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CORK Bibliography: Prostitution

40 citations. January 2009 to present

Prepared: March 2011

Beckerleg S. Khat chewing as a new Ugandan leisure activity. Journal of Eastern African Studies 3(1): 42-54, 2009. (27 refs.)

A culture of hedonism that attaches a high value to leisure has prevailed in much of Uganda. Having in the past been associated only with Somali and Yemeni migrants, khat consumption has spread among all ethnic groups and to all parts of Uganda. The locus of consumption has moved from the living room to video halls, alleyways and the ghettos of both urban and rural areas. Khat chewing, which takes several hours if the full sequence of effects is to be achieved, is viewed as idling by mainstream society, and as an affront to the core Ugandan values of hard work and education. There are two types of consumer: 1) the traditional users, maqatna, who chew khat accompanied by soft drinks; 2) the mixers who combine khat sessions with alcohol and/or cannabis use. The mixers have abandoned the rules and rituals of consumption that pertain in other khat-using settings. Many Ugandans confuse cannabis and khat, condone alcohol use, and brand khat chewers as, at best, idlers, and at worst violent criminals.

Bobashev GV; Zule WA; Osilla KC; Kline TL; Wechsberg WM. Transactional sex among men and women in the south at high risk for HIV and other STIs. Journal of Urban Health 86(Special Issue, Supplement 1): S32-S47, 2009. (48 refs.)

Transactional sex refers to selling sex (exchanging sex for money, drugs, food, shelter, or other items) or purchasing sex (exchanging money, drugs, food, shelter, or other items for sex). These activities have been associated with a higher risk for HIV and other sexually transmitted infections in a variety of populations and settings. This paper examines correlates of purchasing and selling sex in a large sample of drug users, men who have sex with men, and sex partners of these groups. Using respondent-driven sampling, participants were recruited between 2005 and 2008 in two urban and two rural counties in North Carolina. We used multiple logistic regressions to examine separate models for selling and purchasing sex in men and women. In addition, we estimated direct and indirect associations among independent variables in the logistic regression models and transactional sex using structural equation models. The analysis shows that factors associated with women selling and buying sex include being homeless, use of stimulants, bisexual behavior, and neighborhood disorder. There was also a significant difference by race. For men, the factors associated with selling and buying sex include being homeless, bisexual behavior, and not being in a relationship. Although neighborhood violence and disorder show significance in bivariate associations with the outcome, these associations disappear in the structural equation models.

Burnette ML; Schneider R; Timko C; Ilgen MA. Impact of substance-use disorder treatment on women involved in prostitution: Substance use, mental health, and prostitution one year after treatment. Journal of Studies on Alcohol and Drugs 70(1): 32-40, 2009. (30 refs.)

Objective: Prostitution is common among women with substance-use disorders (SUDs). However, little is known about the outcomes of SUD treatment for women involved in prostitution relative to their peers or the impact of SUD treatment on subsequent prostitution. Method: Participants were 1,287 women from a national study of SUD treatment sites. Women completed a baseline interview at entry to SUD treatment and a follow-up interview roughly I year after discharge. We compared the substance-related and mental health outcomes at follow-up of women involved in prostitution and women not involved in prostitution, and determined if prostitution declined significantly at follow-up. Among women reporting prostitution at baseline (n = 533), we examined whether receipt of specific ancillary services (medical, mental health, psychosocial) was associated with cessation of prostitution and whether cessation of prostitution was associated with better substance-related and mental health outcomes. Results: Women reporting prostitution at baseline had more frequent drug and alcohol use, reduced abstinence rates, and more mental health symptoms at follow-up compared with their peers. However, the rate of prostitution declined from baseline to follow-up. Receipt of more mental health and psychosocial services during treatment was associated with the cessation of prostitution at follow-up, and cessation of prostitution was associated with lower substance use, higher rates of abstinence, and fewer mental health symptoms at follow-up. Conclusions: Comprehensive services may be needed to effect significant reductions in substance use and mental health symptoms among women engaged in prostitution.

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.

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 , 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.

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.

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.

Draus PJ; Carlson RG. "The Game Turns on You:" Crack, sex, gender, and power in small-town Ohio. Journal of Contemporary Ethnography 38(3): 384-408, 2009

Exchanges of sex for crack cocaine have received much attention from public health researchers and ethnographers of substance abuse. These exchanges are often viewed as one-dimensional relationships in which men use their access to crack cocaine and women's dependence on the drug to exploit them sexually. Drawing on in-depth interview data gathered during three years of research conducted in central Ohio, this article examines the relationship between sexual behavior and crack cocaine use from both male and female perspectives. Bourdieu's concept of fields is then applied to illuminate the relational dimensions of gender, sex, and power within this local crack-cocaine using scene, while also illustrating the domination inherent in most scenarios involving crack-for-sex exchange. Implications for possible interventions based on this analysis are also discussed.

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.

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 , 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.

Galvan FH; Ortiz DJ; Martinez V; Bing EG. The use of female commercial sex workers' services by Latino day laborers. Hispanic Journal of Behavioral Sciences 31(4): 553-575, 2009. (44 refs.)

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was used. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day laborers reported having had sex with a CSW in the previous 12 months. A lower likelihood of having sex with a CSW was found for those with more than 6 years of education and for those who were married and living with their spouses. A higher likelihood of having sex with a CSW was found for those who met the criteria for harmful drinking or drug dependence. Commercial sex work has been associated with sexually transmitted infections and other problems among clients of CSWs and warrants further attention by providers working with day laborers.

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.

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.

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.

Kerr T; Marshall BDL; Miller C; Shannon K; Zhang R; Montaner JSG et al. Injection drug use among street-involved youth in a Canadian setting. BMC Public Health 9: article 171, 2009. (48 refs.)

Background: Street-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality. In addition, there has been growing concern regarding high-risk drug use among street-involved youth, in particular injection drug use. We undertook this study to examine the prevalence of injection drug use and associated risks among street-involved youth in Vancouver, Canada. Methods: 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 to 26 in Vancouver, Canada. Using multiple logistic regression, we compared youth with and without a history of injection. Results: The sample included 560 youth among whom the median age was 21.9 years, 179 (32%) were female, and 230 (41.1%) reported prior injection drug use. Factors associated with injection drug use in multivariate analyses included age >= 22 years (adjusted odds ratio [AOR] = 1.18, 95% CI: 1.10-1.28); sex work involvement (AOR = 2.17, 95% CI: 1.35-3.50); non-fatal overdose (AOR = 2.10, 95% CI: 1.38-3.20); and hepatitis C (HCV) infection (AOR = 22.61, 95% CI: 7.78-65.70). Conclusion: These findings highlight an alarmingly high prevalence of injection drug use among street-involved youth and demonstrate its association with an array of risks and harms, including sex work involvement, overdose, and HCV infection. These findings point to the need for a broad set of policies and interventions to prevent the initiation of injection drug use and address the risks faced by street-involved youth who are actively injecting.

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.

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.

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.

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.

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 , 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.

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.

Mosedale B; Kouimtsidis C; Reynolds M. Sex work, substance misuse and service provision: The experiences of female sex workers in south London. Drugs: Education, Prevention and Policy 16(4): 355-363, 2009. (14 refs.)

Background: Observations suggest that patterns of drug use may be changing among sex workers and that service provision may be failing this group. The aim of this study was to investigate life, substance-related, and service-provision experiences of women who are both substance users and involved in sex work. Methods: The study was carried out using unstructured recorded confidential interviews and analysis of the themes arising from them. Results: Twelve women were interviewed. Most of them came from an abusive background. There is a vicious circle between sex working and taking drugs-sex work generates funds and drugs facilitate continuation of work. The emergence of crack cocaine was consistently significant. Conclusion: Experiences of the women discussed here are not new and confirm existing knowledge. Important issues related to service provision were discussed. Flexible services are necessary to attract, engage and support this vulnerable group.

Norris AH; Kitali AJ; Worby E. Alcohol and transactional sex: How risky is the mix? Social Science & Medicine 69(8): 1167-1176, 2009. (40 refs.)

This study examines alcohol use, transactional sex (TS), and sexually transmitted infection (STI) risk among sugar plantation residents near Moshi, Tanzania, from 2002 to 2004. We compare popular discourse gathered through ethnographic methods with cross-sectional questionnaire and STI prevalence data to illuminate the close correspondence of alcohol use and TS with STI transmission. People attributed to alcohol varied consequences: some socially desirable (relaxing, reducing worries) and others (drunkenness, removing shame) thought to put alcohol abusers at risk for STIs. TS-exchanging money, food, gifts, alcohol or work for sex-was not stigmatized, but people believed that seeking sexual partners for money (or providing money to sexual partners) led to riskier sexual relationships. We explore popular discourse about how alcohol use and TS independently and in combination led to increased STI exposure. Popular discourse blamed structural circumstances-limited economic opportunities, few social activities, separated families-for risky sex and STIs. To understand individual behavior and risk, we surveyed 556 people. We measured associations between their self-reported behaviors and infection with herpes simplex virus type-2 (HSV-2), syphilis, and HIV in 462 participants who were tested. Alcohol abuse was associated with prevalent STI and HIV infection. Exchanging sex for alcohol and work were both associated with prevalent STI. Participants who both abused alcohol and participated in TS had greatest risk for STI. Findings from the two analytic methods-interrogation of popular discourse, and association between self-reported behavior and STIs-were largely in agreement. We posit explanations for discrepancies we found through the concepts of sensationalization, self-exceptionalization, and the influence of an authoritative moral discourse.

Ohlund LS; Gronbladh L. Patterns of deviant career in the history of female methadone clients: an exploratory study. International Journal of Social Welfare 18(1): 95-101, 2009. (27 refs.)

The aim of this article is to describe the drug career of 71 severely opioid-dependent women who had a history of selling sex and were enrolled in methadone maintenance treatment. Data were collected through semi-structured interviews, from medical records and reports from social agencies and correctional institutions. The sequential pattern could be described in the following order: initiation of the first drug of abuse, opioid onset, initiation of selling sex, first non-methadone treatment episode, first sentence and, finally, methadone maintenance treatment. There were significant age differences and correlations between most of the events. The main correlation (r = 0.70) was the one between debut of opioid use and selling sex, which was confirmed in a stepwise multiple regression analysis. In addition, a history of running away from home advanced the age at which the women started selling sex for those with an onset of opioid use at an older age than the mean of 18.4 years.

Parry CDH; Dewing S; Petersen P; Carney T; Needle R; Kroeger K et al. Rapid assessment of HIV risk behavior in drug using sex workers in three cities in South Africa. AIDS and Behavior 13(5): 849-859, 2009. (40 refs.)

A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.

Patterson TL; Goldenberg S; Gallardo M; Lozada R; Semple SJ; Orozovich P et al. Correlates of HIV, sexually transmitted infections, and associated high-risk behaviors among male clients of female sex workers in Tijuana, Mexico. AIDS 23(13): 1763-1769, 2009. (30 refs.)

Objectives: To determine sociodemographic and behavioral correlates of HIV infection among male clients of female sex workers (FSWs) in Tijuana. Methods: Four hundred men aged 18 years or older who had paid or traded for sex with a FSW in Tijuana during the past 4 months were recruited in Tijuana's 'zone of tolerance,' where prostitution is practiced openly under a Municipal permit system. Efforts were made to balance the sample between residents of the United States (San Diego County) and of Mexico (Tijuana). Participants underwent interviews and testing for HIV, syphilis, gonorrhea, and Chlamydia. Logistic regression identified correlates of HIV infection. Results: Mean age was 36.6 years. One-quarter had injected drugs within the previous 4 months. Lifetime use of heroin, cocaine, and methamphetamine was 36, 50, and 64%), respectively. Men had frequented FSWs for an average of 11 years, visiting FSWs all average of 26 times last year. In the past 4 months, one-half reported having unprotected sex with a FSW; 46% reported being high fairly or very often when having sex with a FSW. Prevalence of HIV, syphilis, gonorrhea, and Chlamydia was 4, 2, 2.5, and 7.5%; 14.2% were positive for at least one infection. Factors independently associated with HIV infection were living in Mexico, ever using methamphetamine, living alone, and testing positive for syphilis. Conclusion: Male clients of FSWs in Tijuana had a high sex and drug risk profile. Although sexually transmitted infection prevalence was lower than among FSWs, HIV prevalence was comparable suggesting the need for interventions among clients to prevent spread of HIV and sexually transmitted infections.

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 , 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.

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.

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.

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.

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.

Shannon K; Kerr T; Strathdee SA; Shoveller J; Montaner JS; Tyndall MW. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. British Medical Journal 339(article b2939), 2009. (46 refs.)

Objective: To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution. Design: Prospective observational study. Setting Vancouver, Canada during 2006-8. Participants Female sex workers 14 years of age or older (inclusive of transgender women) who used illicit drugs (excluding marijuana) and engaged in street level sex work. Main outcome measure Self reported gender based violence. Results Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aOR(physicalviolence)) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aOR(rape)) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aOR(clientviolence)) 2.13, 1.26 to 3.62; aOR(physicalviolence) 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aOR(clientviolence) 1.50, 1.08 to 2.57); prior assault by police (aOR(clientviolence) 3.45, 1.98 to 6.02; aOR(rape) 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aOR(physicalviolence) 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aOR(clientviolence) 2.13, 1.26 to 3.62). Conclusions: Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender based violence against street based female sex workers. Socio-legal policy reforms, improved access to housing and drug treatment, and scale up of violence prevention efforts, including police-sex worker partnerships, will be crucial to stemming violence against female sex workers.

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.

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.

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).

Tyler KA. Risk factors for trading sex among homeless young adults. Archives of Sexual Behavior 38(2): 290-297, 2009. (30 refs.)

Although numerous homeless youth report trading sex, few studies have examined risk factors associated with trading sex and even fewer have employed multivariate analyses to examine this relationship, even though trading sex is associated with many negative health outcomes. Based on a sample of 151 homeless young adults in the midwestern United States, logistic regression analyses revealed that for each additional year of age, youth were 37% more likely to have traded sex (AOR = 1.37; 95% CI = .99-1.90). White youth were 84% less likely to have traded sex than non-white youth (AOR = .16; 95% CI = .03-.77). Furthermore, youth who had been employed full time were 80% less likely to have traded sex (AOR = .20; 95% CI = .05-.85). For every one unit increase in depressive symptoms, there was an 11% increase in the likelihood of ever having traded sex (AOR = 1.11; 95% CI = .99-1.24). Additionally, those who had friends who traded sex were approximately five times more likely to have ever traded sex themselves compared to those with no friends who had traded sex (AOR = 5.17; 95% CI = .95-28.12). Finally, youth who were propositioned to trade sex were almost five and one-half times more likely to have ever done so compared to youth who had not been propositioned (AOR = 5.45; 95% CI = 1.02-29.17). Overall, the results have important implications for the health and well-being of this high-risk population.

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.

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.

Wechsberg WM; Wu LT; Zule WA; Parry CD; Browne FA; Luseno WK et al. Substance abuse, treatment needs and access among female sex workers and non-sex workers in Pretoria, South Africa. Substance Abuse Treatment, Prevention and Policy 4: e-article 11, 2009. (29 refs.)

Background: This study examined cross-sectional data collected from substance-using female sex workers (FSW) and non-sex workers (non-SW) in Pretoria, South Africa, who entered a randomized controlled trial. Methods: Women who reported alcohol use and recently engaging in sex work or unprotected sex were recruited for a randomized study. The study sample (N = 506) comprised 335 FSW and 171 female non-SW from Pretoria and surrounding areas. Self-reported data about alcohol and other drug use as well as treatment needs and access were collected from participants before they entered a brief intervention. Results: As compared with female non-SW, FSW were found to have a greater likelihood of having a past year diagnosis of alcohol or other drug abuse or dependence, having a family member with a history of alcohol or other drug abuse, having been physically abused, having used alcohol before age 18, and having a history of marijuana use. In addition, the FSW were more likely to perceive that they had alcohol or other drug problems, and that they had a need for treatment and a desire to go for treatment. Less than 20% of participants in either group had any awareness of alcohol and drug treatment programs, with only 3% of the FSW and 2% of the non-SW reporting that they tried but were unable to enter treatment in the past year. Conclusion: FSW need and want substance abuse treatment services but they often have difficulty accessing services. The study findings suggest that barriers within the South African treatment system need to be addressed to facilitate access for substance-using FSW. Ongoing research is needed to inform policy change that fosters widespread educational efforts and sustainable, accessible, woman-sensitive services to ultimately break the cycle for current and future generations of at-risk South African women.