Survival Sex Research Articles

Trauma as a Potential Source of Solidarity

Trauma as a Potential Source of Solidarity

Exploration of Arrest Activity among Homeless Young Adults in Four U.S. Cities

Research suggests that in comparison with their housed peers, homeless young adults have disproportionately greater involvement in criminal activity, including theft, property offenses, and illicit substance use (Baer, Peterson, & Wells, 2004; Thompson, Jun, Bender, Ferguson, & Pollio, 2010). Because 20% to 30% of the nearly 2 million homeless young people have arrest histories (O'Grady & Gaetz, 2004; Whitbeck, 2009), a conservative estimate translates to 150,000 homeless young people encountering the criminal justice system each year. These estimates are cause for societal and economic concern because criminal involvement among homeless young adults is associated with unemployment and labor market exclusion (O'Grady & Gaetz, 2004) and chronic adult homelessness (Tyler & Johnson, 2006). Previous studies have suggested that homeless young people become more estranged from conventional institutions and prosocial groups the longer they remain on the streets (Thompson & Pollio, 2006). Those who have been homeless longer are also more likely than those who have been homeless for shorter durations to experience greater transience (Ferguson, Jun, Bender, Thompson, & Pollio, 2010). Geographic mobility prohibits bonding to prosocial institutions, such as family, school, and employment, and encourages interactions with other homeless peers that facilitate further acculturation to the streets (Gaetz & O'Grady, 2002). There is evidence that substance abuse is more likely with increased length of homelessness, societal estrangement, and affiliation with substance-using peers (Johnson, Whitbeck, & Hoyt, 2005). Young people who are addicted to drugs and embedded in a street lifestyle often turn to panhandling, theft, survival sex, and other survival strategies to finance their addictions (Baron, 2009; Farabee, Shen, Hser, Grella, & Anglin, 2001). These activities may serve as a gateway to more serious forms of crime (Tolan, Gorman-Smith, & Loeber, 2000). Finally, certain demographic variables, such as gender, may increase the risk of engaging in criminal behavior, with male runaway youths being significantly more likely than female runaway youths to commit criminal activity (Kempf-Leonard & Johansson, 2007). This review thus suggests that chronically homeless young adults who are disaffiliated from conventional institutions, rely on support from peers, and are embedded in the street economy may engage in criminal activity for economic survival (Tyler & Johnson, 2006).

Sexual Risk Behavior and Type of Sexual Partners in Transnational Indigenous Migrant Workers

Indigenous migrant workers (IMWs) have a high vulnerability to HIV and STDs due to poverty and marginalization. This study examined factors associated with sexual risk behavior (SRB) according to type of partner in transnational young male IMWs at a sugar cane agro-industrial complex in western Mexico. A total of 192 sexually active IMWs were recruited from four laborer shelters to participate in a sexual partner survey. The IMWs were interviewed about their sexual partners and practices over the last 12 months during which it emerged that they had had a total of 360 sexual partners. Multiple linear regression analyses were performed to identify factors related to SRB in 222 main (spouse, mistress and girlfriend) and 138 casual partners (colleague, friend, casual encounter and sex worker). Results showed a significantly higher SRB score with casual partners. For the main partner regression model, prior exposure to HIV- and STD-preventive information and sexual intercourse with higher employment status partners (formal workers vs. self-employed in informal activities and unemployed) were associated with lower SRB scores, but if the sexual relations occurred in Mexico (vs. the U.S.), the SRB scores increased. For the casual partner model, the practice of survival sex (sex in exchange for basic needs), sexual relations in Mexico (vs. the U.S.), and being a circular migrant (person traveling for temporary work to return home when the contract is over) were related to higher SRB scores. Findings support the implementation of preventive interventions using different messages depending on the type of partners, main or casual, within the labor migrant context.

Influence of Sex on the Survival of Patients With Esophageal Cancer

The prognostic value of sex for esophageal cancer survival is currently unclear, and growing data suggest that hormonal influences may account for incidence disparities between men and women. Therefore, moving from the hypothesis that hormones could affect the prognosis of patients with esophageal cancer, we investigated the primary hypothesis that sex is associated with survival and the secondary hypotheses that the relationship between sex and survival depends, at least in part, on age, histology, and race/ethnicity. By using the SEER databases from 1973 to 2007, we identified 13,603 patients (34%) with metastatic esophageal cancer (MEC) and 26,848 patients (66%) with locoregional esophageal cancer (LEC). Cox proportional hazards model for competing risks were used for analyses. In the multivariate analysis, women had longer esophageal cancer-specific survival (ECSS) than men in both MEC (hazard ratio [HR], 0.949; 95% CI, 0.905 to 0.995; P = .029) and LEC (HR, 0.920; 95% CI, 0.886 to 0.955; P < .001) cohorts. When age and histology were accounted for, there was no difference for ECSS between men and women with adenocarcinoma. In contrast, women younger than age 55 years (HR, 0.896; 95% CI, 0.792 to 1.014; P = .081) and those age 55 years or older (HR, 0.905; 95% CI, 0.862 to 0.950; P < .001) with squamous cell LEC had longer ECSS than men. In the squamous cell MEC cohort, only women younger than age 55 years had longer ECSS (HR, 0.823; 95% CI, 0.708 to 0.957; P = .011) than men. Sex is an independent prognostic factor for patients with LEC or MEC. As secondary hypotheses, in comparison with men, women age 55 years or older with squamous cell LEC and women younger than age 55 years with squamous cell MEC have a significantly better outcome. These last two findings need further validation.

Prevalence and correlates of sexual risk among male and female sex workers in Tijuana, Mexico

We investigated prevalence and correlates of sexual risk behaviours among male and female sex workers in Tijuana, Mexico, the busiest border crossing area on the US – Mexico border, analysing survey data from a purposive, cross-sectional sample of male and female sex workers who worked in a range of indoor and outdoor settings. Logistic regression was used to determine factors that were associated with sexual risk-taking, defined as failing to use a condom with last client. In bivariate regression models, gender, work setting (e.g., indoor vs. outdoor), poverty, engaging in survival sex, marital status and perceived drug addiction were correlated with sexual risk. When controlling for work location, housing insecurity, poverty, survival sex, marital status and perceived drug addiction, male sex workers were still 10 times more likely than female sex workers (FSW) to engage in sex without a condom during their last encounter with a client. And, although FSW were significantly more likely than males to have used a condom with a client, they were significantly less likely than males to have used a condom with their regular partner. Future research should further examine how gender shapes sexual risk activities in both commercial and non-commercial relationships.

Prevention interventions for human immunodeficiency virus in drug-using women with a history of partner violence

The intersecting epidemics of human immunodeficiency virus (HIV) and partner violence disproportionately affect women who use drugs. Despite accumulating evidence throughout the world linking these epidemics, HIV prevention efforts focused on these synergistic issues as well as underlying determinants that contribute to the HIV risk environment (eg, housing instability, incarceration, policing practices, survival sex) are lacking. This article highlights selected behavior change theories and biomedical approaches that have been used or could be applied in HIV prevention interventions for drug-using women with histories of partner violence and in existing HIV prevention interventions for drug-using women that have been gender-focused while integrating histories of partner violence and/or relationship power dynamics. To date, there is a paucity of HIV prevention interventions designed for drug-using women (both in and outside of drug treatment programs) with histories of partner violence. Of the few that exist, they have been theory-driven, culture-specific, and address certain aspects of gender-based inequalities (eg, gender-specific norms, relationship power and control, partner violence through assessment of personal risk and safety planning). However, no single intervention has addressed all of these issues. Moreover, HIV prevention interventions for drug-using women with histories of partner violence are not widespread and do not address multiple components of the risk environment. Efficacious interventions should target individuals, men, couples, and social networks. There is also a critical need for the development of culturally tailored combination HIV prevention interventions that not only incorporate evidence-based behavioral and biomedical approaches (eg, microbicides, pre-exposure prophylaxis, female-initiated barrier methods) but also take into account the risk environment at the physical, social, economic and political levels. Ultimately, this approach will have a significant impact on reducing HIV infections among drug-using women with histories of partner violence.

Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment

BackgroundSubstitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been associated with poor Opioid Agonist Treatment (OAT) engagement, retention and response. Therefore, this study was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent women receiving OAT.MethodsData from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI), conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months).ResultsA total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment initiation, women who were younger and had fewer years of education were more likely to be engaged in sex work. The multivariate logistic generalized estimating equation regression analysis determined that psychological symptoms, and high illicit heroin and cocaine use correlated with women's involvement in sex work during the study period.ConclusionsAfter entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes.Trial RegistrationNCT00175357.

Decision Processes about Condom Use among Shelter-Homeless LGBT Youth in Manhattan.

Health behavior interventions based on Theory of Planned Behavior address participants' personally-held beliefs, perceived social norms, and control over the behavior. New data are always needed to “member check” participants' decision processes and inform interventions. This qualitative study investigates decision processes around condom use among 81 homeless LGBT youth ages 18–26. Findings indicated considerable endorsement of the conventional policy of always using condoms, promulgated in HIV prevention education targeting this population. Although some participants reported risk behavior in contexts of sex work, survival sex, casual encounters, open relationships, and substance use, most were aware of these risks and consistently safe in those situations. Condoms use boundaries became vulnerable in states of emotional need and negative mood. The only effect participants acknowledged of homelessness on condom use was indirect, through negative mood states. The most prevalent context of condom non-use was with long-term primary partners, a potential area of vulnerability because, of 13 participants for HIV or HCV, nine mentioned how they had been infected, and all nine believed they had acquired it from a primary partner. Findings imply programs should emphasize HIV risk potential within long-term romantic partnerships and mental health services to remediate negative mood states.

Piloting a Savings-Led Microfinance Intervention with Women Engaging in Sex Work in Mongolia: Further Innovation for HIV Risk Reduction.

This paper describes a pilot study testing the feasibility of an innovative savings-led microfinance intervention in increasing the economic empowerment and reducing the sexual risk behavior of women engaging in sex work in Mongolia. Women’s economic vulnerability may increase their risk for HIV by compromising their ability to negotiate safer sex with partners and heightening the likelihood they will exchange sex for survival. Microfinance has been considered a potentially powerful structural HIV prevention strategy with women conducting sex work, as diversification of income sources may increase women’s capacity to negotiate safer transactional sex. With 50% of all reported female HIV cases in Mongolia detected among women engaging in sex work, direct prevention intervention with women conducting sex work represents an opportunity to prevent a potentially rapid increase in HIV infection in urban Mongolia. The piloted intervention consisted of a matched savings program in which matched savings could be used for business development or vocational education, combined with financial literacy and business development training for women engaging in sex work. Results of the pilot demonstrate participants’ increased confidence in their ability to manage finances, greater hope for pursuing vocational goals, moderate knowledge gains regarding financial literacy, and an initial transition from sex work to alternative income generation for five out of nine participants. The pilot findings highlight the potential for such an intervention and the need for a clinical trial testing the efficacy of savings-led microfinance programs in reducing HIV risk for women engaging in sex work in Mongolia.

Effect of Air Humidity on Sex Ratio and Development of LadybirdHarmonia axyridis(Coleoptera: Coccinellidae)

Length of development of larvae and pupae of the invasive alien ladybird beetleHarmonia axyridis, their survival rates, sex ratio, and fresh mass of the emerged adults were measured at three contrasting levels of relative air humidity: 30, 60, and 90%, 25°C and photoperiod 16L : 8D. Overall sex ratio was 51%, but there was a strong trend for higher proportion of males at low humidity and higher proportion of females at high humidity. Survival rate, larval developmental time, and adult mass were all differently influenced by air humidity depending on the food type. In individuals fed with aphidAcyrthosiphon pisumthere was a trend for better survival, shorter development, and higher mass gained at higher humidity. These trends were opposite or nonsignificant in individuals fed with frozen eggs of mothEphestia kuehniella.

Microclimate of American crocodile nests in Banco Chinchorro biosphere reserve, Mexico: Effect on incubation length, embryos survival and hatchlings sex

Crocodilians have temperature-dependent sex determination (TSD) in which incubation temperature determines sex of embryo. Global warming is expected to alter hatchling sex ratio, leading to the extinction of small populations. Regional climate influence on crocodile nest microclimate and hatchlings' characteristics is poorly known. Here, microclimate in natural nests of American crocodile ( Crocodylus acutus) and its relation with incubation length, hatchling sex and nesting success was studied in Banco Chinchorro Biosphere Reserve (Mexico) from 2007 to 2010. Temperature and relative humidity in different locations within and outside the nests were registered by data loggers. Incident solar radiation above nest was calculated from hemispheric photographs. Incubation length, proportion of hatchling reaching complete development and hatchling sex were determined at hatching. Nest temperatures exhibited a cyclic daily fluctuation due to solar radiation, which is the major heat source for nests. Clutch temperature was relatively stable and its daily amplitude was negatively correlated with clutch depth and size. Rainfall was the major source of clutch temperature decrease. Clutch and metabolic temperatures increased significantly during incubation. A small sample size failed to demonstrate a statistical relationship between length of incubation and mean clutch temperature. Proportion of embryos reaching complete development depended on maximum and minimum clutch temperature, maximum daily amplitude of clutch temperature and maximum decrease in clutch temperature on a period ≤4 day. Results confirmed a Female–Male–Female TSD pattern for C. acutus, with 31 and 32.5 °C as possible pivotal temperatures. Population and hatchling sex ratios were male-biased and fate of crocodiles of Banco Chinchorro could depend on the magnitude of temperature increase in the future.

Understanding survival sex: young women, homelessness and intimate relationships

This article seeks to explore gendered experiences of homelessness through an examination of survival sex. Survival sex is usually understood to be the exchange of sex for material support, however, this research found a greater complexity in the intimate relationships being undertaken by young women experiencing homelessness. In-depth interviews were conducted with 15 young women aged 18–25 years living in Melbourne, Australia. Participants were asked about their experiences of intimate relationships and survival sex while homeless in order to provide a better understanding of gendered practices of marginalisation. This research found that young women experiencing homelessness are subject to the pressures of individualisation that have been produced by the neoliberal policies of Western capitalist societies. As such, they are required to find individual solutions to structural problems and, for young women experiencing homelessness, sex and intimate relationships are among the few resources at their disposal. The reasons provided for engaging in intimate relationships included material support, physical protection and emotional security and stability. Some avoided intimate relationships or engaged in intimate relationships that challenged gendered expectations of survival sex. This article argues that survival sex and intimate relationship management occur within a context of gendered discourses regarding young women experiencing homelessness and their sense of personal responsibility for managing their situations.

Pilot Test Results of an HIV Prevention Intervention for High-Risk Women

Minority women, incarcerated women, and women using drugs or engaged in survival sex are most vulnerable to HIV. This pilot study was designed to estimate efficacy of an intervention, Women First!, to help these women correctly and consistently use male condoms. Women (N = 74) were recruited from jails, substance-abuse treatment centers, and public health clinics, and enrolled in a randomized controlled trial with an attention-only comparison group. The intervention, based on social cognitive theory and the theory of gender and power and awakening, was delivered over 6 weeks; unprotected vaginal intercourse and correct condom use were measured before and after the intervention. Changes on the dependent variables did not rise to statistical significance due to low power, but descriptive statistics and the multivariate partial η(2) effect size estimate of 0.27 suggest that Women First! is a promising intervention. Future research will require improvements in recruitment, retention, and measurement.

Modeling Initiation into Drug Injection among Street Youth

This study aimed at examining the predictors of initiation into drug injection among street youth using social cognitive theory framework. A prospective cohort study based on semi-annual interviews was carried out. Psychosocial determinants referred to avoidance of initiation. Other potential predictors were: sociodemographic characteristics, relationships with injectors, parent's substance misuse, drug use patterns, homelessness, survival sex, sexual abuse. Independent predictors were identified using Cox proportional hazards regression models. Among the 352 participants, high control beliefs about avoidance of initiation was protective while younger age, daily alcohol consumption, heroin use, cocaine use, and survival sex all increased risk of initiation. Preventive strategies targeting street youth should both enhance youth's control beliefs and actual control over their substance use and improve their life conditions.

Individual and Structural Vulnerability Among Female Youth Who Exchange Sex for Survival

Because of growing concerns regarding the heightened vulnerabilities and risk of human immunodeficiency virus infection among youth who exchange sex for survival, we investigated individual risk patterns and structural barriers among young (≤24 years) female sex workers (FSWs) in Vancouver, Canada. Between 2005 and 2008, a total of 255 street-based FSWs (≥14 years) were enrolled into a community-based prospective cohort, and were asked to participate in baseline and biannual questionnaires administered through interviews and human immunodeficiency virus screening. We used contingency table analysis to compare individual and structural barrier results obtained at baseline for younger (≤24 years) FSWs with those of the older (>25 years) FSWs. For longitudinal data, we used generalized estimating equations throughout the follow-up period to determine factors associated with being a young FSW in the past 6 months. In comparison with older FSWs (n = 199), youth (n = 56) were more likely to spend fewer years engaging in sex exchange (median: 6.4 [interquartile range: 4.6-9.1] vs. 19.9 [interquartile range: 10.0-26.8]; p ≤ .001), belong to an aboriginal ancestry (59% vs. 44%; p = .052), and be homeless (68% vs. 36%; p ≤ .001). In the multivariate generalized estimating equations analysis, youth reported a significantly elevated proportional odds of being homeless (odds ratio [OR]: 1.26 [confidence interval {CI}: 1.08-1.48]), servicing clients in public places (OR: 1.28 [CI: 1.04-1.57]), injecting heroin on a daily basis (OR: 1.35 [CI: 1.06-1.74]), and a significantly reduced odds of accessing methadone maintenance therapy (OR: .76 [CI: .62-.93]). This study demonstrates significant displacement of youth who engage in sex exchange to marginalized working and living spaces. The findings of this study bring to attention the critical need for targeted structural interventions including access to youth and gender-specific social housing, safe working spaces, reduction in the amount of harm caused to them, and addiction treatment services for youth engaged in survival sex work.

Abstract LB-52: Integrative protein and transcriptomic analysis identified an EMT-associated secretory phenotype that correlates with metastasis and predicts survival in lung adenocarcinoma patients

Abstract The epithelial-mesenchymal transition (EMT) confers many clinicaly relevant properties to cancer cells, including migratory and invasive capacity, resistance to apoptosis, drug resistance, evasion of host immune surveillance, and tumor stem cell traits. Therefore, we reasoned that characterizing the secretome of cultured cells in EMT may identify biomarkers which allow monitoring of EMT in tumors and provide a signature to predict metastasis and survival in patients with cancers. Utilizing aTGF-β-induced EMT model with A549 lung adenocarcinoma cells, we harvested serum-free conditioned media from control and EMT cells (5 ng/ml TGF-β, 72h) to quantitatively profile differentially expressed proteins by GeLC-MS/MS and spectral counting. We identified &amp;gt;2000 proteins, &amp;gt;70% of which were putative secretory proteins. Corresponding transcriptomic analysis was performed by Affymetrix U133-plus microarray which identified ∼3,500 genes as differentially expressed. By integrating these two data sets we derived an EMT-associated secretory phenotype (EASP) comprising 97 genes of secretory proteins that were differentially up-regulated by at least two-fold during EMT both for protein and mRNA levels. Several of these proteins were validated by MRM. Analysis of EASP expression in a gene expression dataset from 443 human lung adenocarcinoma tumors revealed strong positive correlations with lymph node metastasis (p&amp;lt;0.05), advanced tumor stage (p=0.006) and histological grade (p&amp;lt;0.00001). After splitting the 443 tumors into a training (n=254) and test (n=189) sets, random forest survival analysis, including age, sex and stage as variables, stratified the test-set into low, medium and high-risk groups with significant differences in overall survival (p=0.0002). For further validation we tested EASP in two independent histologically distinguished lung cancer data sets. Interestingly, EASP predicted survival only in the dataset with adenocarcinomas (n=111, p=0.03), not in the dataset with squamous tumors (n=130). This result indicates that integrative analysis of relevant biological processes in cell-culture models may provide mechanism-related, tumor type-specific, clinically-relevant biomarkers with significant prognostic value. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-52. doi:10.1158/1538-7445.AM2011-LB-52

Promoting health, preserving culture: adapting RARE in the Maasai context of Northern Tanzania

HIV/AIDS prevention strategies often neglect traditions and cultural practices relevant to the spread of HIV. The role of women in the HIV/AIDS context has typically been relegated to high-risk female groups such as sex workers, or those engaged in transactional sex for survival. Consequently, these perceptions are born out in the escalation of HIV/AIDS among communities, and female populations in particular where prevention frameworks remain culturally intolerant. We have attempted to address these issues by using an adapted Rapid Assessment Response and Evaluation (RARE) model to examine the impact of HIV/AIDS in the Maasai community of Ngorongoro. Our adapted RARE model used community engagement venues such as stockholder workshops, key informant interviews, and focus groups. Direct observations and geomapping were also done. Throughout our analysis, a gender and a pastoralist-centered approach provided methodological guidance, and served as value added contributions to out adaptation. Based in the unique context of a rural pastoralist community, we made recommendations appropriate to the cultural setting and the RARE considerations.

Prevention of Hepatitis C Virus in Injecting Drug Users: A Narrow Window of Opportunity

prevalence among IDUs and higher risk of HCV infection following injection with a contaminated syringe (2.5%‐ 5.0% for HCV [5‐8] vs .5%‐2.0% for HIV [8‐11]). High HCV incidence and rapidly increasing HCV prevalence are observed among young IDUs in different settings [12]. Factors associated with HCV acquisition include recent initiation to injecting [13, 14], unstable housing [15], female gender [16], ethnicity [17, 18], survival sex work [13, 19], frequent injecting cocaine use [13, 16, 20, 21], imprisonment [21], having a partner who injects [20], injecting networks [22], requiring help injecting [20], and borrowing injecting equipment [13]. The high risk of HCV among younger and recent IDUs indicates a narrow window of opportunity for prevention, with estimates of the

Survival Processing Advantage and Sex Differences in Location Memory

Survival Processing Advantage and Sex Differences in Location Memory

Correlates of Engaging in Survival Sex among Homeless Youth and Young Adults

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium™, crack cocaine, alcohol, Coricidin™, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.