History Of Sexual Violence Research Articles

Time from COVID-19 Shutdown, Gender-Based Violence Exposure, and Mental Health Outcomes Among a State Representative Sample of California Residents

Background: There is increasing evidence of the negative impact of the COVID-19 pandemic and resultant shutdowns on mental health. This issue may be of particular concern to those affected by intimate partner violence (IPV) and sexual violence. Methods: We conducted a cross-sectional analysis using data from a California state-representative online survey conducted in the two weeks following the state stay-at-home order, enacted March 19, 2020 (unweighted N=2081). We conducted a series of multivariate multinomial logistic regressions to assess the associations between a) days since stay-at-home order and b) gender-based violence exposure with anxiety and/or depression symptoms, accounting for demographics, and secondarily demographics and social support. Findings: Nearly one in five (17·9%) respondents reported moderate or severe mental health symptoms in the past two weeks; 15·7% had a history of IPV and 10·1% had a history of sexual violence. In models adjusting for gender, gender-based violence history, and other demographics, days since shutdown was significantly associated with greater mental health symptom severity, as were IPV and sexual violence. When social support was additional controlled for, however, effects of days from shutdown were lost and effects related to violence were slightly attenuated. Interpretation: The odds of poor mental health symptoms increased daily under COVID-19 shutdown conditions in this study, and for those with a history of IPV. These findings were respectively lost and attenuated after adjusting for social support, suggesting the value of social support programs to address mental health concerns under the pandemic. Funding: Blue Shield Foundation of California Grant RP-1907-137. Bill and Melinda Gates Foundation OPP1179208.Declaration of Interests: The authors have no conflicts of interest to declare.Ethics Approval Statement: All research procedures were approved by both NORC/University of Chicago and the University of California San Diego Institutional Review Board (Project #191904XX).

Examining the Factors Associated With Sexual Violence Against Women in Sierra Leone: A Nationwide Cross-Sectional Study

In 2019, Sierra Leone declared national emergency over rape and other forms of sexual violence (SV), hence diverting resources from other issues to tackle SV. However, little is known about nationwide risk/protective factors for SV, and this has been a source of critique for the new policy. To fill this gap in knowledge, we investigated the factors for SV toward women using a nationally representative sample. We analyzed the 2013 Demographic and Health Survey (DHS) data, including 16,658 women, aged 15-49 years. The outcome was current SV, defined as being physically forced to have sexual intercourse within the last 12 months. We examined respondent's background, sexual activities, and experience of domestic violence (DV). Logistic regression analyses were performed using STATA/SE v.15.1, accounting for survey design and sample weights. Values of p less than .05 were considered statistically significant. ArcMap was used to demonstrate geographic distribution of SV cases. We found that about 258 (6.3%) women reported SV. In adjusted analysis, women in the north (than south; 2.88, 95% CI = [1.44, 5.75]) and women circumcised between the ages of 1 and 14 (1.67, 95% CI = [1.10, 2.54]) reported higher risk of SV, respectively. Women who had sex more than 25 times per year were 6.9 times more likely to report SV, compared with those with 1 to 24 times (6.91, 95% CI = [1.48, 32.19]). The odds of SV were 6 times higher among women who reported experiencing recent physical violence (5.86, 95% CI = [2.49, 13.80]) or history of SV (6.34, 95% CI = [2.57, 15.65]). In conclusion, this study adds to the literature by providing information on major factors associated with SV toward women in Sierra Leone using a nationally representative sample. Women in the north (Tonkolili), circumcised between the ages of 1 and 14, had sex more than 25 times per year, reported physical violence (12 months before the survey) and SV (ever forced to have sex) reported higher risk for current SV. While more research is needed, these findings will help inform the current emergency operations against SV in Sierra Leone.

Effect of sexual violence on planned, mistimed and unwanted pregnancies among women of reproductive age in sub-Saharan Africa: A multi-country analysis of Demographic and Health Surveys.

IntroductionSexual violence plays a key role in women's pregnancy intention. We investigated the influence of sexual violence on planned, mistimed, and unwanted pregnancies in sub-Saharan Africa (SSA).Materials and methodsData from the Demographic and Health Survey (DHS) of 22 countries in SSA were used in this study. Both descriptive and inferential analyses were conducted. We carried out a multinomial logistic regression analysis to examine the effect of sexual violence on planned, mistimed, and unwanted pregnancies. STATA version 14.2 was used to carry out all analyses. Statistical significance was declared at p<0.05.ResultsAt the descriptive level, we found that 74.1% of women of reproductive age in SSA had planned pregnancies, with the remaining 25.9% having either mistimed (20.4%) or unwanted (5.5%) pregnancies. Women in Nigeria had the lowest proportion of mistimed pregnancies (7.5%) whereas those in Burundi had the greatest percentage of unwanted pregnancies (12.4%). Women who had history of sexual violence had increased risk of mistimed [ARRR = 1.5, CI = 1.3–1.7] and unwanted pregnancies [ARRR = 1.6, CI = 1.3–2.0], compared to those with no history of sexual violence. Women aged 40–44 [ARRR = 3.3, CI = 1.4–7.6] and 45–49 [ARRR = 4.4, CI = 1.7–11.2] had higher risk of unwanted pregnancies, compared to women aged 15–19. Women who were cohabiting had higher risk of mistimed [ARRR = 1.3, CI = 1.1–1.4] and unwanted pregnancies [ARRR = 1.6, CI = 1.3–2.1], compared to married women.ConclusionSexual violence plays a key role in mistimed and unwanted pregnancies. It is, therefore, prudent to develop various assessment techniques to detect sexual violence in unions and refer victims to appropriate services to diminish the risk of mistimed and unwanted pregnancies. Our findings provide a basis for developing and implementing policies and interventions aimed at reducing mistimed and unwanted pregnancies.

Cluster Randomized Trial of a College Health Center Sexual Violence Intervention

Sexual violence, particularly in the context of drinking, is prevalent on college campuses. This study tested a brief intervention to prevent sexual violence among students receiving care from college health centers. This study was a two-arm, unblinded cluster RCT. On 28 campuses with health/counseling centers (1:1 randomization allocation; 12 intervention and 16 control), from September 2015 to March 2018, a total of 2,291 students seeking care at college health centers completed surveys before the appointment, immediately after, 4 months later, and 12 months later. Intervention college health center staff received training on delivering sexual violence education to all students seeking care. Control sites provided information about drinking responsibly. The primary outcome was students' change in recognition of sexual violence. Additional outcomes included sexual violence disclosure and use of services among students with a history of sexual violence at baseline. Generalized linear mixed models accounting for campus-level clustering assessed intervention effects. Data were analyzed from September 2018 to June 2019. Half (55%) of students seeking care at college health centers reported any history of sexual violence exposure. No between-group differences in primary (β=0.001, 95% CI= -0.04, 0.04) or secondary outcomes emerged between intervention and control students. Post-hoc analyses adjusting for the intensity of intervention delivery (intensity-adjusted) revealed an increase in self-efficacy to use harm reduction strategies (β=0.09, 95% CI=0.01, 0.18) among intervention participants. Among those who reported sexual violence at baseline, intervention students had increased odds of disclosing violence during the visit (AOR=4.47, 95% CI=2.25, 8.89) in intensity-adjusted analyses compared with control. No between-group differences emerged for remaining outcomes. Sexual violence exposure is high among students seeking care in college health centers. A brief provider-delivered sexual violence intervention, when implemented with fidelity, was associated with improved self-efficacy to use harm reduction and increased disclosure of sexual violence during clinical encounters but no increased use of services. More interventions that are stronger in intensity are needed to connect students to sexual violence services. This study is registered at www.clinicaltrials.gov NCT02355470.

Perceptions of College Campus Alcohol and Sexual Violence Prevention Among Students with Disabilities: "It Was A Joke".

The purpose of this study was to understand perceptions of campus-based alcohol and sexual violence (SV) prevention programming among college students with disabilities to inform future development of prevention programs appropriate for the needs of these students. The study included semi-structured, qualitative interviews with 51 college students with disabilities who reported histories of SV recruited from a larger parent study investigating a brief universal intervention to reduce alcohol related SV involving 28 campuses across Western Pennsylvania and West Virginia. Interviews focused on college-related experiences of prevention programming, and experiences of health, disability, alcohol use and violence victimization. Data were analyzed using thematic analysis. Three themes emerged: (1) Students with disabilities described campus prevention programming as ineffective and irrelevant to their experiences, including referring to programs as "a joke," (2) Students wanted multi-dose, developmentally relevant content that directly addresses the complexities of their experiences with disability, alcohol, and violence, and (3) Students called for programing focused on engaging their interests. Our results point to the need to augment campus-based programming, with attention to the unique needs and relevant concerns of students with disabilities, within the broader context of campus prevention programming.

"The pen is the blade, my skin the paper": risk factors for self-injury in adolescents.

to describe the risk factors that influence the self-injury behavior of adolescents assisted at a Psychosocial Care Center for Children and Adolescents, according to subjects' own perceptions. a descriptive, exploratory, qualitative study carried out through medical records and a focus group with 07 adolescents. The statements were submitted to thematic content analysis. in the risk factors category, four subcategories emerged: Family adversity factors; Social contagion; Adverse life events; Personal characteristics. Conflicts, lack of support, drug use in the family, meeting someone who cuts themselves, social networks, religiosity, history of sexual violence and bullying were identified as risk factors that influence self-injury. adolescents pointed out the need for prejudice-free dialogues in schools, in health and family devices, configuring protective factors to avoid this practice that comes from several negative events throughout life.

Challenges in Prosecuting Sexual Violence in Armed Conflict under Nigerian Law

In the past decade, Nigeria has experienced an increased rate of sexual violence in armed conflict between the armed forces of the State and the dissident armed group, Boko Haram. This paper carefully examines the challenges of prosecuting sexual violence in armed conflict under the Nigerian law. The paper extensively analyzes sexual violence in the context of non international armed conflict. It traces the history of sexual violence in armed conflicts in Nigeria. The paper reaffirms the point that sexual violence in times of armed conflict constitutes an international crime. It contends that the inability to prosecute is based on some factors which include the lack of relevant laws to address the crime as well as the absence of domestication of international treaties in this regard as a major constraint to prosecution. It is argued therefore that this creates a gap in terms of protection afforded victims as well as accountability of perpetrators. The paper concludes by recommending that all laws prohibiting sexual violence which have been ratified should be domesticated in order to have the platform upon which accountability will stand.

1158: The association between sexual violence history and gynecological and obstetrical behaviors, pregnancy, and delivery outcome

Sexual violence is a global public health problem. We aimed to evaluate the association between self-reported history of sexual violence and women's health behaviors, with a focus on routine gynecological and prenatal care practices and outcomes. This was a retrospective questionnaire-based study, including mothers of live singleton newborns delivered at a regional tertiary medical center from October 2018 to February 2019. Participants were asked to answer 4 questionnaires, including screening for sexual violence history (SES), posttraumatic stress disorder (PDS), and postpartum depression (EPDS), as well as demographic and medical history data. Computerized perinatal records were reviewed. Multiple analyses were performed, comparing background and outcome variables across all levels of SES severity. Multivariable regression models were constructed while adjusting for confounders. During the study period, 210 women met the inclusion criteria. Of them, 26.3% (57) reported unwanted sexual encounter victimization, 23% (50) reported coercion, 1.8% (4) assault and attempted rape, and 1.4% (3) reported they were raped. Several multivariate regression models were constructed, to assess the independent association between sexual violence history and delivery mode, perineal damage and EPDS score (Table 1). Sexual violence history was found to be independently and significantly associated with the risk of postpartum depression while adjusting for maternal age, education, and ethnicity (adjusted OR=4.46; 95%CI 2.03-9.81). Exposed women were also more likely to report a negative relationship with their gynecologist and avoid gynecological care (33.9% versus 16.7%, p=0.012). A significant association was found between both positive EPDS screening as well as post trauma and sexual violence history (Table 2). No significant association was found between sexual violence history and pregnancy outcomes. Sexual violence history is extremely common among post-partum women. It is independently associated with post-partum depression, neglected gynecological care, and post trauma.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Relationship between Sexual Violence with Self Efficacy among Female Adolescent at Junior High School in Tasikmalaya City

Background: Sexual violence is one of the health issues in the world. The most important impact of sexual violence on adolescent girls is pregnancy, which subsequently victims experience stress, depression, attempts to abort their pregnancy and even suicide attempts.&#x0D; Objectives: This study aims to determine the relationship between the sexual violence with Self Efficacy among female adolescent at Junior High School in Tasikmalaya City.&#x0D; Method: The study was an analytical method with a cross-sectional approach.ThepopulationwasallfemalestudentsofJuniorHighSchool in Tasikmalaya City. The sampling technique used quota sampling. The study was conducted in 2019 to recruited 100 respondents Data analysis was using chi-square to find out the relationship between two variables.&#x0D; Results: The results showed a significantrelationshipbetweensexualviolence with self-efficacy s with p value0.005 and odds ratio was 16.&#x0D; Conclusion: The conclusion is history of sexual violence in the form of sexual intercourse had 16 times the chance to have lower self-efficacy, as well as students who had experienced touches of intimate organs such as mouth, breasts and genitals tend to have lower self-efficacy 9 times compared to those who did not experience it. The finding could be recommended to conduct training to improve self-efficacysothatviolenceagainststudentsgettinglowevendoesnotoccuranymore.

SAFETY OF THE TREATMENT FOR VOLUNTARY PREGNANCY TERMINATION BY GESTATIONAL AGE. MEDELLÍN, COLOMBIA, 2013-2014

To describe the safety of medical and surgical treatments used in women seeking voluntary pregnancy termination. Historical cohort of all pregnant women with up to 26 weeks of gestation who received treatment for voluntary pregnancy termination in a referral institution in Medellín, Colombia, between January 2013 and December 2014.Sampling was consecutive. Measured variables included sociodemographic and obstetric variables, undesired effects, and complications of the voluntary pregnancy termination treatment. A descriptive analysis was carried out. Overall, 87 women were included. The mean age at the time of termination was 24 years (inter-quartile range [IQR] = 12), 69.0% were single, and 73,4% were unemployed. The main reason for termination was the risk to the mother's health in 61,0% of cases, followed by a history of sexual violence in 26.4% and fetal malformations in 12.6%; a total of 70 women (80,4%) had less than 18 weeks of gestation and were treated with misoprostol plus manual vacuum aspiration; 17 (19,6%) had between 18 and 26 weeks of gestation and were treated with misoprostol followed by dilation and curettage. The first group (gestational age <18 weeks) experienced undesired effects such as pain and vomiting; in the second group (> or equal to 18 weeks), 41.0% of the women experienced hemorrhage. The risk to the mother's health was the main reason for the termination of pregnancy. Termination before 18 weeks was found to be safe, while termination between 18 and 26 weeks using misoprostol and curettage was associated with a high frequency of hemorrhage.

History of Sexual Violence and Associated Negative Consequences: The Mediating Role of Body Image Dissatisfaction

This article explores body image dissatisfaction (BID) as a potential mediating variable that may explain why those who have experienced sexual violence are more vulnerable to negative outcomes. It was hypothesized that women with a history of sexual violence would be more likely to report greater BID, which would be associated with experiencing increased psychological symptoms and distress, increased sexual risk behavior, and reduced sexual assertiveness. Structural equation models with bias-corrected bootstrapping were used to evaluate the conceptual model. Mediational analyses demonstrated that for women, experiences of sexual violence are significantly associated with greater BID, which, in turn, was predictive of increased depression, anxiety, and posttraumatic stress disorder (PTSD) as well as decreased sexual assertiveness. The implications of the current study are important, as they may inform clinical prevention and treatment of BID, support future research, and provide the opportunity to empower assault survivors by reducing the deleterious effects of sexual violence.

When Rape Was Legal—The Untold History of Sexual Violence During Slavery by Rachel A.Feinstein. 2018. Routledge, Taylor and Francis Group: New York, NY. 108 pp. $29.57 paper. ISBN: 9781138629684.

Book Review of When Rape Was Legal—The Untold History of Sexual Violence During Slavery by Rachel A. Feinstein In When Rape Was Legal—The Untold History of Sexual Violence During Slavery, Rachel A. Feinstein writes clearly and succinctly on the often ignored and dismissed history of sexual violence against black women during slavery in the American South. More than just a historical account of the systematic sexual exploitation of these women, this book builds on Collins’ (2005) matrix of domination by examining the larger consequences of this history in shaping the intersectional gendered racist system of oppression that persists today. Though reductive at times, this analysis provides a glimpse into the layered nature of intersectional oppression, forcing us to consider how modern-day white privilege and power are still in part shaped by the sexual violence and exploitation of black women during slavery. [...]

Sexual violence and male prisons: an Australian queer genealogy

ABSTRACTThis paper investigates the history of sexual violence in Australian male prisons. It traces a genealogy of sex between incarcerated men from the penal colonies to the 1990s, drawing on a range of criminal justice and sexological and cultural records to show how sexual violence inflected both conceptions and experiences of homosexual prisoners. We outline how these inmates shifted from being perceived as an institutional threat to a victim of the institution, an uneven process propelled by competing and contradictory ideas about the constitution and practice of sexual behaviours, identities and power behind bars.Before the decriminalisation of sex between consenting adult males, Australian authorities tended to emphasise the dangers such men posed in the penitentiary. At its height in the mid-twentieth century, such alarmism culminated in the creation in 1957 of a homosexual-only gaol in Cooma, New South Wales. From the 1970s onwards, and influenced by contemporary gay, feminist and prisoner’s rights movements, ideas about menace slowly gave way to a focus on vulnerability. Political agitators, the judiciary and prison officials increasingly framed gay prisoners as victims of sexual violence, the targets of aggressive heterosexual inmates from whom the state was unwilling or unable to offer protection. This history of sex between inmates, the carceral state and the criminal justice system reveals that the prison was a crucial setting for the public recognition of sexual violence between men. Shifting and unstable concepts that linked the homosexual with danger and violence shows the discursive overlap between sexual violence and men seeking sexual intimacy and the competing and contradictory thinking and practices linking affective desire, identities, sex between men and homosexuality with coercion and risk.

Brief Report: PrEP Eligibility Among At-Risk Women in the Southern United States: Associated Factors, Awareness, and Acceptability.

Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV. We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women's Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models. Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models. Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.

High Rates of Unprotected Receptive Anal Intercourse and Their Correlates Among Young and Older MSM in Brazil.

The aim of this study was to estimate the prevalence and factors associated with unprotected receptive anal intercourse (URAI), stratified by age (18-24 or 25 + years old), in a sample of 4,129 MSM recruited by respondent driven sampling in 12 Brazilian cities in 2016. The prevalence of URAI was higher among younger MSM (41.9% vs 29.7%) (p < 0.01). Multivariate analysis indicated that perception of risk, sexual identity, self-rated health status, and having commercial sex were associated with URAI among younger MSM. History of sexual violence, sex with younger partners, having 6 + partners and unprotected sexual debut were associated with URAI among older MSM. Marital status, having stable partner, and reporting sex with men only were associated with URAI in both groups. Despite access to condoms and lubricants, preventive efforts may not be reaching MSM effectively. Age specific intervention approaches, including stigma, discrimination, and perception of risk must be considered.

Violence With Femicide Risk: Its Effects on Women and Their Children.

The objective of this study is to assess the effects that a specific type of severe violence-violence with femicide risk (VFR)-has on women's physical and mental health, as well as the physical health of their children. I focus on Peru, a country in which 7 out of 10 women have been victims of some form of intimate partner violence. In Latin America, Peru is one of the countries with the highest rates of violence against women. Methodological gaps in the existing literature (sampling size, selection bias, and reverse causality) are covered using an important nationally representative sample (Demographic and Health Survey: N = 84,136) and the use of propensity score matching. Results show that VFR increases symptoms of depression, as well as alcohol and tobacco consumption. The children of victims of VFR had significantly more recent episodes of bloody stool, diarrhea, fever, and coughing. These effects are heterogeneous. They vary based on violence characteristics (history of sexual violence) and on victims' socioeconomic status. According to the relevant literature, these effects can be understood to stem from somatization, stress, substance use (as a facilitator of violence), and neurological damage due to exposure to this type of violence. Results suggest VFR may have life-course altering effects given victims' distinct coping strategies.

Sexual Abuse of Elderly Women in Southwest Nigeria: A Sociological Exposition of an Emerging Crime

Indeed, appreciable research has considered the dynamics of sexual assault involving young victims. However, very little criminological research has considered the dynamics of sexual abuse of elderly people. To fill this void, this current study developed a profile of sexual abuse cases among women aged 50 and older, based on the accounts of their abusers. Specifically, the study investigated the motives and mechanisms for sexual abuse of the aged in the country as well as the factors that account for the vulnerability of aged women. A sample of 21 elderly sexual abuse offenders from six prisons in Ogun and Lagos states were purposively engaged to shed some light on the nature and dimensions of sexual abuse of elderly women in the country. Results from qualitative analyses of official demographic and offence history data, and in-depth interviews of offenders challenge a couple of commonly held beliefs, assumptions and assertions about sexual abuse of elderly in literature, news journals and public discourse. As against a general belief that young men that sexually abuse older women are ‘money ritualists,’ this study found sexual violence history, mental illness, substance abuse, and sexual deviancy as factors fuelling perpetrators’ action. The majority of perpetrators were intrafamiliar offenders who are family members, neighbours, workers and associates of the victims. Offenders expressed awareness of usual non-reporting of sexual victimisation by the abused, which is a factor that encourages intrafamiliar offending. As a growing social menace in Nigeria, sexual abuse of the elderly is factored by neglect, and exposure of adults to both environmental and situational pressures. Therefore, proper caregiving, meeting of essential needs of the elderly, response from the criminal justice system and encouraging reportage of sexual victimisation are suggested.

Stressful Life Memories Relate to Ruminative Thoughts in Women With Sexual Violence History, Irrespective of PTSD.

More than one in every four women in the world experience sexual violence (SV) in their lifetime, most often as teenagers and young adults. These traumatic experiences leave memories in the brain, which are difficult if not impossible to forget. We asked whether women with SV history experience stronger memories of their most stressful life event than women without SV history and if so, whether strength relates to ruminative and trauma-related thoughts. Using the Autobiographical Memory Questionnaire (AMQ), women with SV history (n = 64) reported this memory as especially strong (p < 0.001), remembering more sensory and contextual details, compared to women without SV history (n = 119). They further considered the event a significant part of their personal life story. The strength of the memory was highly correlated with posttraumatic cognitions and ruminative thoughts, as well as symptoms of depression and anxiety (p's < 0.001, n = 183). A third (33%) of the women with SV history were diagnosed with posttraumatic stress disorder (PTSD), but PTSD alone did not account for the increase in memory strength (p's < 0.001). These data suggest that the experience of SV increases the strength of stressful autobiographical memories, which are then reexperienced in everyday life during posttraumatic and ruminative thoughts. We propose that the repeated rehearsal of vivid stressful life memories generates more trauma memories in the brain, making the experience of SV even more difficult to forget.

Characterizing the Patterns of HIV Disclosure to Clients Among South African Female Sex Workers in Port Elizabeth.

Female sex workers (FSW) in South Africa are disproportionately affected by HIV, yet little is known about their HIV-status disclosure with clients. Among 410 FSW participating in a cross-sectional study, 213 were HIV positive and aware of their status prior to enrollment. Among FSW aware of their HIV-status, 35% (74/213) reported disclosing their HIV-status to paying clients, whereas 75% (118/158) of those with regular, non-paying partners disclosed to them. In a multivariable analysis, disclosure to clients was associated with more years of education, disclosure to non-paying partners, and meeting clients at established sex work venues, whereas a history of sexual violence was associated with less disclosure. There was also evidence of mutual disclosure with clients, however disclosure was not associated with condom use with clients or being on antiretrovirals. Safer working environments may improve FSW HIV disclosure practices, however disclosure must also be linked with protective behaviors in this population.

Differences in Trauma-Related Guilt in Females with History of Sexual Violence Based on Insomnia Severity

Differences in Trauma-Related Guilt in Females with History of Sexual Violence Based on Insomnia Severity