Abstract
ObjectivesIntimate partner violence (IPV) is associated with increased risk of HIV among women globally. There is limited evidence and understanding about IPV and potential HIV risk pathways among sex workers (SWs). This study aims to longitudinally evaluate prevalence and correlates of IPV among street and off-street SWs over two-years follow-up.MethodsLongitudinal data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010–2012). Prevalence of physical and sexual IPV was measured using the WHO standardized IPV scale (version 9.9). Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine interpersonal and structural correlates of IPV over two years.ResultsAt baseline, 387 SWs had a male, intimate sexual partner and were eligible for this analysis. One-fifth (n = 83, 21.5%) experienced recent physical/sexual IPV at baseline and 26.2% over two-years follow-up. In multivariable GEE analysis, factors independently correlated with physical/sexual IPV in the last six months include: childhood (<18 years) sexual/physical abuse (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI]: 1.14–3.69), inconsistent condom use for vaginal and/or anal sex with intimate partner (AOR = 1.84, 95% CI: 1.07–3.16), <daily prescription opioid use (AOR = 1.72, 95% CI: 1.02–2.89), providing financial support to intimate partner (AOR = 1.65, 95% CI: 1.05–2.59), and sourcing drugs from intimate partner (AOR = 1.62, 95% CI: 1.02–2.26).DiscussionOur results demonstrate that over one-fifth of SWs in Vancouver report physical/sexual IPV in the last six months. The socio-structural correlates of IPV uncovered here highlight potential HIV risk pathways through SWs’ intimate, non-commercial partner relationships. The high prevalence of IPV among SWs is a critical public health concern and underscores the need for integrated violence and HIV prevention and intervention strategies tailored to this key population.
Highlights
Male-perpetrated intimate partner violence (IPV) is a pervasive human rights violation and public health concern, with substantial negative impacts on morbidity and mortality, including poor sexual and reproductive health outcomes, HIV, and sexually transmitted infections (STIs) [1,2]
Eligibility criteria for AESHA participants at baseline includes being female, older than 14 years of age, having exchanged sex for money within the last 30 days, and providing written informed consent. This analysis is restricted to AESHA participants who reported having at least one intimate partner, which is defined as having a sexual, non-commercial, male partner in the last six months, at baseline
Socio-Demographic Characteristics Of the total cohort (n = 652), our analyses were restricted to participants who reported having at least one male, intimate sexual partner in the past six months for a sample of 387 street and off-street sex workers (SWs)
Summary
Male-perpetrated intimate partner violence (IPV) is a pervasive human rights violation and public health concern, with substantial negative impacts on morbidity and mortality, including poor sexual and reproductive health outcomes, HIV, and sexually transmitted infections (STIs) [1,2]. IPV includes violence in the form of ‘‘sexually, psychologically and physically coercive acts used against adult and adolescent women by a current or former intimate partner, without her consent’’ [4]. Immediate consequences of IPV include injuries and death from physical assault, unintended pregnancies, HIV/STIs, and psychological distress [5]. Long-term conditions associated with IPV include chronic pain conditions, gastro-intestinal syndromes and other physical disabilities [6], post-traumatic stress disorder, depression, anxiety, substance abuse, and suicide [7,8]. The UN has declared an urgent need to strengthen the knowledge base on all forms of violence against women to inform policy and strategy development [10]
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