Abstract
BackgroundResearch suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Structural vulnerabilities reflect societal level factors (e.g., sexism, homophobia, racism) that constrain an individual’s agency, particularly related to health outcomes. This study examines the association between SM status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based FSW.MethodsThe current study utilizes baseline data from the SAPPHIRE study, a prospective cohort of cis gender and transgender FSW in Baltimore, MD, recruited through targeted time-location sampling from April 2016 to January 2017. The current analysis focuses on cisgender women. The baseline survey ascertained demographics, substance use, intimate partner violence (IPV), and sex work characteristics. Multivariable models were constructed using self-identity and behaviorally defined SM status as independent variables with vulnerability outcomes (e.g., injection drug use, injection speedball, binge drinking, homelessness, physical IPV, ever had a pimp, and being a minor at sex work entry (age < 18)) as dependent variables.ResultsOf the participants (n = 247), 25.5% (n = 63) self-identified as a SM by identity (e.g., gay or bisexual), and 8.5% (n = 21) reported SM behavior (e.g., same-gender sexual behavior) in the past 3 months. In multivariable logistic regression models, SM status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical IPV, and being a minor at sex work entry. SM status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry.ConclusionThe study indicates disproportionate structural vulnerability and heightened HIV risk among SM-FSW, as compared to their heterosexual counterparts, with differences in their profile by sexual identity and behavior. Findings suggest a need for nuanced interventions tailored to these populations.
Highlights
Research suggests sexual minority female sex workers (SM-Female sex workers (FSW)) face elevated structural vulnerability and Human immunodeficiency virus (HIV) risk compared to their heterosexual counterparts
While FSW are characterized by significant structural vulnerabilities and HIV risk, we found these outcomes exacerbated among Sexual minority (SM)-FSW, by both identity and behavior, including substance use, homelessness, physical intimate partner violence (IPV), entering sex work as a minor, or ever having a pimp
We found that SMFSW by identity have higher odds of physical IPV compared to their heterosexual counterparts, aligning with previous research among a general sexual minority women (SMW) population [67, 68], indicating unique vulnerability related to sexual minority status
Summary
Research suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Female sex workers (FSW) who are sexual minorities (SM-FSW) face greater structural vulnerabilities, which exacerbate their HIV risk, compared to their heterosexual counterparts [1,2,3,4]. While studies about HIV risk and SM-FSW are limited, data indicate that sexual minority women (SMW) are more likely to engage in sex work and experience disparate amounts of structural vulnerability (e.g., housing insecurity, violence) and have worse HIV risk outcomes than their heterosexual counterparts [2,3,4]. Identity is self-defined based on how one identifies their sexual orientation. We state SM-FSW by identity or by behavior when differentiating between the groups
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