Challenges faced by marginalized communities such as transgenders in Pakistan

Challenges faced by marginalized communities such as transgenders in Pakistan. Read more at: http://ow.ly/M0yD30mlMyV   

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The Use of Female Sex Workers Among Men in Nepal: Prevalence, STIs/HIV-Related Risk Behaviors, and Gender Ideology

Heterosexual sex involving female sex workers (FSWs) is widely documented for its role in facilitating the spread of sexually transmitted infections (STIs)/HIV. Critical to such studies, and increasingly considered essential to HIV prevention efforts, is the gender constructs and power dynamics within relationships. However, little efforts have been made, which focus on male clients of FSWs, particularly on the relationship between gender ideologies and men’s sexual contact with FSWs, within the Nepali context. 

The present study aims to fill this critical gap by assessing the prevalence of use of FSWs and its association with STIs/HIV-related risk behaviors and gender ideologies among Nepali men. We used data from the nationally representative Nepal Demographic Health Survey (NDHS) 2011. For the purpose of analyses, we included a sample of 4,121 men, aged 15–49 years. During data analyses, we used multivariate logistic regression models, adjusted for the following variables: age, region, residence, religion, educational level, wealth index, employment status, and cigarette smoking status. 

Of the total sample, approximately 5% reported the use of FSWs in their lifetime. In regression models, men who had sex with FSWs were more likely to report a history of STIs, not using condom all the time, more than one sexual partner, and have had early sexual debut. Respondents reporting the endorsement of violence against wives and male sexual entitlement were significantly more likely to report sexual contact with FSWs. 

Our findings highlight the need to develop and implement specifically tailored interventions toward male clients of FSWs, with a particular emphasis on promoting equitable gender roles and beliefs.

Full article at:    http://goo.gl/e97o7T

By: Roman Shrestha,^1,2 Pramila Karki,^2,3 and Michael Copenhaver^2,3

¹Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA

²Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA

³Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA

Prim Prev Insights. Author manuscript; available in PMC 2016 Jun 27.

Published in final edited form as:

Prim Prev Insights. 2016; 6: 11–17.

Published online 2016 Jun 9. doi:  10.4137/PPRI.S39664

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This pill allows you to have anxiety-free sex. So why aren't more people taking it? - Video

The relationship between violence and engagement in drug dealing and sex work among street-involved youth

OBJECTIVES:

Street-involved youth are highly vulnerable to violence. While involvement in income-generating activities within illicit drug scenes is recognized as shaping youths' vulnerability to violence, the relative contributions of different income-generating activities remain understudied. We sought to examine the independent effects of drug dealing and sex work on experiencing violence among street-involved youth.

METHODS:

Data were derived from a prospective cohort of street-involved youth aged 14-26 who used drugs in Vancouver, British Columbia, between September 2005 and May 2014. Multivariable generalized estimating equations were used to examine the impact of involvement in drug dealing and sex work on experiencing violence.

RESULTS:

Among 1,152 participants, including 364 (31.6%) women, 740 (64.2%) reported having experienced violence at some point during the study period. In multivariable analysis, involvement in drug dealing but not sex work remained independently associated with experiencing violence among females (adjusted odds ratio [AOR]: 1.43; 95% confidence interval [CI]: 1.08-1.90) and males (AOR: 1.50; 95% CI: 1.25-1.80), while involvement in sex work only was not associated with violence among females (AOR: 1.15; 95% CI: 0.76-1.74) or males (AOR: 1.42; 95% CI: 0.81-2.48).

CONCLUSION:

Findings indicate that involvement in drug dealing is a major factor associated with experiencing violence among our sample. In addition to conventional interventions, such as addiction treatment, novel approaches are needed to reduce the risk of violence for drug-using youth who are actively engaged in drug dealing. The potential for low-threshold employment and decriminalization of drug use to mitigate violence warrants further study.

Purchase full article at:   http://goo.gl/emWqd9

By: Hayashi K1, Daly-Grafstein B, Dong H, Wood E, Kerr T, DeBeck K.

• 1Department of Medicine, University of British Columbia; British Columbia Centre for Excellence in HIV/AIDS. khayashi@cfenet.ubc.ca.
• Can J Public Health. 2016 Jun 27;107(1):e88-93. doi: 10.17269/cjph.107.5219. 

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Shame, Guilt, and Suicide Ideation among Bondage and Discipline, Dominance and Submission, and Sadomasochism Practitioners: Examining the Role of the Interpersonal Theory of Suicide

To date, no study has examined rates of suicide ideation or theory-based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty-seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma-related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.

Purchase full article at:  http://goo.gl/Llv4sj

By: Roush JF1, Brown SL1, Mitchell SM1, Cukrowicz KC1.

• 1Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
• Suicide Life Threat Behav. 2016 Jun 20. doi: 10.1111/sltb.12267 

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Exchange Sex and HIV Infection among Men Who Have Sex with Men: 20 US Cities, 2011

This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive-unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. 

Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive-unaware. 

In multivariable analysis, exchange sex was associated with being HIV-positive-unaware (aPR 1.34, 95 % CI 1.05-1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. 

MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.

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By: M Nerlander L^1,2, Hess KL³, Sionean C³, E Rose C³, Thorson A⁴, Broz D³, Paz-Bailey G³.

¹Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA, 30329, USA. vif7@cdc.gov.

²Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. vif7@cdc.gov.

³Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA, 30329, USA.

⁴Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

AIDS Behav. 2016 Jun 15. [Epub ahead of print]

  

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High prevalence of unhealthy alcohol use and comparison of self-reported alcohol consumption to phosphatidylethanol among women engaged in sex work and their male clients in Cambodia

BACKGROUND:

In Cambodia, most of the female sex workers (FSW) work in venues where unhealthy alcohol use is ubiquitous and potentially contributing to the HIV epidemic. However, no accurate data exists. We compare self-reported unhealthy alcohol consumption to a biomarker of alcohol intake in Cambodian FSW and male clients, and determine factors associated with unhealthy alcohol use.

METHODS:

A cross-sectional study was conducted among FSW (n=100) and male clients (n=100) in entertainment and sex work venues in Cambodia. Self-reported unhealthy alcohol use (AUDIT-C) was compared to phosphatidylethanol (PEth) positive (≥50ng/ml), a biomarker of alcohol intake. Sociodemographics data was collected. Correlates of self-reported unhealthy alcohol use and PEth positive were determined.

RESULTS:

The prevalence of PEth positive in FSW was 60.0%. Self-reported unhealthy alcohol consumption was reported by 85.0% of the women. Almost all women (95.0%) testing PEth positive also reported unhealthy alcohol use. Prevalence of unhealthy alcohol consumption (self-report and PEth positive) was higher in FSW working in entertainment establishments compared to other sex work venues (p<0.01). Among male clients, 47.0% reported unhealthy alcohol consumption and 42.0% had a PEth positive. However, only 57.1% of male clients with PEth positive reported unhealthy alcohol use.

CONCLUSIONS:

Unhealthy alcohol consumption is prevalent in Cambodian sex work settings. Self-reported unhealthy alcohol use is well reported by FSW, but less by male clients. These findings highlight the urgency of using accurate measures of unhealthy alcohol consumption and integrating this health issue into HIV prevention interventions.

Purchase full article at:  http://goo.gl/OVW2hK

By:  Couture MC¹, Page K², Sansothy N³, Stein E⁴, Vun MC⁵, Hahn JA⁶.

¹Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, United States. Electronic address: mcouture@usfca.edu.

²University of New Mexico Health Sciences Center, Dept. of Internal Medicine MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States.

³National Center for HIV, AIDS, Dermatology and STDs, #245H, Street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia; University of Health Sciences-Cambodia, #73 Monivong Boulevard, Srah Chak, Phnom Penh, Cambodia.

⁴Global Health Sciences/Prevention and Public Health Group, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.

⁵National Center for HIV, AIDS, Dermatology and STDs, #245H, Street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia.

⁶Department of Medicine, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.

Drug Alcohol Depend. 2016 May 21. pii: S0376-8716(16)30117-X. doi: 10.1016/j.drugalcdep.2016.05.011. [Epub ahead of print]

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The use of structural equation modelling and behavioural theory to target priority interventions to increase condom use among the intimate partners of sex workers in French Guiana

French Guiana is the French overseas territory that is most affected by HIV. Sex work seems to be an important driver of the epidemic. Although female sex workers are informed by local NGOs, they still have risky behaviours, including not using condoms with their intimate partner despite knowing HIV is highly prevalent. 

The objective of this study was to find intervention targets on this specific behaviour. For this, a structural equation model (SEM) was built using assumptions from behavioural theories. Behaviour theories attempt to connect research and practice. Within the health belief model framework, perceived threats, perceived benefits, and self-perceived efficacy were tested. Vulnerability was added because of the particular context of French Guiana. 

The results highlight that female sex workers’ perceived self-efficacy was central in condom use with the intimate partner (with a significant correlation coefficient of 0.52 in the SEM). The perceived self-efficacy was strongly influenced by sociodemographic factors, particularly by nationality. Female sex workers from Brazil seemed to be more comfortable about asking their intimate partner to use condoms (OR: 7.81; CI: 1.87–32.63) than sex workers of other nationalities. 

These results emphasize that prevention interventions for female sex workers should emphasize their empowerment.

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By:  Marie-Claire Parriault^a*, Astrid Van Melle^a, Célia Basurko^a, Leila Adriouch^b, Stéphanie Rogier^a, Pierre Couppié^c & Mathieu Nacher^ab

^a INSERM CIC 1424, Cayenne General Hospital, Cayenne, French Guiana

^b COREVIH Guyane, Cayenne General Hospital, Cayenne, French Guiana

^c Department of Dermatology, Cayenne General Hospital, Cayenne, French Guiana

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What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. 

This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. 

In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. 

These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.

Purchase full article at:  http://goo.gl/ifrptC

By:  Mantell JE¹, LeVasseur MT, Sun X, Zhou J, Mao J, Peng Y, Zhou F, DiCarlo AL, Kelvin EA.

¹ HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.

Glob Public Health. 2015;10(8):947-67. doi: 10.1080/17441692.2015.1045918.

  

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Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers

OBJECTIVES:

Sex workers face stigma, discrimination and violence across the globe and are almost 14 times more likely to be HIV infected than other women in low-and middle income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions it is important to understand micro-level social and structural factors that influence sexual behaviors of sex workers to be sustainable. This study assesses the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers in Nepal.

METHODS:

This quantitative study included 610 female sex workers that were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioral information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills) and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex.

RESULTS:

The HIV prevalence was 1% and this is presumably representative with a large sample of female sex workers in Nepal. The prevalence of unprotected sex with client was high (24%). For each additional adverse physical, social and economic condition, the probability of non-use of condoms with clients increased substantially: 1 problem=12%, p-value 0.005; 2 problems=19%, p-value <0.001; 3-5 problems= 38%, p-value <0.001.

CONCLUSIONS:

Interactions between two or more adverse conditions linked to physical, social and economic environment increased the risk of unprotected sex among Nepalese female sex workers.

Purchase full article at:   http://goo.gl/sza5PI

By:  Deuba K¹, Anderson S², Ekström AM³, Pandey SR⁴, Shrestha R⁵, Karki DK⁶, Marrone G³.

¹Public Health and Environment Research Center, Kathmandu, Nepal; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address: deuba4k@gmail.com.

²Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

³Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.

⁴FHI360, Kathmandu, Nepal.

⁵Centre for International Health, University of Bergen, Bergen, Norway.

⁶Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal.

Int J Infect Dis. 2016 Jun 13. pii: S1201-9712(16)31091-8. doi: 10.1016/j.ijid.2016.06.007. [Epub ahead of print]

  

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Prevalence of HIV and Associated Risks of Kampala among Youth in the Slums of Kampala

Purpose. 

The purpose of this study is to examine the prevalence of and risk factors for engaging in sex work among youth living in Kampala, Uganda. 

Methods. 

Analyses are based on a cross-sectional study (N = 1,134) of youth aged 12-18 years, living in the slums of Kampala, conducted in Spring of 2014. The analytic sample consisted of only sexually active youth (n = 590). Youth who reported engaging in sex work were compared to youth who did not report sex work. Multivariable analyses were conducted to examine factors associated with sex work. 

Results. 

Among the youth who had ever had sexual intercourse (n = 590), 13.7% (n = 81) reported engaging in sex work. Self-reported HIV prevalence was 13.9% among the total sample (n = 81) and 22.5% (n = 18) among youth engaged in sex work. Engaging in sex work was associated with being female (AOR 10.4; 95% CI: 3.9, 27.4), being an orphan (AOR 3.8; 95% CI: 1.7, 8.4), ever drinking alcohol (AOR 8.3; 95% CI 3.7, 19.0), and experiencing any rape (AOR 5.3; 95% CI: 2.9, 9.5). 

Discussion. 

The reported prevalence of sex work is high among youth in the slums of Kampala and is associated with high HIV prevalence, ever drinking alcohol, previously being raped, and being an orphan.

Table 2

Bivariate and multivariable associations between sex work and covariates among youth living in the slums of Kampala (n = 590).

Variable	Sex workers Yes n (%)	Sex workers No n (%)	Total sample n (%)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	P
	81 (13.7)	509 (68.3)	590 (100)
Age
12–14 years	4 (4.9)	27 (5.3)	31 (5.3)	Ref	—	0.67
15-16 years	15 (18.5)	116 (22.8)	131 (22.2)	0.9 (0.3–2.8)
17-18 years	62 (76.5)	366 (71.9)	428 (72.5)	1.1 (0.4–3.4)
Sex, n (%)
Females	76 (93.8)	271 (53.2)	347 (58.8)	Ref	Ref	∗∗
Males	5 (6.2)	238 (46.8)	243 (41.2)	13.4 (5.3–33.5)	10.4 (3.9–27.4)
School attendance
Yes	67 (83.7)	480 (94.3)	547 (93.8)	Ref	Ref	∗∗
No	13 (16.3)	23 (5.7)	36 (6.2)	4.1 (2.0–8.4)	2.2 (0.8–5.7)
Religion
Christian Catholic	28 (34.6)	196 (38.5)	224 (38.0)	Ref	—	0.09
Christian (other)	37 (45.7)	169 (33.2)	206 (34.9)	1.5 (0.9–2.6)
Muslim	11 (13.6)	118 (23.2)	129 (21.9)	0.7 (0.3–1.4)
Other	5 (6.2)	26 (5.1)	31 (5.3)	1.3 (0.5–3.8)
Parental drunkenness
Yes	51 (63.0)	259 (51.0)	310 (52.6)	1.6 (1.0–2.7)	—	0.05
No	30 (37.0)	249 (49.0)	279 (47.4)	Ref
No parents alive	36 (44.4)	108 (21.2)	144 (24.4)	5.4 (2.7–10.9)	3.8 (1.7–8.5)	∗∗
1 parent alive	33 (40.7)	205 (40.3)	238 (40.3)	2.6 (1.3–5.2)	1.7 (0.8–3.6)
2 parents alive	12 (14.8)	196 (38.5)	208 (35.3)	Ref	Ref
Ever alcohol use
Yes	72 (90.0)	271 (53.5)	343 (58.4)	7.8 (3.7–16.6)	8.3 (3.7–19.0)	∗∗
No	8 (10.0)	236 (46.5)	244 (41.6)	Ref	Ref
Any rape
Yes	55 (67.9)	98 (19.2)	153 (25.9)	8.9 (5.3–14.9)	5.3 (2.9–9.5)	∗∗
No	26 (32.1)	411 (80.8)	437 (74.0)	Ref	Ref
Parental abuse of youth
Yes	35 (43.2)	197 (38.8)	232 (39.4)	1.8 (1.1–2.9)	0.8 (0.4–1.4)	0.45
No	46 (56.8)	311 (61.2)	357 (60.6)	Ref	Ref
HIVa
Yes	18 (22.5)	63 (12.5)	81 (13.9)	—	—	∗
No	62 (77.5)	440 (87.5)	502 (86.1)
Other STIa
Yes	63 (77.8)	248 (48.7)	311 (52.7)	—	—	∗∗
No	18 (22.2)	261 (51.3)	279 (47.3)

Note: P value is obtained from chi-square analyses.

aHIV and other STIs not included in the logistic regression analyses due to HIV/STI being hypothesized outcomes of commercial sex work instead of risk factors.

Full article at: http://goo.gl/vtZVwm

By:   Swahn MH¹, Culbreth R¹, Salazar LF¹, Kasirye R², Seeley J³.

¹School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995, USA.

²Uganda Youth Development Link, P.O. Box 12659, Kampala, Uganda.

³London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

AIDS Res Treat. 2016;2016:5360180. doi: 10.1155/2016/5360180. Epub 2016 Apr 28. 

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