Abstract
BackgroundHIV prevalence is increasing among female sex workers (FSWs) in Mexico’s Northern border region, who experience multiple occupational risks. Improving vulnerable populations’ education, empowerment, and access to preventive services are important components of harm reduction strategies. Given the increasing interest in adapting harm reduction principles from drug use to sex work and other public health responses to the HIV epidemic, we used a sex work harm reduction framework to guide our investigation of FSWs’ HIV knowledge.MethodsFrom 2004–2006, FSWs aged ≥18 years in Tijuana and Ciudad Juarez participated in a behavioral intervention study and completed structured interviews. Measures included HIV knowledge assessment and factors within each domain of our theoretical framework for sex work harms: (1) socio-demographic factors that may lead to sex work, (2) sex work characteristics and behaviors that may lead to harm, and (3) mutually reinforcing harms that lead to sex work and result from it (e.g., drug abuse). Negative binomial regression identified factors independently associated with suboptimal HIV knowledge (i.e., incorrect responses during the HIV knowledge assessment).ResultsAmong 924 FSWs, the median proportion of incorrect responses was nearly one third (28% incorrect). Examination of item responses revealed misconceptions regarding specific transmission and prevention mechanisms, including prevention of mother to child transmission. Suboptimal HIV knowledge was independently associated with older age, lower education, living in Tijuana (vs. Ciudad Juarez), inconsistent condom use for vaginal sex with male clients, and lacking prior HIV testing.ConclusionsOur application of a sex work harm reduction framework to the study of FSWs’ HIV knowledge is an important first step in enhancing HIV prevention efforts in Northern Mexican border cities. Our findings imply that interventions should identify and discredit local HIV misconceptions to improve knowledge of specific HIV transmission routes and self-protective strategies (e.g., condom negotiation). Interventions will require materials appropriate for women from diverse socio-economic backgrounds and may benefit from innovative harm reduction approaches such as peer education and outreach.
Highlights
Female sex workers (FSWs) face many physical and mental health harms through their occupation, including risk of disease acquisition (e.g., Human immunodeficiency virus (HIV) and other sexually transmitted infections; Sexually transmitted infections (STI)), physical and sexual violence, discrimination, criminalization and exploitation [1]
To identify factors associated with suboptimal HIV knowledge, we modeled the proportion of incorrect responses using negative binomial regression with the total number of incorrect responses as the outcome variable and the log of the total number of questions answered as the offset term
The third domain of our theoretical framework, we found that recent drug use before or during sex was marginally associated with suboptimal HIV knowledge (RR = 0.93; 95% 95% confidence interval (CI): 0.87–1.00)
Summary
Female sex workers (FSWs) face many physical and mental health harms through their occupation, including risk of disease acquisition (e.g., HIV and other sexually transmitted infections; STIs), physical and sexual violence, discrimination, criminalization and exploitation [1]. Researchers and practitioners who work with FSWs are calling for a broader application of the harm reduction agenda from drug use to sex work and other public health responses to the HIV epidemic [1,2]. Potential components of harm reduction interventions for FSWs could include increasing vulnerable FSWs’ education, empowerment, access to prevention and healthcare services, occupational health and safety policies, decriminalization of sex work and other human rights approaches [1]. Educational components of harm reduction programs can work with local populations of FSWs to increase knowledge of HIV/STIs and protective behaviors, dispel misconceptions, decrease risk behaviors, and improve access to services [3]. Designing effective interventions to increase HIV knowledge and reduce harms associated with sex work require an assessment of populations’ baseline knowledge and their access to accurate, timely health information [14]. Given the increasing interest in adapting harm reduction principles from drug use to sex work and other public health responses to the HIV epidemic, we used a sex work harm reduction framework to guide our investigation of FSWs’ HIV knowledge
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