Association of Violence Against Female Sex Workers Who Use Drugs With Nonfatal Drug Overdose in Kazakhstan

Abstract

IMPORTANCE Female sex workers (FSWs) who use drugs face increased risk of intimate partner violence (IPV) and nonpartner violence (NPV). The association between violence and drug overdose is unknown. OBJECTIVE To examine the association between IPV, NPV, and nonfatal drug overdose among FSWs who use drugs in Kazakhstan. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 400 adult FSWs in Kazakhstan who reported illicit drug use in the past year, exchanged sex for money or drugs, and reported having unprotected sex in the past 90 days. Baseline data were collected from February 2015 to May 2017 from Project Nova, an HIV prevention study among FSWs who use drugs in Kazakhstan. Data analysis was conducted from April 2019 to March 2020. EXPOSURES Lifetime and recent (past 90 day) experiences of physical, sexual, and psychological IPV and NPV using the Revised Conflict Tactics Scale. Subtypes of violence were identified using exploratory factor analysis. MAIN OUTCOMES AND MEASURES Lifetime and recent incidence of nonfatal overdose; sociodemographic characteristics as well as lifetime and recent sex work and drug use behaviors were also collected. RESULTS The 400 participants had a mean (SD) age of 34.1 (8.4) years. Most experienced food insecurity (358 [89.5%]) and homelessness (232 [58.0%]) in the past 90 days; one-third (130 [32.5%]) reported a history of incarceration. Most (359 [89.7%]) experienced some form of violence; 150 (37.5%) reported a lifetime nonfatal overdose, of whom 27 (18.0%) reported nonfatal overdose in the past 90 days. Lifetime severe physical violence (adjusted odds ratio [aOR], 1.27; 95% CI,

Prevalence and high-risk behaviors associated with non-fatal overdose among people who use illicit opioids: A systematic review and meta-analysis

“…Findings showed that PWUIOs who were female were more likely to experience non-fatal overdose. According to previous studies, high rates of overdose among women have been reported, with 37.5% reporting a lifetime overdose and 18% reporting an overdose in the past three months, with most overdoses related to heroin or nonmedical use of prescription opioids (El-Bassel et al, 2020;Goldenberg, 2020). Although opioid-related overdoses is a major public health problem and may affect many groups of individuals, current knowledge of gendered experiences and requirements in the context of drug overdoses are arguably inadequate (Collins et al, 2019).…”

Association Between Multiple Experiences of Violence and Drug Overdose Among Black Women in Community Supervision Programs in New York City

“…Identifying such drivers may thus better guide overdose prevention efforts. Emerging evidence suggests that experiences of violence by intimate partners and non-intimate partners, including police violence, may be contributing to the escalating rates of drug overdose deaths among women (Ataiants et al, 2020;El-Bassel et al, 2020). To our knowledge, however, no studies have examined the effects of different types of violence on non-fatal drug overdose among Black women despite their higher rates of exposures to all types of violence (Breiding et al, 2015;Ritchie, 2017).…”

“…A recent study of 218 women in harm reduction programs found that higher cumulative scores of lifetime polyvictimization experiences from intimate and non-intimate partners were associated with a higher risk of overdose (Ataiants et al, 2020). Another recent study of 400 sex workers who use drugs in Kazakhstan found that experience of lifetime severe physical violence were associated with greater odds of non-fatal drug overdose (El-Bassel et al, 2020). A study of 624 women who engaged in sex work, the majority of whom identified as Black, found that experiencing police abuse and threats also increased the likelihood of experiencing a non-fatal overdose (Goldenberg et al, 2020).…”

“…Researchers have suggested that the emotional trauma and physical pain from experiencing more severe violence and cumulative violence may trigger the misuse of drugs and overdose (Ataiants et al, 2020; El-Bassel et al, 2020). The relationship between adult experiences of violence and overdose may also be mediated by childhood physical and sexual abuse, which is a well-established predictor of experiencing IPV and sexual assault as an adult (Appel & Holden, 1998; Edleson, 1999), and has also been found to significantly increase risk for an overdose (El-Bassel et al, 2019; Lake et al, 2015).…”

“…To address this gap and other critical gaps in the research on violence and drug overdose, this study examined associations between the experiences of different types of violence by intimate and non-intimate partners and drug overdose indicators among 296 Black women in CSPs in New York City (NYC). We focused on experiences of severe physical and sexual violence that might be more likely to cause physical and emotional pain to trigger substance misuse compared to minor or no violence, consistent with other studies (Ataiants et al, 2020; El-Bassel et al, 2020). In addition to self-report of non-fatal overdose, this study included drug-related hospitalizations as an overdose risk indicator consistent with prior research (El-Bassel et al, 2019; Somerville et al, 2017).…”