Establishment-based Female Sex Workers Research Articles

Prevalence of Self-Reported Symptoms of Sexually Transmitted Infection among Establishment-Based Female Sex Workers in Ethiopia.

Introduction In spite of the fact that female sex workers being regarded as core transmitters of sexually transmitted infections to the general population, previous studies undertaken around STIs in Ethiopia fail to consider this segment of the population. Hence, the present study investigated the prevalence of self-reported symptoms of STIs and the risk factors among FSWs in Adama Town, Ethiopia. Method A cross-sectional study was conducted from May 01, 2017, to April 30, 2017, in Adama Town. Three hundred ninety female sex workers were selected from 120 licensed drinking establishments by using simple random sampling technique. The interviewer-administered structured tool was used to collect data. Data were entered using EPI data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression analyses were used to identify factors associated with the outcome variable. Result Among the requested 423 female sex workers, 390 willingly responded to the interviewer-administered structured questionnaires making a response rate of 92.2%. One hundred thirty-nine (35.6%, 95% CI (33.8%–37.4%) of the female sex workers reported one or more STI symptoms. Several risk factors were identified including inconsistent condom use with a nonpaying client (AOR = 5.43, 95% CI: 2.73, 10.80), alcohol use before sex (AOR = 2.41, 95% CI: 1.35, 4.30), longer duration of sex work (AOR = 2.27, 95% CI: 1.26, 4.08), and having poor knowledge of STIs (AOR = 2.44, 95% CI: 1.31, 4.54). Conclusion Self-reported symptom of STI among female sex workers in Adama Town is relatively high when compared with previous studies. Hence, health education programs should address the issue of inconsistent condom use with nonpaying clients, alcohol consumption before sex, and knowledge of STIs, with a particular emphasis on those female sex workers who stayed longer in the business.

Systematic Differences in HIV, Syphilis and Risk Behaviors among Street Based and Establishment Based Female Sex Workers in Kathmandu Valley of Nepal.

Background: Female Sex Workers (FSWs) are main drivers of the HIV epidemic in Nepal. The work environment of sex work in Nepal is differentiated into establishment based (e.g. massage parlors, dance restaurants, hotels and lodges) and street based (e.g. streets, parks and markets). The study compares HIV, syphilis and risk behaviours among establishment-based FSWs and street-based FSWs in Kathmandu Valley of Nepal. Materials and Methods: Cross-sectional bio-behavioral surveys in 2006, 2008, 2011 and 2015 aimed to sample 2093 FSWs using two stage cluster sampling in the Kathmandu valley. Statistical analysis used chi-squared tests and logistic regression models to assess differences of HIV, syphilis and risk behaviors among street-based FSWs and establishment-based FSWs. Results: The study included 39.7% street-based FSWs and 60.3% establishment-based FSWs. The street-based FSWs had lower education levels, older age groups, separated, longer duration of sex work and inconsistent condom used with clients than establishment-based FSWs (p<0.05). Establishment-based FSWs were lower exposure to HIV intervention programs and pervasive alcohol consumption and use of drugs (p<0.05). The multivariate analysis showed that street-based FSWs were more likely of HIV test (aOR=1.25, 95%CI=1.04, 1.49), HIV (aOR=4.72, 95%CI=2.19, 10.15) and syphilis (aOR=7.96, 95%CI=3.49, 18.15) than establishment-based FSWs. Conclusion: Street-based FSWs possessed higher risk behaviour and have higher HIV and syphilis prevalence. HIV prevention interventions targeting FSWs should consider risks and vulnerability of street-based FSWs. .

HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers.

Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs in China.

Social Support and Sexual Risk Among Establishment-Based Female Sex Workers in Tijuana.

Social support can affect health outcomes of female sex workers. In this inductive feminist grounded theory study based on 20 in-depth interviews, we explore how establishment-based female sex workers in Tijuana perceive the impact of the connections among women on their lives and health. Participants elected to discuss the importance of social support from mothers, sisters, friends, and co-workers, and the empowering and disempowering aspects of these relationships. In previous studies, scholars demonstrated the efficacy of formal organization of female sex workers in promoting the mitigation of sexual and HIV risk. We show the importance of informal ties with other women. Some participants mentioned competitive relationships, others talked about cooperation and the desire for a venue to learn from one another. Social interactions with other women are especially empowering when female sex workers can openly engage in "woman talk" that may contribute to the mitigation of sexual and HIV risk.

Factors associated with establishment-based female sex workers accessing health care services in Shanghai

Female sex workers are a priority population for HIV prevention and health promotion in China. This paper examines the patterns of and factors associated with the utilisation of HIV-related and general health services by establishment-based sex workers in Hongkou District, Shanghai. Participants were recruited through a three-stage sampling strategy and invited to self-complete a brief survey in 2012. The median age of the 400 participants included in the analyses was 33 years (range = 18–52 years old), with over three-quarters being married at the time of the survey. Participants were mostly internal migrants, more than half had lived in Shanghai for six months or longer and nearly two-thirds were working in an establishment with a total of less than five female sex workers. Routine physical examination and HIV testing were the most commonly accessed health services in the previous 12 months. Altogether, 347 women (86.8%) had actively sought, including 157 women had obtained, free health services mainly from local Community Health Service Centres (CHSCs) in the previous 12 months. The active seeking of free, largely CHSC-provided health services was associated with a longer duration of residence in Shanghai (adjusted odds ratio [AOR] = 2.55, 95% CI = 1.32–4.93; p < 0.01) and having tested for HIV in the previous 12 months (AOR = 3.68, 95% CI = 1.84–7.38; p < 0.001). Conversely, a higher annual income (AOR = 0.41, 95% CI = 0.21–0.80; p < 0.01), working in a larger establishment (AOR = 0.40, 95% CI = 0.20–0.79; p < 0.01) and knowing that HIV can be transmitted through blood transfusion with unscreened blood (AOR = 0.21, 95% CI = 0.05–0.91; p < 0.05) were associated with not actively seeking such services. Free, community-based health services are highly demanded by establishment-based female sex workers in Shanghai. Scaling-up of free and integrated health services provided by community-based health service providers in metropolitan areas in China and beyond holds promise for promoting health and well-being of female sex workers.

High prevalence of syphilis among street-based female sex workers in Nanchang, China.

Background:Female sex workers (FSWs) play a critical role in the heterosexual transmission of human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) in China. Several studies reported that street-based FSWs have higher risk behaviors than establishment-based FSWs. Therefore, street-based FSWs should be specifically targeted for HIV and STIs intervention programs.Objectives:This study aims to investigate the prevalence rates and risk factors of HIV and syphilis among FSWs in Nanchang, China.Materials and Methods:Using convenience sampling methods, 361 street-based FSWs were recruited from August 2011 to February 2012. All participants completed an anonymous questionnaire on socioeconomic and sex behavioral information and were tested for HIV and syphilis. Risk for HIV and syphilis infection was assessed using univariate and multivariate logistic regression analyses.Results:No HIV infections were found. The prevalence rate of syphilis was 43.5%. Nearly 46.1% of street-based FSWs reported having education for no more than 6 years. Having reproductive tract infections at current visit, duration of sex work more than 5 years, indulgence in unprotected sex trade in the last time, unprotected sex trade in the last month, and unprotected sex with boyfriend or spouse in the last month were reported by 35.2%, 43.5%, 33.8%, 60.4%, and 93.1% street-based FSWs, respectively. In multivariate logistic regression analysis, having reproductive tract infections at current visit [odds ratio (OR), 12.10; 95% confidence interval (CI), 6.01-24.37], duration of sex work more than five years (OR, 4.26; 95% CI, 2.40-7.54), and unprotected sex trade in the last month (OR, 1.85; 95% CI, 1.06-3.22) were independently associated with syphilis infection.Conclusion:The prevalence rate of syphilis among street-based FSWs is very high. Most street-based FSWs in our survey had low education, long experience of commercial sex, and high rate of inconsistent condom use. Comprehensive interventions targeting this high-risk group, especially scaling up screening and ensuring consistent use of condoms during sex are needed.

Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia

BackgroundAlthough reported condom use between female sex workers and their clients is high in Ethiopia, condom use with regular, non-paying partners remains low, posing a substantial risk of HIV infection to sex workers, their partners and the general population. Previous studies have identified the synergistic effects of substance abuse, violence and HIV risk, but few have examined these inter-relationships among female sex workers and their regular, non-paying partners. This study explored the associations between work-related violence, alcohol abuse and inconsistent condom use among establishment-based female sex workers and their regular, non-paying partners in Adama City, Ethiopia.MethodsA cross-sectional survey was conducted with 350 establishment-based female sex workers, aged 15–35, at 63 bars, hotels and nightclubs. Multivariate logistic regression analysis was conducted to test the association between work-related violence and condom use with regular, non-paying partners, controlling for age, overall income, education and sex workers’ total number of sexual partners in the past week. Alcohol abuse was explored as an effect modifier.ResultsRespondents reported a high prevalence of work-related violence (59%) and alcohol abuse (51%). Work-related violence was statistically significantly associated with unprotected sex with regular, non-paying partners among those who abused alcohol (OR: 6.34, 95% CI: 2.43-16.56) and among those who did not (OR: 2.98, 95% CI: 1.36-6.54). Alcohol abuse was not associated with inconsistent condom use within these partnerships, though it may strengthen the effect of work-related violence on unprotected sex.ConclusionsFindings suggest violence against establishment-based female sex workers is associated with HIV risk within regular, non-paying partnerships. Qualitative work is needed to better understand the links between a violent work environment and condom use with regular, non-paying partners and how interventions can be implemented in this context to prevent violence against sex workers and reduce HIV transmission.

From Violence to Sex Work: Agency, Escaping Violence, and HIV Risk Among Establishment-Based Female Sex Workers in Tijuana, Mexico

Violence experienced by female sex workers has been found to affect the HIV risk and quality of life of these women. Research on this topic has dealt with female sex workers and current experiences of violence with partners, clients, and in the workplace. In this study, we used feminist constructivist grounded theory to explore perceptions of violence among establishment-based female sex workers in Tijuana, Mexico. A key concept that emerged from 20 semi-structured in-depth interviews was "escaping violence with a romantic partner by becoming independent through sex work." The women also emphasized the negative impact of violence in the workplace but felt that achieving separation from a violent partner gave them strength to protect their lives and health. Interventions to help these women protect themselves from HIV infection and improve their quality of life should aim to build upon their strengths and the agency they have already achieved.

Difference in Risk Behaviors and STD Prevalence Between Street-Based and Establishment-Based FSWs in Guangdong Province, China

The major mode of HIV/AIDS transmission in China is now heterosexual activities, but risk for HIV and sexually transmitted diseases (STDs) may differ among different strata of female sex workers (FSWs). Respondent-driven sampling was used to recruit 320 FSWs in Guangdong Province, China. The respondents were interviewed using a structured questionnaire, and tested for HIV, syphilis, gonorrhea, and Chlamydia. The street-based FSWs had lower education levels, a higher proportion supporting their families, charged less for their services, and had engaged in commercial sex for a longer period of time than establishment-based FSWs. The proportion consistently using condoms with clients and with regular non-paying partners was also lower. The prevalence of syphilis, gonorrhea, and Chlamydia was higher among street-based sex workers. Being a street-based sex worker, having regular non-paying sex partners, and having non-regular non-paying partners were independent risk factors for inconsistent condom. Street-based FSWs had more risk behaviors than establishment-based FSWs, and should therefore be specifically targeted for HIV as well as STD intervention programs.

A Multilevel Analysis of Gatekeeper Characteristics and Consistent Condom Use Among Establishment-Based Female Sex Workers in Guangxi, China

Multilevel analytical techniques are being applied in condom use research to ensure the validity of investigation on environmental/structural influences and clustered data from venue-based sampling. The literature contains reports of consistent associations between perceived gatekeeper support and condom use among entertainment establishment-based female sex workers (FSWs) in Guangxi, China. However, the clustering inherent in the data (FSWs being clustered within establishment) has not been accounted in most of the analyses. We used multilevel analyses to examine perceived features of gatekeepers and individual correlates of consistent condom use among FSWs and to validate the findings in the existing literature. We analyzed cross-sectional data from 318 FSWs from 29 entertainment establishments in Guangxi, China in 2004, with a minimum of 5 FSWs per establishment. The Hierarchical Linear Models program with Laplace estimation was used to estimate the parameters in models containing random effects and binary outcomes. About 11.6% of women reported consistent condom use with clients. The intraclass correlation coefficient indicated 18.5% of the variance in condom use could be attributed to their similarity between FSWs within the same establishments. Women's perceived gatekeeper support and education remained positively associated with condom use (P < 0.05), after controlling for other individual characteristics and clustering. After adjusting for data clustering, perceived gatekeeper support remains associated with consistent condom use with clients among FSWs in China. The results imply that combined interventions to intervene both gatekeepers and individual FSW may effectively promote consistent condom use.

Alcohol Use, Unprotected Sex, and Sexually Transmitted Infections Among Female Sex Workers in China

Alcohol use has been suggested to interfere with condom use and to increase sexual risk behaviors. However, data on the prevalence of this practice among female sex workers and its association with condom use and sexually transmitted infections (STIs) are limited. Data were collected through the baseline survey of an HIV prevention project among 454 establishment-based female sex workers in Guangxi, China, in 2004. Both global association and situational analysis were performed using 2 measures of alcohol use (alcohol intoxication and drinking alcohol before having sex with a client). Multiple logistic regression analyses were performed to examine the association of alcohol use with women's condom use and STIs. One-third of women reported being intoxicated with alcohol at least once a month during the previous 6 months, and about 30% reported using alcohol before having sex with clients. In comparison with women who did not use alcohol before engaging in sex with clients, women who did so reported significantly less consistent condom use and higher rates of both current STIs and a history of STI. However, alcohol intoxication was not associated with condom use and STIs. These findings indicate event-specific rather than global associations of alcohol use with inconsistent condom use and STIs. Alcohol use before commercial sex is associated with unprotected sex and increased risk for STIs. Interventions that address both alcohol use and HIV risk behaviors in the context of commercial sex may have a great impact in preventing the spread of HIV in China.

‘As prostitutes, we control our bodies’: perceptions of health and body in the lives of establishment-based female sex workers in Tijuana, Mexico

Many studies of female sex work focus on HIV and other sexually transmitted infections because sex workers are considered bridges between high-risk and low-risk populations. The voices of female sex workers as they pertain to health issues are often lacking in the literature. This paper offers a feminist constructivist grounded theory study with establishment-based female sex workers in Tijuana, Mexico. Analyses of interviews with 20 women reveal that they are aware of the impact of their work on their bodies, but conceptualise their health holistically and not just in terms of HIV. They emphasise that working in the sex industry has implications for sexual health, non-sexual physical health and mental health. The paper concludes that in order for public health interventions to have more sustainable impact on the lives of female sex workers, they should take into account the voices of the women, including how they define their health. The findings suggest that public health professionals need to be more aware that female sex workers have agency and a desire to control their health and their bodies.

Understanding the Dynamics of Condom Use Among Female Sex Workers in China

Condom use within the context of commercial sex work is a complex issue. Drawing on a hypothesized theoretical model that combines concepts from the health belief model and social cognitive theory, this study examines the complex relationships between multiple levels of determinant factors of condom use with clients among female sex workers in China. Data were collected through the baseline survey of an HIV prevention project among 454 establishment-based female sex workers in a rural county of Guangxi, China in 2004. Path analysis was performed to test the hypothesized model that specifies relationships between all observed variables. Within the context of this study's model, STD/HIV knowledge and condom use skills were related to self-efficacy which in turn related to condom use. Susceptibility/severity was related to perceived benefits of unprotected sex. Perceived benefits were in turn inversely related to condom use. STD/ HIV knowledge, condom use skills, and susceptibility/severity had no direct effect on condom use. Their effects on condom use were mediated by self-efficacy and perceived benefits. Self-efficacy was not associated with perceived benefits of unprotected sex. Perceived establishment-level support was positively related to condom use. Self-efficacy, perceived benefits of unprotected sex, and perceived establishment-level support are proximate determinants of condom use among female sex workers. Future HIV prevention interventions should integrate these factors into conceptual frameworks.

Environmental Support and HIV Prevention Behaviors Among Female Sex Workers in China

To examine the influence of environmental support on HIV prevention behaviors (i.e., condom use behaviors, communication and intention, and HIV/STD testing) among female sex workers (FSWs) in China. A cross-sectional survey was administered among 310 FSWs recruited from entertainment establishments in Liuzhou City in Southwest China in 2006. Sex workers were asked about their demographic and working characteristics and their HIV prevention behaviors. Environmental support was measured by a scale consisting of 8 items regarding condom availability, managerial, and social support of HIV prevention (Cronbach alpha = 0.73). After adjusting for demographic and working characteristics, condom use self-efficacy and knowledge, environmental support was strongly associated with following HIV prevention behaviors: overall consistent condom use (aOR = 1.7, 95% CI = 1.3, 2.3), consistent condom use in the last 3 sexual acts (aOR = 1.5, 95% CI = 1.1, 2.0), intention to use condoms consistently (aOR = 1.6, 95% CI = 1.1, 2.2), and HIV testing (aOR = 1.6, 95% CI = 1.1, 2.2). Environmental support is a significant predictor of HIV prevention behaviors among establishment-based FSWs in China. The data underscore the importance of developing environmental/structural HIV/STD interventions for FSWs. Condoms need to be easily accessible in the establishments. Gatekeepers need to be educated to create a supportive environment for condom use and HIV prevention.

Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: A multilevel analysis.

The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.