Summary Background Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the ...HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age. Methods We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age. Findings Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99 878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6–12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0–18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2–31·3; 8627 of 28 075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1–14·8). Interpretation Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed. Funding The World Bank, UN Population Fund.
An action agenda for HIV and sex workers Beyrer, Chris, Prof; Crago, Anna-Louise, MA; Bekker, Linda-Gail, Prof ...
The Lancet (British edition),
01/2015, Letnik:
385, Številka:
9964
Journal Article
Recenzirano
Odprti dostop
Summary 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.
Physical and Sexual Violence Predictors Decker, Michele R., ScD, MPH; Benning, Lorie, MS; Weber, Kathleen M., RN, BSN ...
American journal of preventive medicine,
November 2016, Letnik:
51, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Introduction Gender-based violence (GBV) threatens women’s health and safety. Few prospective studies examine physical and sexual violence predictors. Baseline/index GBV history and polyvictimization ...(intimate partner violence, non-partner sexual assault, and childhood sexual abuse) were characterized. Predictors of physical and sexual violence were evaluated over follow-up. Methods HIV-infected and uninfected participants ( n =2,838) in the Women’s Interagency HIV Study provided GBV history; 2,669 participants contributed 26,363 person years of follow-up from 1994 to 2014. In 2015–2016, multivariate log-binomial/Poisson regression models examined violence predictors, including GBV history, substance use, HIV status, and transactional sex. Results Overall, 61% reported index GBV history; over follow-up, 10% reported sexual and 21% reported physical violence. Having experienced all three forms of past GBV posed the greatest risk (adjusted incidence rate ratio AIRRphysical =2.23, 95% CI=1.57, 3.19; AIRRsexual =3.17, 95% CI=1.89, 5.31). Time-varying risk factors included recent transactional sex (AIRRphysical =1.29, 95% CI=1.03, 1.61; AIRRsexual =2.98, 95% CI=2.12, 4.19), low income (AIRRphysical =1.22, 95% CI=1.01, 1.45; AIRRsexual =1.38, 95% CI=1.03, 1.85), and marijuana use (AIRRphysical =1.43, 95% CI=1.22, 1.68; AIRRsexual =1.57, 95% CI=1.19, 2.08). For physical violence, time-varying risk factors additionally included housing instability (AIRR=1.37, 95% CI=1.15, 1.62); unemployment (AIRR=1.38, 95% CI=1.14, 1.67); exceeding seven drinks/week (AIRR=1.44, 95% CI=1.21, 1.71); and use of crack, cocaine, or heroin (AIRR=1.76, 95% CI=1.46, 2.11). Conclusions Urban women living with HIV and their uninfected counterparts face sustained GBV risk. Past experiences of violence create sustained risk. Trauma-informed care, and addressing polyvictimization, structural inequality, transactional sex, and substance use treatment, can improve women’s safety.
The purpose of the current study was to examine qualitatively the life contexts of young males enrolled in programs addressing perpetration of intimate partner violence (IPV). Semistructured ...interviews were conducted with 19 males recruited from these programs. Interviews were coded to examine life contexts and analyzed using a content analysis approach. Five themes emerged across interviews: (a) disruptive home environment; (b) lack of positive male role models; (c) a peer context characterized by substance use, gang involvement, and behaviors supporting the sexual maltreatment of girls; (d) school circumstances characterized by a lack of academic support; and (e) community exposures to violence. These factors were often interrelated within the various contexts of participants. Further research is needed to provide insight into whether and how these issues may contribute to IPV perpetration. Efforts to support young males regarding a broad array of concerns should be included in programming to reduce IPV perpetration.
Objective To examine the context of pregnancy and sexual health among adolescent females with a history of intimate partner violence (IPV). This paper reports on a subset of females who described ...abusive male partners' explicit pregnancy-promoting behaviors (ie, messages and behaviors that led females to believe their partner was actively trying to impregnate them). Methods Semistructured interviews were conducted with 53 sexually active adolescent females, with known history of IPV, about violence, sexual experiences, and related behaviors. Interviews were analyzed using a content analysis approach; 14 interviews in which females reported that partners were actively trying to impregnate them were further analyzed for pregnancy and contraceptive use. Results Participants (N = 53) were aged 15 to 20 years, with notable minority representation, 21% African American (n = 11) and 38% Latina (n = 20). Over half (n = 31, 58%) had experienced pregnancy. A key finding was that approximately one quarter of participants (26%, n = 14) reported that their abusive male partners were actively trying to get them pregnant. Females' stories revealed that abusive male partners desiring pregnancy manipulated condom use, sabotaged birth control use, and made explicit statements about wanting her to become pregnant. Conclusions Pregnancy-promoting behaviors of male abusive partners may be one potential mechanism underlying associations between adolescent IPV and pregnancy. These findings suggest that exploring pregnancy intentions and behaviors of partners of sexually active adolescents may help to identify youth experiencing IPV. The frequency of birth control sabotage and explicit attempts to cause pregnancy in adolescent IPV needs to be examined at the population level.
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