Individual and Structural Vulnerability Among Female Youth Who Exchange Sex for Survival

Abstract

Purpose Because of growing concerns regarding the heightened vulnerabilities and risk of human immunodeficiency virus infection among youth who exchange sex for survival, we investigated individual risk patterns and structural barriers among young (≤24 years) female sex workers (FSWs) in Vancouver, Canada. Methods Between 2005 and 2008, a total of 255 street-based FSWs (≥14 years) were enrolled into a community-based prospective cohort, and were asked to participate in baseline and biannual questionnaires administered through interviews and human immunodeficiency virus screening. We used contingency table analysis to compare individual and structural barrier results obtained at baseline for younger (≤24 years) FSWs with those of the older (>25 years) FSWs. For longitudinal data, we used generalized estimating equations throughout the follow-up period to determine factors associated with being a young FSW in the past 6 months. Results In comparison with older FSWs (n = 199), youth (n = 56) were more likely to spend fewer years engaging in sex exchange (median: 6.4 [interquartile range: 4.6–9.1] vs. 19.9 [interquartile range: 10.0–26.8]; p ≤ .001), belong to an aboriginal ancestry (59% vs. 44%; p = .052), and be homeless (68% vs. 36%; p ≤ .001). In the multivariate generalized estimating equations analysis, youth reported a significantly elevated proportional odds of being homeless (odds ratio [OR]: 1.26 [confidence interval {CI}: 1.08–1.48]), servicing clients in public places (OR: 1.28 [CI: 1.04–1.57]), injecting heroin on a daily basis (OR: 1.35 [CI: 1.06–1.74]), and a significantly reduced odds of accessing methadone maintenance therapy (OR: .76 [CI: .62–.93]). Conclusions This study demonstrates significant displacement of youth who engage in sex exchange to marginalized working and living spaces. The findings of this study bring to attention the critical need for targeted structural interventions including access to youth and gender-specific social housing, safe working spaces, reduction in the amount of harm caused to them, and addiction treatment services for youth engaged in survival sex work.

Sexual relationship power and intimate partner violence among sex workers with non-commercial intimate partners in a Canadian setting

“…While the findings from this study are limited in its generalizability to sex workers in other political and geographic areas, it can potentially contribute to the body of evidence used to inform programming specifically for sex workers with non-commercial intimate partners. Programming that addresses workplace violence and HIV risk with clients, can also extend to address the high burden of IPV and the aspects of relationship power that increase HIV risk including difficulty negotiating condoms (Harrison et al, 2006), being coerced to consent to unwanted sex under duress (Panchanadeswaran et al, 2008), engage in higher risk activities such as anal sex (Campbell et al, 2009) or sex in exchange for drugs (Miller et al, 2012). …”

Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

“…389 This relationship may be due to lower levels of risk reduction self-efficacy. 10–12 Age and power imbalances with sex partners and managers may contribute to less decision-making power and risk reduction self-efficacy among adolescent FSWs compared with adult FSWs, particularly in relation to risk reduction strategies requiring partner cooperation such as condom use.…”

Trading Sex for Money or Compensation: Prevalence and Associated Characteristics from a Sexually Transmitted Infection (STI) Clinic Sample

“…Trading sex is closely linked to substance use (Otto-Salaj, Gore-Felton, McGarvey, & Canterbury, 2002), in addition to depression (Hudson & Nandy, 2012) and sexually transmitted inflections (STIs; Khan et al, 2008). Some scholars have also documented trading sex for basic needs as a pathway into prostitution (Miller et al, 2011; Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 2001). …”