Lianne A. Urada

Police sexual coercion and its association with risky sex work and substance use behaviors among female sex workers in St. Petersburg and Orenburg, Russia.

Background Extensive research documents that female sex workers (FSWs) in Russia are very vulnerable to abuses from police, including police sexual coercion. However, despite qualitative data suggesting abusive policing practices are more likely for FSWs contending with substance abuse issues and risky sex work contexts, there is a paucity of quantitative study evaluating these associations specifically in terms of police sexual coercion. Such research is needed to guide structural interventions to improve health and safety for FSWs in Russia and globally. Objective The purpose of this study is to assess the prevalence of police sexual coercion among FSWs from two Russian cities, St. Petersburg and Orenburg, and to determine whether riskier sex work behaviors and contexts and substance use behaviors, including both IDU and risky alcohol use, are associated with increased risk for sexual coercion from police Method FSWs in St. Petersburg and Orenburg were recruited via time-location and convenience sampling and completed structured surveys on demographics (age, education), sex work risks (e.g., violence during sex work) and substance use. Logistic regression analyses assessed associations of substance use and risky sex work with police sexual coercion, adjusting for demographics. Results Participants (N=896) were aged 15 and older (94% were 20+ years). Most (69%) reported past year binge alcohol use, and 48% reported IDU the day before. Half (56%) reported 4+ clients per day. Rape during sex work ever was reported by 64%. Police sexual coercion in the past 12 months was reported by 38%. In the multivariate model, both current IDU (AOR=2.09, CI=1.45–3.02) and past year binge alcohol use (AOR=1.46, CI=1.03–2.07) were associated with police sexual coercion, as was selling sex on the street (not in venues) (AOR=7.81, CI=4.53–13.48) and rape during sex work (AOR=2.04, CI=1.43–2.92). Conclusion Current findings document the substantial role police sexual violence plays in the lives of FSWs in Russia. These findings also highlight heightened vulnerability to such violence among self-managed and substance abusing FSWs in this context. Structural interventions addressing police violence against FSWs may be useful to improve the health and safety of this population.

Sex Work and Its Associations With Alcohol and Methamphetamine Use Among Female Bar and Spa Workers in the Philippines

To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.

The role of non-formal education in combating the HIV epidemic in the Philippines and Taiwan

The Philippines is experiencing a low but slowly growing prevalence of HIV, with a UN estimate of 6,000–11,000 cases out of a population of 91 million, and a 150% increase in new cases in 2008 compared to previous years. Earlier education programmes employed non-formal educational training techniques in the southern Philippines to target high-risk groups such as female sex workers and their establishment managers; the effort was expanded to target males in the community. In comparison, as of 2009, Taiwan has an estimated 40,000 cases of HIV/AIDS in a population of 23 million. It experienced a major increase in HIV infection among injecting drug users, from 77 newly reported cases in 2003 to 2,381 such cases in 2007. This article compares and contrasts the response to the epidemic in each country, describing non-formal educational programmes targeted and tailored to specific high-risk populations.

Organizational policy recommendations for control of STI/HIV among female sex workers in China: regular examination of workers in social hygiene clinics.

Abstract This article aims to address female sex workers at high risk for contracting HIV in China by recommending evidence-based socio-structural interventions and policies at the national level that have yielded effective outcomes in other countries. National governments such as the Philippines and Hong Kong have utilized the Social Hygiene Clinic (SHC) model. A similar national policy can be highly effective in China. Evidence-based research study results indicate significant reductions in STI and consistent condom use among female sex workers in both China and the Philippines. Consistent condom use in both countries continues to be significantly associated with interpersonal- and venue-level factors. Individuals who had higher appointment-keeping ratios in the Philippines had higher rates of consistent condom use (OR = 2.7, 95% CI = 1.6–3.7) and significantly lower rates of STI (OR = 0.43, 95% CI = 0.26–0.57). By beginning with provinces, which already have a good relationship between establishment venues and the local Health Department, China can develop city ordinances and establishment regulations that begin to require regular examinations of female sex workers and entertainers in the local STI clinic.

Age Differences among Female Sex Workers in the Philippines: Sexual Risk Negotiations and Perceived Manager Advice

Consistent condom use among high risk groups such as female sex workers (FSWs) remains low. Adolescent female sex workers are especially at higher risk for HIV/STI infections. However, few published studies have compared the sexual risk negotiations among adolescent, emerging adult, and older age groups or the extent a managers advice about condom use is associated with an FSWs age. Of 1,388 female bar/spa workers surveyed in the southern Philippines, 791 FSW who traded sex in the past 6 months were included in multivariable logistic regression models. The oldest FSWs (aged 36–48) compared to adolescent FSWs (aged 14–17) were 3.3 times more likely to negotiate condoms when clients refused condom use. However, adolescent FSWs received more advice from their managers to convince clients to use condoms or else to refuse sex, compared to older FSWs. Both adolescent and the oldest FSWs had elevated sexually transmitted infections (STIs) and inconsistent condom use compared to other groups. Having a condom rule at the establishment was positively associated with condom negotiation. Factors such as age, the advice managers give to their workers, and the influence of a condom use rule at the establishment need to be considered when delivering HIV/STI prevention interventions.

Short-Term Cessation of Sex Work and Injection Drug Use: Evidence from a Recurrent Event Survival Analysis

OBJECTIVE This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation. METHODS We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico. RESULTS Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation. CONCLUSIONS Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry.

History of intimate partner violence is associated with sex work but not sexually transmitted infection among HIV-positive female drinkers in Russia

Summary This paper assesses the associations between intimate partner violence (IPV) and sexually transmitted infections (STIs) and sexual risks among HIV-positive female drinkers in St Petersburg, Russia. Survey and STI data were analysed from 285 women in HERMITAGE, a secondary prevention study of HIV-positive heavy drinkers. Logistic and Poisson regression analyses assessed associations of IPV with STI and risky sex. Most women (78%) experienced IPV and 19% were STI positive; 15% sold sex. IPV was not significantly associated with STI, but was with selling sex (adjusted odds ratio = 3.56, 95% confidence interval = 1.02–12.43). In conclusion, IPV is common and associated with sex trade involvement among Russian HIV-positive female drinkers.

Global HIV and AIDS: Calling all Social Work Educators

As the HIV/AIDS global pandemic continues to grow through a third decade, the need for social work educators to prepare social workers in distinct fields of practice with skills to assist those infected with and affected by HIV is of paramount importance. HIV/AIDS holds multi-level and multi-system effects for vulnerable populations. This article features global HIV and AIDS teaching resources beginning with common global practice challenges. Next, five teaching units focus on practice needs and challenges of divergent vulnerable populations including men who have sex with men, women, injecting drug users (IDU), commercial sex workers, and children orphaned by AIDS. Discussion questions, selected readings and electronic resources accompany each unit. The authors close the article with suggested recommendations for content integration into social work courses, and next steps for the profession.

A Collaborative Methodology for Investigating the Ethical Conduct of Research on Female Sex Workers in the Philippines

Designing research in an ethical, non-exploitative manner that investigates concerns around privacy, confidentiality, and voluntariness is imperative for female sex work populations (Shaver, 2005; Urada & Simmons, 2014). Some community-led interventions, especially those focused on empowerment, education, and economic independence, have been effective with female sex workers across the globe (Biradavolu, Blankenship, Jena, Dhungana, 2012; Kerrigan et al., 2006; Swendeman, Basu, Das, Jana, & Rotheram-Borus, 2009; Sherman et al., 2000). To avoid disillusionment from sex workers and their managers when they do not see positive changes resulting from research, designing and adapting interventions is a critical research aim for this population. This article is a companion publication with “Social and Structural Constraints on Disclosure and Informed Consent for HIV Survey Research Involving Female Sex Workers and their Managers in the Philippines” (Urada & Simmons, 2014), a study examining the contextual factors that influence participants’ disclosure of sensitive topics in non-governmental survey interviews and their consent to participate in HIV prevention intervention research. However, the collaborative methodology in this study may be useful for research carried out with female sex workers in other similar contexts. This paper focuses on the collaborative aspects of the methodology in the aforementioned study. The more general methodological approach is summarized in the companion paper noted above. This qualitative study explored the ethical issues of female sex workers’ participation in HIV prevention research. The studys main findings included the following. Informed consent was constrained by perceived government coercion and skepticism that research results would translate into community benefits. Disclosure was also constrained by distrust; sex workers did not trust that confidentiality would be maintained. They also felt many of the survey questions were intrusive, particularly those that were meant to elicit information about substance use and sex work. Structural constraints imposed by police also played a significant role in non-disclosure. Police raids were common and sex workers and managers were frustrated by the government’s inability to stop police from using condoms as evidence of prostitution. In conclusion, HIV interventions must move beyond didactic prevention workshops, include female sex workers in intervention design and implementation, and aim to reduce social and structural constraints on participation. As indicated in the main paper, our methodological aims were to be as transparent and participatory as possible, without causing harm to participants through heightened visibility or extensive time commitments. Sex work is highly stigmatized and illegal in the Philippines, as is common elsewhere, and women commonly do not disclose sex work to family members. The sex workers who participated in the study were also especially concerned about losing clients and the money they generated. Even the relatively small fees for work permits from the health department were difficult for women to pay. Collaboration with our Community Advisory Boards and the Peer Ed ME PAMACQ (Peer Educators Movement for Empowerment of Pasay, Manila, Caloocan and Quezon City) enhanced recruitment efforts, the development of rapport with the female sex workers and their managers, and helped to produce relevant findings and continued collaboration.

Socio-structural and behavioral risk factors associated with trafficked history of female bar/spa entertainers in the sex trade in the Philippines

To explore factors associated with trafficking (deceptive/coercive entry to sex trade) among female bar/spa entertainers who traded sex in the Philippines.