Female Migrant Sex Workers in Moscow: Gender and Power Factors and HIV Risk

This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which researchers conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women's health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies.     

Unprotected Tajik Male Migrant Workers in Moscow at Risk for HIV/AIDS

This paper focuses on Tajik male migrant workers in Moscow and seeks to address the global public health problem of HIV prevention amongst male migrant workers. To develop feasible and effective preventive interventions for reducing HIV risk behaviors amongst Tajik male migrant workers in Moscow, this study aimed to characterize their HIV/AIDS risk and protective knowledge, attitudes, and behaviors, as well as key contextual factors that would likely impede or facilitate a preventive intervention. This was a collaborative multi-sited ethnography in Moscow that included minimally structured interviews with 16 participants and focus group discussions with an additional 14 participants. The results suggest that many Tajik male migrant workers in Moscow are having unprotected sex with commercial sex workers. Although some of the migrants have basic knowledge about HIV, the migrants' ability to protect themselves from acquiring HIV is compromised by harsh living and working conditions as a consequence of being unprotected by law in Russia. To respond to HIV/AIDS risks amongst Tajik male migrant workers in Moscow, preventive interventions must be developed that respond to their sense of being unprotected in the midst of harsh living and working conditions and that draw upon existing sources of religious, community, and family support.     

Sexual Risks and Policing among Male Migrant and Non-migrant Market Vendors in Central Asia

The following study examined associations between sexual risk behaviors and policing among external migrant, internal migrant, and non-migrant male market workers in Almaty, Kazakhstan. Negative binomial regression and logistic regressions examined associations between sexual risk behaviors and policing (questioning by market officials and migration police, and arrest) for 1342 external, internal, and non-migrant workers recruited using respondent-driven sampling (RDS). Incidence rate ratios (IRR) and adjusted odds ratios (OR) were stratified by migration status. External migrants were more likely than non-migrants to experience questioning by market officials (IRR = 2.07, p<0.01), migration police (IRR = 3.60, p<0.001), and arrest (OR = 5.32, p<0.001). When stratified by migration status, being under the influence of drugs or alcohol (IRR = 3.04, p<0.01) and sex with men (IRR = 2.71, p<0.05) were associated with being questioned or harassed by market police among external migrants. External migrant who reported having more than one sex partner while traveling were also more likely to report being arrested than external migrants (OR = 3.92, p<0.05). Meeting HIV prevention needs of labor migrants demands acknowledging the role of policing and allocating sufficient resources to support the implementation of HIV prevention programs in these settings.     

建筑业劳务输出人员性病艾滋病影响因素定性研究

目的了解建筑业劳务输出人员性病艾滋病相关危险行为及其影响因素,为该人群的性病艾滋病防治工作提供依据。方法采用半结构式访谈方法,对劳务输出人员、劳务公司负责人、中介公司老板、南通市对外贸易经济合作局、当地疾病预防控制中心的相关工作人员等26名关键知情人进行访谈。结果商业性行为是建筑劳务输出人员感染性病艾滋病的主要高危行为,其影响因素包括劳务输出地的性服务市场情况、企业管理制度的执行力度、同伴影响、经济收入、艾滋病知识认知不足以及工人的自身素质等。结论应重视劳务输出人员性病艾滋病的防制,并采取适当的干预措施减少高危行为的发生。     

Immigrant Workers’ Knowledge of HIV/AIDS and Their Sexual Risk Behaviors: A Respondent-Driven Sampling Survey in South Korea

As the labor market goes global, immigrant workers are becoming important around the world. However, little research has focused on the characteristics of their sex behaviors. This study examines foreign employees in Korea in order to investigate their understanding of HIV and sexual risk behaviors. The sample (N?=?547) was formed from migrant workers in the industrial complex in Ansan district, which depends highly on foreigners as its labor source. Logistic regression, analysis revealed that 36.0% of the respondents were engaged in more than one sexual risk behavior. Those who knew someone infected with HIV (OR?=?2.583) and Thai respondents (OR?=?3.007) showed high sexual risk behaviors, while married (OR?=?0.182) and Korean Chinese (OR?=?0.280) workers showed low sexual risk behaviors. Those who had a wealth of knowledge about HIV took a less discriminatory position against the person who had infected them, but this had no statistical effects over the sexual risk behaviors.     

HIV-Related Risk Behaviors Among Labor Migrants,Their Wives and the General Population in Nepal

Nepalese labor migrants and their wives are considered as at-risk populations for HIV infection. There may be a risk of HIV transmission from the labor migrant and their wives to the general population due to HIV-related risk behaviors, but so far empirical evidence to support this hypothesis is scarce. Therefore, this study was conducted to compare HIV-related risk behaviors between labor migrants, their wives, and males and females from the general population in the far-western region of Nepal. This was a cross-sectional study, in which structured face-to-face interviews were conducted with 261 male labor migrants, 262 wives of labor migrants, 123 males and 122 females from the general population. We found that the proportion of the labor migrants and their wives reporting having had extramarital sex in the previous year did not differ significantly with the males (11.9 vs. 13.4?%, p value 0.752) and females (2.0 vs. 1.7?%, p value 0.127) from the general population. However, the labor migrants compared with the males from the general population were 1.51 times and the wives of labor migrants compared with the females from the general population were 2.37 times more likely to have been tested for HIV. Both the males from the general population and the labor migrants are equally engaged in unprotected extramarital sex. Therefore, it is recommended that the prevention programs, including access to condoms and HIV testing, should be scaled up targeting a broader range of individuals in the far-western region of Nepal.     

1481名农村男性外出务工人员艾滋病相关知识、行为及感染状况调查

目的了解江西省铅山县鹅湖镇男性外出务工人员艾滋病知识、高危行为和艾滋病感染状况。方法自拟调查表,于2013年2月,采用整群抽样方法,采用入户面访方式,经知情同意后,对鹅湖镇男性外出务工返乡人员进行问卷调查和采血检测。结果共调查1481名男性外出务工人员,其艾滋病知识总知晓率为72.38%,艾滋病单项知识知晓率在65.02%～96.15%之间;全部否认有吸毒行为和男男同性性行为,最近1年与小姐（暗娼）发生性行为的比例为4.96%;HIV阳性检出率为0.14%,梅毒抗体阳性检出率为1.22%。结论鹅湖镇男性外出务工人员艾滋病知识掌握不全面,存在高危性行为,存在艾滋病知识与行为发生分离的情况,存在已被感染HIV的情况。     

HIV Testing Histories and Risk Factors Among Migrants and Recent Immigrants Who Received Rapid HIV Testing from Three Community-Based Organizations

Migrants and recent immigrants in the US constitute a large population that is vulnerable to HIV. From March 2005 to February 2007, three community-based organizations conducted rapid HIV testing among migrants in five states. Participants were asked to complete a survey on sociodemographics, HIV-risk behaviors, and HIV-testing histories with the aim of understanding factors associated with HIV testing. Among 5,247 persons tested, 6 (0.1 %) were HIV-positive. Among 3,135 persons who completed surveys, more than half had never been tested for HIV previously (59 %). Participants reported high levels of HIV-risk behaviors in the past year, including 2 or more sex partners (45 %), sex while high/drunk (30 %), and transactional sex (29 %). Multivariate analysis identified several factors independently associated with decreased likelihood of prior HIV testing, including poor spoken English. Continued efforts are needed to ensure that migrant populations have improved access to HIV testing and prevention services. Understanding factors associated with migrants’ lack of previous HIV testing may help focus these efforts.     

Alcohol Use and Sexual Risk Behaviors in a Migrant Worker Community

There are not many studies exploring the association between alcohol use and risky sexual behaviors among migrant workers. This study analyzed how changes in alcohol use was associated with changes in risky sexual behavior and psychosocial variables. Data for this study was drawn from an HIV risk reduction project. Repeated measures ANOVA and Linear mixed model statistical method was conducted to find changes and association between alcohol use, sexual risk and psychosocial variables over time. The sample (n = 203) was composed of African Americans (33.0 %) and Hispanics (77.0 %) men. Both groups, over time, showed reduction in sexual risk in accordance with reduction in alcohol use. Changes in alcohol use and psychosocial variables showed significant association with sexual risk changes over time. Psychological strategies like building social support should be considered for HIV risk reduction intervention directed towards high alcohol consuming migrant workers.     

Risks for HIV Infection Among Male Street Laborers in Urban Vietnam

Risks for HIV infection remain unknown in male street laborers. This research investigates patterns of self-reported risk behaviors among these men in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 men, mostly low-skilled and unregistered migrant laborers across 13 districts in Hanoi were approached for interviews. The study revealed that male street laborers were at high risk of acquiring and transmitting HIV. One in every 12 men reported homosexual or bisexual behavior. These men on average had three sexual partners within the preceding year, and condom use was inconsistent. Close to 95 % of the men had reported sexual encounters with regular partners. One-third with commercial sex workers (CSW) and 24.2 % with casual partners, but just under one-third had ever used condoms with regular partners and CSWs and very few (17.6 %) with casual partners at their last sexual encounter. 17.11 % used illicit drugs sometimes, with 66.7 % of them frequently sharing injecting equipment with peers. These men had limited HIV knowledge; 51.4 % incorrectly believed that, once you trust your partner, you no longer need to use condoms and 42.4 % believed that you can tell by looking at someone if they have HIV. Access to HIV prevention was also limited; only 19.8 % of men had been tested for HIV during the previous 12 months, almost 10 % of whom neither returned for the result nor knew their HIV status. The study provides interesting directions for future research and suggests ways to effectively design prevention strategies for these men.     

A Framework for Sexual Decision-Making Among Female Sex Workers in Jamaica

The Jamaican government has provided targeted HIV and sexually transmitted infection prevention, treatment, and other services for female sex workers (FSW) since 1989. HIV prevalence among FSW declined from 20 to 12 % between 1989 and 1994, then to 9 % in 2005, 5 % in 2008, and 4.1 % in 2011. This article distills the literature and two decades of experience working with FSW in Jamaica. Drawing on the constant comparative method, we put forward an innovative conceptual framework for explaining sexual decision-making and risk behaviors within both transactional and relational sexual situations. This framework helps fill the gaps in existing models that focus on individual behaviors. The model identifies interactions between environmental and structural elements of sex work, and three individual-level factors: risk perception, perceived relationship intimacy, and perceived control, as the four primary mediating factors influencing sexual decision-making among FSW. We propose that other factors such as violence, socioeconomic vulnerability, and policy/legal frameworks influence sexual decision-making through these primary mediating factors. This conceptual model may offer a useful framework for planning and evaluating prevention interventions among sex workers. However, it remains to be tested in order to establish its value.     

辽宁省零工市场务工人员艾滋病知识及相关行为调查

目的了解零工市场务工人员艾滋病知识及相关行为现状,分析其影响因素,为开展预防控制艾滋病健康教育活动提供依据。方法在辽宁省沈阳、大连、鞍山、丹东和铁岭等5个城市各抽取1个劳务市场,对4250名18~60岁零工市场务工人员进行问卷调查。结果有91.62%的零工市场务工人员听说过艾滋病,对艾滋病相关知识的平均知晓率为67.78%;3869例曾经听说过艾滋病的务工人员的平均得分为6.78±2.53分,地区、性别、年龄、文化程度、婚姻情况、职业分类是艾滋病知识知晓率的影响因素;64.98%的务工人员有过性行为,第一次性行为发生在婚前者占32.65%。结论零工市场务工人员是艾滋病的脆弱人群,应采取相应措施加强艾滋病防治知识宣传力度,提高艾滋病知识知晓率,控制艾滋病的蔓延。     

Pornography,Sexual Enhancement Products,and Sexual Risk of Female Sex Workers and their Clients in Southern India

Despite their large numbers, and important role in the HIV epidemic in India, male clients of female sex workers (FSWs) are a difficult to reach population and little is known about their sexual behaviors. Using data from an integrated behavioral and biological assessment of 684 clients in Bangalore in 2012, we examined factors associated with their reports of having sex with three or more different female sex workers in the last month, and anal sex with sex workers. We included sociodemographic and sexual behavior factors and, for the first time in client studies in India, included data on the use of pornography and sexual enhancement products (SEPs) such as pills, oils, and sprays, in our multivariable analyses of client risk. Seventy-eight percent of clients had seen pornographic material and 8 % reported ever having used SEPs. The profiles of men practicing the two risk behaviors examined were quite different. Travel in the past year, drunkenness in the past month, young age at first commercial sex, non-use of condoms at last sex, and finding sex workers in public places (but not use of pornography and SEPs) were independently associated with multiple partnering. Sex with a man or transsexual, being a white collar worker, seeking out FSWs at home, pornography and SEP use, and condom use at last FSW sex, were all independently associated with anal sex with an FSW. More research is needed to better understand the links between pornography and SEPs, and HIV risk behaviors, and HIV prevention programs need to be cognizant of the importance of ensuring that condom use is adequately promoted and supported in the context of anal sex in female sex worker–client interactions.     

Circular Migration by Mexican Female Sex Workers Who are Injection Drug Users: Implications for HIV in Mexican Sending Communities

Circular migration and injection drug use increase the risk of HIV transmission in sending communities. We describe female sex workers who are injection drug users’ (FSW-IDUs) circular migration and drug use behaviors. Between 2008-2010, 258 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. 24% of FSW-IDUs were circular migrants. HIV prevalence was 3.2% in circular migrants and 6.1% in non-circular migrants; 50% of circular and 75% of non-circular migrants were unaware of their HIV infection. Among circular migrants, 44% (n = 27) consumed illicit drugs in their birthplace; 74% of these (n = 20) injected drugs and one-half of injectors shared injection equipment in their birthplace. Women reporting active social relationships were significantly more likely to return home. Circular migrant FSW-IDUs exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing and treatment and access to substance use services is critical for FSW-IDUs and their sexual/drug-using contacts.     

Design and implementation of a sexual health intervention for migrant construction workers situated in Shanghai,China

Background

China’s growing population of internal migrants has exceeded 236 million. Driven by rapid development and urbanization, this extreme population mobility creates opportunities for transmission of HIV and sexually-transmitted infections (STI). Large numbers of rural migrants flock to megacities such as Shanghai in search of employment. Although migrants constitute a key population at heightened risk of acquiring HIV or an STI, there is a lack of easily accessible sexual health services available for them. In response, we designed a short, inexpensive sexual health intervention that sought to improve HIV and STI knowledge, while reducing stigma, risky sexual behaviour, and sexual transmission of HIV and STI among migrant construction workers (MCW) situated in Shanghai, China.

Results

We implemented a three-armed, community-randomized trial spread across three administrative districts of Shanghai. The low-intensity intervention included educational pamphlets. The medium-intensity intervention included pamphlets, posters, and videos. The high-intensity intervention added group and individual counselling sessions. Across 18 construction sites, 1871 MCW were allocated at baseline to receive one intervention condition. Among baseline participants, 1304 workers were retained at 3-months, and 1013 workers were retained at 6-months, representing a total of 579 person-years of follow-up. All workers, regardless of participation, had access to informational materials even if they did not participate in the evaluation. Overall outputs included: 2284 pamphlets distributed, 720 posters displayed, 672 h of video shown, 376 participants accessed group counselling, and 61 participants attended individual counselling sessions. A multivariable analysis of participation found that men (aOR = 2.2; 95 % CI 1.1, 4.1; p = 0.036), workers situated in Huangpu district (aOR = 5.0; 95 % CI 2.6, 9.5; p < 0.001), and those with a middle school education (aOR = 1.9; 95 % CI 1.2, 3.0; p = 0.01) were more likely to have participated in intervention activities.

Conclusion

A brief educational intervention that prioritized ease of delivery to a highly mobile workforce was feasible and easily accessed by participants. Routine implementation of sexual health interventions in workplaces that employ migrant labour have the potential to make important contributions toward improving HIV and STI outcomes among migrant workers in China’s largest cities.

     

Correlates of Self-Efficacy for Condom Use Among Male Clients of Female Sex Workers in Tijuana,Mexico

Male clients of female sex workers (FSWs) in Tijuana, Mexico engage in high levels of unprotected sex. While behavioral change theories posit that self-efficacy predicts condom use, correlates of self-efficacy for condom use remain largely unstudied. We examined these correlates among male clients of FSWs in Tijuana. Eligible male clients were at least 18 years of age, HIV-negative, lived in Tijuana or San Diego, reported unprotected sex with a Tijuana FSW at least once in the past 4 months, and agreed to be treated for sexually transmitted infections (STIs). Participants completed an interviewer-administered questionnaire including demographics, substance use, psychosocial and psychosexual characteristics (e.g., outcome expectancies for negotiation of safer sex, social support, and sexual sensation seeking), and sexual behaviors. Participants also underwent HIV/STI testing. A stepwise hierarchical multiple regression analysis identified correlates of self-efficacy for condom use. Of 393 male clients, median age was 37 years. Participants were mostly Spanish-speaking and employed. Factors independently associated with higher self-efficacy for condom use were higher positive outcome expectancies for negotiation of safer sex, lower sexual sensation seeking scores, and higher social support scores. Both psychosocial and psychosexual factors may influence self-efficacy for condom use among male clients of FSWs. These factors represent central constructs in sociocognitive models that explain behavioral change and could be intervention targets for improving self-efficacy for condom use and, ultimately, safer sex behavior.     

HIV Vulnerability and Condom Use Among Migrant Women Factory Workers in Puebla,Mexico

International migration is associated with increased HIV vulnerability, but little is known about the vulnerability of internal migrants. This qualitative study explored perceptions of HIV and condom use among Mexican migrant female factory workers. Migration and male sexual infidelity contributed to increased HIV vulnerability and unprotected sex was ubiquitous. The dominant cultural discourse that dichotomizes “good” (monogamous) and “bad” (sexually stigmatized) women, and male partner's resistance, were barriers to condom use. Women's positive attitudes toward the dual protection (pregnancy and sexually transmitted infections) offered by condoms and sexual agency expressed by refusing unwanted sexual contact are resources for HIV prevention.     

2011年福州市外来务工人员艾滋病相关知识、态度、行为调查

[目的]了解福州市外来务工人员艾滋病（AIDS）相关的知、信、行情况,为外来务工人员宣传教育方案的制定提供依据。[方法]2011年7月,对福州市参与红丝带健康包＂百校进千企＂项目的9家企业的1 100名外来务工人员进行调查。[结果]调查786人,AIDS相关知识知晓率为67.68%,其中传播途径的知晓率为56.74%。调查806人,经常有商业性行为的14人,每次性行为时均使用安全套的12人;偶尔有商业性行为的43人,其中每次性行为时均使用安全套的7人。调查786人,认为AIDS与己无关的占12.72%,认为歧视、冷漠比艾滋病病毒（HIV）更可怕占25.19%;获取AIDS相关知识的途径是电视、广播的占70.36%;是书报杂志的占57.89%。[结论]2011年福州市外来务工人员外来务工人员对AIDS了解不足,部分人员有不安全性行为。