Gender Based Violence as a Risk Factor for HIV-Associated Risk Behaviors Among Female Sex Workers in Armenia

Abstract

This cross-sectional study identified the prevalence of gender based violence (GBV) and examined its association with sexual risk behavior among female sex workers (FSWs). Among 120 participants between ages 20 and 52, a total of 56.7 % reported lifetime GBV. Multivariate analyses revealed that GBV was significantly associated with inconsistent condom use, unprotected sex, condom misuse, fear of client reaction to requests of condom use, self-reported history of STIs, and earlier age of initiation of sex work. GBV must be considered an urgent public health priority among FSWs in Armenia. Interventions addressing FSWs, in addition to targeting skill-based, sexual risk reduction must also introduce a discourse among FSWs, sexual partners, clients and community members about the role of GBV in HIV-associated risk behaviors and infection. Structural level initiatives must address economic opportunities for women, health-sector policies and responses to FSWs' health needs, law enforcement training and societal norms toward women.

Sexual Violence, Condom Negotiation, and Condom Use in the Context of Sex Work

“…Consistent with violence research in other low-and middle-income settings, these findings highlight the potential implications of violence exposures among sex workers on successful negotiation of condom use. 1,[7][8][9] Mathematical models have gone further to highlight the impact of sexual violence against sex workers, demonstrating that reductions in violence against FSWs in Kenya may avert 17%-25% of new HIV infections among FSWs within 5-10 years and may avert new infections among the general adult population, by improving levels of condomprotected sex acts during sex work. 1,33 The study presented here further supports the relationship between single and multiple experiences of sexual violence affecting FSW, sustained effects on condom negotiation self-efficacy, and ultimately condom use or nonuse with clients.…”

“…5,6 Taken together, violence against sex workers may offer several potential mechanisms for HIV transmission, including condom breakage, exposure to sexually transmitted infections (STIs), and/or immediate or sustained condom nonuse or misuse. 1,[7][8][9] The heightened burden of HIV among FSW across HIV epidemic settings has been well described. 10,11 Globally, but particularly in sub-Saharan African (SSA) settings, the prevalence of HIV among FSWs seems to be a magnification of the prevalence that exists among the general adult population.…”

Gender-Based Violence: A Crucial Challenge for Public Health

“…14,19 The violence is commonly experienced by women at various phases of the life cycle from prenatal period, infancy, childhood, adolescence, reproductive age to old age in different forms. 4,12,[20][21][22] In addition, the raped women are rejected by their families and their communities, among them those who had a child from rape, widowhood, husband abandonment and gang rape have more risk of rejection. 23 Besides, rape results not only in physical and psychological trauma, but can destroy family and community structures.…”

Access to antiretroviral therapy and survival in eastern Europe and central Asia: a case study in Armenia

“…Eastern Europe and central Asia is the only region of the world where HIV incidence and AIDS-related deaths continue to increase [1–3]. From 2001 to 2010, the number of people living with HIV (PLHIV) in the region has risen by 250% [4].…”