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CORK Bibliography: Prostitution



50 citations. January 2010 to present

Prepared: March 2012



Bedford O; Hwang SL. Flower drinking and masculinity in Taiwan. Journal of Sex Research 48(1): 82-92, 2011. (32 refs.)

This study explores the role of the hostess club culture in the creation and maintenance of masculinity in Taiwan. The article focuses on flower drinking (the consumption of alcohol in bars, often integrated with prostitution), which is a common practice in Taiwan. Data were obtained from 58 in-depth interviews with men from a variety of occupations and social backgrounds (mean age = 38.50, SD = 11.00) and 73 questionnaires administered to soldiers (mean age = 21.00, SD = 1.10). Findings indicated that demonstration of skill at flower drinking and facility with the related social etiquette are important channels for male bonding that were central to the mid-to upper-class participants' professional development. Flower drinking also provided a method of discriminating men from other men through their choices of why and where to go and how to behave while there. Specific ways that Taiwanese masculinity differs from Western and from Japanese masculinity, and support for the continuing relevance of the traditional Confucian ideal of masculinity, wen-wu, are discussed.

Copyright 2011, Taylor & Francis


Bell H; Steiker LH. Prostitution and substance abuse. Journal of Social Work Practice in the Addictions 10(2): 218-223, 2010. (0 refs.)

This article is the transcript of an interview of Holly Bell, whose professional efforts as a clinical social and as researcher in the area of prostitution and the role of drug and alcohol abuse.

Copyright 2010, Routledge


Bowen KJ; Dzuvichu B; Rungsung R; Devine AE; Hocking J; Kermode M. Life circumstances of women entering sex work in Nagaland, India. Asia-Pacific Journal of Public Health 23(6): 843-851, 2011. (15 refs.)

Background and objectives: The study objective was to enhance understanding of female sex workers' lives in Nagaland, India (one of the country's highest HIV prevalence states), to inform the development of interventions to reduce HIV transmission and assist women who want to leave sex work. Methods: A cross-sectional survey (n = 220) and semi-structured interviews (n = 30) were conducted with sex workers. Topics included the following: life situated currently and at time of initial engagement in sex work, circumstances of first sex work occasion, and current patterns of sex work. Results: Participants' lives at time of entry into sex work were socio-culturally and economically vulnerable as evidenced by the early age of sexual debut, low levels of education, unemployment, absence of protective male parents, and poor relationships with families. Participants experienced high levels of mobility, insecure accommodation, the need to financially support family, and the demand to give a portion of their income to others. The use of alcohol and other drugs, including heroin, was widespread. Discussion and conclusions: For these women, sex work can be seen as a pragmatic option for earning sufficient income to live. The women's lives would be improved by strategies to promote their health, ensure their safety, and protect their rights as long as they are engaging in sex work. This is likely to benefit not only the sex workers but also their children, their families, and the wider community. The development of alternative employment opportunities is vital to protect against entry into sex work and to support women who want to exit sex work.

Copyright 2011, Sage Publications


Cavanaugh CE; Hedden SL; Latimer WW. Sexually transmitted infections among pregnant heroin- or cocaine-addicted women in treatment: the significance of psychiatric co-morbidity and sex trade. International Journal of STD & AIDS 21(2): 141-142, 2010. (7 refs.)

Psychiatric co-morbidity and sex trade were tested as correlates of sexually transmitted infections (STIs) among 76 pregnant heroin- or cocaine-dependent women. Participants were recruited from a drug treatment programme and attended a clinician-administered assessment including the Structured Clinical Interview for DSM-IV (SCID-IV-TR) and self-report questionnaires about lifetime histories of sex trade and STIs (i.e. gonorrhoea, syphilis, chlamydia, herpes, genital warts or trichomonas). Lifetime and six month rates of STIs were 53.9% and 18.4%, respectively. The majority of women also had lifetime histories of psychiatric co-morbidity (61.8%) and/or sex trade (60.5%). Participants with psychiatric co-morbidity (adjusted odds ratio [AOR] 3 9; 95% confidence interval [CI] 1.3-11.6) and/or sex trade (AOR 3.2; 95% CI 1.1-9.5) were more likely to report STIs during their lifetime compared with those without such histories while controlling for age, education and race/ethnicity. Results suggest that as many as one-in-five pregnant heroin- or cocaine-dependent women in treatment have one or more STIs that are concurrent with their pregnancy and may contribute to risk for contracting HIV and pregnancy complications; psychiatric co-morbidity and/or sex trade were associated with greater STI risk. Findings underscore the importance of identifying and addressing co-morbid psychiatric disorders and sex trade behaviour in this population.

Copyright 2010, Royal Society of Medicine PRESS LTD


Champion JD. Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58(1): 61-67, 2011. (37 refs.)

Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14-18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self-report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self-reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported 'getting high' and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.

Copyright 2011, Wiley-Blackwell


Chettiar J; Shannon K; Wood E; Zhang R; Kerr T. Survival sex work involvement among street-involved youth who use drugs in a Canadian setting. Journal of Public Health 32(3): 322-327, 2010. (29 refs.)

Drug users engaged in survival sex work are at heightened risk for drug- and sexual-related harms. We examined factors associated with survival sex work among street-involved youth in Vancouver, Canada. From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14-26 who use illicit drugs. Using multiple logistic regression, we compared youth who reported exchanging sex for money, drugs etc. with those who did not. The sample included 560 youth: median age 22; 179 (32%) female; 63 (11%) reporting recent survival sex work. Factors associated with survival sex work in multivariate analyses included non-injection crack use [adjusted odds ratio (AOR) = 3.45, 95% confidence interval (CI): 1.75-6.78], female gender (AOR = 3.02, 95% CI: 1.66-5.46), Aboriginal ethnicity (AOR = 2.35, 95% CI: 1.28-4.29) and crystal methamphetamine use (AOR = 2.02, 95% CI: 1.13-3.62). In subanalyses, the co-use of crack cocaine and methamphetamine was shown to be driving the association between methamphetamine and survival sex work. This study demonstrates a positive interactive effect of dual stimulant use in elevating the odds of survival sex work among street youth who use drugs. Novel approaches to reduce the harms associated with survival sex work among street youth who use stimulants are needed.

Copyright 2010, Oxford University Press


Collinson S; Straub R; Perry G. The invisible men: Finding and engaging with the male partners of street sex workers. Journal of Men's Health 8(3): 202-207, 2011. (5 refs.)

Men, in general, remain less likely than women to seek medical care, and are only half as likely as women to undertake preventive health visits and/or screening tests. There is a great need to increase men's health awareness and reduce this significant gender disparity. Furthermore, marginalised and socially excluded men rarely access health services, even though the reasons for their social exclusion, particularly drug and alcohol dependency, invariably mean that their need for health interventions is greater than in the normal population. The Open Doors Sexual Health Service has been working with female street sex workers (SSWs) in the London Borough of Hackney since 2006, in order to help them address their physical, psychological and social needs. Open Doors is based in, and partly funded by, City and Hackney Primary Care Trust. As Open Doors' staff's relationships with the women grew and the team developed an understanding of the lives of the women and their networks, it became clear that their relationships with the men in their lives (historically characterised as "pimps") were more significant and enduring than had previously been assumed, and that working with couples had the potential to be of greater benefit than working with the women only. In July 2008, a male worker joined the Open Doors team, in order to work exclusively with the male partners of women using the service, and to develop access to clinical and social services for this shadowy group. During the first 12 months, the male partners' coordinator (MPC) engaged with 23 men, each one of whom has needed intensive case management, as illustrated by a Case Study. The MPC's contract has been renewed for a further year, and the scope of the post widened to include other marginalised men, such as street drinkers, squatters and undocumented migrants, achieved by close collaboration with key services, especially the TB service, the Department of Sexual Health (DoSH) and the Specialist Addictions Unit (SAU) in Hackney's local hospital, the Homerton. This paper will describe the work done by the MPC during the first 12 months of his tenure.

Copyright 2011, Elsevier Science


Couture MC; Sansothy N; Sapphon V; Phal S; Sichan K; Stein E et al. Young women engaged in sex work in Phnom Penh, Cambodia, have high incidence of HIV and sexually transmitted infections, and amphetamine-type stimulant Use: New challenges to HIV prevention and risk. Sexually Transmitted Diseases 38(1): 33-39, 2011. (40 refs.)

Objectives: To estimate prevalence and incidence of HIV and sexually transmitted infections (STI) and associated risk factors among young women working as sex workers (SWs) in Phnom Penh, Cambodia. Methods: A prospective study of young (<29 years) women working as SWs in brothels, entertainment establishments, and freelance. Sociodemographics, sexual risk, and use of amphetamine-type stimulants (ATS) ("yama" and "crystal") were assessed by self-report. HIV and STI (Chlamydia trachomatis and Neisseria gonorrhoeae) testing were conducted on blood and urine specimens, respectively. Results: Baseline prevalences of HIV, C. trachomatis, and N. gonorrhoeae were 23%, 11.5%, and 7.8%, respectively. HIV incidence was 3.6 per 100 person-years (95% confidence interval [CI], 1.2%-11.1%); STI incidence was 21.2 per 100 person-years (95% CI, 12.6%-35.8%). At baseline, 26.5% reported recent ATS use. HIV infection was associated with freelance SW (adjusted odds ratio, 5.85; 95% CI, 1.59-21.58) and younger age of first sex (<= 15 years; adjusted odds ratio, 3.06; 95% CI, 1.01-8.46). Incident STI was associated with duration (per year) of SW (adjusted hazard ratio, 1.1; 95% CI, 1.1-1.2) and recent yama use (adjusted hazard ratio, 3.9; 95% CI, 1.5-10.3). Conclusions: HIV and STI infection rates were high among SWs working in various settings; freelancers had highest risk. ATS use was associated with incident STI. Venue of sex work and drug prevention should be considered in prevention programs.

Copyright 2011, Lippincott, Williams & Wilkins


De Genna NM; Feske U; Angiolieri T; Gold MA. Race and sexually transmitted diseases in women with and without borderline personality disorder. Journal of Women's Health 20(3): 333-340, 2011. (49 refs.)

Background: The purpose of this study was to examine the history of sexually transmitted diseases (STDs) among women with borderline personality disorder (BPD) with and without a lifetime substance use disorder (SUD) and to compare their histories to those of a group of women with a current nonpsychotic axis I disorder. Methods: Two-hundred fifteen women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses (SCID-I), Structured Interview for DSM-IV Personality for Axis II diagnoses (SIDP-IV), and a sexual health interview. African American women were oversampled because little is known about BPD in African American women and because they are at greater risk for STDs than non-African American women. Results: Women with a lifetime SUD (especially cannabis use disorder) reported more STD risk factors and STDs than women without a lifetime SUD. BPD dimensional scores and African American race were predictors of STD, even after controlling for age, socioeconomic status (SES), SUDs, and participation in the sex trade. Conclusions: Determining predictors of STDs within at-risk subpopulations may help reduce the spread of STDs and prevent HIV infection within these groups by helping providers identify women at the highest risk of infection.

Copyright 2011, Mary Ann Liebert


DeBeck K; Wood E; Qi JZ; Fu E; McArthur D; Montaner J et al. Interest in low-threshold employment among people who inject illicit drugs: Implications for street disorder. International Journal of Drug Policy 22(5): 376-384, 2011. (68 refs.)

Background: Income generation opportunities available to people who use illicit drugs have been associated with street disorder. Among a cohort of injection drug users (IOU) we sought to examine street-based income generation practices and willingness to forgo these sources of income if other low-threshold work opportunities were made available. Methods: Data were derived from a prospective community recruited cohort of IOU. We assessed the prevalence of engaging in disorderly street-based income generation activities, including sex work, drug dealing, panhandling, and recycling/salvaging/vending. Using multivariate logistic regressions based on Akaike information criterion and the best subset selection procedure, we identified factors associated with disorderly income generation activities, and assessed willingness to forgo these sources of income during the period of November 2008 to July 2009. Results: Among our sample of 874 IOU, 418 (48%) reported engaging in a disorderly income generation activity in the previous six months. In multivariate analyses, engaging in disorderly income generation activities was independently associated with high intensity stimulant use, as well as binge drug use, having encounters with police, being a victim of violence, sharing used syringes, and injecting in public areas. Among those engaged in disorderly income generation, 198 (47%) reported a willingness to forgo these income sources if given opportunities for low-threshold employment, with sex workers being most willing to engage in alternative employment. Conclusion: Engagement in disorderly street-based income generation activities was associated with high intensity stimulant drug use and various markers of risk. We found that a high proportion of illicit drug users were willing to cease engagement in these activities if they had options for causal low-threshold employment. These findings indicate that there is a high demand for low-threshold employment that may offer important opportunities to reduce drug-related street disorder and associated harms.

Copyright 2011, Elsevier Science BV


Deering KN; Kerr T; Tyndall MW; Montaner JSG; Gibson K; Irons L et al. A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting. Drug and Alcohol Dependence 113(1): 46-54, 2011. (70 refs.)

Background: The objectives of this study were to examine the determinants of using a peer-led mobile outreach program (the Mobile Access Project [MAP]) among a sample of street-based female sex workers (FSWs) who use drugs in an urban Canadian setting and evaluate the relationship between program exposure and utilizing addiction treatment services. Methods: A detailed questionnaire was administered at baseline and bi-annual follow-up visits over 18 months (2006-2008) to 242 FSWs in Vancouver, Canada. We used bivariate and multivariate logistic regression with generalized estimating equations for both objectives, reporting unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results: Over 18 months, 42.2% (202) reports of peer-led mobile outreach program use were made. High-risk women, including those servicing a higher weekly client volume (10+ compared to <10; AOR: 1.7, 95%CIs: 1.1-2.6) and those soliciting clients in deserted, isolated settings (AOR: 1.7, 95%CIs: 1.1-2.7) were more likely to use the program. In total, 9.4% (45) reports of using inpatient addiction treatment services were made (7.5% detoxification; 4.0% residential drug treatment), and 33.6% (161) using outpatient treatment (28.8% methadone; 9.6% alcohol/drug counsellor). Women who used the peer-led mobile outreach were more likely to use inpatient addiction treatment (AOR: 4.2, 95%CIs: 2.1-8.1), even after adjusting for drug use, environmental-structural factors, and outpatient drug treatment. Discussion: Our findings demonstrate that FSWs at higher risk for sexually transmitted infections and violence are more likely to access this peer-led mobile outreach program and suggest that the program plays a critical role in facilitating utilization of detoxification and residential drug treatment.

Copyright 2011, Elsevier Science


Deering KN; Shoveller J; Tyndall MW; Montaner JS; Shannon K. The street cost of drugs and drug use patterns: Relationships with sex work income in an urban Canadian setting. Drug and Alcohol Dependence 118(2-3): 430-436, 2011. (52 refs.)

Background: This study investigated the relationship between drug use and sex work patterns and sex work income earned among street-based female sex workers (FSWs) in Vancouver, Canada. Methods: We used data from a sample of 129 FSWs who used drugs in a prospective cohort (2007-2008), for a total of 210 observations. Bivariate and multivariable linear regression using generalized estimating equations was used to model the relationship between explanatory factors and sex work income. Sex work income was log-transformed to account for skewed data. Results: The median age of the sample at first visit was 37 years (interquartile range[IQR]: 30-43), with 46.5% identifying as Caucasian, 48.1% as Aboriginal and 5.4% as another visible minority. The median weekly sex work income and amount spent on drugs was $300 (IQR = $100-$560) and $400 (IQR = $150-$780), respectively. In multivariable analysis, for a 10% increase in money spent on drugs, sex work income increased by 1.9% (coeff: 0.20, 95% CIs: 0.04-0.36). FSWs who injected heroin, FSWs with higher numbers of clients and youth compared to older women (<25 versus 25+ years) also had significantly higher sex work income. Conclusions: This study highlights the important role that drug use plays in contributing to increased dependency on sex work for income among street-based FSWs in an urban Canadian setting, including a positive dose-response relationship between money spent on drugs and sex work income. These findings indicate a crucial need to scale up access and availability of evidence-based harm reduction and treatment approaches, including policy reforms, improved social support and economic choice for vulnerable women.

Copyright 2011, Elsevier Science


Eiroa-Orosa FJ; Verthein U; Kuhn S; Lindemann C; Karow A; Haasen C et al. Implication of gender differences in heroin-assisted treatment: Results from the German randomized controlled trial. American Journal on Addictions 19(4): 312-318, 2010. (44 refs.)

Despite a lower prevalence of opioid dependence among females, drug-related problems and risk factors such as prostitution have a negative effect for women in treatment. This study was conducted with the purpose of analyzing gender differences in the German trial on heroin-assisted treatment (HAT), which compared HAT with methadone maintenance treatment (MMT). Significant baseline gender differences were found, with females showing a greater extent of mental distress. Differences in retention and outcome were significant for male patients, but no differences between treatment options were found for female patients. Ongoing prostitution was found to influence drug use outcomes. Other outcome criteria may need to be stressed when assessing the effect of HAT for women.

Copyright 2010, Wiley-Blackwell


Fisher JC; Cook PA; Kapiga SH. Alcohol use before sex and HIV risk: Situational characteristics of protected and unprotected encounters among high-risk African Women. Sexually Transmitted Diseases 37(9): 571-578, 2010. (39 refs.)

Objectives: To compare the situational characteristics of protected and unprotected sexual encounters that involved alcohol use 2 hours prior with ones that did not. Methods: Data were collected between December 2002 and December 2005 as part of enrollment in a prospective cohort study designed to identify HIV seroconversion risk factors among women bar and hotel workers in Northern Tanzania. A total of 608 (37.3%) of the women who were inconsistent condom users were asked a set-matched questions concerning situational characteristics surrounding their last protected and unprotected sexual encounter including whether they had been drinking within 2 hours of sex. The associations between drinking 2 hours before sex (yes/no), condom use (protected/unprotected), and their interaction with the situational descriptors were examined with a 2 x 2 model for paired categorical data after controlling for time since the last type of encounter. Results: Condom failure was 5 times more likely if someone (woman, man, or both partners) had been drinking in advance of the encounter (OR, 5.19; 95% CI, 2.05-15.46) and was especially likely to occur if only the woman had been drinking before sex (OR, 14.05; 95% CI, 4.03-50.41). Alcohol use before sex was associated with sexual contacts where the woman was having sex with her partner for the first time, their relationship was casual or transitory or sex was transactional, the location was unfamiliar and less under her control, and the partner had been drinking or using drugs before having sex. Condom use was more frequent in precisely the same types of encounters. Interestingly, there were no significant interactions between alcohol use before sex and condom use, suggesting that drinking before sex and use of condom are distinct and not contingent risk factors. Conclusions: Alcohol use before sex is associated with an increased likelihood of condom failures and with high-risk sexual encounters, ones that have consistent situational characteristics regardless of whether condoms are used or not.

Copyright 2010, Lippincott, Williams & Wilkins


Gollub EL; Armstrong K; Boney T; Mercer D; Chhatre S; Fiore D et al. Correlates of trichomonas prevalence among street-recruited, drug-using women enrolled in a randomized trial. Substance Use & Misuse 45(13): 2203-2220, 2010. (66 refs.)

Objectives. Substance-using women need prevention technologies and programs to reduce risk of HIV/sexually transmitted infection (STI). We examined STI prevalence and identified risk correlates for female drug users. Methods. We used interviewer-administered and computer-assisted surveys, and tested specimens for four, treatable STIs (trichomonas, early syphilis, gonorrhea, chlamydia) on 198 HIV-seronegative, street-recruited, substance-using women enrolled in a randomized trial to reduce HIV/STI risk. Results. Most women were crack users (88%), reported sex exchange (80%) and were not in drug user treatment (74%). Two-thirds were African-American and nearly all were unemployed. Protection during sex was infrequent. African-American women reported fewer unprotected sex acts and fewer sexual partners, but greater crack use and more sex-for exchange, than whites or Hispanics. Trichomonas prevalence (36.9%) exceeded that for chlamydia (3.5%), syphilis (1.5%), and gonorrhea (0%). In multivariate logistic regression, having a primary and casual partner more than doubled (AOR 2.86) the risk of having trichomonas and being African-American raised the risk by more than 8 times (AOR 8.45). Conclusions. African-American, drug-using women, and women with multiple partner types, are in urgent need of effective STI/HIV prevention interventions.

Copyright 2010, Taylor & Francis


Gu J; Lau JTF; Chen HY; Tsui HY; Ling WH. Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China. International Journal of Drug Policy 22(1): 26-33, 2011. (39 refs.)

Background: Female injecting drug users who are sex workers (IDUFSWs) are at high risk of contracting HIV. They may bridge HIV transmissions from injecting drug users to clients of female sex workers. Methods: A total of 216 non-institutionalised IDUFSWs were recruited by snowball sampling methods. Anonymous face-to-face interviews were conducted to collect data. Univariate, multivariate and hierarchical logistic regression models were fitted to investigate the associations between background characteristics, cognitive variables, psychological stress and syringe sharing behaviours among IDUFSWs. Results: Respectively 33.8% and 27.8% of the respondents injected drugs with others' used syringes and gave used syringes to others for drug injection in the last month. These two syringe sharing behaviours were significantly associated with inconsistent condom use during commercial sex (OR=5.00 and 1.92, p<0.05). Over 90% of the respondents reported at least one type(s) of psychological distress included in this study. Adjusting for significant background variables, all variables that are related to the Theory of Planned Behaviour (attitude, norm, perceived control and behavioural intention) and psychological distress (except for depression) were significantly associated with injecting drugs with others' used syringes (adjusted OR=2.08-6.25, p < 0.05), whilst variables related to perceived control, behavioural intention and insomnia were significantly associated with providing used syringes to others for injection (adjusted OR = 2.00-3.56, p<0.05). In two separate summary multivariate models, variables related to the Theory of Planned Behaviours and psychological distress were independently associated with injecting drugs with others' used syringes (OR = 1.98-4.02, p<0.05) and giving used syringes to others for injection (OR = 2.06-3.59, p<0.05). Conclusions: Syringe sharing behaviours were prevalent among IDUFSWs and were associated with cognitive and psychological factors. Effective integrative intervention programmes targeting IDUFSWs are warranted.

Copyright 2011, Elsevier Science


Hedden SL; Hulbert A; Cavanaugh CE; Parry CD; Moleko AG; Latimer WW. Alcohol, drug, and sexual risk behavior correlates of recent transactional sex among female black South African drug users. Journal of Substance Use 16(1): 57-67, 2011. (34 refs.)

Methods: In order to inform HIV interventions, drug, and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black South African women in Pretoria were examined using log binomial regression. Results: Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use [adjusted prevalence ratio (APR) = 1.3, 95% CI = 1.1, 1.5] and knew of anyone who died of AIDS (APR = 1.5, 95% CI = 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR = 0.6, 95% CI = 0.4, 0.8), condom use in their first sexual encounter (APR = 0.7, 95% CI = 0.6, 1.0), or reported a recent steady sexual partnership (APR = 0.8, 95% CI = 0.7, 0.9). Conclusions: Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.

Copyright 2011, Informa Healthcare


Hesse M; Tutenges S. Young tourists visiting strip clubs and paying for sex. Tourism Management 32(4): 869-874, 2011. (26 refs.)

Little is known about young adults' use of strip clubs and prostitution during their holidays abroad. This study examined this issue with a sample of 1125 Danish tourists between the ages of 16 and 34, and sought data about the frequency with which they paid for sex and attended strip clubs while they were on holiday. The tourists were surveyed at a Bulgarian airport before their return trip home. The incidence of strip-club patronage during holiday was 48% for men and 8% for women. Of the men, 12.5% reported paying for sex during their holiday. Among the men paying for sex, 47% reported having done it for the first time. Among the men who attended strip clubs, 32% reported having done it for the first time. Strip-club patronage and paying for sex were both associated with higher levels of drinking, use of Viagra (R), and with having done the same thing before the holiday. Paying for sex was uniquely associated with non-use of condoms with one or more sexual partners. The results of this study can be interpreted as part of a wider culture of commodified debauchery, which predominates many nightlife resorts.

Copyright 2011, Elsevier Science


Hudson AL; Wright K; Bhattacharya D; Sinha K; Nyamathi A; Marfisee M. Correlates of adult assault among homeless women. Journal of Health Care for the Poor and Underserved 21(4): 1250-1262, 2010. (46 refs.)

The purpose of this study was to assess predictors of sexual and physical assault among homeless women. A multivariate, correlation design was utilized to identify independent correlates of adult physical and sexual assault. The sample consisted of 202 homeless women residing in shelters or living on the street in the Skid Row area of Los Angeles. Respondents reporting a history of child sexual abuse were almost four times more likely to report being sexually assaulted as adults and were almost two and one third times more likely to report being physically assaulted as adults. A range of factors increase homeless women's risk of adult physical and sexual victimization, including child sexual abuse, substance use, lifetime sex trade activity, and previous incarceration. It is important for homeless service providers to develop an individual risk profile for homeless women and to intervene in order to decrease their risk of re-victimization.

Copyright 2010, Johns Hopkins University Press


Johnston CL; Callon C; Li K; Wood E; Kerr T. Offer of financial incentives for unprotected sex in the context of sex work. Drug and Alcohol Review 29(2): 144-149, 2010. (37 refs.)

Introduction and Aims. Commercial sex workers (CSW) are often portrayed as vectors of disease transmission. However, the role clients play in sexual risk taking and related decision making has not been thoroughly characterised. Design and Methods. Participants were drawn from the Vancouver Injection Drug Users Study, a longitudinal cohort. Analyses were restricted to those who reported selling sex between June 2001 and December 2005. Using multivariate generalised estimating equation, we evaluated the prevalence of and factors associated with being offered money for sex without a condom. Results. A total of 232 CSW were included in the analyses, with 73.7% reporting being offered more money for condom non-use, and 30.6% of these CSW accepting. Variables independently associated with being offered money for sex without a condom included daily speedball use [adjusted odds ratio (AOR) = 1.21, 95% confidence interval (CI): 0.23-0.62], daily crack smoking (AOR = 1.51, 95% CI: 1.04-2.19), daily heroin injection (AOR = 1.76, 95% CI: 1.27-2.43) and drug use with clients (AOR = 3.22, 95% CI: 2.37-4.37). Human immunodeficiency virus seropositivity was not significant (AOR = 0.98, 95% CI: 0.67-1.44). Discussion and Conclusions. Findings highlight the role clients play in contributing to unprotected sex through economic influence and exploitation of CSW drug use. HIV serostatus has no bearing on whether more money is offered for sex without a condom. Novel interventions should target both CSW and clients.

Copyright 2010, Wiley-Blackwell


Kidd SA; Liborio RMC. Sex trade involvement in Sao Paulo, Brazil and Toronto, Canada: Narratives of social exclusion and fragmented identities. Youth & Society 43(3): 982-1009, 2011. (60 refs.)

An extensive international literature has been developed regarding the risk trajectories of sex trade-involved children and youth. This literature has not, however, substantially incorporated the narratives of youths regarding their experiences. In this article, the contemporary literature on child and youth sex trade-involvement is reviewed and the findings of a qualitative analysis of the narratives of 14 youth from Sao Paulo, Brazil and 58 youth from Toronto, Canada are presented. Substantial similarities were found between the groups of narratives with respect to abusive and unstable home experiences, pathways into the sex trade, social exclusion, and the impacts of the sex trade on physical and mental health. Key areas of divergence included the roles of poverty and drug use in entering the sex trade. The implications of shared experiences of social exclusion and fragmented identity across differing sociocultural contexts for policy and intervention are discussed.

Copyright 2011, Sage Publications


Li Q; Li XM; Stanton B. Alcohol use among female sex workers and male clients: An integrative review of global literature. (review). Alcohol and Alcoholism 45(2): 188-199, 2010. (122 refs.)

Aims: To review the patterns, contexts and impacts of alcohol use associated with commercial sex reported in the global literature. Methods: We identified peer-reviewed English-language articles from 1980 to 2008 reporting alcohol consumption among female sex workers (FSWs) or male clients. We retrieved 70 articles describing 76 studies, in which 64 were quantitative (52 for FSWs, 12 for male clients) and 12 qualitative. Results: Studies increased over the past three decades, with geographic concentration of the research in Asia and North America. Alcohol use was prevalent among FSWs and clients. Integrating quantitative and qualitative studies, multilevel contexts of alcohol use in the sex work environment were identified, including workplace and occupation-related use, the use of alcohol to facilitate the transition into and practice of commercial sex among both FSWs and male clients, and self-medication among FSWs. Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive. Conclusions: Alcohol use in the context of commercial sex is prevalent, harmful among FSWs and male clients, but under-researched. Research in this area in more diverse settings and with standardized measures is required. The review underscores the importance of integrated intervention for alcohol use and related problems in multilevel contexts and with multiple components in order to effectively reduce alcohol use and its harmful effects among FSWs and their clients.

Copyright 2010, Oxford University Press


Liao MZ; Jiang ZX; Zhang XJ; Kang DM; Bi ZQ; Liu XZ et al. Syphilis and methamphetamine use among female sex workers in Shandong Province, China. Sexually Transmitted Diseases 38(1): 57-62, 2011. (31 refs.)

A study of female sex workers in China, found alarmingly high prevalence of methamphetamine use. Methamphetamine users were more likely to be single, younger, inconsistent condom users, and have syphilis.

Copyright 2011, Lippincott, Williams & Wilkins


Loza O; Patterson TL; Rusch M; Martinez GA; Lozada R; Staines-Orozco H et al. Drug-related behaviors independently associated with syphilis infection among female sex workers in two Mexico-US border cities. Addiction 105(8): 1448-1456, 2010. (38 refs.)

Aims: To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. Design: Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers > 1 : 8) were identified by logistic regression. Setting: Tijuana and Ciudad Juarez, two Mexican cities on the US border that are situated on major drug trafficking routes and where prostitution is quasi-legal. Participants: A total of 914 FSWs aged >= 18 years without known human immunodeficiency virus (HIV) infection who had had recent unprotected sex with clients. Measurement: Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. Findings: Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 31.4% had clients in the last 6 months who injected drugs, and 68.6% reported having clients from the United States. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.08), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65) and having any US clients (AOR: 2.85; 95% CI: 1.43, 5.70). Conclusions: Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were associated more closely with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use.

Copyright 2010, Society for the Study of Addiction


Loza O; Strathdee SA; Lozada R; Staines H; Ojeda VD; Martinez GA et al. Correlates of early versus later initiation into sex work in two Mexico-US border cities. Journal of Adolescent Health 46(1): 37-44, 2010. (40 refs.)

Purpose: To examine correlates of early initiation into sex work in two Mexico-U.S. border cities. Methods: Female sex workers (FSWs) >= 18 years without known HIV infection living in Tijuana and Ciudad Juarez who had recent unprotected sex with clients underwent baseline interviews. Correlates of initiation into sex work before age 18 were identified with logistic regression. Results: Of 920 FSWs interviewed in Tijuana (N = 474) and Ciudad Juarez (N = 446), 9.8% (N = 90) were early initiators (<18 years) into sex work. Median age of entry into sex work was 26 years (range: 6-58). After adjusting for age, compared to older initiators, early initiators were more likely to use inhalants (21.1% vs. 9.6%, p = .002), initiate sex work to pay for alcohol (36.7% vs. 18.4%, p < .001), report abuse as a child (42.2% vs. 18.7%, p < .0001), and they were less likely to be migrants (47.8% vs. 62.3%, p = .02). Factors independently associated with early initiation included inhalant use (adjOR = 2.39), initiating sex work to pay for alcohol (adjOR = 1.88) and history of child abuse (adjOR = 2.92). Factors associated with later initiation included less education (adjOR = 0.43 per 5-year increase), migration (adjOR = 0.47), and initiating sex work for better pay (adjOR = 0.44) or to support children (adjOR = 0.03). Conclusions: Different pathways for entering sex work are apparent among younger versus older females in the Mexico-U.S. border region. Among girls, interventions are needed to prevent inhalant use and child abuse and to offer coping skills; among older initiators, income-generating strategies, childcare, and services for migrants may help to delay or prevent entry into sex work.

Copyright 2010, Society for Adolescent Medicine


Loza O; Strathdee SA; Martinez GA; Lozada R; Ojeda VD; Staines-Orozco H et al. Risk factors associated with chlamydia and gonorrhoea infection among female sex workers in two Mexico-USA border cities. International Journal of STD & AIDS 21(7): 460-465, 2010. (32 refs.)

Female sex workers (FSWs) aged >= 18 years without known HIV infection living in Tijuana and Ciudad Juarez, Mexico who had recent unprotected sex with clients underwent interviews and testing for chlamydia and gonorrhoea using nucleic acid amplification. Correlates of each infection were identified with logistic regression. Among 798 FSWs, prevalence of chlamydia and gonorrhoea was 13.0% and 6.4%, respectively. Factors independently associated with chlamydia were younger age, working in Tijuana versus Ciudad Juarez and recent methamphetamine injection. Factors independently associated with gonorrhoea were working in Tijuana versus Ciudad Juarez, using illegal drugs before or during sex, and having a recent male partner who injects drugs. Chlamydia and gonorrhoea infection were more closely associated with FSWs' drug use behaviours and that of their sexual partners than with sexual behaviours. Prevention should focus on subgroups of FSWs and their partners who use methamphetamine and who inject drugs.

Copyright 2010, Royal Society of Medicine


Maher L; Phlong P; Mooney-Somers J; Keo S; Stein E; Couture MC et al. Amphetamine-type stimulant use and HIV/STI risk behaviour among young female sex workers in Phnom Penh, Cambodia. International Journal of Drug Policy 22(3): 203-209, 2011. (60 refs.)

Background: Use of amphetamine-type substances (ATS) has been linked to increased risk of HIV and other sexually transmitted infections (STI) worldwide. In Cambodia, recent ATS use is independently associated with incident STI infection among young female sex workers (FSWs). Methods: We conducted 33 in-depth interviews with women (15-29 years old) engaged in sex work to explore ATS use and vulnerability to HIV/STI. Results: Participants reported that ATS, primarily methamphetamine in pill and crystalline forms (yama), were cheap, widely available and commonly used. Yama was described as a "power drug" (thnam kamlang) which enabled women to work long hours and serve more customers. Use of ATS by clients was also common, with some providing drugs for women and/or encouraging their use, often resulting in prolonged sexual activity. Requests for unprotected sex were also more common among alternatives intoxicated clients and strategies typically employed to negotiate condom use were less effective. Conclusion: ATS use was highly functional for young women engaged in sex work, facilitating a sense of power and agency and highlighting the occupational significance and normalization of ATS in this setting. This highly gendered dynamic supports the limited but emerging literature on women's use of ATS, which to date has been heavily focused on men. Results indicate an urgent need to increase awareness of the risks associated with ATS use, to provide women with sustainable alternatives for income generation, to better regulate the conditions of sex work, and to work with FSWs and their clients to develop and promote culturally appropriate harm reduction interventions.

Copyright 2011, Elsevier Science


Malta M; Magnanini MMF; Mello MB; Pascom ARP; Linhares Y; Bastos FI. HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A systematic review and meta-analysis. BMC Public Health 10: article 317, 2010. (91 refs.)

Background: The Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ? men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group. Methods: Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis. Results: The studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2). Conclusions: FSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (similar to 0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e. g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.

Copyright 2010, Biomedical Central


McCabe I; Acree M; O'Mahony F; McCabe J; Kenny J; Twyford J et al. Male street prostitution in Dublin: A psychological analysis. Journal of Homosexuality 58(8): 998-1021, 2011. (48 refs.)

This study assessed the mental health characteristics of 12 male street prostitutes (MSPs) in Dublin, with particular regard to issues of homelessness, substance abuse, depression, suicidal ideation, and self-esteem. Participants completed five psychometric tests, which indicated that all of the participants had above average levels of depression and suicidal ideation and low levels of self-esteem. This study found that candidates likely to become MSPs are young males with a combination of factors, including a background of childhood sexual or physical abuse, leaving school early, running away from home, and a dependence on heroin.

Copyright 2011, Haworth Press


Morris MD; Case P; Robertson AM; Lozada R; Vera A; Clapp JD et al. Prevalence and correlates of 'agua celeste' use among female sex workers who inject drugs in Ciudad Juarez, Mexico. Drug and Alcohol Dependence 117(2-3): 219-225, 2011. (35 refs.)

Background: Agua celeste, or "heavenly water", is the street name for a sky-blue colored solvent reportedly inhaled or ingested to produce an intoxicating effect. Study aims were to (1) describe prevalence of agua celestse (AC) use, and (2) identify correlates of lifetime and recent use of AC use among female sex workers who also inject drugs (FSW-IDUs) in northern Mexico. Methods: Between 2008 and 2010, baseline data from FSW-IDUs >= 18 years old living in Tijuana or Ciudad Juarez participating in a longitudinal behavioral intervention were analyzed using logistic regression. Results: Among 623 FSW-IDUs (307 from Tijuana and 316 from Ciudad Juarez (CJ)), 166 (26%) reported ever using AC, all of whom lived in CJ. Among the CJ sample, lifetime prevalence of AC use was 53%, median age of first use was 16 years (IQR: 14-23), and 10% reported it as their first abused substance. Ever using AC was independently associated with ever being physically abused and younger age, and was marginally associated with initiating injection drug use and regular sex work at age eighteen or younger. Among those ever using AC, 70/166(42.2%) reported using it within the last 6 months, which was independently associated with using drugs with clients before or during sex, being on the street more than 8 h per day, and younger age. Discussion: We observed considerable geographic variation in the use of AC in northern Mexico. Future studies exploring factors influencing use, its precise formulation(s), and its potential health effects are needed to guide prevention and treatment.

Copyright 2011, Elsevier Science


Nappo SA; Sanchez Z; De Oliveira LG. Crack, AIDS, and women in Sao Paulo, Brazil. Substance Use & Misuse 46(4): 476-485, 2011. (43 refs.)

Brazil is currently experiencing a growing number of newly recorded cases of HIV infection among women, with transmission mainly occurring by sex. This increase may be associated with the development of sexually risky behavior among female crack users who, according to informal reports, prostitute themselves for drugs or for money to be used for buying drugs. Since epidemiologic studies have not yet addressed this phenomenon, the aim of this study was to investigate this in depth using a qualitative ethnographic approach. An intentional sample was utilized, composed of 75 female crack users in Sao Paulo, who were selected by specific criteria using the snowball strategy and key informants. Fourteen different chains of users were investigated, allowing us to include the largest possible number and variety of users. Each participant was submitted to a semi-structured in-depth interview that was guided by a questionnaire. Verbal information was corroborated and extended using participative observation. These 14-45-year-old women, who had little schooling and no job connections, opted to sell their bodies as a strategy to obtain drugs and to satisfy their compulsive use of crack. The subjects engaged in up to nine acts of sexual intercourse per day, in unsafe locations and with multiple partners who were approached in a besieging way and selected using subjective criteria. These crack users generally exchanged sex under craving for ridiculously low prices and left the use of protection up to the client. Because the users used inadequate pipes to smoke crack, it was common for them to have lesions on their lips and mouths. Since they often provided oral sex, they exposed themselves to considerable risk for infection with STDs including HIV, because of the contact of their partners" semen with their open wounds. These women make up an important risk group with respect to the transmission of STDs including AIDS.

Copyright 2011, Informa Healthcare


Padilla MB; Guilamo-Ramos V; Godbole R. A syndemic analysis of alcohol use and sexual risk behavior among tourism employees in Sosua, Dominican Republic. Qualitative Health Research 22(1, special issue): 89-102, 2012. (57 refs.)

The Dominican Republic has high rates of HIV infection and alcohol consumption. Unfortunately, little research has been focused on the broader sources of the synergy between these two health outcomes. We draw on syndemic theory to argue that alcohol consumption and sexual risk behavior are best analyzed within the context of culture and economy in Caribbean tourism spaces, which produce a synergy between apparently independent outcomes. We sampled 32 men and women working in the tourism industry at alcohol-serving establishments in SosAa, Dominican Republic. Interviewees described alcohol consumption as an implicit requirement of tourism work, tourism industry business practices that foster alcohol consumption, and an intertwining relationship between alcohol and sexual commerce. The need to establish relationships with tourists, combined with the overconsumption of alcohol, contributed to a perceived loss of sexual control, which participants felt could impede condom use. Interventions should incorporate knowledge of the social context of tourism areas to mitigate the contextual factors that contribute to HIV infection and alcohol consumption among locals.

Copyright 2012, Sage Publications


Pollini RA; Gallardo M; Hasan S; Minuto J; Lozada R; Vera A et al. High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico. International Journal of Infectious Diseases 14(Supplement 3): E117-E122, 2010. (38 refs.)

Background: Soft tissue infections are common among injection drug users (IDUs), but information on correlates and treatment in this highly marginalized population is lacking. Methods: Six hundred twenty-three community-recruited IDUs in Tijuana, Mexico, completed a detailed interview on abscess history and treatment. Univariate and multiple logistic regressions were used to identify factors independently associated with having an abscess in the prior 6 months. Results: Overall, 46% had ever had an abscess and 20% had had an abscess in the past 6 months. Only 12% had sought medical care for their most recent abscess; 60% treated the abscess themselves. The most common self-treatment method was to apply heated (24%) or unheated (23%) Aloe vera leaf. Other methods included draining the wound with a syringe (19%) or knife (11%). Factors independently associated with recent abscess were having income from sex work (adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI) 2.08-10.00), smoking methamphetamine (aOR 1.65, 95% CI 1.05-2.62), seeking someone to help with injection (aOR 2.06, 95% CI 1.18-3.61), and reporting that police affected where they used drugs (aOR 2.14, 95% CI 1.15-3.96). Conclusions: Abscesses are common among IDUs in this setting, but appropriate treatment is rare. Interventions to reduce barriers to medical care in this population are needed. Research on the effectiveness of Aloe vera application in this setting is also needed, as are interventions to provide IDU sex workers, methamphetamine smokers, and those who assist with injection with the information and equipment necessary to reduce abscess risk.

Copyright 2010, Elsevier Science


Reid JA. An exploratory model of girl's vulnerability to commercial sexual exploitation in prostitution. Child Maltreatment 16(2): 146- 157, 2011. (68 refs.)

Due to inaccessibility of child victims of commercial sexual exploitation, the majority of emergent research on the problem lacks theoretical framing or sufficient data for quantitative analysis. Drawing from Agnew's general strain theory, this study utilized structural equation modeling to explore: whether caregiver strain is linked to child maltreatment, if experiencing maltreatment is associated with risk-inflating behaviors or sexual denigration of self/others, and if these behavioral and psychosocial dysfunctions are related to vulnerability to commercial sexual exploitation. The proposed model was tested with data from 174 predominately African American women, 12% of whom indicated involvement in prostitution while a minor. Findings revealed child maltreatment worsened with increased caregiver strain. Experiencing child maltreatment was linked to running away, initiating substance use at earlier ages, and higher levels of sexual denigration of self/others. Sexual denigration of self/others was significantly related to the likelihood of prostitution as a minor. The network of variables in the model accounted for 34% of the variance in prostitution as a minor.

Copyright 2011, Sage Publications


Rodriguez DC; Krishnan AK; Kumarasamy N; Krishnan G; Solomon D; Johnson S et al. Two sides of the same story: Alcohol use and HIV risk taking in South India. AIDS and Behavior 14(Supplement 1): 136-146, 2010. (43 refs.)

This qualitative study examines the role of alcohol in sexual risk among male migrant workers and female sex workers in two South Indian states. Most men reported using alcohol for increased energy and courage prior to their sexual experiences and to reduce feelings of loneliness and isolation. Sex workers, on the other hand, often stated that they avoided alcohol prior to sex in order to stay alert and reduce the risk of violence. Both groups reported that drinking often increased male aggression and reduced condom use. Research is needed to examine the prevalence of these patterns as well as factors associated with sexual risk and violence, in order to develop targeted interventions for these groups. Future risk reduction programs may benefit from addressing safer ways of meeting the needs expressed by the participants. This may include strategies to defuse volatile situations, safe ways of improving the sexual experience, and interventions aimed at alleviating loneliness and isolation for migrants.

Copyright 2010, Springer Press


Sallmann J. Going hand-in-hand : Connections between women's prostitution and substance use. Journal of Social Work Practice in the Addictions 10(2): 115-138, 2010

Little is known about the impact of prostitution involvement on women's substance use and recovery. Interpretive phenomenological data analysis was used to analyze transcribed, in-depth interviews conducted with 14 women recruited from a Midwestern program providing prostitution-specific services. Interviews focused on what it means to be a woman who has engaged in prostitution. Participants described patterns of using substances and exchanging sex as going hand-in-hand, highlighting unique ways women understand the relationships between these phenomena and how they construct meaning. What emerges is a deeper understanding of the complexity and impact of these relationships, an issue not adequately addressed in existing literature.

Copyright 2010, Routledge


Samet JH; Pace CA; Cheng DM; Coleman S; Bridden C; Pardesi M et al. Alcohol use and sex risk behaviors among HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in India. AIDS and Behavior 14(Supplement 1): 74-83, 2010. (42 refs.)

Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Given alcohol's association with risky sex in other populations and alcohol's role in HIV disease progression, we investigated patterns of alcohol use in HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in Mumbai. Analyses identified factors associated with heavy alcohol use and evaluated the relationship between alcohol use and risky sex. We surveyed 211 female and 205 male individuals; 80/211 FSWs (38%) and 127/205 male clients (62%) drank alcohol in the last 30 days. Among females, 32 and 11% drank heavily and were alcohol-dependent, respectively; among males the respective proportions were 44 and 29%. Men's heavy alcohol use was significantly associated with inconsistent condom use over the last year (AOR 2.40, 95% CI 1.21-4.77, P = 0.01); a comparable association was not seen in women. These findings suggest a need to address alcohol use both to avoid the medical complications of its heavy use in this population and to mitigate inconsistent condom use, the latter issue possibly requiring gender specific approaches. Such efforts to reduce drinking will be an important dimension to secondary HIV prevention in India.

Copyright 2010, Springer Press


Semple SJ; Strathdee SA; Zians J; Patterson TL. Correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual methamphetamine users. Journal of Psychoactive Drugs 43(2): 79-88, 2011. (66 refs.)

While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, hinging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.

Copyright 2011, Haight-Ashbury Publishing


Semple SJ; Strathdee SA; Zians J; Patterson TL. Social and behavioral characteristics of HIV-positive men who trade sex for methamphetamine. American Journal of Drug and Alcohol Abuse 36(6): 325-331, 2010. (33 refs.)

Background: Previous research among drug-using men who have sex with men (MSM) indicates that trading sex for methamphetamine may be common. Objectives: This study identified background characteristics, substance use variables, contextual factors, and sexual risk behaviors associated with trading sex for methamphetamine in a sample of HIV-positive MSM. Baseline data were gathered from 155 participants who were enrolled in a sexual risk-reduction intervention. Logistic regression was used to compare MSM who traded sex for methamphetamine with men who did not. Results: Forty-three percent of the sample reported trading sex for methamphetamine in the past 2 months. Trading sex for methamphetamine was associated with being a binge user, homelessness, having an income of less than $20,000 per year, being less assertive at turning down drugs, engaging in more anal sex without a condom, and seeking out risky sex partners when high on methamphetamine. Conclusions and Scientific Significance: These data suggest that the trading of sex for methamphetamine may be a primary source of new HIV infections within and outside of the MSM community, necessitating targeted interventions with this vulnerable subgroup.

Copyright 2010, Taylor & Francis


Sherman SG; Reuben J; Chapman CS; Lilleston P. Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD. Drug and Alcohol Dependence 114(2-3): 249- 252, 2011. (20 refs.)

Background: There is a dearth of research focusing on sex work in exotic dance clubs. We conducted a cross-sectional study to examine the prevalence and correlates of crack cocaine smoking among a sample of exotic dancers. Methods: The "block," a historical red-light district in downtown Baltimore, MD, is comprised of 30 adult-entertainment establishments. Between 01/09 and 08/09, we conducted a survey with exotic dancers (N = 98). The survey explored demographic, and drug and sexual/drug risk behaviors. Bivariate and multivariate analysis was conducted using Poisson regression with robust variance estimates to examine correlates of current crack smoking. Results: Crack cocaine smokers compared to non-crack cocaine smokers were significantly more likely to report: older age (29 vs. 23 years, respectively, p < 0.0001); being White (79% vs. 50%, respectively, p = 0.008); having been arrested (93% vs. 67%, respectively, p = 0.008); daily alcohol consumption (36% vs. 17%, p = 0.047); current heroin injection (57% vs. 13%, p < 0.001); and current sex exchange (79% vs. 30%, p < 0.001). In the presence of other variables, crack cocaine smokers compared to non-crack cocaine smokers were significantly older, more likely to report current heroin injection, and more likely to report current sex exchange. Discussion: We found high levels of drug use and sexual risk behaviors as well as a number of risks behaviors associated with crack cocaine smoking among this very under-studied population. Targeted interventions are greatly needed.

Copyright 2011, Elsevier Science


Sirotin N; Strathdee SA; Lozada R; Nguyen L; Gallardo M; Vera A; Patterson TL. A comparison of registered and unregistered female sex workers in Tijuana, Mexico. Public Health Reports 125(Supplement 4): 101-109, 2010. (44 refs.)

Objective. Sex work is regulated in Tijuana, Mexico, but only half of the city's female sex workers (FSWs) are registered with the municipal health department, which requires regular screening for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). We examined correlates of registration to determine if it confers measurable health benefits. Methods. From 2004 to 2006, we interviewed FSWs in Tijuana >= 18 years of age who reported recent unprotected sex with at least one client and were not knowingly HIV-positive, and tested them for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with registration. Results. Of 410 FSWs, 44% were registered, 69% had been tested for HIV, 6% were HIV-positive, and 44% tested positive for any STI. Compared with unregistered FSWs, registered FSWs were more likely to have had HIV testing (86% vs. 56%, p<0.001) and less likely to test positive for any STI (33% vs. 53%, p<0.001) or HIV (3% vs. 8%, p=0.039). Factors independently associated with registration included ever having an HIV test (adjusted odds ratio [AOR] = 4.19) and earning >$30 per transaction without a condom (AOR=2.41), whereas working on the street (AOR=0.34), injecting cocaine (AOR=0.06), snorting or smoking methamphetamine (AOR=0.27), and being born in the Mexican state of Baja California (AOR=0.35) were inversely associated with registration. Conclusion. Registered FSWs were more likely than unregistered FSWs to have had HIV testing and to engage in less drug use, but did not have significantly lower HIV or STI prevalence after adjusting for confounders. Current regulation of FSWs in Tijuana should be further examined to enhance the potential public health benefits of registration.

Copyright 2010, Association of Schools of Public Health


Sloss CM; Harper GW. Legal service needs and utilization of women who trade sex. Sexuality Research and Social Policy 7(3): 229-241, 2010. (51 refs.)

Women who trade sex for money or drugs experience extensive victimization and criminalization and could benefit from legal services. In this study, 91 women currently trading sex disclosed experiences of community, intimate partner, societal, and police abuse, and a history of arrests and incarcerations. The majority of respondents indicated a need for services to help with abuse, violence, and/or legal problems, yet they reported a low perceived need and even lower use of legal services. The women revealed a higher tendency of disclosing their legal and abuse history to spiritual, mental health, and addiction service providers, than to legal service providers. The most frequently reported barrier to their legal service utilization was mistrust of the police and legal system, in part due to prior negative experiences and their own criminal status. Other barriers included fearing and protecting their perpetrators, wanting privacy, and using substances. The implications of the criminalization of sex work are discussed with regard to its impact on female sex traders' vulnerability to abuse and their use of legal services.

Copyright 2010, Springer


Su JR; Berman SM; Davis D; Weinstock HW; Kirkcaldy RD. Congenital syphilis --- United States, 2003--2008. MMWR. Morbidity and Mortality Weekly Review 59(14): 413-417, 2010. (9 refs.)

To assess recent trends in congenital syphilis (CS) rates, CDC analyzed national surveillance data from the period 2003--2008. This report summarizes the results of that analysis, which indicated that, after declining for 14 years, the CS rate among infants aged <1 year increased 23%, from 8.2 cases per 100,000 live births in 2005 to 10.1 during 2008. That increase followed a 38% increase in the P&S syphilis rate among females aged �10 years from 2004 to 2007. During 2005--2008, CS rates increased primarily in the South (from 9.6 per 100,000 live births to 15.7) and among infants born to black mothers (from 26.6 per 100,000 live births to 34.6). The increase in the CS incidence rate from 2005 to 2008 reflects an increase in the P&S syphilis rate among women in the United States. After declining from 17.3 cases per 100,000 in 1990 to 0.8 in 2004, the P&S syphilis rate among females increased, particularly in the South (1). In the South, CS rates increased among infants born to black mothers, reflecting the increase in P&S syphilis rates among black women. Recent increases in P&S syphilis among black women in the South have been linked to crack cocaine use and commercial sex work (2). Prevention of CS must rely on prevention of P&S syphilis among women. In 2008, infants of black mothers accounted for 50% of CS cases, infants of Hispanic mothers accounted for 31% of cases, and infants of white, Asian/Pacific Islander, and American Indian/Alaskan Native mothers accounted for 15%, 2%, and 1%, respectively. Of 431 CS cases reported in 2008, mothers of 125 (29%) infants did not receive prenatal care, and syphilis infection was detected at delivery (Table 2). Among 276 CS cases in which the mother received prenatal care, in 75 (27%) cases mothers were first screened for syphilis �30 days of delivery, and in 67 (24%) cases mothers screened positive >30 days before delivery but were untreated. These 2008 data were similar to those reported for 2003 and 2005. In 2008, 25 (6%) infants with CS were stillborn, and three (1%) died �30 days of delivery, for a case fatality ratio of 6.5%. In 2003, 29 (7%) infants with CS were stillborn, and four (1%) died �30 days of delivery, for a case fatality ratio of 7.6%. In 2008, only 64% of mothers of infants with CS received prenatal care, a percentage virtually unchanged from 2003 and 2005.

Public Domain


Townsend L; Ragnarsson A; Mathews C; Johnston LG; Ekstrom AM; Thorson A; Chopra M. "Taking Care of Business": Alcohol as currency in transactional sexual relationships among players in Cape Town, South Africa. Qualitative Health Research 21(1): 41-50, 2011. (42 refs.)

In this article we examine the dynamics of social relationships in which alcohol use and risky sexual behaviors cooccur. As part of a larger biological and behavioral HIV surveillance survey, 20 men who lived in an urban, informal settlement on the outskirts of Cape Town, South Africa participated in in-depth interviews. Interview transcripts were analyzed according to a latent content analysis. Findings highlight the latent association between alcohol and transactional sex, and enable an in-depth examination of the normative role that alcohol plays in the formation of casual sexual partnerships characterized by exchange. We build on an existing conceptual model that traces the potential pathways by which alcohol use and transactional sex are linked to sexual risk behaviors. The study findings point to the need for multilevel HIV risk-reduction interventions among men to reduce excessive alcohol use, risky sexual behaviors, and underlying perceptions of ideal masculinity.

Copyright 2011, Sage Publications


Tripathi BM; Sharma HK; Pelto PJ; Tripathi S. Ethnographic mapping of alcohol use and risk behaviors in Delhi. AIDS and Behavior 14(Supplement 1): 94-103, 2010. (22 refs.)

This paper examines mapping and related data-gathering at geographical locations of vulnerable urban groups with regard to risky sexual behaviors and alcohol/drug use in the capital city of Delhi. The aim is to describe the situations of special geographic locations and sub-groups in relation to alcohol/drug use and risks of HIV/STI infections. The study was part of a community program for alcohol and drug users in slum communities in West and East Delhi carried out by the National Drug Dependence Treatment Centre (NDDTC) of the All India Institute of Medical Science (AIIMS), New Delhi, India. As part of a WHO multi-centered qualitative study among selected groups, mapping was done at different sites concerning alcohol use, social contexts, involvement in sexual risk behavior, availability of sex partners and related factors. Easy access to alcohol and drugs, accompanied by availability of sex workers appeared as compound risk factors in the study sites. Reported risky sexual behaviors included nonuse or irregular use of condoms, multiple sex partners, group sex, and anal sex with hijras (eunuchs).

Copyright 2010, Springer Press


Ulibarri MD; Strathdee SA; Ulloa EC; Lozada R; Fraga MA; Magis-Rodriguez C et al. Injection drug use as a mediator between client-perpetrated abuse and HIV status among female sex workers in two Mexico-US border cities. AIDS and Behavior 15(1): 179-185, 2011. (42 refs.)

We examined relationships between client-perpetrated emotional, physical, and sexual abuse, injection drug use, and HIV-serostatus among 924 female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico-US border cities. We hypothesized that FSWs' injection drug use would mediate the relationship between client-perpetrated abuse and HIV-seropositivity. The prevalence of client-perpetrated emotional, physical, and sexual abuse in the past 6 months was 26, 18, and 10% respectively; prevalence of current injection drug use and HIV was 12 and 6%, respectively. Logistic regression analyses revealed that client-perpetrated sexual abuse was significantly associated with HIV-seropositivity and injection drug use, and that injection drug use was positively associated with HIV-seropositivity. Injection drug use partially mediated the relationship between client-perpetrated sexual abuse and HIV-seropositivity. Results suggest the need to address client-perpetrated violence and injection drug use when assessing HIV risk among FSWs.

Copyright 2011, Springer


van Veen MG; Gotz HM; van Leeuwen PA; Prins M; van de Laar MJW. HIV and sexual risk behavior among commercial sex workers in the Netherlands. Archives of Sexual Behavior 39(3): 714-723, 2010. (51 refs.)

In 2002-2005, a cross-sectional study to assess the potential for HIV transmission was carried out among 557 female and male-to-female transgender commercial sex workers (CSW) in three cities in the Netherlands. Female CSW (F-CSW), drug-using female CSW (DU), and transgender sex workers were recruited in street-based and establishment-based sites. An anonymous questionnaire was administrated by interviewers and a saliva sample was collected for HIV antibody testing. The overall HIV prevalence was 5.7% (31/547; 10 samples were excluded because of "intermediate" test results). HIV was more prevalent among transgender (18.8%, 13/69) and DU (13.6%, 12/88) sex workers than among F-CSW (1.5%, 6/390). Of the HIV positive CSW, 74% were unaware of their infection. Consistent condom use with clients was 81%. Regular condom failure with clients was reported by 39%. In multivariate analyses, transgender sex workers (OR = 22.9), drug-using CSW who ever injected drugs (OR = 31.1), African (OR = 19.0), and South European ethnicity (OR = 7.2) were independently associated with HIV. Condom failure (PRR = 2.0), anal sex (PRR = 2.1), and drug use (PRR = 3.8) were associated with inconsistent condom use with clients. There is a potential risk for further spread of HIV, through clients and (private) partners of sex workers, to the general population. Targeted health promotion activities are indicated for transgender sex workers and drug-using female CSW; active HIV testing must be continued.

Copyright 2010, Springer


Wang HB; Brown KS; Wang GX; Ding GW; Zang CP; Wang JJ et al. Knowledge of HIV seropositivity is a predictor for initiation of illicit drug use: Incidence of drug use initiation among female sex workers in a high HIV-prevalence area of China. Drug and Alcohol Dependence 117(2-3): 226-232, 2011. (30 refs.)

Background: Drug use and sex work have had facilitative roles in the transmission of HIV/AIDS in China. Stopping drug use among sex workers may help to control the growth of the HIV/AIDS epidemic among Chinese sex workers. Methods: From March 2006 to November 2009, female sex workers (FSW) in Kaiyuan City, Yunnan, China were recruited into an open cohort study. Participants were interviewed and tested for drug use and HIV/sexually transmitted infection (STI) prevalence. Follow-up surveys were conducted every six months. Multivariate Cox proportional hazards regression model with time dependent variables was used to measure the associations between independent variables and drug initiation. Results: During the course of the study, 66(8.8%) FSWs initiated drug use yielding an overall incidence of 6.0 per 100 person years (PY) (95% confidence interval [CI], 4.67-7.58). In the multivariate Cox proportional hazards regression model, being HIV-positive and aware of positive serostatus (adjusted hazard ratio [AHR] 2.6, 95% Cl 1.24-5.55), age at initiation of commercial sex work <20 years (AHR 1.8, 95% CI 1.12-3.01), and working in a high-risk establishment (AHR 1.9, 95% CI 1.14-3.04) were associated with illicit drug initiation. Conclusions: Being HIV-positive and aware of positive serostatus was the most salient predictor for the initiation of illicit drug use. Interventions offering sources of education, treatment, support, and counseling to HIV-positive FSWs need to be implemented in order to help promote self-efficacy and safe behaviors among this group of high-risk women.

Copyright 2011, Elsevier Science


Washington TA; Brocato J. Exploring the perspectives of substance abusing Black men who have sex with men and women in addiction treatment programs: A need for a human sexuality educational model for addiction professionals. American Journal of Men's Health 5(5): 402-412, 2011. (75 refs.)

This study examined the perspectives of African American male injection drug users who have sex with both men and women (IDU-MSM/W) and who are involved in sex trade regarding the need for a human sexuality educational model (HSEM) for addiction professionals. Focus groups were conducted involving an exploratory sample (N = 105) of men who met the following parameters: aged 18 to 40 years, African American, engage in injection drug using behavior, have sex with male and female partners, and who frequent parks and other sex working areas in Baltimore City and surrounding areas. Data suggest that an HSEM may be useful for addiction professionals who work with substance abusing Black MSM/W. Moreover, the model should include opportunities for addiction professionals to (a) identify their personal biases about homosexuality in general (acknowledging personal biases so not to allow those personal biases to influence service); (b) understand the diversity within the Black MSM/W community (e.g., challenge assumptions that all Black MSM/W self-identify as gay); (c) understand how to, and the need for, assessing sexual trauma in Black MSM/W; and (d) understand the need to incorporate risk factors and safer sex practices that may be of concern to a subpopulation of Black MSM/W, such as "barebacking." These findings suggest the need for, and topics to include in, an HSEM that assists professionals with exploring their biases about sexuality and MSM/W and better prepares counselors to address HIV prevention and risky behavior using language that is appropriate for the Black IDU-MSM/W population.

Copyright 2011, Sage Publications


Whitaker T; Ryan P; Cox G. Stigmatization among drug-using sex workers accessing support services in Dublin. Qualitative Health Research 21(8): 1086-1100, 2011. (66 refs.)

Findings from 35 qualitative interviews with drug users who were engaging in or who had engaged in sex work in Dublin, Ireland, illuminated how, because of a result of felt stigma and internalized shame, they tried to hide their drug use, thus endangering their own lives. This group carried multiple layers of stigma because of sex work, drug use (including injecting drug use), and having contracted human immunodeficiency virus (HIV) or hepatitis C virus (HCV). This stigma was powerfully reinforced by the language routinely used by health professionals. To improve the effectiveness of harm-reduction interventions, it is recommended that service providers change their language, in particular in recognition of the human dignity of these clients, but also to help attract and retain drug users in services, and to help reduce the unacceptable mortality levels among drug users.

Copyright 2011, Sage Publications