Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers

Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity ( p < .05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity ( p < .05). Binge drinking also appeared to be a contributing factor ( p < .05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.

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The DRD2 Taq1A polymorphism moderates the effect of PTSD symptom severity on the left hippocampal CA3 volume: a pilot study

Psychopharmacology ◽

10.1007/s00213-021-05882-z ◽

2021 ◽

Author(s):

Minlan Yuan ◽

Hongru Zhu ◽

Yuchen Li ◽

Fenfen Ge ◽

Su Lui ◽

...

Keyword(s):

Symptom Severity ◽

Ptsd Symptom ◽

Imaging System ◽

Dopamine D2 Receptor ◽

Magnetic Resonance Imaging System ◽

Hippocampal Function ◽

Hippocampal Ca3 ◽

Ptsd Symptom Severity ◽

Ptsd Symptomatology ◽

Ptsd Severity

Abstract Rationale and objectives The hippocampus, especially the CA1, CA3, and dentate gyrus (DG) subfields, is reported to be associated with post-traumatic stress disorder (PTSD) after trauma. However, neuroimaging studies of the associations between PTSD and hippocampal subfield volumes have failed to yield consistent findings. The aim of this study is to examine whether the dopamine D2 receptor (DRD2) Taq1A polymorphism, which is associated with both hippocampal function and PTSD, moderated the association between PTSD severity and hippocampal CA1, CA3 and DG volumes. Methods T1-weighted images were acquired from 142 trauma survivors from the 2008 Wenchuan earthquake using a 3.0-T magnetic resonance imaging system. Hippocampal subfield segmentations were performed with FreeSurfer v6.0. We used the simple moderation model from the PROCESS v3.4 tool for SPSS 23.0 to examine the association between the rs1800497 polymorphism, PTSD severity, and hippocampal CA3 and DG volumes. Results A significant genotype × PTSD symptom severity interaction was found for the left CA3 volume (ΔF = 5.01, p = 0.008, ΔR2 = 0.05). Post hoc, exploratory analyses deconstructing the interaction revealed that severe PTSD symptomatology were associated with reduced left CA3 volume among TC heterozygotes (t = − 2.86, p = 0.005). Conclusions This study suggests that DRD2 Taq1A polymorphism moderates the association between PTSD symptomatology and left CA3 volume, which promotes an etiological understanding of the hippocampal atrophy at the subfield level. This highlights the complex effect of environmental stress, and provides possible mechanism for the relationship between the dopaminergic system and hippocampal function in PTSD.

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Perpetration of Violence by Female Sex Workers in Papua New Guinea: ‘We will Crush their Bones’

The British Journal of Criminology ◽

10.1093/bjc/azaa058 ◽

2020 ◽

Vol 61 (1) ◽

pp. 104-122

Author(s):

Angela Kelly-Hanku ◽

H Worth ◽

M Redman-MacLaren ◽

S Nosi ◽

R Boli-Neo ◽

...

Keyword(s):

Papua New Guinea ◽

Sex Workers ◽

Female Sex Workers ◽

Physical Violence ◽

New Guinea ◽

Middle Income ◽

Middle Income Countries ◽

Female Sex ◽

Low And Middle Income

Abstract There is a small but important body of literature on female sex workers’ (FSWs) violence towards others, but little of that focused on low- and middle-income countries. Drawn from a larger biobehavioural study of FSWs in three cities in Papua New Guinea, we analyse the interviews from 19 FSWs who reported having perpetrated physical violence towards four major groups: (1) ex-husbands; (2) clients; (3) other sex workers and (4) other people (mainly women). Our study demonstrates that FSWs’ use of violence arises from a complex set of social, material and gendered circumstances and cannot be addressed in isolation from other aspects of their lives.

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Sexual and physical violence against female sex workers in Kenya: a qualitative enquiry

AIDS Care ◽

10.1080/09540121.2010.525605 ◽

2011 ◽

Vol 23 (5) ◽

pp. 612-618 ◽

Cited By ~ 58

Author(s):

Jerry Okal ◽

Matthew F. Chersich ◽

Sharon Tsui ◽

Elizabeth Sutherland ◽

Marleen Temmerman ◽

...

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

Physical Violence ◽

Female Sex

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Sexual and physical violence and associated factors among female sex workers in Rwanda: a cross-sectional survey

International Journal of STD & AIDS ◽

10.1177/0956462418800848 ◽

2018 ◽

Vol 30 (3) ◽

pp. 241-248 ◽

Cited By ~ 2

Author(s):

Mwumvaneza Mutagoma ◽

Laetitia Nyirazinyoye ◽

Dieudonné Sebuhoro ◽

David J Riedel ◽

Joseph Ntaganira

Keyword(s):

Sexual Violence ◽

Sex Workers ◽

Associated Factors ◽

Female Sex Workers ◽

Social Protection ◽

Physical Violence ◽

Cross Sectional Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Female Sex

Female sex workers (FSWs) frequently face violence in their working place. This study assessed the physical and sexual violence and associated factors among FSWs in Rwanda. A cross-sectional study was conducted among FSWs in Rwanda in 2015. Venue–Day–Time sampling method was used for recruitment. Descriptive analyses and logistic regression models were computed to assess factors associated with violence. In total, 1978 FSWs were recruited. A large proportion (18.3%) had been sexually abused outside of the family circle, and 37.8% had faced physical violence before 15 years of age. Clients were most often reported (67.0%) as perpetrators of physical violence in sex work. Being aged 25 years old and above, and having sexually transmitted infections (STIs) were positively associated with sexual violence (aOR = 2.1[95%CI: 1.80–2.39]) and (aOR = 3.0[95%CI: 1.01–2.14], respectively). Being aged 25 years old and above (aOR = 0.8[95%CI: 0.76–0.89]) and drinking alcohol every day (aOR = 0.6[95%CI: 0.42–0.87]) were negatively associated with physical violence. Sexual and physical violence was common among FSWs in Rwanda. Single FSWs are the most vulnerable to sexual violence. Alcohol consumption and having STIs are associated with violence against FSWs. Human rights and social protection as well as health promotion among FSWs is needed.

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Client-Initiated Violence Against Zambian Female Sex Workers: Prevalence and Associations With Behavior, Environment, and Sexual History

Journal of Interpersonal Violence ◽

10.1177/0886260519860083 ◽

2019 ◽

pp. 088626051986008 ◽

Cited By ~ 2

Author(s):

Kalonde Malama ◽

Luis Sagaon-Teyssier ◽

Rachel Parker ◽

Amanda Tichacek ◽

Tyronza Sharkey ◽

...

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

Physical Violence ◽

Sexual Debut ◽

Sexual History ◽

Sub Saharan Africa ◽

Gender Based Violence ◽

Cross Sectional ◽

Female Sex ◽

Male Clients

Violence against women is a known risk factor for HIV and affects female sex workers (FSW) in sub-Saharan Africa. Little is known about the magnitude and determinants of violence against FSW in Zambia, where HIV and gender-based violence prevalence are high. We conducted a cross-sectional study, using multivariable logistic regression, to determine the prevalence and correlates of client-initiated physical violence among 419 FSW in Lusaka and Ndola. The prevalence of client-initiated physical violence was 39%. The odds of violence were higher for FSW who: lived in Lusaka, recruited clients from the street, serviced clients in the clients’ homes, had a physically forced sexual debut, and had a higher client volume. Our results call for safer working spaces for FSW and violence prevention interventions for their male clients.

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Age differences in PTSD among Canadian veterans: age and health as predictors of PTSD severity

International Psychogeriatrics ◽

10.1017/s1041610214001884 ◽

2014 ◽

Vol 27 (2) ◽

pp. 297-304 ◽

Cited By ~ 3

Author(s):

Candace Konnert ◽

May Wong

Keyword(s):

Age Differences ◽

Symptom Severity ◽

Ptsd Symptom ◽

Age Groups ◽

Symptom Clusters ◽

Pain Severity ◽

Ptsd Symptoms ◽

Outpatient Services ◽

Ptsd Symptom Severity ◽

Ptsd Severity

ABSTRACTBackground:To date, few studies have investigated age differences in posttraumatic stress disorder (PTSD) symptoms and none has examined age differences across symptom clusters: avoidance, re-experiencing, and hyperarousal. The first objective of this study was to investigate age differences in PTSD and its three symptom clusters. The second objective was to examine age and indices of health as predictors of PTSD symptom severity.Methods:Participants were 104 male veterans, aged 22 to 87 years, receiving specialized mental health outpatient services. Assessments included measures of health-related quality of life, pain severity, number of chronic health conditions, and symptoms of PTSD, both in total and on the symptom clusters.Results:There were significant age differences across age groups, with older veterans consistently reporting lower PTSD symptom severity, both in total and on each of the symptom clusters. Hierarchical regression analyses indicated that the inclusion of health indices accounted for significantly more variance in PTSD symptoms over and above that accounted for by age alone. Pain severity was a significant predictor of PTSD total and the three symptom clusters.Conclusions: This is the first study to report lower levels of PTSD severity among older veterans across symptom clusters. These findings are discussed in relation to age differences in the experiencing and processing of emotion, autobiographical memory, and combat experiences. This study also emphasizes the importance of assessing pain in those with symptoms of PTSD, particularly older veterans who are less likely to receive specialized mental healthcare.

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Adverse Pregnancy Outcomes and Sexual Violence Among Female Sex Workers Who Inject Drugs on the United States–Mexico Border

Violence and Victims ◽

10.1891/0886-6708.11-00129 ◽

2013 ◽

Vol 28 (3) ◽

pp. 496-512 ◽

Cited By ~ 10

Author(s):

Lotus McDougal ◽

Steffanie A. Strathdee ◽

Gudelia Rangel ◽

Gustavo Martinez ◽

Alicia Vera ◽

...

Keyword(s):

Sexual Violence ◽

Sex Workers ◽

Female Sex Workers ◽

Physical Violence ◽

The United States ◽

Gender Based Violence ◽

Hiv Intervention ◽

Female Sex ◽

Male Clients ◽

History Of

This study examines the prevalence of miscarriage/stillbirth among female sex workers who inject drugs (FSW-IDUs) and measures its associations with physical and sexual violence. Baseline data from 582 FSW-IDUs enrolled in an HIV intervention study in Tijuana and Ciudad Juárez, Mexico were used for current analyses. 30% of participants had experienced at least one miscarriage/stillbirth, 51% had experienced sexual violence, and 49% had experienced physical violence. History of miscarriage/stillbirth was associated with sexual violence (adjusted odds ratio [aOR] = 1.7, p = .02) but not physical violence. Additional reproductive risks associated with miscarriage/stillbirth included high numbers of male clients in the previous month (aOR = 1.1 per 30 clients, p = 0.04), history of abortion (aOR = 3.7, p < .001), and higher number of pregnancies (aOR = 1.4 per additional pregnancy, p < .001). Programs and research with this population should integrate reproductive health and consider gender-based violence.

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Prevalence and correlates of physical violence and rape among female sex workers in Ethiopia: a cross-sectional study with respondent-driven sampling from 11 major towns

BMJ Open ◽

10.1136/bmjopen-2018-028247 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028247 ◽

Cited By ~ 2

Author(s):

Minilik Demissie Amogne ◽

Taye Tolera Balcha ◽

Anette Agardh

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

Physical Violence ◽

Red Light ◽

Cross Sectional Study ◽

Heavy Episodic Drinking ◽

Respondent Driven Sampling ◽

Sectional Study ◽

Cross Sectional ◽

Female Sex

ObjectiveThis study examined the prevalence and correlates of physical violence and rape among female sex workers (FSWs) in Ethiopia.DesignA cross-sectional study using respondent-driven sampling technique.SettingEleven major towns in Ethiopia.Participants4900 FSWs.Main outcome measuresThe prevalence of experiences of physical beating and rape.ResultsAmong FSWs, 17.5% reported physical beating within the last year and 15.2% reported rape since they started selling sex. FSWs aged 35+ years (AOR 0.59, 95% CI 0.38 to 0.92) were less exposed to physical beating than those aged 15–24 years. FSWs working on the street (AOR 1.92, 95% CI 1.53 to 2.39), in red-light houses (AOR 1.63, 95% CI 1.12 to 2.38) and in local drinking houses (AOR 1.35, 95% CI 1.02 to 1.78) experienced more physical beating than FSWs working in bars/hotels. FSWs who consumed alcohol four or more days in a week (AOR 1.92, 95% CI 1.21 to 3.04), and who chewed khat frequently experienced more physical violence. Rape was associated with having a low monthly income, drinking alcohol four or more days per week (AOR 2.33, 95% CI 1.47 to 3.7), experience of heavy episodic drinking in a month (AOR 1.71, 95% CI 1.24 to 2.38) and chewing khat 3–4 days per week (AOR 2.15, 95% CI 1.55 to 2.98). Condom breakage was more frequent among FSWs who reported both physical beating (AOR 1.51, 95% CI 1.25 to 1.84) and rape (AOR 1.26, 95% CI 1.03 to 1.55).ConclusionFSWs in Ethiopia are vulnerable to physical and sexual violence, and the risk increases when they are younger, street-based and high consumers of alcohol or khat. Therefore, targeted efforts are needed for prevention and harm reduction.

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