Physical and sexual violence, childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia

Abstract

Background Although low, HIV prevalence in Mongolia could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Methods Two-hundred twenty-two women who: (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods; and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression, and modified Poisson regression were performed. Results Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Conclusion Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs.

Association Between Childhood Sexual Abuse and HIV-Related Risk Factors for HIV-Positive Haitian Women

“…Studies have long established that victims of CSA exhibit greater sexual risk behaviors than persons who have not experienced CSA (Parcesepe et al, 2015;O'Cleirigh, Safren, & Mayer, 2012;Sikkema et al 2013;Pence et al, 2012;Jones, et al, 2010b;Whetten, 2006;McCauley et al, 1997). The few studies conducted in developing countries on the matter have also produced the same results, indicating the pervasiveness of higher levels of sexual risk behaviors among victims of CSA, regardless of country of origin (Parcesepe et al, 2015;Richter et al, 2014;Longman-Mills et al, 2013;Tomaszewski, 2012). Jones and colleagues (2010b) noted that the accepted hypothesis is that CSA "results in a sense of powerlessness that may undermine the self-efficacy critical to navigating relationships, including sexual relations, increasing the likelihood that alcohol, for example, may be used to cope with impending sexual encounters" (p. 668).…”

“…The consequences of CSA do not end with contracting HIV. Recent studies have reported that people living with HIV/AIDS (PLWH) who have been exposed to CSA still exhibit more at-risk sexual behaviors after infection than PLWH who were not exposed to CSA (Parcesepe, 2015;O'Cleirigh, Safren, & Mayer, 2012;Pence et al, 2012). These "at-risk behaviors" and poor health outcomes include many of this study's variables of interest namely unprotected sex with multiple partners, increased alcohol use, and intimate partner violence.…”

“…The rising number of new HIV infections among women across the globe, including Haiti. (Parcesepe, 2015;UNAIDS, 2014;Machtinger, Wilson, & Haberer, 2012;Pence et al, 2012) combined with the fact that women are most often the victims of CSA (Parcesepe, 2015;O'Cleirigh, Safren, & Mayer, 2012), underscores the importance of studying the link between CSA and current HIV-related risk factors.…”

“…As discussed, the majority of studies conducted in the United States, Canada, and Western Europe highlight the fact that there is a great need to increase research in poorer nations to determine ways to improve disease outcomes and quality of life (Parcesepe et al, 2015;Longman-Mills et al, 2013;Lanius, Vermetten, & Pain, 2010;Whetten et al, 2008;Sikkema et al, 2008;Myers et al, 2006;Masinda & Muhindo, 2004;Wyatt, Myers, & Loeb, 2004;Wyatt et al, 2002;DeJong et al, 2001). These and other recent studies underscore the need to address CSA and various levels of trauma when addressing HIV risk reduction programs, regardless of the racial/ethnic background of the participants.…”

“…However, there is limited research on the subject in lowresource settings such as Haiti, Mongolia, Latin America, the Caribbean, and Francophone African countries (Parcesepe et al, 2015;Longman-Mills et al, 2013;Lanius, Vermetten, & Pain, 2010;Whetten et al, 2008;Masinda & Muhindo, 2004;DeJong et al, 2001). Where the research does exist in third world or low-resource settings such as parts of Asia, the Middle East, and English-speaking African countries like Rwanda and South Africa, it primarily focuses on childhood trauma due to war, famine, and natural disasters, with some research dedicated to sexual abuse in South Africa (LeGrand et al, 2015;Richter et al, 2014;Lanius, Vermetten, & Pain, 2010;Masinda & Muhindo, 2004).…”