Substance Use and HIV Among Female Sex Workers and Female Prisoners

Abstract

Female sex workers (FSWs) and female prisoners experience elevated HIV prevalence relative to the general population because of unprotected sex and unsafe drug use practices, but the antecedents of these behaviors are often structural in nature. We review the literature on HIV risk environments for FSWs and female prisoners, highlighting similarities and differences in the physical, social, economic, and policy/legal environments that need to be understood to optimize HIV prevention, treatment, and policy responses. Sex work venues, mobility, gender norms, stigma, debt, and the laws and policies governing sex work are important influences in the HIV risk environment among FSWs, affecting their exposure to violence and ability to practice safer sex and safer drug use behaviors. Female prisoners are much more likely to have a drug problem than do male prisoners and have higher HIV prevalence, yet are much less likely to have access to HIV prevention and treatment and access to drug treatment in prison. Women who trade sex or are imprisoned and engage in substance use should not be considered in separate silos because sex workers have high rates of incarceration and many female prisoners have a history of sex work. Repeated cycles of arrest, incarceration, and release can be socially and economically destabilizing for women, exacerbating their HIV risk. This dynamic interplay requires a multisectoral approach to HIV prevention and treatment that appreciates and respects that not all women are willing, able, or want to stop sex work or drug use. Women who engage in sex work, use drugs, or are imprisoned come from all communities and deserve sustained access to HIV prevention and treatment for substance use and HIV, helping them and their families to lead healthy and satisfying lives.

Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions

“…Even fewer interventions incorporated women-specific and/or trauma-informed content, but those that did achieved more compelling intervention effects on HIV-related outcomes. This finding reflects known gender differences in the medical, psychiatric, and social service needs (11, 59), longitudinal HIV treatment outcomes during and following incarceration (60, 61), and HIV risk behaviors (14, 57) of CJ-involved populations. To be gender-specific (and thereby culturally competent) for target audiences of CJ-involved women, interventions should incorporate HIV risk reduction strategies that center on achieving self-efficacy or empowerment and acknowledge relational factors like IPV that contribute to women’s HIV risk and care engagement.…”

“…Women who are CJ-involved often experience extraordinary stigma related to their incarceration, substance use, commercial sex work, and other risk behaviors (14). Stigma can exacerbate health disparities to negatively affect health outcomes and also restrict access, limiting the potential for intervention delivery (62).…”

“…Despite experiencing a disproportionate burden of disease, women are less likely than men to have access to HIV prevention or treatment services or access to drug treatment during incarceration (14). CJ-involved women are frequently Black or Latina, experience SUDs including injection drug use (IDU), commercial sex work (CSW), stigma, intimate partner violence (IPV), and confinement in closed settings, making them a key target population for HIV prevention (15, 16).…”

Multi-level risk factors associated with sex trading among women living with HIV in Kazakhstan: A neglected key population

“…A number of studies have indicated that women who trade sex have many risk factors for HIV acquisition and transmission, including physical, social, economic, and policy risk factors. 10–13 HIV-positive women who trade sex may be particularly vulnerable to these risk environments and face a number of factors that fuel their engagement in sex trading and increase their risk of HIV transmission. 14,15 For example, regarding the physical risk environment, research has shown that women who trade sex are more likely than women who have not traded sex to have higher levels of alcohol and substance use and more frequently experience intimate partner violence, which may decrease their ability to engage in safe sex and increase their likelihood of contracting or transmitting HIV.…”

Determinants of Consistent Condom Use Among Iranians Living with HIV/AIDS: Implication for Prevention

“…Evidence leaves no doubt that women are more vulnerable to HIV/AIDS than men (17,29,30). In this study "partner's condom refusal" was the main reason of condom non-use among women living with HIV/AIDS.…”