Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD

Abstract

Background: Research suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Structural vulnerabilities reflect societal level factors (e.g., sexism, homophobia, racism) that constrain an individual's agency, particularly related to health outcomes. This study examines the association between SM status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based FSW. Methods: The current study utilizes baseline data from the SAPPHIRE study, a prospective cohort of cis gender and transgender FSW in Baltimore, MD, recruited through targeted time-location sampling from April 2016 to January 2017. The current analysis focuses on cisgender women. The baseline survey ascertained demographics, substance use, intimate partner violence (IPV), and sex work characteristics. Multivariable models were constructed using selfidentity and behaviorally defined SM status as independent variables with vulnerability outcomes (e.g., injection drug use, injection speedball, binge drinking, homelessness, physical IPV, ever had a pimp, and being a minor at sex work entry (age < 18)) as dependent variables. Results: Of the participants (n = 247), 25.5% (n = 63) self-identified as a SM by identity (e.g., gay or bisexual), and 8.5% (n = 21) reported SM behavior (e.g., same-gender sexual behavior) in the past 3 months. In multivariable logistic regression models, SM status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical IPV, and being a minor at sex work entry. SM status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry. Conclusion: The study indicates disproportionate structural vulnerability and heightened HIV risk among SM-FSW, as compared to their heterosexual counterparts, with differences in their profile by sexual identity and behavior. Findings suggest a need for nuanced interventions tailored to these populations.

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

“…First, data were self-reported and, therefore, subject to recall and responses biases. Second, unlike other studies [ 20 , 48 ], we did not measure the genders of MWUO’s sexual partners, including those who paid for sex with participants, which could induce potential misclassification of sexuality among MWUO with discordant sexual identities and behaviors. Third, the absence of specific substance use indicators (e.g., types of drugs used and routes of administration, polysubstance use) and risk indicators (e.g., condomless sex, HIV status, physical and sexual violence victimization), which other studies have linked to transactional sex among men who use drugs [ 19 , 20 , 39 ], renders our findings susceptible to residual confounding.…”

Internet solicitation linked to enhanced occupational health and safety outcomes among sex workers in Metro Vancouver, Canada 2010–2019

“…While SWs have been well documented to face inequities related to race, gender identity, sexual orientation and socioeconomic marginalisation, limited research has used an intersectional lens 16–18. Increasing literature demonstrates sexual minorities (eg, lesbian, bisexual),19 gender minorities (eg, trans)16 and racialised groups (eg, im/migrants, Indigenous) are greatly overrepresented in sex work 20 21…”

Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City

“…Estimates of transactional sex among women who use drugs range from 15–66% in the US, and women often exchange sex to pay for drug use [ 16 , 18 ]. Women who use drugs and exchange sex have heightened HIV-related risks such as condomless sex, more partners, client/partner violence victimization, and syringe sharing, along with overall higher mortality rates [ 1 , 19 , 20 , 21 , 22 , 23 ]. Women’s occupational risk environments are compounded by the dual criminalization of sex work and drug use, leading to increased interaction with law enforcement and incarceration among women who sell sex [ 24 ].…”