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Tag Archives: Health and HIV/AIDS

Kimberly Page, Ellen Stein, Neth Sansothy, Jennifer Evans, Marie-Claude Couture, Keo Sichan, Melissa Cockroft, Julie Mooney-Somers, Pisith Phlong, John Kaldor, Lisa Maher, and on behalf of the Young Women’s Health Study Collaborative, John Kaldor, Serey Phal Kien, Kimberly Page, Joel M Palefsky, Vonthanak Saphonn, and Mean Chhi Vun. “Sex work and HIV in Cambodia: trajectories of risk and disease in two cohorts of high-risk young women in Phnom Penh, Cambodia” BMJ Open. 2013; 3(9): e003095

Abstract:

Objectives
HIV prevalence among Cambodian female sex workers (FSW) is among the highest in Southeast Asia. We describe HIV prevalence and associated risk exposures in FSW sampled serially in Phnom Penh, Cambodia (Young Women’s Health Study (YWHS)), before and after the implementation of a new law designed to combat human trafficking and sexual exploitation.

Design
Cross-sectional analysis of baseline data from two prospective cohorts.

Setting
Community-based study in Phnom Penh, Cambodia.

Participants
Women aged 15–29 years, reporting ≥2 sexual partners in the last month and/or engaged in transactional sex in the last 3 months, were enrolled in the studies in 2007 (N=161; YWHS-1), and 2009 (N=220; YWHS-2) following information sessions where 285 and 345 women attended.

Primary outcomes
HIV prevalence, sexual risk behaviour, amphetamine-type stimulant (ATS) and alcohol use, and work-related factors were compared in the two groups, enrolled before and after implementation of the new law.

Results
Participants in the two cohorts were similar in age (median 25 years), but YWHS-2 women reported fewer sex partners, more alcohol use and less ATS use. A higher proportion of YWHS-2 compared with YWHS-1 women worked in entertainment-based venues (68% vs 31%, respectively). HIV prevalence was significantly lower in the more recently sampled women: 9.2% (95% CI 4.5% to 13.8%) vs 23% (95% CI 16.5% to 29.7%).

Conclusions
Sex work context and risk have shifted among young FSW in Phnom Penh, following implementation of anti-prostitution and anti-trafficking laws. While both cohorts were recruited using the same eligibility criteria, more recently sampled women had lower prevalence of sexual risk and HIV infection. Women engaging more directly in transactional sex have become harder to sample and access. Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission.

Full text available here.

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Basil Donovan, Christine Harcourt, Sandra Egger and Christopher K. Fairley, “Improving the health of sex workers in NSW: maintaining success” (2010) New South Wales Public Health Bulletin 21(4) 74–77.

Abstract:

NSW has a diverse sex industry that is limited in its size by modest demand. There is no evidence that decriminalisation in 1995 increased the frequency of commercial sex in NSW. Though the largest sector, female brothels, is now mainly staffed by Asian women, condom use for vaginal and anal sex exceeds 99% and sexually transmissible infection rates are at historic lows. These gains are attributable to the long-term support of the NSW Department of Health in collaboration with the community-based Sex Workers Outreach Project and sexual health services, facilitated by the removal of criminal sanctions without the expense and access barriers of licensing systems.

Full text available here.

This report highlights 42 innovative examples from 28 countries and regions in which the workplace and/or workforce was used as an entry point to reach sex workers, men who have sex with men, transgender populations, people who inject drugs, migrant workers, truckers, ship and dockworkers and the prisons populations with HIV services. Country case studies are presented from Cameroon, Cote d’Ivoire, Kenya, Lesotho, Malawi, Namibia, South Africa, Southern Africa, Zambia and Zimbabwe (Africa); Canada, Guyana and USA the Americas); United Arab Emirates (Arab States); Bangladesh, Cambodia, China, India, Papua New Guinea, Sri Lanka, Thailand and Vietnam (Asia and the Pacific); and Albania, Austria, the European Union, Scotland and the United Kingdom (Europe and Central Asia.

Full report available here. 

Robertson, Angela M.; Syvertsen, Jennifer L.; Amaro, Hortensia; u. a.: Can’t Buy My Love: A Typology of Female Sex Workers’ Commercial Relationships in the Mexico–U.S. Border Region, in: Journal of Sex Research 51 (6), 2014, S. 711–720.
Abstract:
Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs’ conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs’ HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who “fell in love” with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients’ social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs’ commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.

McMillan K., and H. Worth (2011) Risky Business Vanuatu: Selling sex in Port Vila. International HIV Research Group, UNSW, Sydney.

Full text available here.

No abstract available. Introductory paragraphs:

This report documents the findings of a qualitative investigation into the selling of sex in Port Vila. It is intended that this information will be useful to HIV prevention strategies and programs aimed at serving sex workers. The report is based on fieldwork carried out during November and December 2010 in Port Vila, Vanuatu. In-depth interview data were gathered from 18 young women and 2 young men, who talked about their lives and their personal experiences of selling sex.

“The research was conducted by the International HIV Research Group (IHRG) of the School of Public Health and Community Medicine at the University of New South Wales, Australia in partnership with the Pacific STI and HIV Research Centre (PSHRC) of the Fiji School of Medicine. The study was funded through an AusAID targeted HIV social research grant and contributes to a larger regional project investigating sex work, HIV prevention and transmission risk behaviour in the Pacific that is currently being undertaken by IHRG.

Smarajit Jana, Bharati Dey, Sushena Reza-Paul, Richard Steen (2013): Combating human trafficking in the sex trade: can sex workers do it better? in: Journal of Public Health.

Background The dominant anti-trafficking paradigm conflates trafficking and sex work, denying evidence that most sex workers choose their profession and justifying police actions that disrupt communities, drive sex workers underground and increase vulnerability.

Methods We review an alternative response to combating human trafficking and child prostitution in the sex trade, the self-regulatory board (SRB) developed by Durbar Mahila Samanwaya Committee (DMSC, Sonagachi).

Results DMSC-led interventions to remove minors and unwilling women from sex work account for over 80% of successful ‘rescues’ reported in West Bengal. From 2009 through 2011, 2195 women and girls were screened by SRBs: 170 (7.7%) minors and 45 (2.1%) unwilling adult women were assisted and followed up. The remaining 90.2% received counselling, health care and the option to join savings schemes and other community programmes designed to reduce sex worker vulnerability. Between 1992 and 2011 the proportion of minors in sex work in Sonagachi declined from 25 to 2%.

Conclusions With its universal surveillance of sex workers entering the profession, attention to rapid and confidential intervention and case management, and primary prevention of trafficking—including microcredit and educational programmes for children of sex workers—the SRB approach stands as a new model of success in anti-trafficking work.

Martin Mbonye et al (2013): ‘It is like a tomato stall where someone can pick what he likes’: structure and practices of female sex work in Kampala, Uganda, BMC Public Health 2013, 13:741 doi:10.1186/1471-2458-13-741.

Full paper available here

Abstract

Background
Effective interventions among female sex workers require a thorough knowledge of the
context of local sex industries. We explore the organisation of female sex work in a low
socio-economic setting in Kampala, Uganda.

Methods
We conducted a qualitative study with 101 participants selected from an epidemiological
cohort of 1027 women at high risk of HIV in Kampala. Repeat in-depth life history and work
practice interviews were conducted from March 2010 to June 2011. Context specific factors f female sex workers’ day-to-day lives were captured. Reported themes were identified and
categorised inductively.

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