Sexual Coercion,HIV-Related Risk,and Mental Health Among Female Sex Workers in China

We performed this study to examine the association of sexual coercion with HIV-related risk behaviors and suicidal thoughts and attempts among female sex workers (FSWs) in Guangxi, China. Four hundred fifty-four FSWs in 57 entertainment establishments (including shampooing salons, massage parlors, and restaurants) were interviewed between March and May 2004. Fifteen percent of the women reported having been coerced into sex in the last 6 months. The prevalence of suicidal thoughts and suicide attempts in the last 6 months were 14.3% and 8.4%, respectively. Sexual coercion was significantly associated with both an increased rate of HIV-related risk behavior, and suicidal thoughts and attempts among FSWs. Therefore, along with the awareness and intervention programs, efforts should be taken to reduce the exposure of FSWs to sexual coercion and to improve the mental health of FSWs.     

Social Support and Condom Use Among Female Sex Workers in China

While the relationship between social support and psychological well-being has been well established, limited studies have explored how social support might affect condom use among female sex workers (FSWs). Using cross-sectional data from 1,022 FSWs in Guangxi, China, we examined how different forms of support from diverse sources may influence condom use among FSWs. Friends, coworkers, and stable partners were FSWs’ main sources of social support. Social support from diverse sources differently impacts FSWs’ condom use. Policymakers need to consider the complicated profile of social support received by FSWs and create supportive environment for FSWs to protect themselves from HIV risks.     

Sexualized Drug Use Among Female Sex Workers from Eight Cities in China: A Cross-Sectional Study

There is a rich literature on sexualized drug use (i.e., drug use before or during sex) for men who have sex with men but less data from female sex workers (FSW), particularly from low- and middle-income countries. We describe the sexual and reproductive health outcomes in FSW reporting sexualized drug use. In 2019, we conducted a cross-sectional study in eight cities from seven provinces in China. We recruited FSW through community organizations working with sex workers and included those aged 18 years or above, exchanged sex at least once for money or goods in the past three months, and had traded sex for longer than a year. Multivariable logistic regression models were used. In total, 650 women participated: average age was 38.8 years (SD 10.2), 57.1% reported a monthly income over 5000 RMB ($USD 707), and 12.8% completed high school or above. Among participants, 65 (10.0%, 95% confidence interval (CI) 7.8–12.6) reported a history of sexualized drug use. Compared to FSW who never reported a history of sexualized drug use, FSW who reported a history of sexualized drug use had greater odds of working for a manager compared to being self-employed (adjusted odds ratio (AOR) 4.04, 95% CI 2.12–7.69), work in a sauna (AOR 2.43, 95% CI 1.09–5.41), charging a higher price for vaginal sex (AOR 2.15, 95% CI 1.14–4.06), and ever diagnosed with STIs (AOR 4.51, 95% CI 2.61–7.80). One in ten FSW reported sexualized drug use. Although they had similar risk profiles in terms of consistency of condom use and reproductive health outcomes, these women were more likely to report past STIs than those who reported no sexualized drug use. Health workers who work with substance users should devote attention to the sexual practices of their clients to make sure that they have safer sex.

     

Mental Health and Interpersonal Factors Associated with HIV-Related Risk Behaviors Among Non-Institutionalized Female Injection Drug Users Who Are Also Sex Workers in China

Female injecting drug users who are sex workers (IDUFSWs) are an important bridge population in HIV transmission. Few studies have investigated the associations between mental health, interpersonal problems, and HIV-related risk behaviors among injecting drug users who are sex workers. A total of 234 non-institutionalized injecting drug users who are sex workers were recruited using the snowball method. Multiple logistic regression was used for data analysis. A high prevalence of mental health (depression, hopelessness, pessimism) and interpersonal (lack of social support and submissive gender power) problems was reported. Optimism and social support were negatively associated with inconsistent condom use during sex work in the last six months (adjusted odds ratios [AOR] = 0.62–0.86); positive associations were observed for depression, hopelessness, pessimism, and gender power (AOR = 1.17 to 1.68). Injecting with others' used syringes in the last six months was negatively associated with social support (AOR = 0.75) and positively associated with hopelessness and gender power (AOR = 1.13–1.27). In two summary models using all significant independent variables as candidates, optimism was negatively (OR = 0.62) and submissive gender powers were positively (OR = 1.67) associated with inconsistent condom use during sex work; submissive gender power was positively associated with injecting with others' used syringes (OR = 1.38). HIV interventions targeting mental health and interpersonal problems are needed among injecting drug users who are sex workers.     

Intimate Partner Violence,Depression, PTSD,and Use of Mental Health Resources Among Ethnically Diverse Black Women

This study examined exposure to violence and risk for lethality in intimate partner relationships as factors related to co-occurring MH problems and use of mental health (MH) resources among women of African descent. Black women with intimate partner violence (IPV) experiences (n?=?431) were recruited from primary care, prenatal or family planning clinics in the United States and the U.S. Virgin Islands. Severity of IPV was significantly associated with co-occurring MH problems, but was not associated with the use of MH resources among African-American women. Risk for lethality and co-occurring problems were also not significantly related to the use of resources. African Caribbean women with severe physical abuse experiences were significantly less likely to use resources. In contrast, severity of physical abuse was positively associated with the use of resources among Black women with mixed ethnicity. Severe IPV experiences are risk factors for co-occurring MH problems, which in turn, increases the need for MH services. However, Black women may not seek help for MH problems. Thus, social work practitioners in health care settings must thoroughly assess women for their IPV experiences and develop tailored treatment plans that address their abuse histories and MH needs.     

Intimate Partner Violence and Comorbid Mental Health Conditions Among Urban Male Patients

PURPOSE We wanted to explore the associations between intimate partner violence (IPV) and comorbid health conditions, which have received little attention in male patients.     

有固定性伴女性性工作者心理健康状况调查

目的 了解有固定性伴女性性工作者心理健康及固定性伴知情状况.方法 采用自编知情调查问卷、症状自评量表(SCL-90)对183名有固定性伴女性性工作者进行调查,其心理健康水平与中国常模及有固定性伴的打工女性比较.结果 74.32%的固定性伴不知情女性性伴从事性服务工作,知情者中大多数持反对态度.有固定性伴女性性工作者心...     

Intimate Partner Violence and Health Care-Seeking Patterns Among Female Users of Urban Adolescent Clinics

To assess the prevalence of intimate partner violence (IPV) and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. A self-administered, anonymous, computerized survey was administered to female clients ages 14–20 years (N = 448) seeking care in five urban adolescent clinics, inquiring about IPV history, reasons for seeking care, and IPV screening by and IPV disclosure to providers. Two in five (40%) female urban adolescent clinic patients had experienced IPV, with 32% reporting physical and 21% reporting sexual victimization. Among IPV survivors, 45% reported abuse in their current or most recent relationship. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization was associated with both poor current health status (AOR 1.57, 95% CI 1.03–2.40) and having foregone care in the past year (AOR 2.59, 95% CI 1.20–5.58). Recent IPV victimization was associated only with past 12 month foregone care (AOR 2.02, 95% CI 1.18–3.46). A minority (30%) reported ever being screened for IPV in a clinical setting. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low. Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed.     

2006-2008年山东省部分女性性工作者安全套使用及其影响因素分析

[目的]了解女性性工作者安全套使用及其影响因素,为制定防治对策和干预措施提供依据。[方法]2006～2008年每年的7～9月,分层整群抽取青岛、烟台及德州3个市娱乐场所的女性性工作者,进行问卷调查。[结果]合计调查3460人,75．17％的人〈25岁,未婚者占75．87％,初中文化者占71．27％;最近1个月发生商业性行为时坚持使用安全套率为45．10％,与固定性伴这一比例为24．25％;11．20％的调查对象承认有吸毒史;31．42％最近1年做过HIV检测;不同场所、年龄、婚姻状况、文化程度、民族、艾滋病知识得分以及是否接受过干预服务之间安全套使用率有统计学意义（P〈0．01或0．05）。[结论]山东省部分女性性工作者最近1个月与商业性伴及固定性伴安全套使用率呈上升趋势。     

Correlates of Suicidal Ideation and Attempt Among Female Sex Workers in China

The purpose of this study was to explore the factors associated with suicidal ideation and attempt among female sex workers (FSWs) in China. A cross-sectional survey was administered among 454 FSWs in a rural county of Guangxi, China. About 14% of FSWs had thought of suicide and 8% had attempted suicide in the past 6 months. Multiple logistic regression analyses indicated that those FSWs who were dissatisfied with life, abused alcohol, were deceived or forced into commercial sex, and had stable sexual partners were more likely to report suicidal ideation. Female sex workers who had multiple stable partners, experienced sexual coercion, and worried about an inability to make enough money were more likely to report a suicide attempt. These FSWs who entered commercial sex because of financial needs or who were influenced by the peers were less likely to report a suicide attempt. Our data suggested that the rates of suicidal ideation and attempts were high among FSWs in China, and there were multiple factors associated with their suicidality. Future health education and promotion efforts among FSWs need to take into consideration substance abuse, interpartner conflict, and psychological stress.     

2006～2008年山东省部分女性性工作者安全套使用及其影响因素分析

[目的]了解女性性工作者安全套使用及其影响因素,为制定防治对策和干预措施提供依据。[方法]2006～2008年每年的7～9月,分层整群抽取青岛、烟台及德州3个市娱乐场所的女性性工作者,进行问卷调查。[结果]合计调查3 460人,75.17%的人<25岁,未婚者占75.87%,初中文化者占71.27%;最近1个月发生商业性行为时坚持使用安全套率为45.10%,与固定性伴这一比例为24.25%;11.20%的调查对象承认有吸毒史;31.42%最近1年做过HIV检测;不同场所、年龄、婚姻状况、文化程度、民族、艾滋病知识得分以及是否接受过干预服务之间安全套使用率有统计学意义(P<0.01或0.05)。[结论]山东省部分女性性工作者最近1个月与商业性伴及固定性伴安全套使用率呈上升趋势。     

Psychological Stressors in the Context of Commercial Sex Among Female Sex Workers in China

Because of the illegality and stigma associated with female sex workers (FSWs) in China, data were limited regarding their psychological stressors examined through the lens of occupational health. Analyzing qualitative data from 16 gatekeepers and 38 FSWs, we explored these stressors in the context of commercial sex in China. We found that FSWs faced a continuum of stressors that resulted from poverty, limited employment, lack of social protection, violence perpetrated by clients, and limited social support from peers and stable partners. We call for empowerment and a structural approach to address the needs of FSWs to improve their psychological well-being.     

Violence and HIV Sexual Risk Behaviors Among Female Sex Partners of Male Drug Users

SUMMARY

Objective: Violence and HIV are emerging as interconnected public health hazards among drug users and their families. The purposes of this study are to (1) determine the prevalence of sexual and physical abuse of non-drug-using female sex partners of male drug users, and (2) ascertain the association between such violence and HIV-related risk behaviors. Methods: From 11/93 to 11/95, 208 female sex partners of injection drug or crack users in Collier County, FL, Tucson, AZ, and Portland, OR, were interviewed as part of a NIDA-funded HIV risk reduction project. Their mean age was 30 years (range 18–54); 21% were White, 6% African American, 7% Native American, and 63% Hispanic. Results: Of the 208 women, 28% reported being sexually molested and 20% raped before age 13; 41% reported being raped at least once in their lifetime. Forty-two percent of the women were physically assaulted by their sex partners; 36% had been threatened with assault by their sex partners. Those who were raped or threatened with assault were more likely to have multiple sex partners and engage in unprotected anal sex; there was a trend for women who had been physically assaulted to be more likely to engage in unprotected anal sex. Discussion: Rape, assault and the threat of assault are commonplace in the histories of female sex partners of male drug users. Experiences of violence and threats of violence are associated with heightened risk for the sexual transmission of HIV. Providers of HIV prevention need to understand the sequelae of violence, and design interventions which empower women to protect themselves from sexual transmission of HIV.     

Syphilis Infection Among Female Sex Workers in Colombia

Objective To study the epidemiology of Treponema pallidum (syphilis) among female sex workers (FSW) in Santa Fe de Bogotá, Colombia. Design A cross-sectional study was conducted. Participants were interviewed using a standardized questionnaire, which collected socio-demographic characteristics and risk behavior information. Blood samples were screened for syphilis using the VDRL test and the MHATP assay. Results The prevalence of syphilis was 10.3% (53/514). Adjusted risk factors significantly associated with syphilis were: age (linear increase), education (primary or no education), monthly income (<US$ 180), time in sex work (≥4 years), number of clients per week (≥22), main workplace (street), inconsistent (never) condom use in sex work, previous STI history, and use of illegal drugs. Conclusions Effective health education programs for improving the level of knowledge of STI and the promotion of consistent condom use activities along with other appropriate harm reduction activities are urgently required among FSW in Colombia. Human Use Statement: The study protocol was approved by the Instituto Nacional de Salud of the Colombian Ministry of Health.     

Intimate Partner Violence Among Asian Americans and Their Use of Mental Health Services: Comparisons with White, Black, and Latino Victims

Studies have been conducted on intimate partner violence (IPV) among Asian Americans, but knowledge on their use of mental health services is limited. This study seeks to fill this gap by using a national sample to examine Asian victims' use of mental health services. We analyzed data from the Collaborative Psychiatric Epidemiology Surveys. The dependent variable was use of mental health services. The independent variables included race, employment, and the type of IPV. Results showed that Asian victims used the service less than other racial groups. The rates of use of mental health services were lower among older people and men. The lowest rate of mental health service use among Asian victims indicates a possible gap between their needs to be met and mental health services available to them. It is crucial to increase access to mental health services for ethnic minorities.     

Intimate Partner Violence/Abuse and Depressive Symptoms among Female Health Care Workers: Longitudinal Findings

Intimate partner violence and abuse (IPV/A) have been shown to have a major impact on mental health functioning. This study assessed the longitudinal association between recent IPV/A and depressive symptoms to identify potential targets for preventive interventions for women. Random effects models were used to examine four waves of data collected at 6-month intervals from a cohort of 1,438 female health care workers. IPV/A (e.g., sexual and physical violence, psychological abuse) in the past 5 years was associated with higher Center for Epidemiologic Studies Depression Scale (CES-D) 10 scores across four waves after adjustment for age, time, marital status, and childhood trauma. Women who reported IPV/A in the past 5 years had higher CES-D 10 scores (β, 1.31; 95% confidence interval, 0.79–1.82; p < .0001) than nonabused women. This association was generally constant with time, suggestive of a cross-sectional association across all four waves of data. Additionally, recent IPV/A was associated with change in depressive symptoms over time among the full cohort and those with CES-D 10 scores below 10 (the threshold for likely depression) at baseline. Recent IPV/A was independently associated with depressive symptoms both cross-sectionally and longitudinally. The longitudinal association was stronger among those not depressed at baseline. Implications for health care settings and workplace policies addressing IPV/A are discussed.     

Mass Media and HIV/AIDS Prevention Among Female Sex Workers in Beijing,China

The current study aimed to identify the sources of HIV prevention information for female sex workers in Beijing and assess the associations between levels of mass media exposure of HIV/AIDS prevention information and HIV/AIDS knowledge as well as condom use–related attitudes, beliefs, and behaviors. Cross-sectional data were collected from 359 female sex workers in Beijing, China. Chi-square tests and one-way ANOVA tests were employed. Female sex workers sampled in Beijing were more likely to obtain HIV/AIDS prevention information from television and street posters than radio and the Internet. However, a higher level of exposure to and a lasting impression on online information were significantly associated with a higher level of condom use self-efficacy and more consistent condom use among the participants. Exposure to HIV/AIDS prevention information delivered by radio, street posters, and the Internet was found to be associated with sexual communication about HIV or condom use with sexual partners. Overall, this study provides preliminary evidence of the utility of various mass media outlets in delivering HIV/AIDS prevention information among female sex workers in China. Future studies are needed to systematically examine the effectiveness of mass media–based prevention education on HIV/AIDS related attitudes and behaviors among female sex workers and other populations in China.