Love,power, resilience and vulnerability: relationship dynamics between female sex workers in Ghana and their intimate partners

Little is known about female sex workers’ daily lives or emotional relationships. Using relational-cultural theory, this study explored the relationship dynamics between sex workers and their intimate partners in Kumasi, Ghana. We collected qualitative data from 37 male intimate partners through 24 in-depth interviews and two focus group discussions (FGDs) with 13 male partners. We also conducted three FGDs with 20 women involved in sex work. Relationships between sex workers and their intimate partners were mutual, reciprocal and transactional. Male partners provided protection for financial support, a place to sleep and intimacy. Both men and women described their relationships in terms of friendship, love and a hopeful future. Women were reluctant to quit sex work because they depended on it for income. Most respondents did not use condoms in these romantic relationships, citing trust, love, faithfulness and commitment. Both men and women described high levels of violence in their relationships. The context of sex work heightens vulnerability but also appears to facilitate resilience and creative coping strategies. The relational dynamics between sex workers and their intimate partners in Ghana merit further exploration to examine the extent to which women involved in sex work hold and exert power within these relationships.     

Prevalence and Correlates of HIV and Sexually Transmitted Infections among Female Sex Workers and Their Non-commercial Male Partners in Two Mexico-USA Border Cities

Female sex workers (FSWs) acquire HIV and other sexually transmitted infections (STIs) through unprotected sex with commercial and non-commercial (intimate) male partners. Little research has focused on FSWs'' intimate relationships, within which condom use is rare. We sought to determine the prevalence and correlates of HIV/STIs within FSWs'' intimate relationships in Northern Mexico. From 2010 to 2011, we conducted a cross-sectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month). Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals'' HIV/STI positivity using bivariate probit regression. Among 212 couples (n = 424), prevalence of HIV was 2.6 % (n = 11). Forty-two (9.9 %) tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %, p < 0.05). FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients. Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs. Higher sexual decision-making power was protective against HIV/STIs for women. Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs. Within FSWs'' intimate relationships in two Mexican-US border cities, nearly one in ten partners tested positive for HIV/STIs. Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability.     

Sex Differences in Attraction to Familiar and Unfamiliar Opposite-Sex Faces: Men Prefer Novelty and Women Prefer Familiarity

Familiarity is attractive in many types of stimuli and exposure generally increases feelings of liking. However, men desire a greater number of sexual partners than women, suggesting a preference for novelty. We examined sex differences in preferences for familiarity. In Study 1 (N = 83 women, 63 men), we exposed individuals to faces twice and found that faces were judged as more attractive on the second rating, reflecting attraction to familiar faces, with the exception that men’s ratings of female faces decreased on the second rating, demonstrating attraction to novelty. In Studies 2 (N = 42 women, 28 men) and 3 (N = 51 women, 25 men), exposure particularly decreased men’s ratings of women’s attractiveness for short-term relationships and their sexiness. In Study 4 (N = 64 women, 50 men), women’s attraction to faces was positively related to self-rated similarity to their current partner’s face, while the effect was significantly weaker for men. Potentially, men’s attraction to novelty may reflect an adaptation promoting the acquisition of a high number of sexual partners.     

Acceptability of vaginal microbicides among female sex workers and their intimate male partners in two Mexico–US border cities: A mixed methods analysis

Female sex workers (FSWs) may benefit from pre-exposure prophylaxis (PrEP) including microbicides for HIV prevention. Since adherence is a key factor in PrEP efficacy, we explored microbicide acceptability and potential barriers to use within FSWs’ intimate relationships in Tijuana and Ciudad Juárez, Mexico, where HIV prevalence is increasing. FSWs and their verified intimate (non-commercial) male partners completed quantitative and qualitative interviews from 2010 to 2012. Our complementary mixed methods design followed an iterative process to assess microbicide acceptability, explore related relationship dynamics and identify factors associated with concern about male partners’ anger regarding microbicide use. Among 185 couples (n=370 individuals), interest in microbicides was high. In qualitative interviews with 28 couples, most participants were enthusiastic about microbicides for sex work contexts but some explained that microbicides could imply mistrust/infidelity within their intimate relationships. In the overall sample, nearly one in six participants (16%) worried that male partners would become angry about microbicides, which was associated with higher self-esteem among FSWs and lower self-esteem and past year conflicts causing injury within relationships among men. HIV prevention interventions should consider intimate relationship dynamics posing potential barriers to PrEP acceptability and adherence, involve male partners and promote risk communication skills.     

Men’s Controlling Behaviors and Women’s Experiences of Physical Violence in Malawi

In the feminist paradigm, intimate partner violence (IPV) among heterosexual couples is gender asymmetric and largely a tactic of male control. However, research on the relationship between men’s controlling behavior and physical violence against women is limited. This study examines whether having a controlling partner is associated with women’s reports of experiencing physical violence in Malawi. Bivariate and multivariate analyses were conducted using data from 8,385 women who completed the domestic violence module of the Malawi 2004 Demographic and Health Survey. About 18 % of women reported they had experienced moderately severe physical violence and 1 % experienced very severe violence in the past 12 months. A third of women reported their partners had ever been controlling. Results from multivariable ordinal logistic regression showed that women who had controlling partners were significantly more likely to report experiencing physical violence. Other factors significantly associated with women’s experience of physical violence included women who reported initiating physical violence against their partners, women’s work status, partners’ lower education level, and partners’ alcohol consumption. Women with controlling partners were at increased risk of experiencing physical violence in the past year. However, women who reported initiating physical violence in the past year were nearly four times more likely to experience partner violence in the same time period. Future research should attempt to elucidate these two important risk factors for IPV.     

Post Sex Affectionate Exchanges Promote Sexual and Relationship Satisfaction

The current research examined the role of post sex affection in promoting sexual and relationship satisfaction in ongoing romantic partnerships. Since romantic partners view the period after engaging in sex as an important time for bonding and intimacy, we sought to determine if and how the duration and quality of post sex affection might promote satisfaction in romantic relationships. In two studies, we tested the link between post sex affectionate behavior (e.g., cuddling, caressing, shared intimacy) and sexual and relationship satisfaction. In Study 1, a cross-sectional survey of individuals in romantic relationships (N = 335), duration of post sex affection was associated with higher sexual satisfaction and, in turn, higher relationship satisfaction. In Study 2, a daily experience study of 101 established couples (N = 202) with a 3-month follow-up, day-to-day changes in post sex affection duration and quality were associated with both partners’ sexual and relationship satisfaction, and engaging in longer and more satisfying post sex affection over the course of the study was associated with higher relationship and sexual satisfaction 3 months later. In general, the pattern of results was consistent for men and women, but the association between the duration of post sex affection and relationship satisfaction was stronger for women than for men (Study 1) and women, but not men, felt more sexually satisfied when their partner reported higher quality post sex affection (Study 2). The findings suggest that the period after sex is a critical time for promoting satisfaction in intimate bonds.     

Intimate partner violence among rural South African men: alcohol use,sexual decision-making,and partner communication

Nearly one-third of South African men report enacting intimate partner violence. Beyond the direct health consequences for women, intimate partner violence is also linked to varied risk behaviours among men who enact it, including alcohol abuse, risky sex, and poor healthcare uptake. Little is known about how to reduce violence perpetration among men. We conducted retrospective, in-depth interviews with men (n = 53) who participated in a rural South African programme that targeted masculinities, HIV risk, and intimate partner violence. We conducted computer-assisted thematic qualitative coding alongside a simple rubric to understand how the programme may lead to changes in men's use of intimate partner violence. Many men described new patterns of reduced alcohol intake and improved partner communication, allowing them to respond in ways that did not lead to the escalation of violence. Sexual decision-making changed via reduced sexual entitlement and increased mutuality about whether to have sex. Men articulated the intertwined nature of each of these topics, suggesting that a syndemic lens may be useful for understanding intimate partner violence. These data suggest that alcohol and sexual relationship skills may be useful levers for future violence prevention efforts, and that intimate partner violence may be a tractable issue as men learn new skills for enacting masculinities in their household and in intimate relationships.     

Emotional intimate partner violence experienced by men in same-sex relationships

Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus-group discussions with gay and bisexual men were conducted to examine perceived typologies, antecedents and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men.     

Physical and sexual violence,childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia

Although the prevalence of human immunodeficiency virus (HIV) in Mongolia is low, it could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Two-hundred twenty-two women who (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression and modified Poisson regression were performed. Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs.     

Does Maltreatment in Childhood Affect Sexual Orientation in Adulthood?

Epidemiological studies find a positive association between physical and sexual abuse, neglect, and witnessing violence in childhood and same-sex sexuality in adulthood, but studies directly assessing the association between these diverse types of maltreatment and sexuality cannot disentangle the causal direction because the sequencing of maltreatment and emerging sexuality is difficult to ascertain. Nascent same-sex orientation may increase risk of maltreatment; alternatively, maltreatment may shape sexual orientation. Our study used instrumental variable models based on family characteristics that predict maltreatment but are not plausibly influenced by sexual orientation (e.g., having a stepparent) as natural experiments to investigate whether maltreatment might increase the likelihood of same-sex sexuality in a nationally representative sample (n = 34,653). In instrumental variable models, history of sexual abuse predicted increased prevalence of same-sex attraction by 2.0 percentage points [95 % confidence interval (CI) = 1.4–2.5], any same-sex partners by 1.4 percentage points (95 % CI = 1.0–1.9), and same-sex identity by 0.7 percentage points (95 % CI = 0.4–0.9). Effects of sexual abuse on men’s sexual orientation were substantially larger than on women’s. Effects of non-sexual maltreatment were significant only for men and women’s sexual identity and women’s same-sex partners. While point estimates suggest much of the association between maltreatment and sexual orientation may be due to the effects of maltreatment on sexual orientation, confidence intervals were wide. Our results suggest that causal relationships driving the association between sexual orientation and childhood abuse may be bidirectional, may differ by type of abuse, and may differ by sex. Better understanding of this potentially complex causal structure is critical to developing targeted strategies to reduce sexual orientation disparities in exposure to abuse.     

Disability status and violence against women in the home in North Kivu,Democratic Republic of Congo

ABSTRACT

Few studies have investigated how women’s disability status may influence violence against women within conflict settings. A mixed-methods analysis of formative qualitative research and cross-sectional baseline pilot data from a violence prevention program in North Kivu, eastern Democratic Republic of Congo (DRC), was used to examine violence against disabled adult women within the home. Logistic regression models were constructed to examine the relationship between past-month physical/sexual intimate partner violence, disability status, and older age (N?=?98 women). Deductive thematic analysis of focus groups and individual interviews (N?=?57 men, 59 women) was used to identify community norms and perceptions of violence against women with disabilities in the home. Women who reported mild disability reported higher experiences of past-month physical and/or sexual IPV (85.0%) compared to those who reported severe or no disability (76.5% vs. 70.8%, respectively). Older women with mild disability were more likely to report physical IPV compared to their younger counterparts as well (OR?=?1.23, 95%CI: 1.01, 1.49, p?<?0.039). Qualitative findings suggested family members may be deterred from perpetrating abuse against older women. These findings highlight a complex relationship between women’s disability status and violence perpetration, underscoring the importance of having inclusive, contextual violence against women prevention and response programming in conflict settings.     

Client and Partner Violence Among Urban Female Exotic Dancers and Intentions for Seeking Support and Justice

Urban female exotic dancers are thought to experience unique risk for violence and barriers to care, though limited research has focused on this aspect of urban sex industries. We characterize recent client-perpetrated and intimate partner violence (IPV) and their correlates, and describe women’s intentions for violence-related help-seeking, among venue-based exotic dancers in a high-risk urban environment. We conducted a cross-sectional study with new female exotic dancers (n = 117) in Baltimore, MD. Over one third (36%) reported intimate partner violence (IPV), and 16% reported client physical or sexual violence, in the six months prior to the survey. Both forms of violence were correlated with arrest, sex trade, substance use, and childhood abuse. Violence-related help-seeking intentions were highest for club management. Intentions to seek help from police and violence-related support hotlines were lowest among those with recent experiences of violence. Recent violence, particularly from intimate partners, was pervasive in this sample of female exotic dancers, and enabled by substance use, criminal history, and sex trade. Preferences for help within venues, rather than the justice sector and publicly funded support services, indicate the need for systems reform to meet the needs of this high-risk group of women.     

The social context of gender-based violence,alcohol use and HIV risk among women involved in high-risk sexual behaviour and their intimate partners in Kampala,Uganda

This paper explores the interaction between gender-based violence and alcohol use and their links to vulnerability to HIV-infection in a population of women and their regular male partners in Kampala, Uganda. Data derive from 20 life history interviews (10 women and 10 men). Participants were drawn from a cohort of women at high risk of sexually transmitted infection (including HIV). Six of the women were current or former sex workers. Findings reveal that life histories are characterised by recurrent patterns of gender inequity related to violence, limited livelihood options and socioeconomic disadvantage. Overall, findings suggest women are able to negotiate safer sex and protect themselves better against abuse and violence from clients than from their intimate partners, although the status of men as ‘client’ or ‘partner’ is transitory and fluid. Among male respondents, alcohol led to intimate partner violence and high levels of sexual-risk taking, such as engagement with sex workers and reduced condom use. However, male partners are a heterogeneous group, with distinct and contrasting attitudes towards alcohol, condom use and violence. Actions to address gender-based violence need to be multi-pronged in order to respond to different needs and circumstances, of both women and men.     

Gender Attitudes,Sexual Risk,Intimate Partner Violence,and Coercive Sex Among Adolescent Gang Members

Purpose

Adolescent gang members are at greater risk of poor sexual health outcomes than nongang members. Gang members' beliefs about gender may explain variation in their sexual health outcomes. The purpose of this study was to examine how gangs' and gang members' beliefs about gender are associated with sexual health outcomes, including sexual risk-taking, intimate partner violence, and coercive sex.

Peer network influence on intimate partner violence perpetration among urban Tanzanian men

Male perpetration of intimate partner violence (IPV) against women in Tanzania is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, although research on this topic in sub-Saharan Africa is limited. Grounded in social learning theory, social influence theory, and the theory of gender and power, the purpose of this study was to examine whether and how peer networks influence men’s perpetration of IPV in Dar es Salaam, Tanzania. We conducted in-depth interviews (n = 40) with a sub-sample of 20 men enrolled in the control condition of an ongoing cluster-randomised controlled trial. We purposively sampled participants who previously reported perpetrating physical IPV. To analyse the data, we generated narrative summaries and conducted thematic and interpretative coding. We saw no evidence that men self-selected into peer networks with certain values or behaviours. Rather, men described several mechanisms through which their peers influenced the perpetration of IPV, including: (1) the internalisation of peer network norms, (2) pressure to conform to peer network norms and (3) the direct involvement of peers in shaping couple power dynamics. Our findings suggest that peer networks influence men’s perpetration of IPV and should be targeted in future programmes and interventions.     

News Stories of Intimate Partner Violence: An Experimental Examination of Participant Sex,Perpetrator Sex,and Violence Severity on Seriousness,Sympathy, and Punishment Preferences

This study experimentally examines the effects of participant sex, perpetrator sex, and severity of violence on perceptions of intimate partner violence (IPV) seriousness, sympathy toward the victim, and punishment preferences for the perpetrator. Participants (N = 449) were randomly assigned to a condition, exposed to a composite news story, and then completed a survey. Ratings of seriousness of IPV for stories with male perpetrators were significantly higher than ratings of seriousness for stories with female perpetrators. Men had significantly higher sympathy for female victims in any condition than for male victims in the weak or strong severity of violence conditions. Men’s sympathy for male victims in the fatal severity of violence condition did not differ from their sympathy for female victims. Women had the least sympathy for female victims in the weak severity condition and men in the weak or strong severity conditions. Women reported significantly higher sympathy for female victims in the strong and fatal severity of violence conditions. Women’s ratings of sympathy for male victims in the fatal severity of violence condition were statistically indistinguishable from any other group. Participants reported stronger punishment preferences for male perpetrators and this effect was magnified among men. Theoretical implications are presented with attention provided to practical considerations about support for public health services.     

‘He’s not my pimp’: toward an understanding of intimate male partner involvement in female sex work at the Mexico–US border

Female sex work is often perceived as women being controlled by men. We used surveys and qualitative interviews with female sex workers and their intimate partners in two Northern Mexico cities to examine couples’ own perceptions of their relationships and male partners’ involvement in sex work. Among 214 couples, the median age was 34 and relationship duration was approximately 3 years. Only 10 women in the survey reported having a pimp, and the majority reported sole control over sex work decisions. Qualitative analyses revealed that while most men avoided direct involvement in sex work, they offered advice that was largely driven by concern for their partner’s well-being. Our discussion of these results considers the broader socio-political context surrounding these relationships and how changing gender roles, economic insecurity and stigma shape couples’ everyday social interactions. Assumptions that all sex workers’ relationships are coercive and commercial marginalises these couples while leaving their health concerns unaddressed.     

Domestic violence, sexual ownership, and HIV risk in women in the American deep south

Domestic violence and sexual abuse are important correlates of HIV risk in women. This paper examines the links between HIV risk and domestic violence in women in a region with the highest HIV/AIDS rates in the United States. The theoretical framework incorporates Butler's (1993) and (1990) concept of performative gender and Collins' (2000) "controlling images" of African American women as a context for domestic violence in the Deep South. Two focus groups were convened to develop a definition of domestic violence as HIV risk; 50 in-depth individual interviews of HIV-positive women were subsequently conducted for specific information on the topic. A final focus group was conducted for verification and feedback. The interview data revealed that controlling images of women as sexualized bodies were enacted through rape, sexual coercion, and name-calling in intimate relationships. The main finding was that the women lacked the ability to control sexual activities (including condom use) in abusive relationships with HIV-positive men. The women used various strategies to escape abusive partners and to obtain treatment for HIV/AIDS. The study concludes that the links between gender inequity, domestic violence, and HIV transmission should appear in prevention materials to encourage domestic violence screening in health settings, and to provide abused women with information on the not-so-obvious risks of being infected in abusive relationships.     

Needs and Preferences for the Prevention of Intimate Partner Violence Among Hispanics: A Community’s Perspective

Research suggest that Hispanics in the U.S. are disproportionately affected by the consequences of intimate partner violence. Nevertheless, few intimate partner violence prevention interventions have been developed to address the unique needs and preferences of this population. The Partnership for Domestic Violence Prevention is a community-based participatory research project that assessed the needs and preferences for prevention programs for Hispanics in Miami-Dade County. Nine focus groups with domestic violence service providers, victims and general community members were conducted (N = 76). Four major themes emerged from the focus groups. These included immigrants and teens as the highest priority groups to target in prevention efforts, culture as a double-edged sword, the system that helps and hurts the victim, and the need for wide-scale prevention programs that would reach Hispanics systematically. The results from this study have important implications for the development of intimate violence prevention interventions targeting Hispanics in the U.S.