An Effective HIV Risk-Reduction Protocol for Drug-Using Female Sex Workers

Abstract

HIV prevention is an especially salient issue for women, given the ongoing feminization of the epidemic. Female sex workers are especially vulnerable to HIV infection, particularly those who are drug-using and engage in street-based sex exchange. This paper examines risk behaviors and HIV serostatus of 806 drug-using women sex workers in Miami, Florida, and assesses the relative impact of two HIV and hepatitis prevention interventions on changes in risk behavior. Drug-using sex workers were recruited using targeted sampling strategies and were randomly assigned to one of two intervention conditions -the NIDA Standard, or an innovative Sex-Worker Focused (SWF) intervention. Interview data were collected pre-intervention and 3 and 6 months post-intervention, and blood samples were collected for HIV and hepatitis B and C testing. Overall, 21% of the sample tested HIV positive. Outcome analyses indicate that both groups benefited from participation in the intervention trial. However, the SWF intervention was found to be more efficacious with reductions in unprotected oral sex, and sexual violence. These data support the importance of HIV testing and intervention programs for drug-using women sex workers. KeywordsSex workers; HIV interventions; peer counselors; drug use; sexual risk behaviors and violence Among large urban centers in the U.S., Miami remains a high-incidence community for HIV/ AIDS. Miami ranks first in the nation for new cases of HIV with an estimated rate of 48.5 per 100,000 population (CDC 2008), and the impact of HIV/AIDS has been felt most acutely in Miami's African American community (Florida Department of Health 2006). In fact, the Centers for Disease Control and Prevention has declared HIV/AIDS among Miami's African American women -who represent 76% of all female AIDS cases in the county (MDCHD 2007) -to be at state-of-emergency levels (CDC 2001).The geographically clustered communities characterized by the highest concentrations of HIV/ AIDS in Miami also display high rates of substance abuse (Young 2006) and extremely elevated poverty rates. These neighborhoods also contain numerous illegal drug markets, further exacerbating and sustaining the environment of risk that surrounds residents of these communities (Inciardi 1995). The entrenched HIV epidemic in Miami is linked to high rates of drug abuse in these areas. For almost four decades, Miami has been both a port of entry and corridor community for the trafficking of illegal drugs, and it has been a well-known epicenter for the abuse of cocaine, crack, heroin, and other drugs (Inciardi & Pottieger 1998 Drug-using street sex workers are most visible in Miami, and although most express a preference for commercial solicitation along local prostitution "strolls" (i.e., locations where sex workers openly walk the streets soliciting customers), many resort to sex-for-drugs exchanges when they have an immediate need for drugs, when money is scarce, and when paying "dates" (customers) are few in number (Inciardi & Surratt 2001). Because ...

Prevalence of HIV Among U.S. Female Sex Workers: Systematic Review and Meta-analysis

“…Two of the included studies had longitudinal experimental designs intended to assess other outcomes [18, 33] and one was an observational cohort study [8]; from these, we collected baseline HIV prevalence data. We critically evaluated each included study to assess the likelihood that the prevalence estimates reported might be biased using the Joanna Briggs Institute critical appraisal tool for prevalence studies [34].…”

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African-American Female Sex Workers

“…For highly marginalized female sex workers, social support may be even more crucial for expressions of resilience. Findings from a risk reduction intervention study among street-based sex workers in Miami suggested that social support from peer counselors facilitated better engagement with and retention of the interventions (Surratt & Inciardi, 2010). Similar results were found among vulnerable sexual minority African American men (Buttram, Kurtz, & Surratt, 2013).…”

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Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study

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