Jennifer Toller Erausquin

Police-Related Experiences and HIV Risk Among Female Sex Workers in Andhra Pradesh, India

Research suggests experiences with police are related to human immunodeficiency virus (HIV) sexual risk among women working as sex workers. However, little is known about the links between specific police-related behaviors and HIV vulnerability. We examine whether 5 police-related experiences are associated with measures of HIV risk and violence among a sample of female sex workers (FSWs) in Andhra Pradesh, India, and consider the implications for HIV prevention. FSWs at least 18 years of age (n = 835) were recruited through respondent-driven sampling for a cross-sectional survey conducted as part of Avahan, the India AIDS Initiative. Using logistic regression models adjusted for age, age at start of sex work, and sex work venue, we assessed police-related experiences reported by FSWs in relation to HIV risk behaviors and violence. Results showed having sex with police to avoid trouble, giving gifts to police to avoid trouble, having police take condoms away, experiencing a workplace raid, and being arrested were associated with sexually transmitted infection symptoms, inconsistent condom use, acceptance of more money for sex without a condom, and experience of client violence. These findings suggest a need for interventions targeting police-FSW interactions to reduce HIV vulnerability among FSWs.

Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention

Background Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention. Methods The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time. Results The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009–2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009–2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time. Conclusions Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The interventions strategies may be contributing to population-level HIV risk reduction among FSWs.

A Worksite Obesity Intervention: Results From a Group-Randomized Trial

OBJECTIVES We used a participatory process to develop an obesity intervention appropriate for elementary school personnel. METHODS A randomized controlled trial included 16 school worksites (8 intervention, 8 control). Intervention schools formed committees to develop and implement health promotion activities for employees. Anthropometric and self-report data were collected at baseline and postintervention (2 years later). The primary outcome measures were body mass index (BMI), waist-hip ratio, physical activity, and fruit and vegetable consumption. RESULTS After adjustment for age, ethnicity, and job classification, employees in intervention schools reduced their BMI by an average of 0.04 kg/m2, and those in control schools increased their BMI by an average of 0.37 kg/m2. Comparisons for waist-hip ratio, weekly physical activity minutes, and fruit and vegetable consumption were not significant. CONCLUSIONS The participatory process appeared to be an effective means for stimulating change. The intervention may have slowed and perhaps reversed the tendency of adults to gain weight progressively with age.

Increasing the Reach of HIV Testing to Young Latino MSM: Results of a Pilot Study Integrating Outreach and Services

Background. In the U.S., HIV infections are increasing among men who have sex with men (MSM), particularly young, racial/ethnic minority MSM. Objective. To examine the feasibility of increasing HIV testing among young Latino MSM by integrating tailored outreach strategies with testing, counseling, and HIV medical services. Design. Descriptive study comparing demographic characteristics, behaviors, and HIV test results of clients from the intervention period with clients who tested during other time periods. Results. Clients in the intervention period were younger and more likely to be Latino than those in other time periods. In addition, clients who received outreach were more likely than those who did not receive outreach to report methamphetamine use, sex with an HIV-positive person, and sex with a sex worker. Conclusion. Venue-based and selective media outreach, in combination with linking rapid testing to HIV care, may help overcome some of the barriers to testing among high-risk young Latino MSM.

Nutrition Knowledge and Behaviours of Low-Income Latino Parents of Preschoolers: Associations with Nutrition-Related Parenting Practices.

Parents are in an ideal position to promote long-term healthy dietary behaviours for their children. This study aimed to determine parent and child characteristics and to test their associations in a cross-sectional sample of urban low-income, low-education Latino immigrants with preschool-age children. Also determined were family demographic characteristics, child feeding practices, parent nutrition knowledge, parent fruit and vegetable consumption, and child Body Mass Index (BMI). Our analysis shows several significant associations: (1) lower parent nutrition knowledge and less healthy child feeding practices (increased pressure, p = 0.017 and increased restrictions, p = 037); (2) higher parent vegetable consumption and healthier child feeding practices (more responsibility for the types and amount of food eaten, p = 0.022, and less restrictions on child eating, p = 0.030); and (3) a significant difference by child gender, such that parents of girls with higher BMIs for their age group being more concerned about their daughters weight (p = 0.004) and practising healthier feeding practices, that is, less pressure (p = 0.008). Our findings support promoting healthy eating within the context of the family, and contribute to a growing literature on preschool parent–child feeding practices. Understanding the practices of immigrant Latino parents can help researchers and practitioners develop culturally appropriate interventions to address childhood obesity.

Listening to the voices of Latina women: Sexual and reproductive health intervention needs and priorities in a new settlement state in the United States

ABSTRACT Latina women in the United States are disproportionately affected by negative sexual and reproductive health outcomes. Our community-based participatory research partnership conducted in-depth interviews exploring sexual and reproductive health needs and priorities with 25 Latinas in North Carolina and identified themes through constant comparison, a grounded theory development approach. Participants described individual-, interpersonal-, and clinic-level factors affecting their sexual and reproductive health as well as potentially successful intervention characteristics. Our findings can be used to inform culturally congruent interventions to reduce sexual and reproductive health disparities among Latinas, particularly in new settlement states in the southeastern United States.

Trajectories of risk behaviors across adolescence and young adulthood: The role of race and ethnicity.

INTRODUCTION Despite important advances of longitudinal research in substance use behaviors, most studies stratify analyses by gender or race, which limits the ability to directly compare the likelihood of a particular developmental pathway across demographic groups. Thus, there is critical need for well-designed research to examine the associations of race/ethnicity with developmental trajectories of substance use behaviors across adolescence through adulthood. METHODS Using an accelerated longitudinal design, we examined behaviors across ages 12-31 from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health. We performed growth mixture modeling, resulting in estimated trajectories over time. Next, we assessed the association between race/ethnicity and trajectory membership using multinomial logistic regression. RESULTS Five trajectories resulted for marijuana use, four for cigarette smoking, three for smokeless tobacco use and number of days drunk, and two trajectories for heavy episodic drinking. Controlling for gender and family socioeconomic status, African Americans and Hispanics were less likely than non-Hispanic Whites to use cigarettes or smokeless tobacco early or to use alcohol heavily. CONCLUSIONS Substance use behavior development follows different pathways for US adolescents and young adults, with some individuals experimenting earlier in adolescence and others beginning to use later in adolescence or in early adulthood. We extend developmental knowledge about these behaviors by demonstrating that the patterns of behavior vary by race/ethnicity; members of lower-risk trajectories (those involving later or no initiation of substance use) are more likely to be African American or Hispanic than to be non-Hispanic White.

Health, Social, and Economic Outcomes Experienced by Families as a Result of Receiving Assistance from a Community-Based Diaper Bank

Objectives This paper aims to describe low-income recipients of a community-based diaper bank and the multiple daily challenges they face. Our paper seeks to document the health, social, and financial outcomes recipients experienced after receiving assistance. Methods We surveyed families (n = 150) about their experiences receiving diapers from a diaper bank in the southeastern United States. Additionally, we conducted short, focused interviews with families (n = 15) about outcomes after receiving diapers. Results Families experience regularly a range of challenges meeting basic needs. These difficulties include high unmet needs for transportation, food, and nonfood essentials such as personal hygiene items. Families experiencing the greatest difficulty in paying utility or medical bills were significantly more likely to have a high level of diaper need compared to families facing these challenges less often (AORs ranging from 3.40 to 9.39). As a result of receiving diapers, families reported positive health, social, and economic outcomes. Families reported positive changes in parental mood; improved child health and happiness; increased opportunities for childcare, work, and school attendance; and the ability to divert household finances toward other basic needs, including utilities and medical care. Conclusions for Practice The monetary value of the supplemental provision of diapers is a small investment in affected families’ economic, social, and health outcomes. The positive effects continue far longer than the diapers provided. We demonstrate the social value of such an operation, and recommend the expansion of federal, state, and local safety net programs to help low-income families secure a steady supply of diapers.

Client-perpetrated and husband-perpetrated violence among female sex workers in Andhra Pradesh, India: HIV/STI risk across personal and work contexts

Objectives This study examines violence experienced in work and personal contexts and relation to HIV risk factors in these contexts among female sex workers (FSW) in Andhra Pradesh, India. Methods FSW at least 18 years of age (n=2335) were recruited through three rounds of respondent-driven sampling between 2006 and 2010 for a survey on HIV risk. Using crude and adjusted logistic regression models, any sexual/physical violence (last 6 months) perpetrated by clients and husbands were separately assessed in association with accepting more money for sex without a condom (last 30 days), consistent condom use with clients and husbands (last 30 days), and sexually transmitted infection (STI) symptoms (last 6 months). Results The mean age among participants was 32, 22% reported being currently married, and 22% and 21% reported physical/sexual violence by clients and husbands, respectively. In adjusted logistic regression models, FSW who experienced client violence were more likely to report accepting more money for unprotected sex trades (adjusted OR (AOR)=1.7; 95% CI 1.4 to 2.2), less likely to report consistent condom use with clients (AOR=0.6; 95% CI 0.5 to 0.7) and more likely to report STI symptoms (AOR=3.5; 95% CI 2.6 to 4.6). Women who reported husband violence were more likely to report accepting more money for unprotected sex trades (AOR=2.1; 95% CI 1.2 to 3.7), less likely to report consistent condom use with clients (AOR=0.5; 95% CI 0.3 to 0.8) and more likely to report STI symptoms (AOR=2.6; 95% CI 1.6 to 4.1). Conclusions Among FSW, experiences of violence in work and personal contexts are associated with sexual HIV risk behaviours with clients as well as STI symptoms.

Social Support and Sexual Risk Among Establishment-Based Female Sex Workers in Tijuana

Social support can affect health outcomes of female sex workers. In this inductive feminist grounded theory study based on 20 in-depth interviews, we explore how establishment-based female sex workers in Tijuana perceive the impact of the connections among women on their lives and health. Participants elected to discuss the importance of social support from mothers, sisters, friends, and co-workers, and the empowering and disempowering aspects of these relationships. In previous studies, scholars demonstrated the efficacy of formal organization of female sex workers in promoting the mitigation of sexual and HIV risk. We show the importance of informal ties with other women. Some participants mentioned competitive relationships, others talked about cooperation and the desire for a venue to learn from one another. Social interactions with other women are especially empowering when female sex workers can openly engage in “woman talk” that may contribute to the mitigation of sexual and HIV risk.