focusing on level of urbanisation, trucking, mining and borders. At each site, sex worker focus groups mapped local hotspots. Interviews with sex workers at identified hotspots were used to estimate the numbers and genders of sex workers working in each. Estimates provided in the literature were combined with enumeration exercise results to define assumptions that could be applied to a national extrapolation. A working estimate was reached of between 131,000 and 182,000 sex worker in South Africa, or between 0.76 and 1 % of the adult female population. The success of the exercise depended on integral involvement of sex worker peer educators and strong ethical considerations.

HIV INFECTION AMONG FEMALE SEX WORKERS IN CONCENTRATED AND HIGH PREVALENCE EPIDEMICS: WHY A STRUCTURAL DETERMINANTS FRAMEWORK IS NEEDED

PubMed Central

Shannon, Kate; Goldenberg, Shira M.; Deering, Kathleen N.; Strathdee, Steffanie A.

2014-01-01

Purpose of review This article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors. Recent findings Our review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work. Summary Future research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally. PMID:24464089

Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs.

PubMed

Chanda, Michael M; Perez-Brumer, Amaya G; Ortblad, Katrina F; Mwale, Magdalene; Chongo, Steven; Kamungoma, Nyambe; Kanchele, Catherine; Fullem, Andrew; Barresi, Leah; Bärnighausen, Till; Oldenburg, Catherine E

2017-07-01

Zambia has a generalized HIV epidemic, and HIV is concentrated along transit routes. Female sex workers (FSWs) are disproportionately affected by the epidemic. HIV testing is the crucial first step for engagement in HIV care and HIV prevention activities. However, to date little work has been done with FSWs in Zambia, and little is known about barriers and facilitators to HIV testing in this population. FSW peer educators were recruited through existing sex worker organizations for participation in a trial related to HIV testing among FSWs. We conducted five focus groups with FSW peer educators (N = 40) in three transit towns in Zambia (Livingstone, Chirundu, and Kapiri Mposhi) to elicit community norms related to HIV testing. Emerging themes demonstrated barriers and facilitators to HIV testing occurring at multiple levels, including individual, social network, and structural. Stigma and discrimination, including healthcare provider stigma, were a particularly salient barrier. Improving knowledge, social support, and acknowledgment of FSWs and women's role in society emerged as facilitators to testing. Interventions to improve HIV testing among FSWs in Zambia will need to address barriers and facilitators at multiple levels to be maximally effective.

Estimates of the number of female sex workers in different regions of the world

PubMed Central

Vandepitte, J; Lyerla, R; Dallabetta, G; Crabbé, F; Alary, M; Buvé, A

2006-01-01

Objectives To collect estimated numbers of female sex workers (FSW) and present proportions of FSW in the female population (FSW prevalence) in different regions of the world. Methods Subnational and national estimated numbers of FSW reported in published and unpublished literature, as well as from field investigators involved in research or interventions targeted at FSW, were collected. The proportion of FSW in the adult female population was calculated. Subnational estimates were extrapolated to national estimates if appropriate. Population surveys were scanned for proportions of adult women having sex in exchange for money or goods. Results In sub‐Saharan Africa, the FSW prevalence in the capitals ranged between 0.7% and 4.3% and in other urban areas between 0.4% and 4.3%. Population surveys from this same region yielded even higher proportions of women involved in transactional sex. The national FSW prevalence in Asia ranged between 0.2% and 2.6%; in the ex‐Russian Federation between 0.1% and 1.5%; in East Europe between 0.4% and 1.4%; in West Europe between 0.1% and 1.4%; and in Latin America between 0.2% and 7.4%. Estimates from rural areas were only available from one country. Conclusions Although it is well known and accepted that FSW are a highly vulnerable group in the scope of the HIV epidemic, most countries in the world do not know the size of this population group. The estimates of the prevalence of FSW presented in this paper show how important this hard‐to‐reach population group is in all parts of the world. PMID:16735288

Emotional and Behavioral Problems among Impoverished Kenyan Youth: Factor Structure and Sex-Differences

PubMed Central

Harder, Valerie S.; Mutiso, Victoria N.; Khasakhala, Lincoln I.; Burke, Heather M.; Rettew, David C.; Ivanova, Masha Y.; Ndetei, David M.

2014-01-01

Data on youth emotional and behavioral problems from societies in Sub-Saharan Africa are lacking. This may be due to the fact that few youth mental health assessments have been tested for construct validity of syndrome structure across multicultural societies that include developing countries, and almost none have been tested in Sub-Saharan Africa. The Youth Self-Report (YSR), for example, has shown great consistency of its syndrome structure across many cultures, yet data from only one developing country in Sub-Saharan Africa have been included. In this study, we test the factor structure of YSR syndromes among Kenyan youth ages 11–18 years from an informal settlement in Nairobi, Kenya and examine sex-differences in levels of emotional and behavioral problems. We find the eight syndrome structure of the YSR to fit these data well (Root Mean Square Error of Approximation=.049). While Kenyan girls have significantly higher internalizing (Anxious/Depressed, Withdrawn/Depressed, Somatic) problem scores than boys, these differences are of similar magnitude to published multicultural findings. The results support the generalizability of the YSR syndrome structure to Kenyan youth and are in line with multicultural findings supporting the YSR as an assessment of emotional and behavioral problems in diverse societies. PMID:25419046

Patterns of Gender-Based Violence and Associations with Mental Health and HIV Risk Behavior Among Female Sex Workers in Mombasa, Kenya: A Latent Class Analysis.

PubMed

Roberts, Sarah T; Flaherty, Brian P; Deya, Ruth; Masese, Linnet; Ngina, Jacqueline; McClelland, R Scott; Simoni, Jane; Graham, Susan M

2018-03-30

Gender-based violence (GBV) is common among female sex workers (FSWs) and is associated with multiple HIV risk factors, including poor mental health, high-risk sexual behavior, and sexually transmitted infections (STIs). Prior studies have focused on GBV of one type (e.g. physical or sexual) or from one kind of perpetrator (e.g., clients or regular partners), but many FSWs experience overlapping types of violence from multiple perpetrators, with varying frequency and severity. We examined the association between lifetime patterns of GBV and HIV risk factors in 283 FSWs in Mombasa, Kenya. Patterns of GBV were identified with latent class analysis based on physical, sexual, or emotional violence from multiple perpetrators. Cross-sectional outcomes included depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, disordered alcohol and other drug use, number of sex partners, self-reported unprotected sex, prostate-specific antigen (PSA) in vaginal secretions, and a combined unprotected sex indicator based on self-report or PSA detection. We also measured HIV/STI incidence over 12 months following GBV assessment. Associations between GBV patterns and each outcome were modeled separately using linear regression for mental health outcomes and Poisson regression for sexual risk outcomes. Lifetime prevalence of GBV was 87%. We identified 4 GBV patterns, labeled Low (21% prevalence), Sexual (23%), Physical/Moderate Emotional (18%), and Severe (39%). Compared to women with Low GBV, those with Severe GBV had higher scores for depressive symptoms, PTSD symptoms, and disordered alcohol use, and had more sex partners. Women with Sexual GBV had higher scores for disordered alcohol use than women with Low GBV, but similar sexual risk behavior. Women with Physical/Moderate Emotional GBV had more sex partners and a higher prevalence of unprotected sex than women with Low GBV, but no differences in mental health. HIV/STI incidence did not differ significantly by GBV

Alcohol Consumption Patterns and Sexual Risk Behavior among Female Sex Workers in two South Indian Communities

PubMed Central

Heravian, Anisa; Solomon, Raja; Krishnan, Gopal; Vasudevan, CK; Krishnan, AK; Osmand, Thomas; Ekstrand, Maria L.

2012-01-01

Background HIV transmission in India is primarily heterosexual and there is a concentrated HIV epidemic among female sex workers (FSWs). Earlier reports demonstrate that many FSWs consume alcohol regularly before sexual encounters. This qualitative study is part of a larger quantitative study designed to assess alcohol consumption patterns among female sex workers and their association with sexual risk taking. Here we investigate the environmental influence, reasons for and consequences of consuming alcohol in the FSW population. Methods Trained staff from two Non-Governmental Organizations in Andhra Pradesh and Kerala conducted semi-structured interviews with 63 FSWs in Chirala, Andhra Pradesh (n=35) and Calicut, Kerala (n=28) following extensive formative research, including social mapping and key informant interviews, to assess drinking patterns and sexual risk behaviors. Results FSWs reported consuming alcohol in multiple contexts: sexual, social, mental health and self-medication. Alcohol consumption during sexual encounters with clients was usually forced, but some women drank voluntarily. Social drinking took place in public locations such as bars and in private locations including deserted buildings, roads and inside autorickshaws (motorcycle taxis). Consequences of alcohol consumption included failure to use condoms and to collect payments from clients, violence, legal problems, gastrointestinal side effects, economic loss and interference with family responsibilities. Conclusion FSWs consume alcohol in multilevel contexts. Alcohol consumption during transactional sex is often forced and can lead to failure to use condoms. Social drinkers consume alcohol with other trusted FSWs for entertainment and to help cope with psychosocial stressors. There are multiple reasons for and consequences of alcohol consumption in this population and future interventions should target each specific aspect of alcohol use. PMID:22608567

Alcohol consumption patterns and sexual risk behavior among female sex workers in two South Indian communities.

PubMed

Heravian, Anisa; Solomon, Raja; Krishnan, Gopal; Vasudevan, C K; Krishnan, A K; Osmand, Thomas; Ekstrand, Maria L

2012-11-01

HIV transmission in India is primarily heterosexual and there is a concentrated HIV epidemic among female sex workers (FSWs). Earlier reports demonstrate that many FSWs consume alcohol regularly before sexual encounters. This qualitative study is part of a larger quantitative study designed to assess alcohol consumption patterns among female sex workers and their association with sexual risk taking. Here we investigate the environmental influence, reasons for and consequences of consuming alcohol in the FSW population. Trained staff from two Non-Governmental Organizations in Andhra Pradesh and Kerala conducted semi-structured interviews with 63 FSWs in Chirala, Andhra Pradesh (n = 35) and Calicut, Kerala (n = 28) following extensive formative research, including social mapping and key informant interviews, to assess drinking patterns and sexual risk behaviors. FSWs reported consuming alcohol in multiple contexts: sexual, social, mental health and self-medication. Alcohol consumption during sexual encounters with clients was usually forced, but some women drank voluntarily. Social drinking took place in public locations such as bars and in private locations including deserted buildings, roads and inside autorickshaws (motorcycle taxis). Consequences of alcohol consumption included failure to use condoms and to collect payments from clients, violence, legal problems, gastrointestinal side effects, economic loss and interference with family responsibilities. FSWs consume alcohol in multilevel contexts. Alcohol consumption during transactional sex is often forced and can lead to failure to use condoms. Social drinkers consume alcohol with other trusted FSWs for entertainment and to help cope with psychosocial stressors. There are multiple reasons for and consequences of alcohol consumption in this population and future interventions should target each specific aspect of alcohol use. Copyright © 2012 Elsevier B.V. All rights reserved.

HIV Infection and Risk Characteristics Among Female Sex Workers in Hanoi, Vietnam

PubMed Central

Tran, Trung Nam; Detels, Roger; Long, Hoang Thuy; Van Phung, Le; Lan, Hoang Phuong

2010-01-01

Summary The prevalence of HIV/sexually transmitted diseases (STDs) was determined, the risk characteristics examined, and factors associated with HIV infection identified among noninstitutionalized female sex workers (FSWs), using a cross-sectional survey with 2-stage cluster sampling. Four hundred FSWs were interviewed face to face using a structured questionnaire and tested for HIV, syphilis, Chlamydia infection, and gonorrhea. HIV seroprevalence was 12%, syphilis 17% (using the treponemal pallidum hemagglutination assay), Chlamydia infection 3.8% (using polymerase chain reaction [PCR]), and gonorrhea 6.3% (PCR). Lower-class FSWs averaged 2 clients per day, and middle-class FSWs about 1.2. Median duration in sex work was 2.3 years. Consistent condom use was 63% with irregular clients, 41% with regular clients, and only 4.8% with “love mates.” Fifty-five percent had had sex with a drug user(s). Thirty-eight percent used drugs, of whom 83% injected. Factors associated with HIV included being young, having a low level of education, longer residence in Hanoi, being a lower-class FSW, having higher income compared with peers, perception of self being at low risk for HIV, poor knowledge of HIV, and sharing injecting equipment. Intervention strategies should include reduction of both stigmatization and sharing of drug paraphernalia, promotion of nonstigmatizing voluntary testing and counseling, and aggressive marketing and promotion of condoms. PMID:16044011

Social and structural factors associated with consistent condom use among female entertainment workers trading sex in the Philippines.

PubMed

Urada, Lianne A; Morisky, Donald E; Hernandez, Laufred I; Strathdee, Steffanie A

2013-02-01

This paper examined socio-structural factors of consistent condom use among female entertainment workers at high risk for acquiring HIV in Metro Manila, Quezon City, Philippines. Entertainers, aged 18 and over, from 25 establishments (spa/saunas, night clubs, karaoke bars), who traded sex during the previous 6 months, underwent cross-sectional surveys. The 143 entertainers (42% not always using condoms, 58% always using condoms) had median age (23), duration in sex work (7 months), education (9 years), and 29% were married/had live-in boyfriends. In a logistic multiple regression model, social-structural vs. individual factors were associated with inconsistent condom use: being forced/deceived into sex work, less manager contact, less STI/HIV prevention knowledge acquired from medical personnel/professionals, not following a co-workers' condom use advice, and an interaction between establishment type and alcohol use with establishment guests. Interventions should consider the effects of physical (force/deception into work), social (peer, manager influence), and policy (STI/HIV prevention knowledge acquired from medical personnel/professionals) environments on consistent condom use.

The role of collectives in STI and HIV/AIDS prevention among female sex workers in Karnataka, India.

PubMed

Halli, S S; Ramesh, B M; O'Neil, J; Moses, S; Blanchard, J F

2006-10-01

This paper evaluates the role of female sex worker (FSW) collectives in the state of Karnataka, India, regarding their facilitating effect in increasing knowledge and promoting change towards safer sexual behaviour. In 2002 a state-wide survey of FSWs was administered to a stratified sample of 1,512 women. Following the survey, a collectivization index was developed to measure the degree of involvement of FSWs in collective-related activities. The results indicate that a higher degree of collectivization was associated with increased knowledge and higher reported condom use. Reported condom use was higher with commercial clients than with regular partners or husbands among all women and a gradient was observed in most outcome variables between women with low, medium and high collectivization index scores. Collectivization seems to have a positive impact in increasing knowledge and in empowering FSWs in Karnataka to adopt safer sex practices, particularly with commercial clients. While these results are encouraging, they may be confounded by social desirability, selection and other biases. More longitudinal and qualitative studies are required to better understand the nature of sex worker collectives and the benefits that they can provide.

Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia.

PubMed

Roxburgh, Amanda; Degenhardt, Louisa; Copeland, Jan

2006-05-24

This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk behaviours, and trauma history. Cross sectional data collected from 72 women via face to face structured interviews. The interview included structured diagnostic assessment of DSM-IV PTSD; drug dependence; depression; experience of childhood trauma; and an assessment of sex working history. All but one of the women interviewed reported experiencing trauma, with the majority reporting multiple traumas that typically began in early childhood. Child sexual abuse, adult sexual assault and work related violence were commonly reported. Just under half of the women met DSM-IV criteria for PTSD and approximately one-third reported current PTSD symptoms. Adult sexual assault was associated with current PTSD symptoms. Depression and drug dependence were also highly prevalent; cocaine dependence in particular was associated with elevated rates of injecting risk and sexual risk behaviours. These women reported complex trauma histories and despite ongoing opportunities for clinical intervention, they continued to experience problems, suggesting that current models of treatment may not be appropriate. More targeted interventions, and integrated mental health and drug treatment services are needed to address the problems these women are experiencing. Outreach services to these women remain a priority. Education strategies to reduce risky injecting and sexual behaviours among sex workers should also remain a priority.

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

PubMed Central

Wilson, David

2015-01-01

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work. PMID:26079267

Developing human rights-based strategies to improve health among female sex workers in Rwanda.

PubMed

Binagwaho, Agnès; Agbonyitor, Mawuena; Mwananawe, Aimable; Mugwaneza, Placidie; Irwin, Alec; Karema, Corine

2010-12-15

How governments should address sex work is a topic of current debate in Rwanda and other countries. Some constituencies propose harsher punishment of sex workers as the cornerstone of an improved policy. We argue that an adequate policy response to sex work in the Rwandan context must prioritize public health and reflect current knowledge of the social determinants of health. This does not imply intensified repression, but a comprehensive agenda of medical and social support to improve sex workers' access to health care, reduce their social isolation, and expand their economic options. Evidence from social epidemiology converges with rights-based arguments in this approach. Recent field interviews with current and former sex workers strengthen the case, while highlighting the need for further social scientific and epidemiological analysis of sex work in Rwanda. Rwanda has implemented some measures that reflect a rights-based perspective in addressing sex work. For example, recent policies seek to expand access to education for girls and support sex workers in the transition to alternative livelihoods. These policies reinforce the model of solidarity-based public health action for which Rwanda has been recognized. Whether such measures can maintain traction in the face of economic austerity and ideological resistance remains to be seen. Copyright © 2010 Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin, and Karema. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Situating HIV risk in the lives of formerly trafficked female sex workers on the Mexico-US border.

PubMed

Collins, Shane P; Goldenberg, Shira M; Burke, Nancy J; Bojorquez-Chapela, Ietza; Silverman, Jay G; Strathdee, Steffanie A

2013-01-01

Due to stigma and the psychosocial repercussions of past trauma and abuse, survivors of sex trafficking may experience increased susceptibility to violence, revictimization, and various harmful health outcomes, including HIV infection. Given the paucity of research characterizing the experiences of formerly trafficked female sex workers (FSWs), we set out to describe and contextualize perceptions of HIV risk among women who have experienced past episodes of sex trafficking and who are currently engaged in sex work in Tijuana, Mexico. Based on semi-structured interviews and ethnographic fieldwork, we describe the following interrelated themes as influencing formerly trafficked FSWs' perceptions and experiences of HIV risk: economic vulnerability; susceptibility to violence; and psychological trauma. Our findings highlight the need for HIV prevention efforts to incorporate broader structural and social interventions aimed at reducing vulnerability to violence and human rights abuses among this population and improving their general economic, psychological, and social well-being.

Prevalence of HIV Infection and Risk Factors Among Female Sex Workers in a Southeast Province of Vietnam.

PubMed

Nguyen, Tri; Stewart, Donald Edwin; Lee, Chiao Tzu Patricia; Dang, Thi Nhu Hang

2017-08-01

Female sex workers (FSWs) are at heightened risk of HIV infection. This research aims to determine the prevalence of HIV and relevant risk factors and related behavior among FSWs in Ba Ria - Vung Tau, a southeast province of Vietnam. 420 FSWs were interviewed using a structured questionnaire and biological samples tested for HIV. 2.6 % were found to be HIV positive. HIV infection was significantly higher in FSWs who had low income (≤AUD 200 per month), have had anal sex, have had sex with injecting drug users, and had a low level of HIV/AIDS-related knowledge. Improved employment opportunities and income are important to reduce the pressure for young women to engage in sex work for income purposes, but in public health terms, existing HIV treatment, prevention and intervention programs needs better targeting and improvements to reduce the risk of HIV infection.

Social support and recovery among Mexican female sex workers who inject drugs

PubMed Central

Hiller, Sarah; Syvertsen, Jennifer; Lozada, Remedios; Ojeda, Victoria D.

2013-01-01

This qualitative study describes social support that female sex workers who inject drugs (FSW-IDUs) receive and recovery efforts in the context of relationships with family and intimate partners. We conducted thematic analysis of in-depth interviews with 47 FSW-IDUs enrolled in an intervention study to reduce injection/sexual risk behaviors in Tijuana, Mexico. FSW-IDUs received instrumental and emotional social support, which positively and negatively influenced recovery efforts. Participants reported how some intimate partners provided conflicting positive and negative support during recovery attempts. Problematic support (i.e., well-intended support with unintended consequences) occurred in strained family relationships, limiting the positive effects of support. Mexican drug treatment programs should consider addressing social support in recovery curricula through evidence-based interventions that engage intimate partners, children and family to better reflect socio-cultural and contextual determinants of substance abuse. PMID:23375570

Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission.

PubMed

Baral, Stefan David; Friedman, M Reuel; Geibel, Scott; Rebe, Kevin; Bozhinov, Borche; Diouf, Daouda; Sabin, Keith; Holland, Claire E; Chan, Roy; Cáceres, Carlos F

2015-01-17

Male sex workers who sell or exchange sex for money or goods encompass a very diverse population across and within countries worldwide. Information characterising their practices, contexts where they live, and their needs is limited, because these individuals are generally included as a subset of larger studies focused on gay men and other men who have sex with men (MSM) or even female sex workers. Male sex workers, irrespective of their sexual orientation, mostly offer sex to men and rarely identify as sex workers, using local or international terms instead. Growing evidence indicates a sustained or increasing burden of HIV among some male sex workers within the context of the slowing global HIV pandemic. Several synergistic facilitators could be potentiating HIV acquisition and transmission among male sex workers, including biological, behavioural, and structural determinants. Criminalisation and intersectional stigmas of same-sex practices, commercial sex, and HIV all augment risk for HIV and sexually transmitted infections among male sex workers and reduce the likelihood of these people accessing essential services. These contexts, taken together with complex sexual networks among male sex workers, define this group as a key population underserved by current HIV prevention, treatment, and care services. Dedicated efforts are needed to make those services available for the sake of both public health and human rights. Evidence-based and human rights-affirming services dedicated specifically to male sex workers are needed to improve health outcomes for these men and the people within their sexual networks. Copyright © 2015 Elsevier Ltd. All rights reserved.

The influence of having children on HIV-related risk behaviors of female sex workers and their intimate male partners in two Mexico–US border cities

PubMed Central

Rolon, Maria Luisa; Syvertsen, Jennifer L.; Robertson, Angela M.; Rangel, M. Gudelia; Martinez, Gustavo; Ulibarri, Monica D.; Servin, Argentina

2013-01-01

Among female sex workers who use drugs, the experience of having children and its effect on HIV risk behaviors remains underexplored. We draw from a study of 214 female sex workers and their intimate non-commercial partners in Tijuana and Ciudad Juárez, México (n = 428), approximately 30% of whom have children living with them. During qualitative interviews with 41 of these couples, having children emerged as an important topic. Children influenced partners’ lives and HIV-related risk behaviors in positive and negative ways. Couples perceived that children strengthened their relationships. Concern for children’s well-being motivated couples to contemplate healthier lifestyle changes. However, childrearing costs motivated sex work and structural constraints prevented couples from enacting lifestyle changes. Case studies illustrate these themes and highlight implications for couple- and family-based harm reduction interventions. Specifically, our results suggest a need for economic alternatives to sex work while working with families to develop risk reduction skills. PMID:23418131