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CORK Bibliography: Prostitution

96 citations. January 2003 to present

Prepared: March 2008

Aidala A; Cross JE; Stall R; Harre D; Sumartojo E. Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS & Behavior 9(3): 251-265, 2005. (92 refs.)

This paper examines housing as a contextual factor affecting drug and sexual risk behaviors among HIV positive people using pooled interview data from 2149 clients presenting for services at 16 medical and social service agencies participating in a multi-site evaluation study. The odds of recent drug use, needle use or sex exchange at the baseline interview was 2-4 times as high among the homeless and unstably housed compared to persons with stable housing. Follow-up data collected 6-9 months after baseline showed that change in housing status was associated with change in risk behaviors. Persons whose housing status improved between baseline and follow-up significantly reduced their risks of drug use, needle use, needle sharing and unprotected sex by half in comparison to individuals whose housing status did not change. In addition, for clients whose housing status worsened between baseline and follow-up, their odds of recently exchanging sex was over five times higher than for clients whose housing status did not change. The provision of housing is a promising structural intervention to reduce the spread of HIV.

Azim T; Chowdhury E; Reza M; Ahmed M; Uddin M; Khan R et al. Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: Evidence from the baseline survey of a cohort study. Harm Reduction Journal 3(article 33), 2006. (39 refs.)

Background: Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined. Methods: All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression. Results: Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers. Conclusion: Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU.

2006, BioMed Central

Bautista CT; Sanchez JL; Montano SM; Laguna-Torres A; Suarez L; Sanchez J et al. Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America. Sexually Transmitted Infections 82(4): 311-316, 2006. (29 refs.)

Objective: Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America. Methods: Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests. Results: The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (>= 3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries. Conclusions: Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.

Beckerleg S; Hundt GL. Women heroin users: Exploring the limitations of the structural violence approach. International Journal of Drug Policy 16(3): 183-190, 2005. (30 refs.)

This paper reports on the lives of women heroin users resident in a Kenyan coastal resort town. Data on the everyday lives of 24 women were collected using ethnographic field methods. Eighteen women also completed questionnaires about their reproductive health. Using these data, we analyse the extent to which the women are victims of 'structural violence', and how their disadvantaged social status and poverty make them particularly vulnerable to poor health, injury and death. The problems these women face are similar to women heroin users in other parts of the world. These Kenyan women live in a country where the majority of people are victims of 'structural violence', but as drug users and sex workers they face particular disadvantage. The limitations of using individual case studies that detail the lives of 'victims' of structural violence are discussed.

Belcher JR; Herr S. Development of grounded theory: Moving towards a theory of the pathways into street prostitution among low-income women. Journal of Addictions Nursing 16(3): 117-124, 2005. (97 refs.)

The authors examined the social problem of addictions and prostitution using a qualitative study with 15 adult women who were also in addictions treatment. Findings from the study suggest that prostitution is a rite of passage for many women from poor communities and their approach to life is one of passive externalization in which they are ambivalent about their immediate circumstances. Addiction contributes to prostitution, "en-traps" many of the women in prostitution, and acts as barrier in escaping it. Suggestions are made regarding improved methods of practice with this population.

Bletzer KV. Sex workers in agricultural areas: Their drugs, their children. Culture, Health & Sexuality 7(6): 543-555, 2005. (31 refs.)

Most research on female sex workers is urban-based, emphasizing economic necessity and risk-taking. Few authors discuss sex workers and their children. The objective of the present study was to ethnographically explore the influence of street life on childrearing by women involved in sex work in agricultural areas of the southeastern USA. Interviews took place with 38 women. Findings suggest that the sampled women followed the usual paths into substance use. Most began using substances before they began sex work, at which time use escalated to crack-cocaine. Children of 32 of the 34 women who were mothers were living separately from their mothers. None the less, mothers took an interest in children's wellbeing, and many visited them whenever possible. Their principal concern was assuring that children were raised in the best way available. One daughter followed her mother into sex work, and a few older children drank moderately. Several children had experienced abuse from persons other than parents, but the long-term effects of this abuse are unknown.

Bogart LM; Kral AH; Scott A; Anderson R; Flynn N; Gilbert ML et al. Sexual risk among injection drug users recruited from syringe exchange programs in California. Sexually Transmitted Diseases 32(1): 27-34, 2005. (54 refs.)

Objective: The objective of this study was to examine correlates of sexual risk among injection drug users (IDUs). Study: A total of 1445 IDUs were recruited from California syringe exchange programs. Results: Consistent condom use was independently related to being HIV-positive, having multiple sex partners, not having a steady partner, not sharing syringes, and not injecting amphetamines for men; and engaging in sex work, not sharing syringes, and not having a steady partner for women. Having multiple recent sexual partnerships that included a steady partner was related to engaging in sex work, speedball injection, and amphetamine use among men; and younger age, having had a sexually transmitted disease (STD), engaging in sex work, and using alcohol among women. Having heterosexual anal sex was related to having had an STD, having multiple sexual partners, using amphetamines, and syringe-sharing for men; and younger age and amphetamine use for women. Conclusions: Comprehensive prevention interventions addressing multiple sexual and injection risk behaviors are needed for IDUs.

Breen C; Roxburgh A; Degenhardt L. Gender differences among regular injecting drug users in Sydney, Australia, 1996-2003. Drug and Alcohol Review 24(4): 353-358, 2005. (44 refs.)

Previous research has found that female injecting drug users (IDU) are younger and more likely to be involved in risky behaviours such as needle sharing and sex work than male IDU. Aboriginal female drug users, in particular, are over-represented in IDU and prison populations. These factors place female IDU at increased risk of health problems and complicate issues such as homelessness, unemployment and poverty. Although a substantial body of research exists, little trend analysis has been done in Australia and much of the previous literature has focused on treatment populations. Cross- sectional data from 1996 to 2003 from regular IDU in Sydney interviewed as part of Australia's drug monitoring system, the Illicit Drug Reporting System (IDRS) were examined for trends over time. The demographic characteristics, drug use patterns and self- reported risk behaviours of the most recent sample (2003) were analysed for gender differences. Female IDU were younger in all sample years. Female IDU were more likely to identify as Aboriginal or Torres Strait Islander (ATSI) and engage in sex work. There has been a steady increase in these proportions over time. Female IDU were less likely to have a prison history, although there has been an increase among both male and female IDU over time. There were no gender differences in drug use patterns or frequency of drug use. Larger proportions of females report lending needles. Reports of lending and borrowing needles have decreased over time among both male and female IDU. Female IDU may place themselves at greater risk than male IDU by being more likely to share injecting equipment and engage in sex work. Treatment and other measures to reduce harm may need to be targeted specifically at women and, in particular, indigenous women.

Brewer DD; Dudek JA; Potterat JJ; Muth SQ; Roberts JM; Woodhouse DE. Extent, trends, and perpetrators of prostitution-related homicide in the United States. Journal of Forensic Sciences 51(5): 1101-1108, 2006. (44 refs.)

Prostitute women have the highest homicide victimization rate of any set of women ever studied. We analyzed nine diverse homicide data sets to examine the extent, trends, and perpetrators of prostitution-related homicide in the United States. Most data sources substantially underascertained prostitute homicides. As estimated from a conservative capture-recapture analysis, 2.7% of female homicide victims in the United States between 1982 and 2000 were prostitutes. Frequencies of recorded prostitute and client homicides increased substantially in the late 1980s and early 1990s; nearly all of the few observed pimp homicides occurred before the late 1980s. These trends may be linked to the rise of crack cocaine use. Prostitutes were killed primarily by clients, clients were killed mainly by prostitutes, and pimps were killed predominantly by pimps. Another conservative estimate suggests that serial killers accounted for 35% of prostitute homicides. Proactive surveillance of, and evidence collection from, clients and prostitutes might enhance the investigation of prostitution-related homicide.

Chen XJ; Tyler KA; Whitbeck LB; Hoyt DR. Early sexual abuse, street adversity, and drug use among female homeless and runaway adolescents in the midwest. Journal of Drug Issues 34(1): 1-21, 2004. (59 refs.)

Research on homeless and runaway adolescents has shown that this population is at high risk for illicit drug use. Though sexual abuse has been widely considered in the etiology of illicit drug use, we know less about how early sexual abuse affects young people's decisions to run away, to use drugs, and to engage in other deviant behavior on the streets. Based on interviews with 361 female homeless and runaway adolescents in four midwestern states, the current study revealed a high prevalence of drug use, especially use of cocaine among youths with sexual abuse histories. Path analyses showed that early sexual abuse indirectly affected drug use on the streets via running away at an earlier age, spending more time on the street, and use of deviant strategies to survive (e.g., affiliation with deviant peers, trading sex, and use of nonsexual deviant subsistence strategies).

Chiao C; Morisky DE; Rosenberg R; Ksobiech K; Malow R. The relationship between HIV/sexually transmitted infection risk and alcohol use during commercial sex episodes: Results from the study of female commercial sex workers in the Philippines. Substance Use & Misuse 41(10-12): 1509-1533, 2006. (64 refs.)

The HIV-Sexually Transmitted Infection (STI) risk associated with alcohol use between female commercial sex workers (FCSWs) and their customers has been understudied. We examined this relationship for 1,114 FCSWs aged 15-54 with data collected during the baseline study period (1994 to 1998) in four southern provinces of the Philippines. Two alcohol-related risk situations during commercial sex episodes were examined: prior alcohol use by an FCSW and perceived intoxication in a customer. The influence of sociodemographic variables on sexual risk behaviors was also studied. Multiple sexual risk behaviors were observed with more frequency for FCSWs if alcohol was used before commercial sex or if the episode involved a customer perceived to be intoxicated. Forty-two percent of FCSWs who had sex with an intoxicated customer were STI positive, significantly more than FCSWs who did not have sex with an intoxicated customer (28%, p < .01). Similar significant differences were found for FCSWs who did not consume alcohol before having sex and were STI positive (29%) versus FCSW who did consume alcohol before sex and were STI positive (33%, p < .01). Our analyses reinforce accumulating evidence in the field that sexual risk reduction interventions need to go beyond the behaviors of individual FCSWs to meet the layering of risks such as observed in this study. Multilevel strategies targeting customer substance use and other situational and structural factors have proven to be pivotal mediators in our other research with this population. These experiences and the limitations of this study are discussed.

Cusick L. Widening the harm reduction agenda: From drug use to sex work. International Journal of Drug Policy 17(1): 3-11, 2006. (146 refs.)

Harm reduction emerged in the 1980s as a public health response to HIV and injecting drug use. This paper reviews the literature to structure the harms associated with sex work and expand the domains of harm reduction. Sex work-related harms are often rooted in debates where moral arguments and health and criminal justice policies compete for priority. Like drug users, sex workers have a social history in which they have been stigmatised, criminalised, pathologised, and on occasion, celebrated. Yet, by focusing on drug-related harm specifically, the 'harm reduction movement' is missing opportunities to better promote health among sex workers. Harms associated with sex work include: the vulnerabilities that may lead to sex work; harms that are introduced by sex work; and mutually reinforcing harms such as problematic drug use. These harms are overwhelmingly concentrated in street sex markets and where sex workers' pre-existing vulnerabilities can be most exploited. They include predation and victimisation, violence and child abuse, trafficking and slavery, stigma, sanctions and penalties, STIs, exposure to mutually reinforcing harms and public nuisance. Existing interventions and policy developments to reduce these harms are discussed.

Cusick L; Hickman M. 'Trapping' in drug use and sex work careers. Drugs: Education, Prevention and Policy 12(5): 369-379, 2005. (53 refs.)

This paper examines the reinforcement of sex work and drug use. Data from 92 survey and in-depth interviews were analysed to examine associations between vulnerabilities and 'trapping': mutually reinforcing sex work and problematic drug use. Three-quarters of participants had used drugs and half had sold sex before 18. Half had been in care and half had been homeless. One in 5 (21%) had run away or left home before 16 and 80% had been convicted for acquisitive offences. Nevertheless, these experiences did not explain trapping. There were strong associations between being trapped and convictions (81%); and being trapped and outdoor/ drift sex work (92%). After adjustment for the other vulnerabilities in the logistic regression only outdoor/ drift sex work remained significant: with sex workers involved in outdoor/ drift sex-work having an adjusted odds ratio of over 7 (95% c. i. 1.7 - 28.3) of being trapped. Moreover, since the sample over-represents the extent of problematic drug use amongst indoor sex workers the study underestimates differences in trapping potential between sex markets. We conclude that outdoor/ drift sex markets may reinforce vulnerability, sex work and problematic drug use. Interventions are recommended to disentangle sex and drugs markets, and reduce the sex industry's potential for exploitation and abuse.

Dalla RL. "You can't hustle all your life": An exploratory investigation of the exit process among street-level prostituted women. Psychology of Women Quarterly 30(3): 276-290, 2006. (25 refs.)

Between 1998 and 1999, 43 street-level prostituted women were interviewed regarding their developmental experiences, including prostitution entry, maintenance, and exit attempts. Three years later, 18 of the original 43 participants were located and interviewed. This exploratory follow-up investigation focused on the women's life experiences between the two points of contact, with emphasis on sex-industry exit attempts. Five women had maintained their exit efforts and had not returned to prostitution, nine had returned to both prostitution and drug use, and one had returned to prostitution only. Three additional women had violated parole and been reincarcerated. Themes evident among those who were able to stay out of prostitution and refrain from substance use are compared to those whose exit attempts had not been successful. Suggestions for intervention and outreach are presented, as are directions for future work.

Dausey DJ; Desai RA. Psychiatric comorbidity and the prevalence of HIV infection in a sample of patients in treatment for substance abuse. Journal of Nervous and Mental Disease 191(1): 10-17, 2003. (38 refs.)

This article compares the differences in HIV prevalence and risk behaviors in singly diagnosed patients with substance abuse problems and dually diagnosed patients with comorbid psychiatric and substance abuse problems. The National Treatment Improvement Evaluation Study (NTIES) was used to conduct a cross-sectional study on 6593 persons treated for substance abuse disorders. Logistic regression using hierarchal linear modeling (HLM) was utilized to compare risk behaviors of singly and dually diagnosed persons. Compared with singly diagnosed patients, dually diagnosed patients were more likely to share a needle, have sex for money or gifts, have sex with an intravenous drug user, and report being raped. Patients dually diagnosed with psychiatric and substance abuse disorders are an especially high-risk group for HIV infection, in part due to a higher likelihood of engaging in high-risk behavior, and should be targeted for more intense HIV interventions.

Degenhardt L; Day C; Conroy E; Gilmour S. Examining links between cocaine use and street-based sex work in New South Wales, Australia. Journal of Sex Research 43(2): 107-114, 2006. (40 refs.)

We examined potential links between cocaine use and street-based sex work in New South Wales, Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analyzed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested a greater number of primary heroin users were engaging in street-based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.

DeRiviere L. A human capital methodology for estimating the lifelong personal costs of young women leaving the sex trade. Feminist Economics 12(3): 367-402, 2006. (52 refs.)

This article combines case study interviews with the tools of economic cost-benefit analysis to estimate the lifelong effects for individuals in Manitoba, Canada, who began engaging in prostitution as youths. The empirical findings reveal that sex workers retain only a small portion of their earnings from prostitution after feeding drug addictions and third-parties extortions of net residual earnings. The sex-trade worker typically suffers from debilitating addictions and health conditions that are symptomatic of the stress and danger of engaging in this lifestyle. After leaving prostitution, the former sex worker faces major challenges in rejoining the mainstream labor market. The issues engender multiple reasons for policy-makers to direct their attention to counteracting the conditions of vulnerability that bring youth into this lifestyle and, thereby, effectively disrupting the supply of sex workers.

2006, Taylor and Francis

Dickson-Gomez J; Bodnar G; Gueverra A; Rodriguez K; Gaborit M. Childhood sexual abuse and HIV risk among crack-using commercial sex workers in San Salvador, El Salvador: A qualitative analysis. Medical Anthropology Quarterly 20(4): 545-574, 2006. (69 refs.)

This article explores the relationship between childhood sexual abuse (CSA) and later HIV risk. It draws on qualitative, in-depth interviews with 40 women who either used crack or engaged in commercial sex work in the greater metropolitan area of San Salvador, El Salvador, 28 of whom experienced CSA. Although the relationship between CSA and later HIV risk has been clearly demonstrated, the processes that lead women who have experienced CSA to experience HIV risk are unclear. The theoretical model presented here incorporates the psychological effects of CSA, particularly stigmatization, as well as its social consequences and the larger context of poverty in which these women live. The meanings women draw from past abuse experiences and their rationale for choices made help explain the association between CSA and later risk as mediated through sex work and crack addiction. Self-report data gathered in this study indicate that HIV prevalence may be considerably higher in this high-risk population than Salvadoran national rates.

2006, American Anthropological Association

Edwards JM; Halpern CT; Wechsberg WM. Correlates of exchanging sex for drugs or money among women who use crack cocaine. AIDS Education and Prevention 18(5): 420-429, 2006. (27 refs.)

This study examined the correlates of trading sex for drugs or money among women who use crack cocaine. Using baseline data (n = 669) from a woman-focused HIV intervention study among African American women who use crack cocaine, we conducted logistic regression analysis to examine the odds of trading sex associated with distal and proximal factors. The results indicate that heavier crack use, homelessness, and unemployment are associated with trading sex. In addition, childhood abuse is associated with trading sex and this relationship is, in part, mediated by psychological distress. This suggests that distal factors may underlie the relationship between current variables and sex trading. These findings underscore the importance for public health interventions to address both distal and proximal factors that contribute to and/or co-occur with women's drug use which, in turn, may affect their HIV risk and overall well-being.

Flannery BA; Morgenstern J; McKay J; Wechsberg WM; Litten RZ. Co-occurring alcohol and cocaine dependence: Recent findings from clinical and field studies. Alcoholism: Clinical and Experimental Research 28(6): 976-981, 2004. (7 refs.)

This article represents the proceedings of a symposium held at the 2003 annual meeting of the Research Society on Alcoholism in Ft. Lauderdale, FL. The organizer and chair was Barbara A. Flannery, and the discussant was Raye Z. Litten. The presentations were (1) Examining treatment trajectories of alcohol and cocaine dependent patients, by Jon Morgenstern; (2) Outcomes of alcoholics with and without cocaine dependence in a continuing care study, by James R. McKay; (3) Characteristics of non-treatment seeking cocaine and alcohol dependent African Americans, by Barbara A. Flannery; and (4) Cocaine and alcohol use among sex workers in South Africa, by Wendee M. Wechsberg.

Gare J; Lupiwa T; Suarkia DL; Paniu MM; Wahasoka A; Nivia H et al. High prevalence of sexually transmitted infections among female sex workers in the Eastern Highlands Province of Papua New Guinea: Correlates and recommendations. Sexually Transmitted Diseases 32(8): 466-473, 2005. (40 refs.)

Background: More than 200 female sex workers (FSWs) participating in commercial sex along the Highlands Highway of Papua New Guinea were identified in a previous survey. This has implications for the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) to areas and population groups serviced by the road. Goal: The goal of this study was to estimate the prevalence of gonorrhea, chlamydia, syphilis, trichomoniasis, and HIV among FSWs in Goroka and Kainantu in the Eastern Highlands Province (EHP) and to identify correlates that could be considered in intervention and control. Study: Self-identified FSWs recruited through the Goroka Sex Workers Peer-Mediated Programme were invited to participate. All consenting FSWs underwent pretest counseling and provided sociode-mographic and behavioral data using a structured questionnaire. The women were also asked to self-collect vaginal specimens and to provide peripheral blood to detect the respective STIs and HIV. Results: Results were available for 211 FSWs. None of the women were positive for HIV. The overall estimated rates for gonorrhea, chlamydia, syphilis, and trichomoniasis were 21%, 19%, 24%, and 51%, respectively. Seventy-four percent were positive for at least 1 STI and 43% had multiple STI infections. High-risk sexual behaviors were found to be common among the women, including low and inconsistent use of condoms, with most of them attributing this to unavailability, dislike by or familiarity with clients, and being drunk and/or high on marijuana. Conclusions: STIs are prevalent among FSWs in Goroka and Kainantu in the EHP and are maintained by widespread high-risk sexual behaviors, including low use of condoms. Implications for their spread through the highway warrants increased efforts in intervention. Apart from a need to promote condom acceptance, distribution, and use, other high-risk sexual behavior and correlates identified in this study provide important considerations for intervention and control in this population.

Geiger B. Crime, prostitution, drugs, and malingered insanity: Female offenders' resistant strategies to abuse and domination. International Journal of Offender Therapy and Comparative Criminology 50(5): 582-594, 2006. (59 refs.)

Mizrahi female offenders have been described as passive victims propelled into crime, prostitution, and drug abuse as a result of traumatic childhood and life course experiences. This qualitative study adopts a postmodern critical orientation and Foucault's bottom-up microsocial analysis of power to examine the trajectories of resistance of 8 female offenders who break the silence to tell their life story. Analysis of narratives, informal conversations, and more focused, in-depth interviews with these women allow the deconstruction of the stereotype of the passive and helpless female offender. Using the sensitizing concepts of control, agency, and resistant efforts and letting the data speak, this research reconstructs female offending as a hidden script of resistance against intolerable socioeconomic deprivation and extreme forms of abuse.

Gilchrist G; Cameron J; Scoular J. Crack and cocaine use among female prostitutes in Glasgow: Risky business. Drugs: Education, Prevention and Policy 12(5): 381-391, 2005. (21 refs.)

The experience of cocaine and 'crack' use among participants involved in (n=19) or exiting (n=10) prostitution in Glasgow, Scotland, is described. In-depth semi-structured qualitative interviews enquired about their use and experience of using cocaine and their perception of its effect on working practice. Twenty-three of 29 participants had used cocaine and 15 out of 29 had used crack cocaine. In reality, freebase not 'crack' was being self- manufactured from cocaine powder. Participants considered that cocaine use in the city was not restricted to prostitution but was reflected throughout the drug scene generally. One possible reason suggested for this was a perceived reduction in heroin availability at a time when cocaine was increasingly readily available. There was no evidence from participants to suggest that they were first introduced to cocaine through prostitution. Most participants believed that using cocaine did not affect how they worked, however they perceived that other prostitutes were prepared to take more risks to support their cocaine use and had to work longer hours to finance a cocaine habit compared to financing a heroin habit. Only participants recruited from the east end of the city spoke about their desperation for money and the sexual risks that they were prepared to take to buy cocaine. Harm-reduction messages should address the sexual and personal risks that some female prostitutes may be taking to support their cocaine use. Treatment and support services in the city, traditionally established to work with problematic heroin users, need to adapt to the changing drug trends among female drug users, including those involved in prostitution, and offer appropriate treatment options and harm-reduction advice to cocaine users.

Gilchrist G; Gruer L; Atkinson J. Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland (rapid communication). Addictive Behaviors 30(5): 1019-1023, 2005. (8 refs.)

Aims: To compare psychiatric morbidity between 176 female drug users with lifetime involvement in prostitution (prostitutes) and 89 female drug users with no involvement (non-prostitutes) in Glasgow, Scotland. Method: The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. Results: Prostitutes were more likely to report adult physical (OR 1.8) or sexual abuse (OR 2.4), to have attempted suicide (OR 1.7) and to meet criteria for current depressive ideas (OR 1.8) than non-prostitutes. Seventy-two percent of prostitutes and sixty-seven percent of non-prostitutes met criteria for a level of current neurotic symptoms likely to need treatment (CIS-R �18). Being in foster care (OR 8.9), being prescribed medication for emotional problems in the last 30 days (OR 7.7), adult sexual abuse (OR 4.5), poly drug use in the last 30 days (OR 3.6) and adult physical abuse (OR 2.6) were significantly associated with a CIS-R score of �18 for prostitutes using multiple logistic regression. Conclusions: Higher rates of adulthood abuse among prostitutes may explain the greater proportion of prostitutes than non-prostitutes meeting criteria for current depressive ideas and lifetime suicide attempts.

Green LL; Fullilove MT; Fullilove RE. Remembering the lizard: Reconstructing sexuality in the rooms of Narcotics Anonymous. Journal of Sex Research 42(1): 28-34, 2005. (26 refs.)

The crack epidemic was devastating to poor American communities in part because of the destruction wrought by the system of exchanging sex for drugs, which was a key feature of the crack-use culture. Sex-for-drugs exchanges were often conducted under unsafe circumstances and were linked to the spread of AIDS and other STDs as well as unplanned pregnancies. The existence of this alternative system of sexual relationships threatened the economic viability of established commercial sex work and undermined the status and power of women. Narcotics Anonymous (NA) meetings helped men and women recover from crack addiction through a well-described 12-step process. Described as "the rooms," these time- and space-specific encounters helped people become sober in the context of neighborhoods that were centers of the drug trade. Because of the key role of sex in the crack culture, transformation of sexual relationships was essential to establishing and maintaining sobriety. The manner in which the rooms of NA influence the sexuality and lifeworld of addicted people is explored using Barker's theory of ecological psychology.

Hasnain M; Levy JA; Mensah EK; Sinacore JM. Association of educational attainment with HIV risk in African American active injection drug users. AIDS Care 19(1): 87-91, 2007. (28 refs.)

This study explored the association between educational attainment and HIV/AIDS risk among African American active injection drug users (IDUs) in Chicago, US. Using snowball sampling techniques, 813 African American active IDUs were recruited for semi-structured interviewing and HIV counseling, testing and partner notification. Logistic regression examined the relationship between level of education attained (three categories: less than high school; equivalent to high school; and greater than high school) and HIV risk behaviors (12 unsafe sex and drug-related practices) and HIV serostatus (positive or negative). Compared with the reference category (less than high school education), those with education equal to high school were less likely to share water, p = 0.044, OR= 0.70 (95%CI: 0.50-0.99). Compared with the reference category, those with education greater than high school were less likely to receive money for sex, p = 0.048, OR = 0.62 (95%CI: 0.38-0.99); share needles with person having HIV or AIDS, p = 0.015, OR =0.58 (95%CI: 0.37-0.90); and test positive for HIV, p=0.0273 OR =0.58 (95%CI: 0.36-0.94). The significant associations found between educational attainment and certain HIV risk behaviors and HIV serostatus have implications for tailoring HIV prevention efforts for less educated African American IDUs.

2007, Routledge Journals

He N; Wong FY; Huang ZJ; Thompson EE; Fu C. Substance use and HIV risks among male heterosexual and 'money boy' migrants in Shanghai, China. AIDS Care 19(1): 109-115, 2007. (22 refs.)

There is a growing awareness that internal migration in China might shift the HIV epidemic by broadening the social and sexual mixing of its population. However, little is known about how drug use/abuse might contribute to the spread of HIV. This qualitative study aims to elucidate factors for preventing substance abuse and HIV among two types of male migrants living in the Shanghai metropolitan area; the general migrant population and so-called 'money boys' (those who engaged in same-sex activities for money). Compared to most male migrants, the 'money boys' had a slightly better economic situation,rarely visited their hometowns; used alcohol less but drugs more; had more knowledge about HIV and sexually transmitted diseases; higher HIV/STD testing rates and fewer HIV risk behaviors. The general male migrants had more misconceptions about HIV (e.g. the need to pay for HIV testing) than the 'money boys'. However, it was noted that 'money boys' who were new to the enterprise and men who have sex with men but did not engage in commercial sex often lacked HIV knowledge and protective skills. Given the needs of various sub-types of 'migrants', differential approaches to HIV prevention are needed.

2007, Routledge Journals

Jeal N; Salisbury C. A health needs assessment of street-based prostitutes: Cross-sectional survey. Journal of Public Health 26(2): 147-151, 2004. (23 refs.)

Background: Research with prostitutes has tended to concentrate on sexual health rather than wider health issues, and has failed to differentiate between street-based prostitutes and off-street workers. Little is known about the general health and background of street-based sex workers, the group likely to have the greatest needs. Methods: An interview-based survey amongst street-based sex workers in central Bristol was employed. Results Seventy-one women were interviewed. All reported chronic health problems. Sexually transmitted infections were between nine and 60 times more common than the general population. Many women (44 per cent; n = 31) had experienced sexual abuse and 38 per cent (n = 27) had been in care. Women who had experienced care left school earlier (14.1 versus 15.5 years; p < 0.0001 unpaired t-test) and were less likely to have their own children at home [1/18 (5.5 per cent) versus 8/25 (32 per cent); p = 0.06] The stillbirth rate was 50/1000. Most (97 per cent; n = 69) had been offered more money for unprotected sex. Half (51 per cent; n = 36) had unprotected sex in the last week. All had drug or alcohol dependency problems. In the last week, 22 percent (n = 9/41) of injecting drug users had shared needles and 59 per cent (n = 24/41) had shared injecting equipment, despite most (96 per cent; n = 39/41) knowing the risks. Conclusions The health and social inequalities experienced by this group are much worse than any group highlighted in the 'Tackling Health Inequalities Review 2002' and appear cross generational. In neither that report nor the Sexual Health and HIV Strategy report are sex workers identified as a particularly high priority group. There is the potential for their needs to continue to be unmet.

Kalichman SC; Gore-Felton C; Benotsch E; Cage M; Rompa D. Trauma symptoms, sexual behaviors, and substance abuse: Correlates of childhood sexual abuse and HIV risks among men who have sex with men. Journal of Child Sexual Abuse 13(1): 1-15, 2004. (27 refs.)

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N=647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.

Kanzaki N. The alcoholic beverages of bars and restaurants in 17th-19th century Tokyo. IN: Umesao T; Yoshida S; Schalow P, eds. Japanese Civilization in the Modern World. XVIII, Alcoholic Beverages. Senri Ethnological Studies no. 64. Osaka Japan: National Museum of Ethnology (Japan), 2003. pp. 63-76. (17 refs.)

The popularization of everyday drinking is a result of he commercialization of the production and distribution of alcohlic beverages. A key part of commercial distribution is the development of entertainent districts containing both restaurants and pubs where alcohol is served. this paper covers the development of such entertainent districts in tokyo during the 17th and 19th centuries, detailing their role in popularizing alcohol, as well as their function as a major element of urban infrastructure. Individual sections are devoted tot he development of pubs, large-scale distribution of sake brought into Edo, the development of teahouse restaurants, teahouse hostesses and and "parlor entertainment" and a conclusion that addresses the institutionalization of three pleasure industries (the teahouse industry, the geisa out-call and rental room industries.)

Kintz P; Villain M; Cheze M; Pepin G. Identification of alprazolam in hair in two cases of drug-facilitated incidents. Forensic Science International 153(2-3): 222-226, 2005. (9 refs.)

The use of a drug to modify a person's behaviour for criminal gain is not a recent phenomenon. However, the recent increase in reports of drug-facilitated crimes (sexual assault, robbery) has caused alarm by the general public. Among the drugs that can be used, alprazolam (Xanax), an anxiolytic benzodiazepine, has been seldom observed. To document two cases involving this drug, we have developed an approach based on hair testing by LC-MS/MS. After pH 8.4 buffer incubation and extraction with methylene chloride/diethyl ether (80/20, v/v), hair extracts were separated on a XTerra MS C18 column using a gradient of acetonitrile and formate buffer. Alprazolam and diazepam-d(5), used as internal standard, were detected by electospray tandem mass spectrometry. In the first criminal case, alprazolam tested positive in two consecutive 2 cm hair segments at 4.9 and 2.4 pg/mg, from a 12-year-old girl, assaulted by her father who had sedated her three or four times. In the other case, alprazolam was detected in four consecutive 1 cm hair segments at 3.1-0.4 pg/mg, obtained from an adolescent who had been forced to prostitute herself.

Kramer LA; Berg EC. A survival analysis of timing of entry into prostitution: The differential impact of race, educational level, and childhood/adolescent risk factors. Sociological Inquiry 73(4): 511-528, 2003. (52 refs.)

Using survey data obtained from 309 women working in street-level prostitution in Phoenix, Arizona, this investigation examines the influence of minority status, educational level, and the experience of risk factors in an individual's childhood or adolescence on the hazard rate for age of entry into prostitution. Findings of this study show that women engaging in prostitution have limited educational backgrounds and often do not complete high school. Results indicate that both white and minority women engaging in prostitution experienced high rates of physical and sexual abuse in childhood, as well as parental substance abuse. When compared to minority women, white women are more likely to have experienced any one of these three risk factors thought to influence entry into prostitution, yet event-history analysis indicates that minority women consistently experience significantly higher hazard rates for entry into prostitution. Findings suggest the need for future research to better assess the impact of race -- in the form of socioeconomic and social disadvantages associated with minority status -- as it relates to entry into the sex trade.

Kuo WH; Wilson TE; Weber KM; Madhava V; Richardson J; Delapenha R et al. Initiation of regular marijuana use among a cohort of women infected with or at risk for HIV in the women's interagency HIV study (WIHS). AIDS Patient Care and STDS 18(12): 702-713, 2004. (35 refs.)

Our study sought to determine the incidence of weekly marijuana use among HIV-infected and uninfected women, to identify correlates of weekly marijuana use, and to test its association with stage of HIV disease and type of HIV treatment received. A total of 2059 HIV-positive and 569 HIV-negative women from 6 sites were recruited between 1994 and 1995 and followed through 2000. After excluding women who reported weekly marijuana use at baseline, 2050 women were included in the analysis. The incidence rate for initiating marijuana was calculated and survival analysis was performed to determine the correlates of initiating weekly marijuana use. Three hundred and three women initiated weekly marijuana use within 5.5 years of the baseline visit, yielding a cumulative incidence (CI) of 14.8%. There was no significant difference in weekly marijuana use initiation between HIV-infected (CI = 14.5%) and HIV-uninfected women (CI = 16.0%). Younger age and having more sex partners was associated with incident weekly marijuana use among both infected and uninfected women. While undetectable viral load was associated with lower incidence rate (p < 0.001, RH = 0.44) and wasting syndrome with higher incidence (p < 0.01, relative hazard [RH] = 3.1), CD4 count was not. Compared to receiving no AIDS treatment at all, women who received basic combination antiretroviral therapy had significantly higher incidence of weekly marijuana use (p < 0.001, RH = 1.93), while highly active antiretroviral therapy (HAART) receivers had significantly lower incidence (p < 0.001, RH = 0.24). In summary, among HIV-infected women, the incidence of weekly marijuana use was associated with only one marker of HIV disease stage and HAART was associated with lower initiation rate of weekly marijuana use.

Kurtz SP; Surratt HL; Inciardi JA; Kiley MC. Sex work and "date" violence. Violence Against Women 10(4): 357-385, 2004. (46 refs.)

This study employed survey and focus group methods to examine the characteristics and sex work-related behaviors of 294 female street-based sex workers in Miami that make them more likely to be victimized by their clients or "dates." More than half the respondents had experienced date violence in the prior year. Economic desperation, using crack or heroin while working, not controlling the date location, and having sex in the car were strong predictors of victimization. The article concludes with recommendations for a harm-reduction approach to outreach and education, and it calls for increased legal protections for victimized sex workers.

Kurtz SP; Surratt HL; Kiley MC; Inciardi JA. Barriers to health and social services for street-based sex workers. Journal of Health Care for the Poor and Underserved 16(2): 345-361, 2005. (58 refs.)

Homelessness, poverty, drug abuse and violent victimization faced by street-based women sex workers create needs for a variety of health and social services, yet simultaneously serve as barriers to accessing these very services. The present study utilized interview (n = 586) and focus group (n = 25) data to examine the service needs and associated barriers to access among women sex workers in Miami, Florida. Women most often reported acute of service needs for shelter, fresh water, transportation, crisis intervention, and drug detoxification, as well as long-term needs for mental and physical health care, drug treatment, and legal and employment services. Barriers included both structural (e.g., program target population, travel costs, office hours, and social stigma) and individual (e.g., drug use, mental stability, and fear) factors. Bridging these gaps is tremendously important from a public health perspective given the disease burden among this population. Recommendations include service staff training, outreach, and promising research directions.

Kuyper LM; Lampinen TM; Li K; Spittal PM; Hogg RS; Schechter MT et al. Factors associated with sex trade involvement among male participants in a prospective study of injection drug users. Sexually Transmitted Infections 80(6): 531-535, 2004. (34 refs.)

Objectives: While much research to date has examined female sex trade work, little has been done to evaluate factors associated with male sex trade involvement or to assess their health service needs. This is particularly true for male sex trade workers who are also injection drug users (IDUs). Therefore, the present analyses were undertaken to evaluate factors associated with sex trade work in a prospective cohort study of male IDUs. Methods: We identified factors associated with sex trade involvement among male participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available at semiannual intervals, variables potentially associated with sex trade involvement were evaluated with adjusted odds ratios (AOR) and 95% confidence intervals (CI) computed using generalised estimating equations (GEE). Results: Between 1996 and 2003, 995 male IDUs were enrolled into the VIDUS cohort among whom 108 (11%) reported being involved in the sex trade at enrolment and 102 (10%) individuals initiated sex trade involvement during the follow up period. In multivariate analyses, factors independently associated with sex trade involvement included HIV positive serostatus (AOR: 1.77 (95% CI: 1.44 to 2.17)), daily cocaine injection (AOR: 1.37 (95% CI: 1.11 to 1.70)), daily crack smoking (AOR: 1.36 (95% CI: 1.07 to 1.72)), borrowing syringes (AOR: 1.73 (95% CI: 1.32 to 2.25)), and inconsistent use of condoms with casual sexual partners (AOR 0.66, CI 0.53 to 0.82). We also found that male sex trade workers were more likely to report having sought but been unable to access substance abuse treatment (AOR: 1.28 (95% CI: 0.98 to 1.67); p = 0.076). Conclusions: Males involved in the sex trade in this setting have higher levels of HIV infection and engage in risky injection behaviours at an elevated rate. Since these behaviours have major implications for HIV acquisition and public health, prevention efforts and targeted provision of addiction treatment to this population should be expanded.

Kuyper LM; Palepu A; Kerr T; Li K; Miller CL; Spittal PM et al. Factors associated with sex-trade involvement among female injection drug users in a Canadian setting. Addiction Research & Theory 13(2): 193-199, 2005. (16 refs.)

Background: We undertook this study to evaluate the factors associated with sex-trade involvement among a cohort of female injection drug users (IDUs). Methods: We performed a prospective analysis of factors associated with sex-trade involvement among female participants enrolled in a prospective cohort study of Vancouver injection drug users. We examined HIV-status during follow-up and measured time updated social, sex-and drug-related variables relating to activities engaged in during the previous six months. Variables potentially associated with sex-trade involvement were evaluated using generalized estimating equations (GEE) with logit link for binary outcomes. Results: Between May 1, 1996 and November 30, 2003, 565 participants were recruited into the cohort of whom 336 (59%) reported being involved in the sex-trade at baseline. Factors associated with reporting sex-trade involvement among women in the adjusted model included incarceration, daily injected cocaine use, daily crack use, borrowing syringes, lending syringes, and having sought but been unable to access addiction treatment during the previous six months. Conclusions: Our study demonstrates significant risky sexual and injection behaviours as well as difficulties with access to addiction treatment among female IDUs involved in the sex-trade in Vancouver.

Lankenau SE; Clatts MC; Welle D; Goldsamt LA; Gwadz MV. Street careers: Homelessness, drug use, and sex work among young men who have sex with men (YMSM). International Journal of Drug Policy 16(1): 10-18, 2005. (34 refs.)

"Hustling" or sex work is a common means of surviving on the streets and paying for drugs among homeless youth. In this article, we formulate the concepts of "street capital" and "street competencies" to describe how 10 young men who have sex with men (YMSM) in New York City accumulated various knowledge and skills throughout their childhood and adolescence, and later entered into homelessness and the street economy as sex workers. While half of these young men described themselves as gay or bisexual, sexual identity was not a primary consideration amongst these youth. All were homeless and/or users of illegal drugs, and all survived through intimate involvement in the "street economy"-an informal system of exchange that circulates drugs, sex, and money across a range of settings and participants. Based upon an analysis of life history accounts gained through ethnographic interviews, we describe common pathways into the street economy with an emphasis on understanding how these 10 young men of diverse backgrounds became involved in homelessness, drugs, and sex work. In doing this, we document the differential sources of knowledge and particular childhood experiences that launched these youth into coherent street careers.

Latka MH; Metsch LR; Mizuno Y; Tobin K; Mackenzie S; Arnsten JH et al. Unprotected sex among HIV-positive injection drug-using women and their serodiscordant male partners: Role of personal and partnership influences. Journal of Acquired Immune Deficiency Syndromes 42(2): 222-228, 2006. (52 refs.)

We investigated the characteristics of human immunodeficiency virus (HIV)-positive injection drug-using women who reported unprotected vaginal and/or anal sex with HIV-negative or unknown serostatus (serodiscordant) male partners. Of 426 female study participants, 370 were sexually active. Of these women, 39% (144/370) and 40% (148/370) reported vaginal and/or anal sex with serodiscordant main and casual partners, respectively. Sixty percent of women inconsistently used condoms with their serodiscordant main partners, whereas 53% did so with casual partners. In multivariate analysis, during sex with main partners, inconsistent condom users were less likely to feel confident about achieving safe sex (self-efficacy), personal responsibility for limiting HIV transmission, and that their partner supported safe sex. Inconsistent condom use was also more likely among women who held negative beliefs about condoms and in couplings without mutual disclosure of HIV status. Regarding sex with casual partners, inconsistent condom users were more likely to experience psychologic distress, engage in sex trading, but they were less likely to feel confident about achieving safe sex. These findings suggest that there are widespread opportunities for the sexual transmission of HIV from drug-using women to HIV-uninfected men, and that reasons vary by type of partnership. Multifaceted interventions that address personal, dyadic, and addiction problems are needed for HIV-positive injection drug-using women.

Lau JTF; Feng T; Lin X; Wang Q; Tsui HY. Needle sharing and sex-related risk behaviours among drug users in Shenzhen, a city in Guangdong, southern China. AIDs Care 17(2): 166-181, 2005. (38 refs.)

Intravenous drug users (IDUs) are at high risk of contracting HIV, but there is a geographic bias in such research efforts in China. The aim was to study the pattern of needle sharing and sex-related risk behaviours among drug users in southern China. About 260 drug users in a detoxification centre completed an anonymous questionnaire (response rate = 87.3%). The results show that needle sharing among IDUs was prevalent (60.6% and 45.3% for male and female IDUs, respectively); the sharers were often friends, spouses, and acquaintances. Few IDUs sterilized the used needles properly. Commercial sex behaviours (males: 44%; females: 60%) as well as multiple partnership (males: 60%; females: 53%) were also prevalent among all male and female drug users studied. Inconsistent condom use with commercial sex partners, spouses, and regular sex partners was also very common. Yet, few of all drug users studied perceived the susceptibility of contracting HIV (11%) or sexually transmitted diseases (24%) in the future. A better HIV-related knowledge level was associated with lower levels of risk behaviours. It is concluded that harm reduction programmes are urgently warranted in China.

Lin G; Wang QY. Predictors of non-use of condoms among drug users in China: implications for HIV harm reduction. Drugs: Education, Prevention and Policy 10(2): 141-146, 2003. (11 refs.)

In China, the majority of drug users do not use condoms when they engage in premarital and extramarital sex behaviors. The first step to promote safer sex is to identify factors associated with the non-use of condoms. Using a sample of 450 heroin users from a detoxification center in China, this short report documents and examines predictors of non-use of condoms. The results show that non-use of a condom is associated with unmarried males of low income. In addition, attitude factors are important; those who have heard of 'safer sex' and believe in the importance of condom use are more likely to use a condom in premarital and extramarital sex. The findings suggest the importance of educational campaigns to promote the awareness of condom use and its utility.

Liu H; Grusky O; Zhu Y; Li X. Do drug users in China who frequently receive detoxification treatment change their risky drug use practices and sexual behavior? Drug and Alcohol Dependence 84(1): 114-121, 2006. (41 refs.)

Background: Relapse rates among treated drug users in China are high. We examined the associations between frequency of drug detoxification treatment and HIV-related risky drug practices and sexual behavior. Methods: A cross-sectional study was conducted among drug users in two Anhui province detoxification centers in 2003. Results: A total of 312 drug users were recruited. Seventy-seven percent of the subjects had ever received two or more detoxification treatments. The median number of detoxification treatments received was three, with an interquartile range of two to five treatments. More than 7 in 10 (72%) ever injected drugs; 19% shared needles and syringes in the past 30 days; 40% of drug users reported having both regular and commercial sex partners in the past year and 48% reported having only regular sex partners. Multiple Poisson regression analysis documented that the frequency of detoxification treatment was not associated with a decrease in drug practice (injection or sharing needles) and in unprotected sex. Conclusion: Drug users who frequently received detoxification treatment did not change their risky drug use practices and sexual behavior. Effective behavioral interventions and substitution maintenance treatment should become an integral part of detoxification programs in China.

Lung FW; Lin TJ; Lu YC; Shu BC. Personal characteristics of adolescent prostitutes and rearing attitudes of their parents: a structural equation model. Psychiatry Research 125(3): 285-291, 2004. (25 refs.)

The aim of this study was to investigate the risk factors of family structure, personality traits, and other variables among adolescent prostitutes. The subjects comprised 158 adolescent prostitutes in a halfway house as the case group and 65 high school girls as the control group. Data were collected by using questionnaires about demographic information, the Junior Eysenck Personality Questionnaire and the Parental Bonding Instrument. A high rate of tobacco, alcohol, and drug use was found in the case group. Numerous factors distinguished the cause-effect relationship among adolescent prostitutes. Of all risk factors studied, maternal protection, paternal care, neurotic characteristics, tobacco use, discontinuous schooling and a dysfunctional family had the most direct effect. These results provide useful information for the evaluation of and interventions with adolescent prostitution.

Maranda MJ; Han CL; Rainone GA. Crack cocaine and sex. Journal of Psychoactive Drugs 36(3): 315-322, 2004. (20 refs.)

The impact of crack cocaine use on number of sex partners was examined using bivariate analyses and a logistic model on a national treatment cohort of 4,939 individuals. Number of sex partners over the last 12 months was dichotomized as none/one versus multiple partners for the logistic analyses. The model included 11 independent variables not including prostitution or use of crack cocaine. For both genders, the bivariate analyses showed significant positive associations between crack use and number of partners regardless of type of sexual activity; those who used crack had more partners for all sexual activities queried, compared to those who did not. Cocaine, whether in powder or crack form, was positively associated with prostitution for both genders. For men the odds ratio for crack cocaine use ranged from 1.6 (heterosexual anal) to 5.5 (homosexual anal) and for women from 2.9 (heterosexual oral) to 4.1 (homosexual oral). If prostitution is added to the model the odds ratios are reduced for homosexual activities for men and reduced dramatically for all types of sexual activity for women.

Marino R; Minichiello V; Disogra C. A profile of clients of male sex workers in Cordoba, Argentina. International Journal of STD & AIDS 15(4): 266-272, 2004. (37 refs.)

This paper provides a profile of clients seen by male sex workers (MSWs) in Cordoba, Argentina. Thirty-two MSWs completed a diary after each paid sexual encounter with a client over a two-week period. The results show that 254 commercial sex encounters were reported. More than half of these encounters were with first time clients. The most common source of recruiting clients was advertisements followed by street contact. The majority of the clients were aged in their 30s or 20s, and identified as 'middle class' and 'bisexual' or 'gay'. In the majority of the encounters, alcohol or drugs were not used by clients, and in about less than half of the cases, the MSWs had some personal tracing information about the client. Most of the clients indicated to the MSW what sexual activity they wanted and unsafe anal sex was requested in a minority (6%) of the encounters. While most workers reported having no or little attraction to the client, most indicated that they would serve the client again. The implications of the results for public health education and further research are discussed.

Matos TD; Robles RR; Sahai H; Colon HM; Reyes JC; Marrero CA et al. HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico. Drug and Alcohol Dependence 76(3): 229-234, 2004. (24 refs.)

This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck's Depression Index and Beck's Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors.

McKeganey N. Street prostitution in Scotland: The views of working women. Drugs: Education, Prevention and Policy 13(2): 151-166, 2006. (25 refs.)

At the present time in Europe a range of countries are considering their prostitution laws and looking at whether these should be updated in a number of ways including the possible provision of prostitute tolerance zones. While this is an issue that is subject to heated political debate, and considerable divergence within Europe, it is not one where there has been much research evidence to date. One reason for this is the concentration in much prostitution research on sexual rather than work-related matters. This paper considers the issue of prostitute tolerance zones within the context of an ethnography of street prostitution in Scotland. In particular, the paper describes street-working women's views of their work, their reasons for working, their views as to the impact of their work on their lives, and whether it would be beneficial to provide tolerance zones to enable them to work without fear of prosecution.

Medrano MA; Hatch JP; Zule WA; Desmond DP. Childhood trauma and adult prostitution behavior in a multiethnic heterosexual drug-using population. American Journal of Drug and Alcohol Abuse 29(2): 463-486, 2003. (52 refs.)

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to male addicts. Among male subjects, higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.

Minichiello V; Marino R; Khan MA; Browne J. Alcohol and drug use in Australian male sex workers: Its relationship to the safety outcome of the sex encounter. AIDS Care 15(4): 549-561, 2003. (34 refs.)

This paper describes the self-reporting patterns of alcohol and drug consumption among male sex workers (MSWs) in three Australian cities during commercial sex encounters, and examines to what extent alcohol and drugs are used and whether this is related to the safe/unsafe outcome of the commercial sex encounter. One hundred and eighty-six MSWs from Brisbane, Sydney and Melbourne completed a diary following each commercial sex encounter over a two-week period. MSWs reported 2,087 commercial sex encounters during the study period. Alcohol or drug consumption was reported in 50.5% of the encounters. There were 488 instances of marijuana use reported before or during a commercial sex encounter, 210 instances of volatile inhalants use, 149 instances of heroine use and 151 of other drug use, including benzodiasepines, ecstasy, speed and cocaine. These substances were consumed either alone or combined. Marijuana consumption was associated with the commercial sex encounter occurring at the MSWs' place of residence and consumption of alcohol, marijuana and nitrites with the client's place. The results also reveal that consumption of drugs and alcohol was statistically related to length of the encounter, and that clients obtained through escort agencies or brothels were significantly associated with marijuana, other drug consumption and heroin use. Interestingly, a multivariate analysis indicated that encounters where the MSW consumed marijuana or did not consume any substance were less likely to have an unsafe outcome. The paper argues that it is necessary to identify and target risk groups and behaviours that are usually not included in broad based health education messages.

Newman PA; Rhodes F; Weiss RE. Correlates of sex trading among drug-using men who have sex with men. American Journal of Public Health 94(11): 1998-2003, 2004. (50 refs.)

Objectives. We examined correlates of trading sex for money, drugs, and shelter, or food among drug-using men who have sex with men (MSM). Methods. Audio computer-assisted self-interviewing questionnaires were completed by 387 MSM. The association of predictors with sex trading was assessed with chi(2) tests and multiple logistic regression. Results. Sex-trading prevalence was 62.5% (95% confidence interval = 57.7%, 67.4%). Sex trading was associated with crack use, injection drug use, childhood maltreatment, nongay self-identification, and homelessness (adjusted odds ratios = 3.72, 2.28, 2.62, 2.21, and 1.88, respectively). Conclusions. Multiple risk factors are associated with sex trading among MSM. Interventions may need to address crack and injection drug use, homelessness, and childhood maltreatment and target non-gay-identified MSM who engage in sex trading.

Nuttbrock LA; Rosenblum A; Magura S; Villano C; Wallace J. Linking female sex workers with substance abuse treatment. Journal of Substance Abuse Treatment 27(3): 233-239, 2004. (29 refs.)

We evaluated mobile street-based outreach as a modality for linking street-walking female sex workers with substance abuse treatment in New York City. Sex workers (N = 179) approaching an existing outreach facility were randomly assigned to receive usually provided services, or to receive an enhanced version of these services. Among the 144 women successfully followed for 6 months, 35.0% were detoxified; 43.1% of the 78 current heroin users received methadone maintenance; and 35.4% of the followed-up clients received some other type of treatment. Intervention group differences in these outcomes were not significant. Detoxification during followup was associated with heroin dependence and lifetime detoxification. Methadone maintenance (among heroin users) was associated with Hispanic ethnicity and legally mandated treatment. Other types of treatments were negatively associated with the degree of involvement in the sex trade. We conclude that a variety of factors affect motivation for substance abuse treatment among female sex workers, and that street-based outreach is a highly effective modality for linking this population with much needed treatment.

Olley BO. Social and health behaviors in youth of the streets of Ibadan, Nigeria. Child Abuse and Neglect 30(3): 271-282, 2006. (31 refs.)

Objectives: This study documents the extent and impact of perceived patterns of behavior in a sample of youths of the streets of Ibadan, Nigeria, with the purpose of implementing a Life Skills Educational (LSE) intervention. Method: The study uses both qualitative and quantitative methods of data collection. Qualitatively, two Focus Group Discussions (FGD) and two in-depth interviews (IDI) with 20 boys and 2 community leaders were conducted on separate occasions for the purpose of eliciting commonly exhibited behaviors and patterns of street youth. Quantitatively, 169 youths (89.3% male) were consecutively interviewed from five subcultural areas in Ibadan, Nigeria. Street youths were accessed through a snowballing technique made possible by "Area boys" (AB, adults, who serve as a symbol of authority for street children). Results: The mean age of participants was 18.4 years. The majority was on the street for financial reasons, had been on the street for more than 1 year, and had not completed their primary schooling. While youths of the street were economically viable, 69% had a history of alcohol abuse, 14% of drug abuse, and 24% operated as drug couriers; 46% reported school refusal, 27% school suspension, and 47% school truancy. Forty-nine percent admitted to being sex workers and 11% had been raped and were, therefore, at risk of contacting sexually transmitted diseases (STD). One-third of youths had been arrested for various offenses, including street fighting and drug use. While females were in the minority, they were more likely to engage in antisocial behaviors compared with boys. Conclusions: Although many youths of the street display antisocial behaviors, they also are an economically viable group. Some of their antisocial behaviors may have been exhibited within the context of economic survival. Implementing a life skill program to address these antisocial behaviors may help to increase the well being of street youths in developing countries in Africa.

Operario D; Nemoto T. Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women. AIDS Education and Prevention 17(5): 430-443, 2005. (35 refs.)

We examined the prevalence and correlates of HIV-related sexual risk and substance use behaviors among Asian Pacific Islander (API) male-to-female (MTF) transgendered individuals, referred to here as API transgendered women. As part of a larger study on HIV risk among transgendered women of color (Nemoto, Operario, Keatley, Han, & Soma, 2004), a sample of 110 API transgendered women in San Francisco completed individual interviews, of which 13% reported being HIV-positive. In the past 30 days, one fifth of the sample engaged in unprotected receptive anal intercourse (URAI) with any male partner, nearly one half had sex while under the influence of substances, and over half used illicit drugs. In multivariate models, URAI was associated with commercial sex work (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.10, 16.25) and previous attempted suicide (OR = 5.83, 95% CI = 1.02, 33.44). Sex under the influence of substances was associated with commercial sex work (OR = 3.35, 95% CI = 1.11, 10.13) and having a college degree (OR = 5.32, 95% CI = 1.34, 21.18). Illicit drug use was associated with commercial sex work (OR = 7.15, 95% = 2.26, 22.63). Findings suggest that API MTF transgenders are on the front line of HIV risk for the API community, and provide insight into factors within this group that might contribute to unsafe sex and substance use.

Patterson TL; Semple SJ; Fraga M; Bucardo J; De La Torre A; Salazar J. Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico. Substance Use & Misuse 41(10-12): 1535-1549, 2006. (28 refs.)

Female sex workers (FSWs) have been documented to have high rates of sexually transmitted diseases and HIV in many parts of the world. However, little work has been done to characterize the prevalence of these infections along the U.S.-Mexican border, where sexual tourism and culturally sanctioned sex work among nationals is widespread. The objective of this study was to compare differences in background characteristics, HIV risk behaviors, drug use, and sexually transmitted infection/HIV prevalence between FSWs who participated in a behavioral risk intervention in two U.S.-Mexican border cities. Baseline data were collected from March 2004 through September 2005. Data from 295 FSWs were compared between Tijuana and Ciudad (Cd.) Juarez. Among 155 FSWs in Tijuana and 140 in Cd. Juarez, HIV seroprevalence was 4.8% and 4.9%, respectively. FSWs in Cd. Juarez were more likely to test positive for active syphilis (31.3%) compared with Tijuana (11.8%) but did not differ in terms of the prevalence of gonorrhea and chlamydia. FSWs in both sites reported high levels of unprotected sex and use of drugs; however, FSWs in Cd. Juarez were more likely than those in Tijuana to ever have injected drugs (75% vs. 25%, p < .001). Heroin and cocaine use and injection drug use were significantly more common in Cd. Juarez, whereas methamphetamine use was more common in Tijuana. Injection of vitamins was common in both cities. Logistic regression analyses suggested that being younger, working in Cd. Juarez, and using heroin or cocaine were independently associated with active syphilis infection. In Tijuana, methamphetamine use was strongly associated with active syphilis infection. These preliminary results suggest that risk profiles for HIV/sexually transmitted infection among FSWs in these two Mexico-U.S. border cities differ, suggesting a need to tailor interventions to the specific needs in each city.

Pedersen W; Hegna K. Children and adolescents who sell sex: A community study. Social Science & Medicine 56(1): 135-147, 2003. (65 refs.)

This study investigated adolescents who reported having given sexual favors for payment. Adolescents 14-17 years old in the public and private school systems of Oslo, Norway (N = 10,828) were surveyed. The response rate was 94.3%. Analysis of survey data revealed that 1.4% of the sample had sold sex, that boys in this group outnumbered girls three to one, that half of this group had sold sex more than 10 times, and that most were under the legal minimum age of sex in Norway (16 years) at the time of the first incident. No associations were found with sociodemographic variables or Oslo residential area. Sale of sex was associated with low age at initial intercourse, conduct problems, alcohol problems, use of drugs (including heroin), and violent victimization. Many of the clients of these adolescents are assumed to be homosexual or bisexual men. It was concluded that a small proportion of the general adolescent population sells sex and that adolescents who do so are often heavily involved in delinquent behaviors and drug use. Many of these adolescents are probably at risk for sexually transmitted diseases (including human immunodeficiency virus), drug abuse, and delinquent and criminal development.

Plitt SS; Sherman SG; Strathdee SA; Taha TE. Herpes simplex virus 2 and syphilis among young drug users in Baltimore, Maryland. Sexually Transmitted Infections 81(3): 248-253, 2005. (28 refs.)

Objectives: To examine the sex specific seroprevalence and correlates of herpes simplex virus 2 (HSV-2) and syphilis among a cohort of young drug users. Methods: Drug users aged 15 - 30 years old who used heroin, cocaine, or crack were recruited between October 1999 and August 2002. Baseline interviews gathered information on sociodemographics, drug use and sexual behaviours. Serum was tested at baseline for HSV-2 and syphilis seroreactivity. For each sexually transmitted infection (STI), infected and non-infected participants were stratified by sex and compared using chi(2), Mann-Whitney tests, and logistic regression. Results: Of the 543 participants recruited, 42.4% were female and 39.3% were African-American. The seroprevalence of STIs among females and males, respectively, were HSV-2: 58.7% and 22.0%; syphilis: 4.3% and 0.3%. In multivariate models, older age, African-American race, having over 30 lifetime sex partners, current HIV infection and previous incarceration were independently associated with HSV-2 infection among males. For females, older age, African-American race, sex trade, and daily heroin use were independently associated with HSV-2. For females, only a self reported previous syphilis diagnosis was associated with current syphilis seroreactivity in multivariate analyses. Conclusions: Examination of this cohort revealed a particularly high seroprevalence of HSV-2 and syphilis, especially among female drug users. Few infected participants had been previously diagnosed with these infections.

Risser JMH; Timpson SC; McCurdy SA; Ross MW; Williams ML. Psychological correlates of trading sex for money among African American crack cocaine smokers. American Journal of Drug and Alcohol Abuse 32(4): 645-653, 2006. (14 refs.)

This article compares demographic characteristics, sexual practices, and psychosocial status among 193 African American female crack cocaine users who currently, previously, or never traded sex for money. Current traders were less likely to have a main sexual partner, more likely to have a casual sexual partner, and more likely to smoke larger quantities of crack. There was a significant trend towards current traders reporting lower self-esteem, greater depression and anxiety, poorer decision-making confidence, more hostility, less social conformity, greater risk taking behaviors, and more problems growing up, compared to previous and never traders. These differences suggest that interventions should address self-esteem, risk-taking practices, depression and anxiety as well as other psychosocial factors.

2006, Marcel Dekker, Inc.

Rodriguez EM; Gutierrez R; Vega L. Drug consumption in women prostitutes: The area of La Merced. Salud Mental 26(5): 73-81, 2003. (21 refs.)

From ancient times prostitution has existed, usually linked to powerful men who have considered women to be pleasure objects. Ever since, prostitution has assumed different ways, and nowadays, urban prostitution is the most frequent. Nevertheless, although highly penalized, imposed prostitution, and women and children traffic are practices common to many countries where these practices have increased in later years, due to economical and migratory problems, to modern technology and to the expansion of the sex industry. The lack of opportunities that now prevail in Mexico City and the social disparities that affect most inhabitants have created large social sectors that survive through marginal activities. Within informal economy, where such activities take place, prostitution is one of the most relevant facts responsible for the dimensions, diffusion, and complexity of their highly negative consequences. It is taken for granted that prostitution has been present in all societies, though little thought has been given to the conditions that produce and maintain it. just as well prostitutes are supposed to be the "'agents of evil", without considering that they establish a relationship with others and that they also require intermediaries or give place to their mediation. It is not easy to approach this problem and many obstacles have to be surmounted in order to face its illegal and partially, hidden nature. Prostitution has existed and still prevails on behalf of the demand for women present among the male population, and due to the scarce educational and laboral opportunities that women endure, as a consequence of the existing gender inequality. As we mentioned before, this situation makes them vulnerable to exploitation and violence, just as it has been reported to be the case in other countries. Very few scientific research has been published that may help to enlarge our knowledge regarding female prostitution. Such is the case, also, for male prostitution. Drug consumption in sexual workers is one issue that has rarely been explored, although it is somehow taken as a matter linked to prostitution. Nevertheless, drug consumption is a social and health problem that affects them directly. Due to the moral and religious implications arising from this matter, it is not suprising that the mental health problems that these women must endure have not been systematically studied. Although drug consumption is frequenty linked with prostitution by society, its characteristics and effects on the lives of prostitutes are barely known.It is important to stress that in general terms drug consumption in women has been a problem usually underestimated, and that it has been hidden for a long time.In Mexico, the relationship between prostitution and drug consumption has scarcely been explored, though Romero and Quintanilla found out that there are some facts that propitiate it. For instance, that both activities are forbidden, restricted or controlled by police officers and by men. Also, that both phenomena are socially rejected and that a subculture between both areas is established and rejected as well by society. Finally as drugs are available in prostitution surroundings, drug dependence in turn is ready to accept prostitution. Another important finding is that in the extent in which drug abuse is spread in different sectors of a locality, incidence is diminished within prostitution; on the contrary, when drugs become limited in other surroundings, its use among prostitutes is increased. Considering the given facts, the objective of our work is to present the results of a research carried Out on drug consumption in women who live on prostitution in the area of La Merced, located at Mexico City's downtown. This area is characterized I)v having high rates of violence, marginality and poverty. Such conditions make these women vulnerable to abuse on the part of police authorities and to suffer physical and emotional pressure from those who exploit them. We used qualitative methodology and in-depth recorded interviews that lasted one hour and a half. Fourteen women were interviewed. Results and conclusions. Results demonstrate that the environment surrounding prostitution in La Merced favours that women involved in prostitution become Consumers. Most women reported that they consumed alcohol and some other drugs. The main facts that contribute to this situation are the daily problems they have to face, which generate stress, and also, the exploration to which they are submitted. This makes them a part of a vulnerable group because, as we said before, they are highly, exposed to violence, social rejection and institutional indifference.

Romero-Daza N; Weeks M; Singer M. Conceptualizing the impact of indirect violence on HIV risk among women involved in street-level prostitution. Aggression and Violent Behavior 10(2): 153-170, 2005. (97 refs.)

Drawing on a review of the existing literature and on the knowledge derived from many years of direct work with sex workers in the inner city, we conceptualize the mutually reinforcing relation that exists among violence, drug use, and risk for HlV/AlDS among women involved in street-level prostitution. While recognizing the centrality of violence victimization, we call attention to the need to examine exposure to indirect (or witnessed) violence (when the person is the witness rather than the direct victim of violence) as a factor that increases drug- and sex-related HIV risk in this population. Specifically, we hypothesize that the emotional sequela that results from continued exposure to indirect violence has a direct effect on patterns of drug use (including drug use initiation, relapses, and changes in quantity, frequency, and mode of ingestion), and increases women's vulnerability to sexual transmission of HIV by making them more vulnerable to sexual attacks, and less able to demand use of condoms. The impact of indirect violence is especially detrimental when the woman witnesses serious violent acts against other sex workers.

Roxburgh A; Degenhardt L; Breen C. Drug use and risk behaviours among injecting drug users: a comparison between sex workers and non-sex workers in Sydney, Australia. Harm Reduction Journal 2: e-article 7, 2005. (52 refs.)

Background: This paper examines the differences in demographics, drug use patterns and self reported risk behaviours between regular injecting drug users (IDU) who report engaging in sex work for money or drugs and regular injecting drug users who do not. Methods: Cross sectional data collected from regular IDU interviewed as part of the New South Wales (NSW) Illicit Drug Reporting System (IDRS) in 2003 were analysed. Results: IDU who reported engaging in sex work were more likely to be female, and identify as being of Aboriginal and/or Torres Strait Islander descent. They initiated injecting drug use at a significantly younger age and were more likely to report injection related problems than IDU who had not engaged in sex work. There were no differences in the drug classes used, but findings suggested that the sex workers tended to be more frequent users of crystalline methamphetamine (ice) and benzodiazepines. Conclusion: The similarities between these groups were more striking than the differences. Further research, examining a larger sample is needed to clarify whether injecting drug users who are sex workers have heavier use patterns.

Roxburgh A; Degenhardt L; Larance B; Copeland J. Mental Health, Drug Use and Risk among Female Street-based Sex Workers in greater Sydney. NDARC Technical Report No. 237. Sydney: National Drug and Alcohol Research Centre, 2005

The mean age of the sample was 34 years and approximately one-quarter of the sample identified as being of Aboriginal and/or Torres Strait Islander (A&TSI) origin. The median years of school education completed was 9. Fourteen percent reported having no fixed address, or current homelessness and nearly half the sample reported being homeless within the past 12 months. Income apart from sex work in the past month came from several sources, and the vast majority reported sex work as their main source of income in the past month. More than half of the sample reported moving out of home before age 16. Sex work history and working conditions: The median age that participants reported starting sex work was 19, with almost onethird starting before 18. Two-thirds of the sample reported that they found sex work very stressful, and half stated that clients were the reason for this stress. The overwhelming majority of women reported ever having experienced violence while working, most commonly physical assault and rape. Drug use and drug treatment: Ninety four percent of the sample had ever injected any drug, and the median age of first injecting was 18, with approximately one-quarter of the sample reporting first injecting before the age of 16. There were relatively heavy patterns of heroin, cocaine and cannabis use reported among some of the women, while patterns of methamphetamine and alcohol use remained sporadic. Participants who were cocaine dependent were more likely to report sharing injecting equipment in the past month and less likely to use condoms when having penetrative sex with clients. Approximately two-thirds of the sample was in drug treatment at the time of interview. The report provides information on sex work and drug use, injecting drug use, unwanted sexual activityl; Mental health problems; crime and police contact; and access to information and emotional support.

Schalow P. Dangerous pleasure: The discource of drink in early modern Japan. IN: Umesao T; Yoshida S; Schalow P, eds. Japanese Civilization in the Modern World. XVIII, Alcoholic Beverages. Senri Ethnological Studies no. 64. Osaka Japan: National Museum of Ethnology (Japan), 2003. pp. 77-88. (6 refs.)

This chapter considers the role of sake drinking in the 17th century, the point at which discussion of the dangers and pleasures first emerged. Some of the earliest writings were essentially philosophical debates, for example, with recitation of the 15 virtues or 15 detrimental aspects. Another debate focused on the the relative merits of tea versus sake, and whether their use was comparible. Another such debate addressed the impact on male love and female love.

Seloilwe ES. Factors that influence the spread of HIV/AIDS among students of the University of Botswana. Journal of the Association of Nurses in AIDS Care 16(3): 3-10, 2005. (11 refs.)

The results discussed in this report are part of a larger study conducted among the students of the University of Botswana regarding their knowledge, attitudes, and behaviors related to HIV/AIDS. The study triangulated survey methods and focus group discussions. Five main areas were investigated: knowledge and personal experiences of HIV/AIDS, sexual behavior and practices, perceptions about risky sexual behavior on campus, and factors that influence the spread of HIV. This article reports high levels of risky behaviors such as alcohol and drug abuse; unprotected sex; frequent change of sexual partners; sex for financial gain, for prestige, for good grades, to relieve stress, and because of peer pressure; and casual sex as part of socializing.

Shannon K; Bright V; Duddy J; Tyndall MW. Access and utilization of HIV treatment and services among women sex workers in Vancouver's Downtown Eastside. Journal of Urban Health 82(3): 488-497, 2005. (34 refs.)

Many HIV-infected women are not realizing the benefits of highly active antiretroviral therapy (HAART) despite significant advancements in treatment. Women in Vancouver's Downtown Eastside (DTES) are highly marginalized and struggle with multiple morbidities, unstable housing, addiction, survival sex, and elevated risk of sexual and drug-related harms, including HIV infection. Although recent studies have identified the heightened risk of HIV infection among women engaged in sex work and injection drug use, the uptake of HIV care among this population has received little attention. The objectives of this study are to evaluate the needs of women engaged in survival sex work and to assess utilization and acceptance of HAART. During November 2003, a baseline needs assessment was conducted among 159 women through a low-threshold drop-in centre servicing street-level sex workers in Vancouver. Cross-sectional data were used to describe the sociodemographic characteristics, drug use patterns, HIV/hepatitis C virus (HCV) testing and status, and attitudes towards HAART. High rates of cocaine injection, heroin injection, and smokeable crack cocaine use reflect the vulnerable and chaotic nature of this population. Although preliminary findings suggest an overall high uptake of health and social services, there was limited attention to HIV care with only 9% of the women on HAART. Self-reported barriers to accessing treatment were largely attributed to misinformation and misconceptions about treatment. Given the acceptability of accessing HAART through community interventions and women specific services, this study highlights the potential to reach this highly marginalized group and provides valuable baseline information on a population that has remained largely outside consistent HIV care.

Smit J; Myer L; Middelkoop K; Seedat S; Wood R; Bekker LG et al. Mental health and sexual risk behaviours in a South African township: A community-based cross-sectional study. Public Health 120(6): 534-542, 2006. (44 refs.)

Objectives: Despite the high prevalence of both mental illness and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in developing countries, there are few data on the association between different forms of mental illness and sexual risk behaviours in resource-poor settings. The objective of this study was to examine the association between mental illness and HIV risk behaviours in a South African township. Study design: A cross-sectional, study was performed among 645 individuals living in households selected at random. Methods: A self-administered translated questionnaire investigated sexual risk behaviours [including sexual partners, condom use, casual sexual contacts, and sex in exchange for money, drugs or a place to stay (transactional sex)], depression (measured using the Center for Epidemiological Studies Depression Scale), alcohol abuse (from the Alcohol Use Disorders Identification Test), and post-traumatic stress disorder (based on the Life Event Checklist). Results: Of the 645 individuals who completed the survey, 33% reported depression, 17% reported alcohol abuse, and 15% reported post-traumatic stress disorder. After adjusting for demographic characteristics, the presence of any of these three conditions was strongly associated with experiences of forced sex [adjusted odds ratio (AOR) 2.53; 95% confidence intervals (CI) 1.60-4.02], transactional sex (AOR 2.88; 95% CI 1.29-6.48) and increased condom use (AOR 2.07; 95% CI 1.32-3.25). Conclusions: These findings emphasize the substantial burden of mental illness in this setting, and its association with forced and transactional sex. The temporal nature of these associations is not always clear from this cross-sectionat study, and additional prospective research is required. Public health interventions are needed to address the dual burden of HIV/AIDS and mental illness in this and similar settings.

Spittal PM; Bruneau J; Craib KJP; Miller C; Lamothe F; Weber AE et al. Surviving the sex trade: A comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs. AIDS Care 15(2): 187-195, 2003. (34 refs.)

In Canada, very little is known about the factors and processes that cause drug-related harm among female intravenous drug users (ID Us). Women who inject drugs and participate in the survival sex trade are considered to be at increased risk for sexual and drug-related harms, including HIV infection. Between September 1999 and September 2000, women participating in the VIDUS cohort in Vancouver and the St. Luc Cohort in Montreal completed interviewer-administered questionnaires. Analyses were conducted to compare the demographic characteristics, sexual risk behaviours, risky injection practices and drug use patterns among women who self-identified as participating in the sex trade with those who did not identify as participating in the sex trade. Logistic regression was used to identify factors independently associated with exchanging sex for money or drugs. HIV prevalence at the study visit (September 1999-2000) was 29% for sex trade workers and 29.2% for non-sex trade workers. While patterns of sexual risk were similar, the risky injection practice and drug use patterns between sex trade workers and non-sex trade workers were markedly different. Logistic regression analysis of cross-sectional data revealed that independent behaviours associated with the sex trade included: greater than once per day use of heroin (adjusted OR 2.7), smokeable crack cocaine (adjusted OR = 3.3) and borrowing used syringes (adjusted OR = 2.0). Creative, client-driven interventions are urgently needed for women who trade sex for money or for drugs.

Spittal PM; Hogg RS; Li K; Craib KJ; Recsky M; Johnston C. Drastic elevations in mortality among female injection drug users in a Canadian setting. AIDS Care 18(2): 101-108, 2006. (39 refs.)

The health and social conditions of women living in Vancouver's Downtown Eastside has recently been the focus of substantial international attention. Since few studies have examined rates and correlates of death among addicted women in Canada, we have characterized patterns of mortality among female injection drug users (IDUs) in Vancouver. The Vancouver Injection Drug Users Study (VIDUS) is a prospective open cohort study of IDUs. The analyses presented here, were restricted to women enrolled between May 1996 and May 2002 and who were aged 14 years or older. We estimated cumulative mortality rates using Kaplan-Meier methods and Cox regression was used to calculate univariate and adjusted relative hazards. Between May 1996 and May 2002, 520 female IDUs have been recruited from the Vancouver area among whom 68 died during the study period. Elevated rates of mortality were observed among those who reported, baseline sex-trade involvement, those with HIV-infection at baseline, and those who lived in unstable housing at baseline (all log-rank: p < 0.05). In adjusted analyses, HIV infection (RH = 3.09 [95% CI: 1.86 - 5.11]; p <0.001), unstable housing (RH = 1.74 [ 95% CI: 1.10 = 2.86]; p = 0.029) and sex-trade involvement (RH = 1.82 [95% CI: 0.95 - 3.45]; p = 0.071) were associated with the time to death. When the number of observed deaths was compared to the number of expected deaths based on the general female population of British Columbia using indirect standardization, the rate of death among female IDUs was elevated by a factor of 47.3 (95% CI: 36.1 = 58.5). In Vancouver, female IDUs have rates of mortality almost 50 times that of the province's female population. Our findings are consistent with a growing number of reports from other settings internationally, and demonstrate the need for an appropriate evidence-based strategy to address the health and social needs of addicted women.

Surratt HL; Inciardi JA; Kurtz SP; Kiley MC. Sex work and drug use in a subculture of violence. Crime & Delinquency 50(1): 43-59, 2004. (58 refs.)

This article examines the subculture of violence thesis as it relates to female street sex workers in Miami. Interview and focus group methods were used to study the intersections of childhood trauma, drug use, and violent victimization among 325 women. Using targeted sampling, crack- and heroin-using sex workers were recruited through street outreach into an HIV-prevention research program. Interviews used standard instrumentation and focused on drug-related and sexual risk for HIV sex work, violence, childhood trauma, and health status. Nearly half of the respondents reported physical (44.9%) and/or sexual (50.5%) abuse as children, and over 40% experienced violence from clients in the prior year: 24.9% were beaten, 12.9% were raped, and 13.8% were threatened with weapons. Consistent relationships between historical and current victimization suggest that female sex workers experience a continuing cycle of violence throughout their lives. The policy and research implications of these findings are discussed.

Szwarcwald CL; Barbosa-Junior A; Pascom AR; de Souza-Junior PR. Knowledge, practices and behaviours related to HIV transmission among the Brazilian population in the 15-54 years age group, 2004. AIDS 19(Supplement 4): S51-S58, 2005. (25 refs.)

Objective: To describe transmission vulnerability for acquiring HIV infection among the Brazilian population aged 15-54 years. Design: A population-based survey. Methods: Sampling was stratified by geographical region. A total of 6006 interviews were conducted. Indicators of knowledge and sexual practices and the relative sizes of the vulnerable subgroups were estimated. Logistic regression analysis was used to determine the main factors associated with safe sex practices. Results: Regarding knowledge indicators in the age group 15-24 years, a high percentage (91%) spontaneously cited sexual intercourse as a form of HIV transmission, and 62% had correct knowledge of the modes of HIV transmission (five correct items). The proportion of consistent condom use with casual partners was 52%, increasing to 59% in the youngest age group. Higher proportions of inconsistent condom use with any kind of partner were found among women and among the poorest. A multiplicity of sexual partners, low socio-economic status and cocaine use were important predictors of unprotected sex among men living without a companion. Among individuals aged 15-49 years, 0.2% currently inject cocaine, 4.6% of the men paid for sex at least once over the past year and 1.0% of the women were paid in exchange for sex. Among sexually active men of the same age group, 3.5% reported sexual relations with other men. Conclusion: Besides the need to establish the role exercised by the vulnerable subgroups in the HIV transmission dynamics, results indicate that it is necessary to investigate unsafe sexual practices further among the poorer sectors of society.

Tran TN; Detels R; Hien NT; Long HT; Nga PHT. Drug use, sexual behaviours and practices among male drug users in Hanoi, Vietnam: A qualitative study. International Journal of Drug Policy 15(3): 182-188, 2004. (25 refs.)

A qualitative study was conducted among drug users in Hanoi, Vietnam in May and June 2001 to describe their drug use practices and sexual behaviours, as well as potential factors that might contribute to the recent increase of HIV among them and local sex workers. A total of 63 drug users in five main districts of Hanoi were recruited for in-depth interviews and focus group discussions. The study found that drug users in Hanoi have been engaging in high-risk injecting behaviours and practices. They reported frequently visiting female sex workers (FSWs) and low condom use. Drug users had poor understanding and practices of cleaning injecting equipment, little knowledge of infection through sexual routes, and infrequent knowledge of their HIV infection status. The study provided evidence that young and new injecting drug users (IDUs) are at particularly high risk of HIV infection, are sexually active, and can serve as a bridge between the drug user and FSWs populations. They and sex workers should be the focus of intervention activities

Tran TN; Detels R; Long HT; Lan HP. Drug use among female sex workers in Hanoi, Vietnam. Addiction 100(5): 619-625, 2005. (22 refs.)

Aims: To describe the drug use practices among female sex workers (FSWs) in Hanoi and to identify factors associated with their drug injecting. Design, setting and participants: A two-stage cluster survey of 400 FSWs was conducted from June to September, 2002. Participating FSWs were both establishment- (160) and street-based (240), who were practising in seven urban and one suburban districts of Hanoi. Measurements: Subjects were interviewed face to face using a structured questionnaire. Findings: Among the middle-class FSWs, 27% used drugs, of whom 79% injected. Among low-class FSWs, 46% used drugs and 85% injected. Among drug-using FSWs, 86% had started using drugs within the past 6 years. Among drug-injecting FSWs, 81% had started injecting within the past 4 years. Cleaning of injecting equipment was not common among those who shared. Having drug-injecting 'love mates', drug-using clients, longer residence in Hanoi, more clients and not currently cohabiting were found to be independently associated with drug injecting among FSWs. Conclusions: The high prevalence of injecting drug use among FSWs makes them susceptible to HIV infection, and is a threat to their clients. There is a strong relationship between drug-using FSWs and male drug-using clients and non-client partners. Intervention to prevent drug use initiation among non-drug-using FSWs and harm reduction among drug-using FSWs are urgently needed.

Tyler KA; Johnson KA. Trading sex: Voluntary or coerced? The experiences of homeless youth. Journal of Sex Research 43(3): 208-216, 2006. (27 refs.)

This study examined the circumstances surrounding a homeless youth's "decision" to trade sex for food, money, shelter, or drugs. Forty homeless youth in 4 Midwestern states participated in individual, in-depth qualitative interviews. Interviewers recruited youth through both service agencies and street outreach. The findings revealed that approximately one third of the sample had some experience with trading sex, whether it was in the form of having traded sex, having been propositioned to trade sex but having refused, or having friends or acquaintances that had traded sex. Young people's reports indicated that they had traded sex for things they deemed necessary in order to survive (i.e., food, shelter, money, or drugs) and that they did not want to trade sex, but did so because they were desperate and lacked alternatives. Additionally, others were coerced, manipulated, or forced to do so, indicating that the decision to trade sex is not always voluntary. We discuss the implications of these findings in terms of cumulative effects on youths' later development. Directions for future research among this population are also discussed.

Vaddiparti K; Bogetto J; Callahan C; Abdallah AB; Spitznagel EL; Cottler LB. The effects of childhood trauma on sex trading in substance using women. Archives of Sexual Behavior 35(4): 451-459, 2006. (63 refs.)

This article presents a model developed to understand the relationship between childhood victimization, perpetration of violence, and later cocaine dependence and adult sex trading among drug using women. A cohort of heavy drinking and drug using women (N=594) recruited for two on-going community based HIV prevention studies in St. Louis City was analyzed to evaluate this association using path analysis. The women were stratified into two groups: sex traders and non-sex traders. Sex traders were more likely than non-sex traders to report being forced to kiss or touch someone in a sexual way before age 15 (35% vs. 22%), being kissed or touched in a sexual way by others when they did not want to be (42% vs. 31%), and being forced to have sexual intercourse (30% vs. 21%). Sex traders were more likely than non-sex traders to use a weapon or threaten someone with a weapon (29% vs. 18%) and physically hurt others on purpose before age 15 (9% vs. 5%). Path analysis confirmed that childhood victimization had a significant and direct association with both adult cocaine dependence and sex trading. However, the association between childhood perpetration and adult sex trading was mediated by cocaine dependence. This analysis concludes that childhood victimization was the strongest predictor of cocaine dependence and sex trading in adulthood.

Wang QY; Lin G. Sex exchange and HIV-related risk behaviors among female heroin users in China. Journal of Drug Issues 33(1): 119-132, 2003. (33 refs.)

This study examines differences in demographic characteristics and HIV-related risk behaviors between Chinese female heroin users who exchanged sex for drugs or money and those who were never involved in sex exchange. A sample of 171 female heroin users was recruited from a detoxification center in China. Female heroin users who exchanged sex for drugs or money were more likely to be unemployed and were at higher risk in both sexual behaviors and injection drug use. Number of sexual partners in the previous year, unemployment, and injection drug use were independently associated with exchange of sex for drugs or money; adjusted odds ratios were 1.2, 3.8, and 2.6, respectively. Findings show that HIV-related risk behaviors are common among female heroin users in China and that HIV harm reduction should be focused on female heroin users who exchange sex for drugs or money.

Weber AE; Boivin JF; Blais L; Haley N; Roy E. Predictors of initiation into prostitution among female street youths. Journal of Urban Health 81(4): 584-595, 2004. (39 refs.)

Prostitution among female street youths represents an important risk factor for several health problems. Little is known about the incidence and determinants of prostitution in this vulnerable population, and no data have been previously reported based on a longitudinal follow-up study. The objective of this study was to determine predictors of initiation into prostitution among female street youths. Female youths aged 14 to 25 years were enrolled in the Montreal Street Youth Cohort. They completed a baseline and at least one follow-up questionnaire between January 1995 and March 2000. Girls who reported never having engaged in prostitution at baseline were followed prospectively to estimate the incidence and predictors of prostitution. Of the 330 female street youths enrolled as of September 2000 in the cohort, 148 reported no history of involvement in prostitution at baseline and completed at least one follow-up questionnaire. Of these 148 girls, 33 became involved in prostitution over the course of the study (mean follow-up 2.4 years), resulting in an incidence rate of 11.1/100 person-years. Multivariate Cox regression analysis revealed having a female sex partner (adjusted hazard ratio [AHR] 3.8; 95% confidence interval [CI] 1.6-9.1) was an independent predictor of initiation into prostitution after controlling for having been on the street at age 15 years or younger (AHR 1.8, 95% CI 0.9-3.8), using acid or phencyclidine (PCP; AHR 2.0, 95% CI 0.9-4.6), using heroin (AHR 1.9, 95% CI 0.7-5.5), the use of drugs greater than twice per week (AHR 1.9, 95% Cl 0.9-4.2), and injection drug use (AHR 0.8, 95% CI 0.3-2.4). The incidence of prostitution in female street youths was elevated. Having a female sex partner was a strong predictor of initiating involvement in prostitution.

Wechsberg WM; Luseno WK; Lam WK. Violence against substance-abusing South African sex workers: intersection with culture and HIV risk. AIDS Care 17(Supplement 1): S55-S64, 2005. (26 refs.)

The Republic of South Africa has become an epicentre of heterosexual HIV transmission among Black women, and the interface between violence against women, substance abuse, and HIV risk is becoming evident. This paper describes the characteristics of Black South African women who engage in sex work in Pretoria and examines their intersecting experiences of high-risk sexual behaviour, substance abuse, and victimization. Ninety-three women were recruited into the study. Field staff collected biological measures of drug use and administered a structured, self-report interview. Findings indicate that young South African women who engage in sex work and use drugs rely on this activity as their main source of income and are supporting other family members. The majority of sample women reported experiencing some victimization at the hand of men, either clients or boyfriends, with many reporting childhood abuse histories, young women also report great fear of future victimization. Findings also suggest that as a result of their decreased likelihood of using protection, women who reported any sexual or physical victimization are at increased risk for HIV and other STIs. Results support the critical need for targeted, comprehensive interventions that address substance abuse, sexual risk, and violence as interrelated phenomena.

Weiser SD; Dilworth SE; Neilands TB; Cohen J; Bangsberg DR; Riley ED. Gender-specific correlates of sex trade among homeless and marginally housed individuals in San Francisco. Journal of Urban Health 83(4): 736-740, 2006. (18 refs.)

Objective: Sex exchange is a well-established risk factor for HIV infection. Little is known about how correlates of sex trade differ by biologic sex and whether length of homelessness is associated with sex trade. We conducted a cross-sectional study among a sample of 1,148 homeless and marginally housed individuals in San Francisco to assess correlates of exchanging sex for money or drugs. Key independent variables included length of homelessness; use of crack, heroin or methamphetamine; HIV status; and sexual orientation. Analyses were restricted by biologic sex. In total, 39% of women and 30% of men reported a lifetime history of sex exchange. Methamphetamine use and greater length of homelessness were positively associated with a history of sex trade among women while heroin use, recent mental health treatment, and homosexual or bisexual orientation were significantly associated with sex trade for men. Crack use was correlated with sex trade for both genders. Correlates of sex trade differ significantly according to biologic sex, and these differences should be considered in the design of effective HIV prevention programs. Our findings highlight the critical need to develop long-term services to improve housing status for homeless women, mental health services for homeless men, and drug treatment services for homeless adults involved in sex work.

Williams ML; Atkinson J; Klovdahl A; Ross MW; Timpson S. Spatial bridging in a network of drug-using male sex workers. Journal of Urban Health 82(1 Supplement 1): I35-I42, 2005. (32 refs.)

This study sought to determine whether drug-using male sex workers (MSWs) spatially bridge sexual networks across cities and to determine whether the behaviors of MSWs who bridge differ from the behaviors of those who do not. Data were collected from 42 MSWs in Houston , Texas, between May 2003 and February 2004. Spatial bridging was defined as having traded sex for money in another city before traveling to and trading in Houston. Cities bridged by MSWs were geographically plotted and were primarily located in the Gulf Coast and in Florida. Slightly less than half of MSWs were identified as spatially bridging from one city to another. A significantly higher proportion of MSWs who bridged cities were homosexual (55% vs. 23 %) and HIV positive (31 % vs. 5%). Those who bridged cities used marijuana and injected drugs more frequently and bad significantly more male sex partners than MSWs who did not bridge cities. Despite the small sample size, this study found that many drug-using MSWs spatially bridge sexual networks in cities where they trade sex for money.