Drug sharing with clients as a risk marker for increased violence and sexual and drug-related harms among survival sex workers

Abstract

Previous studies have described links between violence, decreased condom use and drug sharing among intimate partners, though limited information exists about the predictors of drug sharing among female sex workers and their clients. The following analysis explored the association between sharing illicit drugs with clients and sexual and drug-related harms among survival sex workers. A total of 198 women participated in interview-administered questionnaires and confidential HIV testing. Of the total, 117 (59%) reported sharing drugs with clients/johns in the last six months and crack cocaine was the primary drug shared (n=108). In logistic regression analysis, sharing drugs with clients/johns was associated with borrowing a used crack pipe (AOR=5.63; 95%CI: 2.71-9.44; p<0.001), intensive/daily crack cocaine smoking (AOR=3.78; 95%CI:1.60-8.92; p<0.002), inconsistent condom use by a client/john (AOR=3.17; 95%CI:1.48-6.77; p<0.003) and having a recent bad date (verbal harassment, physical and/or sexual assault) (AOR=2.71; 95%CI:1.17-6.32; p=0.021). Sharing illicit drugs with clients/johns may be a crucial risk marker for increased violence and sexual and drug-related harms among survival sex workers. HIV prevention and harm reduction initiatives targeting both women and clients/johns are urgently needed, including enhanced support for community and peer-driven sex work initiatives, to address some of the structural facilitators for HIV transmission.

A Border Context of Violence

“…In total, almost two thirds of the women in this research had been confronted with violent encounters with clients at least once during their working careers as sex workers. This rate is 10% to 15% higher than other data on the lifetime incidence of violence against sex workers by clients in different settings (Beattie et al, 2010; Church et al, 2001; El-Bassel et al, 2001; Shannon, Kerr, et al, 2009; Watts & Zimmerman, 2002). This finding may reflect the highly volatile context of the U.S.–Mexico border region (Amnesty International, 2010), as well as the highly stigmatizing and gendered nature of sex work for women in Mexico.…”

“…Much research has focused on violence in the lives of FSWs in a variety of international contexts, including Canada (Lowman, 2000; Shannon, Kerr, Bright, Gibson, & Tyndall, 2008), China (Choi, Chen, & Jiang, 2008), England (Whittaker & Hart, 1996), India (Panchanadeswaran et al, 2008), Scotland (Barnard, 2008), South Africa (Dunkle et al, 2004), Sri Lanka (Miller, 2002), and the United States (Dalla et al, 2003; Kurtz et al, 2004). Understanding the unique contexts in which violence in the sex work industry occurs is especially important considering that rates of violence against sex workers differ across countries (Farley, Baral, Kiremire, & Sezgin, 1998).…”

Fatores associados à violência contra mulheres profissionais do sexo de dez cidades brasileiras

“…Alcohol and drug use has been identified as one of the most important risk markers of increased violence against female sex workers, in all contexts of the sex trade, since the need to acquire these substances and their shared use with sex partners (intimate partners and clients) condition these women to various situations of exposure to violence and thus also unsafe sex practices, which leads in turn to the association of violence with the risk of HIV infection and other STDs 19,20,21,22 .…”

Legal and illegal drug use among female sex workers in bar and club prostitution in Belgium: A quantitative and qualitative study

“…In addition, sharing drugs with clients increases vulnerability to violence, sexual or drug-related harm. Sharing drugs is also connected to prolonged and aggressive sexual contact (Shannon, Kerr, Bright, Gibson, & Tyndall, 2008).…”

“…Other SW consider drug use as a strategy to avoid sex. They try to control the situation by using fewer drugs themselves, and having the client use more (Falcón, 2007;Needle et al, 2008;Shannon et al, 2008).…”