Prevalence and Correlates of Sexual Violence Experienced by Female Sex Workers in Iran: Results from a National HIV Bio-Behavioral Surveillance Survey

Sexual violence increases the risk of adverse health outcomes among female sex workers (FSWs). Using data from the 2015 national bio-behavioral survey, we explored the experience of sexual violence and its associated factors among Iranian FSWs. Lifetime and recent sexual violence were reported by 40.1% and 16.9%, respectively. History of substance use, ever engaging in anal sex, engaging in group sex within the last year, a high number of clients, recent unstable housing, and incarceration increased the likelihood of experiencing recent sexual violence. These findings underscore the need for community-empowerment and policy-level interventions to address violence among FSWs in Iran.

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Lifetime and past-month substance use and injection among street-based female sex workers in Iran

Harm Reduction Journal ◽

10.1186/s12954-021-00477-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Payam Roshanfekr ◽

Mehrdad Khezri ◽

Salah Eddin Karimi ◽

Meroe Vameghi ◽

Delaram Ali ◽

...

Keyword(s):

Alcohol Use ◽

Drug Use ◽

Injection Drug Use ◽

Sex Workers ◽

Female Sex Workers ◽

Injection Drug ◽

Logistic Regression Models ◽

Female Sex ◽

History Of ◽

Group Sex

Abstract Background Street-based female sex workers (FSWs) are highly at risk of HIV and other harms associated with sex work. We assessed the prevalence of non-injection and injection drug use and their associated factors among street-based FSWs in Iran. Methods We recruited 898 FSWs from 414 venues across 19 major cities in Iran between October 2016 and March 2017. Correlates of lifetime and past-month non-injection and injection drug use were assessed through multivariable logistic regression models. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. Results Lifetime and past-month non-injection drug use were reported by 60.3% (95% CI 51, 84) and 47.2% (95% CI 38, 67) of FSWs, respectively. The prevalence of lifetime and past-month injection drug use were 8.6% (95% CI 6.9, 10.7) and 3.7% (95% CI 2.6, 5.2), respectively. Recent non-injection drug use was associated with divorced marital status (AOR 2.00, 95% CI 1.07, 3.74), temporary marriage (AOR 4.31 [1.79, 10.40]), had > 30 clients per month (AOR 2.76 [1.29, 5.90]), ever alcohol use (AOR 3.03 [1.92, 6.79]), and history of incarceration (AOR 7.65 [3.89, 15.30]). Similarly, lifetime injection drug use was associated with ever alcohol use (AOR 2.74 [1.20–6.20]), ever incarceration (AOR 5.06 [2.48–10.28]), and ever group sex (AOR 2.44 [1.21–4.92]). Conclusions Non-injection and injection drug use are prevalent among street-based FSWs in Iran. Further prevention programs are needed to address and reduce harms associated with drug use among this vulnerable population in Iran.

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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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Unmet contraceptive needs among female sex workers (FSWs) in semi urban Blantyre, Malawi

Reproductive Health ◽

10.1186/s12978-020-01064-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Donatien Twizelimana ◽

Adamson S. Muula

Keyword(s):

Side Effects ◽

Sexual Violence ◽

Sex Workers ◽

Female Sex Workers ◽

Outcome Variable ◽

Limited Attention ◽

Reproductive Health Services ◽

Steady Partner ◽

Female Sex ◽

History Of

Abstract Background Research has paid limited attention to understanding factors that are associated with unmet contraceptive needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods We used systematic sampling to recruit 290 female sex workers in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Results Out of the 290 study participants 102 (35.2%) reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: female sex workers’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p < 0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p < 0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p < 0.001. Conclusion Reproductive Health services should address barriers to contraceptives use for instance: violence by female sex workers’ clients, fear and misinformation on contraceptives. There is need to improve awareness of contraceptives. Specific health promotion interventions on female sex workers engaged in a steady partnership are recommended. It is important to enhance the knowledge, attitudes, and counseling skills of health care providers in order to address unmet contraceptive needs among female sex workers in semi-urban Blantyre. Plain English summary Unmet contraceptive needs are defined as lack of contraceptives use in heterosexually active women of childbearing age who do not wish to become pregnant. Unmet contraceptive needs are the main cause of short inter-pregnancy intervals, early childbearing, physical abuse, unintended pregnancy, poor maternal and child health outcomes. Several studies have documented low contraceptives use among female sex workers (FSWs), but research has paid limited attention to understanding factors associated with unmet contraceptive needs among this population in semi urban Blantyre Malawi. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined factors that were associated with unmet contraceptive needs among FSWs in semi urban Blantyre, Malawi. We recruited 290 FSWs and collected quantitative data. These data were analyzed to obtain descriptive statistics. Logistic regression analysis was used to investigate the association between unmet contraceptive needs (the outcome variable) and explanatory variables such as: FSWs with history of physical and sexual violence by clients, having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Out of the 290 FSWs, 35% reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: FSWs’ history of physical and sexual violence by clients, participants with a steady partner and participants who feared contraceptive side effects. Sexual and Reproductive Health services should address barriers to contraceptives use, female sex workers exposure to violence, having a steady partners and concerns about side effects. There is also a need to improve the knowledge, attitudes, and counseling skills of health providers in order to address unmet contraceptive needs among FSWs.

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Mobility for sex work and recent experiences of gender-based violence among female sex workers in Iringa, Tanzania: A longitudinal analysis

PLoS ONE ◽

10.1371/journal.pone.0252728 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252728

Author(s):

Zoé Mistrale Hendrickson ◽

Anna M. Leddy ◽

Noya Galai ◽

S. Wilson Beckham ◽

Wendy Davis ◽

...

Keyword(s):

Sexual Violence ◽

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Community Empowerment ◽

Recent Experience ◽

Gender Based Violence ◽

Female Sex ◽

Gender Based

Female sex workers are highly mobile, which may influence their risk of experiencing physical and sexual violence. However, there remains a paucity of research, particularly longitudinal, from Sub-Saharan Africa exploring mobility and gender-based violence among female sex workers. To address this gap, this study examined the longitudinal relationship between work-related mobility and recent experience of physical or sexual gender-based violence from a client or partner among female sex workers in Iringa, Tanzania. A secondary data analysis was conducted using baseline and 18-month follow-up data from Project Shikamana, a community empowerment-based combination HIV prevention intervention. Responses from 387 female sex workers aged 18 years and older participating in both baseline and follow-up were analyzed. Unadjusted and adjusted Poisson regression models with robust variance estimations, accounting for clustering of female sex workers’ responses over time, were fit. Final models adjusted for socio-demographic characteristics and aspects of participants’ living situations and work environments. Recent physical or sexual violence from a client or partner was common (baseline: 40%; follow-up: 29%). Twenty-six percent of female sex workers at baseline, and 11% at follow-up, had recently traveled outside of Iringa for sex work. In the final adjusted longitudinal model, female sex workers recently mobile for sex work had a 25% increased risk of any recent experience of physical or sexual gender-based violence when compared with their non-mobile counterparts (adjusted incidence rate ratio: 1.25; 95% CI: 1.03–1.53; p<0.05). Interventions must identify ways–such as mobile support services, linkages and referrals to health and other social services while traveling, or the use of mobile or digital technology–to address mobile female sex workers’ unique needs while traveling. Future quantitative and qualitative research is needed to understand the context of female sex workers’ mobility and how and why mobility influences risk environments and experiences of gender-based violence.

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History of sex trafficking, recent experiences of violence, and HIV vulnerability among female sex workers in coastal Andhra Pradesh, India

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2011.03.005 ◽

2011 ◽

Vol 114 (2) ◽

pp. 101-105 ◽

Cited By ~ 29

Author(s):

Jhumka Gupta ◽

Elizabeth Reed ◽

Trace Kershaw ◽

Kim M. Blankenship

Keyword(s):

Sex Workers ◽

Sex Trafficking ◽

Andhra Pradesh ◽

Female Sex Workers ◽

Female Sex ◽

History Of ◽

Hiv Vulnerability

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O23.2 Correlates of Inconsistent Condom Use During Anal Sex with Female Sex Workers (FSWs) Among Male Clients: Survey Findings from Three High Prevalence States of India

Sexually Transmitted Infections ◽

10.1136/sextrans-2013-051184.0217 ◽

2013 ◽

Vol 89 (Suppl 1) ◽

pp. A71.2-A71

Author(s):

S Ramanathan ◽

L Ramakrishnan ◽

P Goswami ◽

D Yadav ◽

B George ◽

...

Keyword(s):

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Anal Sex ◽

Inconsistent Condom ◽

Female Sex ◽

Male Clients ◽

High Prevalence ◽

Inconsistent Condom Use

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Identifying Barriers to Condom Use Among Female Sex Workers: a Systematic Review and Meta-analysis

10.21203/rs.3.rs-48093/v1 ◽

2020 ◽

Author(s):

Tahereh Omidi ◽

Maryam Mohammadian-khoshnoud ◽

Younes Mohammadi

Keyword(s):

Sexual Abuse ◽

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Meta Analysis ◽

Sex Worker ◽

Female Sex ◽

History Of ◽

Hiv Risk Perception ◽

History Of Violence

Abstract Background: Many studies have shown a lot of factors which are as barriers to the condom use among female sex workers (FSWs). However, there is not a comprehensive study to report the number and magnitude of these barriers. This study aimed to resolve this gap by comprehensive systematic review and meta-analysis. Methods: We have searched the electronic databases include Web of Science, PubMed, and Scopus until September 2019. For each database we formulated a separate search strategy using keywords such as “condom use” and “sex worker” and the related synonyms. Epidemiological epidemiology addressed the factors associated with unprotected sex for the female sex worker. The heterogeneity across studies and probability of publication bias was investigated by I2 statistic and Begg's and Egger's tests respectively. The pooled effect size were expressed as odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model.Results: Out of 5854 studies obtained in initial search, 35 studies with sample size 14218 participants had eligibility criteria which were included in the final analysis. Ten factors include marital status, alcohol use, history of violence, history of sexual abuse, history of STIs, STIs knowledge, HIV risk perception, drug use, knowledge about the condom use, condom use self-efficacy were identified in those studies. History of sexual abuse with OR=1.87 and the knowledge on AIDS with OR=1.07 had the strongest association and weakest association with condom use respectively. Conclusion: Many factors with different degrees of association influence on the condom use among female sex workers. However, history of sexual abuse, a history of violence, and HIV risk perception were considered as the major determinants of the condom use. The structural interventions, policy change and empowerment of female sex workers are recommended to increase consistent condom use in FSWs.

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Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India

BMJ Open ◽

10.1136/bmjopen-2017-021389 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021389 ◽

Cited By ~ 7

Author(s):

Alicja Beksinska ◽

Ravi Prakash ◽

Shajy Isac ◽

H L Mohan ◽

Lucy Platt ◽

...

Keyword(s):

Condom Use ◽

Sexual Violence ◽

Sex Workers ◽

Partner Violence ◽

Female Sex Workers ◽

South India ◽

Syphilis Infection ◽

Transmitted Infection ◽

The Past ◽

Female Sex

ObjectivesFemale sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence.MethodsAn Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk.Results1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only.ConclusionHIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.

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