Prevalence and Correlates of Client-Perpetrated Violence against Female Sex Workers in 13 Mexican Cities

BACKGROUND:

Globally, client-perpetrated violence against female sex workers (FSWs) has been associated with multiple health-related harms, including high-risk sexual behavior and increased exposure to HIV/STIs. This study examined correlates of client-perpetrated sexual, physical, and economic violence (e.g., robbery) against FSWs in 13 cities throughout Mexico.

METHODS:

FSWs (N = 1,089) who were enrolled in a brief, evidence-based, sexual risk reduction intervention for FSWs (Mujer Segura) were interviewed about their work context, including experiences of violence perpetrated by clients, sexual risk and substance use practices, financial need, and social supports. Three broad categories of factors (sociodemographic, work context, behavioral and social characteristics of FSWs) were examined as correlates of sexual, physical, and economic violence.

RESULTS:

The prevalence of different types of client-perpetrated violence against FSWs in the past 6 months was: sexual (11.7%), physical (11.8%), economic (16.9%), and any violence (22.6%). Greater financial need, self-identification as a street worker, and lower perceived emotional support were independently associated with all three types of violence. Alcohol use before or during sex with clients in the past month was associated with physical and sexual violence. Using drugs before or during sex with clients, injection drug use in the past month, and population size of city were associated with sexual violence only, and FSWs' alcohol use score (AUDIT-C) was associated with economic violence only.

CONCLUSIONS:

Correlates of client-perpetrated violence encompassed sociodemographic, work context, and behavioral and social factors, suggesting that approaches to violence prevention for FSWs must be multi-dimensional. Prevention could involve teaching FSWs strategies for risk avoidance in the workplace (e.g., avoiding use of alcohol with clients), enhancement of FSWs' community-based supports, development of interventions that deliver an anti-violence curriculum to clients, and programs to address FSWs' financial need by increasing their economic opportunities outside of the sex trade.

Below:  Socio-demographic, work context, and behavioral and social characteristics of FSWs who experienced client-perpetrated violence compared with those who did not (n = 1089)

Full article at:  http://goo.gl/tGu5ft

By:  Semple SJ1, Stockman JK1, Pitpitan EV2, Strathdee SA2, Chavarin CV1, Mendoza DV3, Aarons GA1, Patterson TL1.

• 1Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0680, United States of America.
• 2Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, 92093-0507, United States of America.
• 3Evaluation and Research Department, Mexican Foundation for Family Planning (Mexfam), Distrito Federal, 14000, Mexico. 

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Examining the Associations Between Sex Trade Involvement, Rape & Symptomatology of Sexual Abuse Trauma

The high prevalence of rape and sexual trauma symptomatology among women involved in street-based sex trades is well-established. Because prior research has lacked appropriate, non-sex trade involved comparison groups, it is unknown whether differences exist among similarly situated women who do and do not trade sex. This article explores experiences of childhood and adult rape and symptomatology of sexual abuse trauma among a community-based sample of 322 women who use methamphetamine in San Francisco, California, 61% of whom were involved in the sex trade. 

Study participants were recruited via respondent-driven sampling and eligible if they were cisgender women, aged 18 or older, current methamphetamine users, and sexually active with at least one cisgender man in the past 6 months. The dependent variable was sexual abuse trauma symptomatology, as measured by the Sexual Abuse Trauma Index (SATI) subscale of the Trauma Symptom Checklist–40 (TSC-40), and the explanatory variable was sex trade involvement. 

Potential covariates were age, current homelessness, methamphetamine dependence, and experiences of childhood and adult rape. Sixty-one percent of participants had a SATI subscale score suggestive of sexual abuse trauma. The overall prevalence of rape in childhood and adulthood was 52% and 73%, respectively. In bivariate analysis, sex trade involvement and all of the potential covariates except for homelessness and age were associated with a SATI score suggestive of sexual abuse trauma. 

In multivariate models controlling for significant covariates, there was no longer a statistically significant association between sex trade involvement or childhood rape and an elevated SATI score. Elevated levels of psychological dependence on methamphetamine and experiences of rape as an adult were still associated with a high SATI score. 

These findings highlight that urban poor women, regardless of sex trade involvement, suffer high levels of rape and related trauma symptomatology.

Table 2

Bivariate Correlates of Sexual Abuse Trauma Index Score ≥ 10 (N = 317).

	Sexual Abuse Trauma Index Score > 10
	Yes (n = 193) %	No (n = 124) %	P
Explanatory variable
Traded sex past 6 months	68	50	.002
Potential covariates
Age (>40)	59	52	.244
Homeless	59	53	.31
Psychological dependence on methamphetamine (medium/high)	81	73	.03
Childhood rape	58	42	.015
Adult rape	83	56	<.0001

Table 3

Multivariate Model of Sexual Abuse Trauma Index Score ≥ 10 Among Women Who Use Methamphetamine in San Francisco (N = 317).

	Adjusted Odds Ratio	95% Confidence Interval
Explanatory variable
Traded sex past 6 months	1.6	[0.9, 2.7]
Potential covariates
Psychological dependence on methamphetamine	1.7	[1.1, 2.5]
Childhood rape	1.3	[0.9, 1.8]
Adult rape	2.5	[1.4, 4.3]

Full article at:  http://goo.gl/ub85Pq

By:  Alexandra Lutnick,1 Jennie Harris,1 Jennifer Lorvick,1 Helen Cheng,1 Lynn D. Wenger,1 Philippe Bourgois,2 and Alex H. Kral1

¹RTI International, San Francisco, CA, USA

²University of Pennsylvania, Philadelphia, USA

Corresponding Author: Alexandra Lutnick, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA. Email:gro.itr@kcintula

 

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