Association of Violence Against Female Sex Workers Who Use Drugs With Nonfatal Drug Overdose in Kazakhstan

Nabila El-Bassel,Susan S Witte,Tara Mccrimmon,Assel Terlikbayeva,Trena I Mukherjee,Andrea Norcini Pala,Sholpan Primbetova,Gaukhar Mergenova

doi:10.1001/jamanetworkopen.2020.20802

Nabila El-Bassel, Susan S Witte + Show 6 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2020.20802

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Abstract

Female sex workers (FSWs) who use drugs face increased risk of intimate partner violence (IPV) and nonpartner violence (NPV). The association between violence and drug overdose is unknown. To examine the association between IPV, NPV, and nonfatal drug overdose among FSWs who use drugs in Kazakhstan. This cross-sectional study included 400 adult FSWs in Kazakhstan who reported illicit drug use in the past year, exchanged sex for money or drugs, and reported having unprotected sex in the past 90 days. Baseline data were collected from February 2015 to May 2017 from Project Nova, an HIV prevention study among FSWs who use drugs in Kazakhstan. Data analysis was conducted from April 2019 to March 2020. Lifetime and recent (past 90 day) experiences of physical, sexual, and psychological IPV and NPV using the Revised Conflict Tactics Scale. Subtypes of violence were identified using exploratory factor analysis. Lifetime and recent incidence of nonfatal overdose; sociodemographic characteristics as well as lifetime and recent sex work and drug use behaviors were also collected. The 400 participants had a mean (SD) age of 34.1 (8.4) years. Most experienced food insecurity (358 [89.5%]) and homelessness (232 [58.0%]) in the past 90 days; one-third (130 [32.5%]) reported a history of incarceration. Most (359 [89.7%]) experienced some form of violence; 150 (37.5%) reported a lifetime nonfatal overdose, of whom 27 (18.0%) reported nonfatal overdose in the past 90 days. Lifetime severe physical violence (adjusted odds ratio [aOR], 1.27; 95% CI, 1.02-1.59; P = .03), engagement in sex work for more than 10 years (aOR, 2.54; 95% CI, 1.50-4.28; P < .001), and a history of incarceration (aOR, 4.34; 95% CI, 2.58-7.32; P < .001) were associated with greater odds of nonfatal overdose. Engaging in sex work for more than 10 years (aOR, 3.97; 95% CI, 1.36-11.61; P = .01) and a history of incarceration (aOR, 3.63; 95% CI, 1.39-9.48; P = .008) were associated with greater odds of recent nonfatal overdose. In this study, violence against FSWs who use drugs in Kazakhstan was associated with increased odds of nonfatal overdose. Harm reduction programs for women should consider including services to address gender-based violence and the needs of women after incarceration.

Highlights

Of the 3.5 million women who inject drugs globally, approximately 1 million engage in sex work.[1]
In this study, violence against female sex workers (FSWs) who use drugs in Kazakhstan was associated with increased odds of nonfatal overdose
Overdose data are rarely disaggregated by sex or key population, studies suggest the rate of overdose mortality is increasing faster among women than men[2] and among female sex workers (FSWs), owing to violence and drug use.[3,4]

Summary

Introduction

Of the 3.5 million women who inject drugs globally, approximately 1 million engage in sex work.[1]. Women are disproportionally affected by violence and the drug use epidemic, there are considerable gaps in our understanding of the factors associated with overdose among women.[12]

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Discussion

Conclusion