Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand

Abstract

Background/objectives Commercial sex work is widely recognized as a primary context for heterosexual transmission of HIV/AIDS in many regions, including Southeast Asia. While violence victimization is considered to compromise women’s ability to protect against HIV and other sexually transmitted infections (STIs), with female sex workers (FSWs) uniquely affected, little research has investigated the role of violence as it relates to sexual risk and STI outcomes among FSWs. The current study sought to compare experiences of sexual risk and STI symptoms among FSWs based on their recent exposure to violence. Methods Data from a national sample of FSWs in Thailand (n=815) was used to assess a) the prevalence of experiencing recent physical or sexual violence within the context of sex work, and b) associations of such victimization with sexual risk (i.e., anal sex, condom non-use, condom failure, client condom refusal) and self-reported STI symptoms. Results Approximately 1 in 7 FSWs (14.6%) had experienced physical or sexual violence in the week prior to the survey. As compared with their non-victimized counterparts, FSWs exposed to recent violence were at greater risk for recent condom failure (19.6% vs. 12.3%, ARR 1.92, 95% CI 1.24, 2.95) and client condom refusal (85.7% vs. 69.0%, ARR 1.24, 95% CI 1.14, 1.35). In analyses adjusted for sexual risk, violence related to both STI symptoms collectively (ARR 1.11, 95% CI 1.02, 1.21) and genital lesions as an individual STI symptom (ARR 1.78, 95% CI 1.20, 2.66). Conclusion Physical and sexual violence against FSWs in Thailand appears to be a common experience, with victims of such violence demonstrating diminished capacity for STI/HIV harm reduction and greater prevalence of STI symptoms. Comprehensive efforts to reduce violence towards this vulnerable population must be prioritized, as a means of protecting the human rights of FSWs, and as a key component of STI/HIV prevention and control.

Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

“…[7][8][9][10][11][12][13][14]23,26,46,48,49 Previous studies along Mexico's North Border have contributed to this international consensus by identifying a panoply of associations between criminal justice experiences and behavioral risk factors, including syringe sharing. 29,50,51 We have also observed independent associations between arrest and HIV status.…”

“…As seen in Table 1, median age was 33 (interquartile range [IQR], 27-40); 38 % were married and 42 % had children dependents. Most (80 %) engaged in street-based sex work, with a median of 10 h spent on the street daily (IQR, [7][8][9][10][11][12][13][14][15]. Almost half of the respondents (48 %) reported having syringes confiscated in the last 6 months.…”

“…[4][5][6] A growing body of research explores the synergistic impact of health and human rights challenges facing vulnerable groups, including FSW-IDUs. [7][8][9][10][11][12][13][14][15][16][17] From an epidemiological perspective, FSW-IDUs command special focus because they can acquire communicable infections through both the sexual and injection routes, making them critical to community-level HIV and STI prevention. [18][19][20] From a human rights perspective, this population is doubly marginalized by policies criminalizing drug use and prostitution.…”

“…By pushing their activities underground and restricting access to formal support frameworks, laws can limit these individuals' ability to negotiate safer practices and avoid psychological and physical victimization, including sexual assault, at the hands of clients, pimps, and intimate partners. 10,11,13,16 Police practices rooted in such laws can further facilitate individuals' risky behavior (including receptive syringe sharing and unprotected sex) 18,21 and interfere with public health efforts targeting high-risk populations. 9,[22][23][24] Formal policies and their enforcement are increasingly seen as critical structural factors that shape the "risk environment" for the production of health and disease among vulnerable groups and society at large, including vulnerability to HIV infection.…”

Human Immunodeficiency Virus Transmission

“…Griensven and de Lin van Wijngaarden (2010) all described the syndrome in homosexual and bisexual men and, intravenous drug users, while Harris et al (1983); Padian et al (1991); Cameron et al (1989); Quinn et al (2000) and Decker et al (2010) recognised their mode of transmission through heterosexual activity. Evidences later showed that transmission recipients and haemophiliacs could contract the illness from blood or blood products (CDC, 1982;Peterson, 1992;CDC, 2010) and newborn infants get infected from their mothers' (Ammann et al, 1983;Scarlatti, 1996;Brookmeyer, 1991;Landesman, et al, 1996;Goedert et al, 1989;Mackelprang et al, 2010).…”