Men (and Women) as “Sellers” of Sex in Alcohol-Serving Venues in Cape Town,South Africa

The relationship between transactional sex, HIV risk, and partner violence has been well documented in South Africa, but research has focused primarily on women and has not been conducted in high-risk social contexts. The aim of this study was to examine associations between transactional sex and HIV risk among women and men in alcohol-serving venues in Cape Town, South Africa. We surveyed 1,989 women and 2,468 men attending alcohol-serving venues in Cape Town, South Africa to assess transactional sex behavior (i.e., receiving money or goods in exchange for sex), alcohol and drug use, history of childhood abuse, current relationship violence, and sexual risk behaviors. Among both women and men, trading sex was related to higher alcohol use, greater likelihood of drug use, substance use in sexual contexts, and a greater likelihood of experiencing physical and sexual violence. Compared to other women, women who traded sex reported a greater proportion of condom-unprotected sex; this relationship was not found for men. Analyses showed that men were almost twice as more likely to report trading sex for items, including money or alcohol, than women (9.7 vs. 5.8 %). Overall, men who traded sex were similar to their female counterparts. Similar associations between trading sex and different risk behaviors were found among women and men with limited economic means and substance use problems. Future research should more closely study transactional sex in high-risk venues as it relates to violence and should examine men who trade sex as a potential bridge population between heterosexual women and men who have sex with men.     

Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence

We explored the prevalence and predictors of transactional sex with casual partners and main girlfriends among 1288 men aged 15-26 from 70 villages in the rural Eastern Cape province of South Africa. Data were collected through face-to-face interviews with young men enroling in the Stepping Stones HIV prevention trial. A total of 17.7% of participants reported giving material resources or money to casual sex partners and 6.6% received resources from a casual partner. Transactionally motivated relationships with main girlfriends were more balanced between giving (14.9%) and getting (14.3%). We constructed multivariable models to identify the predictors for giving and for getting material resources in casual and in main relationships. Each model resulted in remarkably similar predictors. All four types of exchange were associated with higher socio-economic status, more adverse childhood experiences, more lifetime sexual partners, and alcohol use. Men who were more resistant to peer pressure to have sex were less likely to report transactional sex with casual partners, and men who reported more equitable gender attitudes were less likely to report main partnerships underpinned by exchange. The most consistent predictors of all four types of transaction were perpetration of intimate partner violence and rape against women other than a main partner. The strong and consistent association between perpetration of gender-based violence and both giving and getting material goods from female partners suggests that transactional sex in both main and casual relationships should be viewed within a broader continuum of men's exercise of gendered power and control. HIV prevention interventions need to explicitly address transactional sex in the context of ideas about masculinity, which place a high emphasis on heterosexual success with, and control of, women.     

Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV

OBJECTIVES: The purpose of this study was to determine the prevalence and effect of domestic violence and childhood sexual abuse in women with HIV or at risk for HIV infection. METHODS: Participants with HIV or at risk for HIV infection enrolled in the Women's Interagency HIV Study. Childhood sexual abuse; all physical, sexual, and coercive violence by a partner; HIV serostatus; demographic data; and substance use and sexual habits were assessed. RESULTS: The lifetime prevalence of domestic violence was 66% and 67%, respectively, in 1288 women with HIV and 357 uninfected women. One quarter of the women reported recent abuse, and 31% of the HIV-seropositive women and 27% of the HIV-seronegative women reported childhood sexual abuse. Childhood sexual abuse was strongly associated with a lifetime history of domestic violence and high-risk behaviors, including using drugs, having more than 10 male sexual partners and having male partners at risk for HIV infection, and exchanging sex for drugs, money, or shelter. CONCLUSIONS: Our data support the hypothesis of a continuum of risk, with early childhood abuse leading to later domestic violence, which may increase the risk of behaviors leading to HIV infection.     

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.     

Sex,violence and HIV on the inside: cultures of violence,denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings

To map the context of HIV in closed settings in Papua New Guinea (PNG), semi-structured interviews were undertaken with 56 prisoners and detainees and 60 key stakeholders. The nature of HIV-related risk differs for detained women and men, and reflects important gender-based issues present in PNG society more broadly. Women in detention are vulnerable to sexual violence and exploitation and at greatest risk of HIV while detained in police holding cells, where they are typically supervised by male officers, in contrast to prisons, where they have little contact with male staff. HIV risk for men in prison is associated with consensual and non-consensual sex; this risk is perpetuated by a pervasive culture of denial and institutionalised homophobia. The illegal nature of sodomy and male-to-male sex provides Correctional Services the legal grounds by which to refuse access to condoms for prisoners. Addressing HIV risk among detained men and women in PNG requires the reform of legislation, police and prison practices and an understanding of broader structural problems of gender-based violence and stigma and discrimination.     

Sexual and drug-use risk factors for HIV and STDs: a comparison of women with and without bisexual experiences

OBJECTIVES: This study was done to compare risk factors for HIV/STDs in women who reported having had sex with both men and women and women who reported having had sex with men only. METHODS: Female participants in a multisite, randomized HIV/STD prevention study in the Seattle area reported both having had sex with a man in the 3 months before and having at least 1 risk factor for HIV/STDs during the year before the study. Of these women, 38% who reported ever having had sex with a woman were compared with those who reported having had sex with men only. RESULTS: Women who had had sex with both men and women were more likely than women who had had sex with men only to report drug use in the 3 months before the study, a greater lifetime number of male partners, a sex partner who had had sex with a prostitute, an earlier age at sexual debut, and forced sexual contact (P < .01 for all comparisons). Women who had had sex with both men and women had a mean of 3.2 of these 5 risk factors, vs 2.1 among women who had had sex with men only (P < .001). CONCLUSION: Women who had had sex with both men and women were more likely than women who had had sex with men only to engage in multiple risk behaviors. Health workers should be aware of bisexual experience among women, since this may be a marker for multiple risk behaviors for HIV/STDs.     

Gender-based violence and HIV sexual risk behavior: Alcohol use and mental health problems as mediators among women in drinking venues, Cape Town

Gender-based violence is a key determinant of HIV infection among women in South Africa as elsewhere. However, research has not examined potential mediating processes to explain the link between experiencing abuse and engaging in HIV sexual risk behavior. Previous studies suggest that alcohol use and mental health problems may explain how gender-based violence predicts sexual risk. In a prospective study, we examined whether lifetime history of gender-based violence indirectly affects future sexual risk behavior through alcohol use, depression and post-traumatic stress disorder (PTSD) in a high-risk socio-environmental context. We recruited a cohort of 560 women from alcohol drinking venues in a Cape Town, South African township. Participants completed computerized interviews at baseline and 4 months later. We tested prospective mediating associations between gender-based violence, alcohol use, depression, PTSD, and sexual risk behavior. There was a significant indirect effect of gender-based violence on sexual risk behavior through alcohol use, but not mental health problems. Women who were physically and sexually abused drank more, which in turn predicted more unprotected sex. We did not find a mediated relationship between alcohol use and sexual risk behavior through the experience of recent abuse or mental health problems. Alcohol use explains the link between gender-based violence and sexual risk behavior among women attending drinking venues in Cape Town, South Africa. Efforts to reduce HIV risk in South Africa by addressing gender-based violence must also address alcohol use.     

Knowledge and perceptions of HIV among peripartum women and among men whose wives are of reproductive age,northern Thailand

To investigate knowledge and perceptions of HIV transmission risk and interest in vaginal microbicides in northern Thailand, we conducted 14 focus group discussions and 80 interviews with men and women in Chiang Rai province. Women were recruited from antenatal or postpartum clinics, and men from various work sites. Participants evinced substantial knowledge about HIV, with two exceptions important for prevention campaigns: (a) confusion about the window period between a new infection and positive HIV-test result and (b) overestimation of the safety of extramarital sex with partners who are not sex workers. Most participants reported no personal HIV risk. Participants described Thai women as generally vulnerable to HIV infection because of the unlikelihood of condom use with their husbands and because women cannot control their husbands' extramarital behavior. Women apparently face particular risk after childbearing; peripartum abstinence averages 6-9 months, during which time some Thai men may have alternative sex partners. Women, and to a lesser degree, men were interested in potential microbicides, although they voiced many thoughtful questions about the products and about efficacy trials.     

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.     

Correlates of Sex Trading among Drug-Involved Women in Committed Intimate Relationships: A Risk Profile

BackgroundDespite a slight decline in new human immunodeficiency virus (HIV) infections in New York, marked increases and concentrated epidemics continue among subsets of the population, including women engaged in sex trading. We examined the prevalence and correlates of sex trading among 346 low-income, HIV-negative women in HIV-concordant intimate relationships.MethodsWomen and their long-term main partners were recruited to participate in an HIV prevention intervention. Baseline data were used in this article.FindingsOf the 346 women in the study, 28% reported sex trading during the prior 90 days. Multivariate analyses showed increased relative risk of sex trading by lifetime experience of severe intimate partner violence (IPV), drug, and alcohol use, and marginal significance for mental health hospitalization, partner drug dependency, and homelessness.ConclusionsThese findings suggest an urgent need for HIV prevention and intervention efforts targeted toward women in intimate relationships who trade sex for money or drugs, with an emphasis on IPV, mental health, history of incarceration, and substance abuse.     

Factors associated with violence by a current partner in a nationally representative sample of German women

Partner violence is a serious human rights violation and public health issue. Although its pervasiveness is well documented, more research is needed on risk and protective factors to inform interventions. This study is based on a secondary analysis of the first national survey on violence against women in Germany. Women who reported partner violence by their current partner were compared to women who never reported partner violence. The prevalence of physical or sexual violence, or both, by current partners was 17 per cent. Women who experienced violence during their childhood had higher odds of experiencing partner violence. Partner violence was associated with women's drug use in the last 5 years, physical disability or debilitating illness, having more than three children, experiencing violence by a non-partner and feeling socially excluded. The odds of violence also increased if both partners were unemployed or lacked vocational training or if only the woman had vocational skills. Relationships shorter than 5 years or where the man or both partners drank heavily were likewise associated with higher odds of violence. Partner violence interventions should focus on reducing children's exposure to violence and preparing women and men for the job market as well as including interventions that tackle social isolation and substance use.     

The role of housing in determining HIV risk among female sex workers in Andhra Pradesh, India: considering women's life contexts

Recent research on HIV prevention, regardless of the population, has increasingly recognized the relevance of contextual factors in determining HIV risk. Investigating such factors among female sex workers (FSW) is especially relevant in the South Indian state of Andhra Pradesh, where HIV rates are among the highest across Indian states and where HIV has largely affected FSW. Stable housing is a particular contextual challenge experienced by female sex workers in this region (as well as elsewhere); however, local studies have not examined the impact of this issue on HIV risk. In this paper, we examine residential instability, defined as a high frequency of reported evictions, among FSW and relation to experiences of violence (as a factor increasing risk for HIV) and sexual risk factors for HIV. Women were recruited through respondent-driven sampling for a survey on HIV risk. Using logistic regression models, we assessed: (1) residential instability and association with HIV sexual risk variables (including unprotected sex, reported STIs, and recent physical and sexual victimization) and (2) whether the association between residential instability and reported STI (as an indicator of HIV risk) was attenuated by individual risk behaviors and violence. In adjusted logistic regression models, FSW who reported residential instability were more likely to report: sexual violence, physical violence, accepting more money for unprotected sex, and a recent STI symptom. Violence associated with residential instability contributed to reported STIs; however, residential instability remained significantly associated with STIs beyond the influence of both violence and unprotected sex with clients. Findings highlight the interrelation among residential instability, violence, and HIV risk. Residential instability appears to be associated with women's HIV risk, above and beyond its association with individual risky sexual behaviors.     

Sex work,discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala

ABSTRACT

The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.     

The risk of HIV infection in a national sample of women with injection drug-using partners.

OBJECTIVES. This study reports on a large, national cohort of women with injection drug-using sex partners. Information is provided on demographic characteristics; human immunodeficiency virus (HIV) risk factors, including unprotected sex and incidence of sexually transmitted diseases; use of noninjected drugs; HIV serostatus; and other selected health variables. METHODS. A sample of 5162 heterosexual women was recruited for a national acquired immunodeficiency syndrome (AIDS) research and demonstration project. A structured interview was administered, and the women had the option of undergoing HIV testing. Statistical analyses compared three groups on variables of interest: women with single sex partners, women with multiple partners, and women with multiple partners who exchanged sex for drugs and/or money. RESULTS. These groups differed significantly on virtually all of the demographic and risk variables examined. Women with multiple partners who exchanged sex for drugs and/or money were at higher risk for HIV than women in the other groups, even when selected demographic variables were controlled. CONCLUSIONS. Research is needed on the efficacy of prevention efforts involving these diverse groups of women at risk for AIDS.     

Sexual culture in low-income older adult housing: norms,behaviours and risks

Abstract

This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness. Reasons for non-intimacy were age and health problems. Generally speaking, both men and women had positive attitudes towards sex. Men took risks by having multiple partners and using condoms irregularly; women believed they could avoid risks by taking time to get to know their partners, but never used condoms. Forty per cent of men who saw sex workers were not regular condom users. They traded risk of gossip, violence and infection for companionship with women seeking money and physical safety. Findings have implications for policies, counselling and interventions for older sexually active adults in institutional and residential settings.     

Awakening as a change process among women at risk for HIV who engage in survival sex

Women who exchange sex for survival requirements risk exposure to the human immunodeficiency virus (HIV). This grounded theory study was conducted to better understand these women's concerns, attitudes, and behaviors related to HIV, with the goal of informing prevention research. Interviews with 11 women engaged in survival sex were analyzed. Women described sliding into survival sex as a result of economic crises. Survival sex exposed women to violence, drug use, sexually transmitted infections, and HIV. Mitigating these risks is a process of awakening in which women reconstruct risk and survival and make changes in their behavior. These findings highlight the complexity of the problem of survival sex and suggest interventions to help women protect themselves against HIV.     

‘You already drank my beer,I can decide anything’: using structuration theory to explore the dynamics of alcohol use,gender-based violence and HIV risk among female sex workers in Tanzania

Abstract

Female sex workers experience high rates of gender-based violence and HIV. Alcohol has been shown to facilitate women’s risk of both gender-based violence and HIV; however, little research has explored how aspects of the sex work environment shape this risk. Drawing on structuration theory, this study explored how social conduct is patterned across time and space within the sex work environment to influence alcohol consumption, gender-based violence and HIV risk among female sex workers. Qualitative in-depth interviews were conducted with 24 female sex workers enrolled in an ongoing community randomised controlled trial of a combination HIV prevention intervention in Iringa, Tanzania. Data were analysed using both inductive and deductive approaches. Findings reveal how routine interactions between female sex workers and their clients occur at three moments of time and space during the sex exchange process to facilitate alcohol consumption and increase women’s risk of gender-based violence and HIV. Findings also highlight how sex workers utilise collective agency to address aspects of the sex work environment that place them at risk of alcohol abuse, gender-based violence and HIV. Implications for future interventions to prevent gender-based violence and HIV among female sex workers in Tanzania and similar contexts are discussed.     

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.