Social and structural factors increase inconsistent condom use by sex workers’ one-time and regular clients in Northern Uganda

Duff, Patricia A.; Birungi, Josephine; Dobrer, Sabina; Akello, Monika; Muzaaya, Godfrey; Shannon, Kate

doi:10.1080/09540121.2017.1394966

Cited by 20 publications

(21 citation statements)

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“…Few studies have examined the role of trust and intimacy in condom use between sex workers and clients. Relationship intimacy or trust has been documented as a key factor that influences condom use among sex workers and clients in Jamaica (Bailey & Figueroa, 2018 ) and Uganda (Duff et al, 2018 ). One study from Uganda found that sex workers develop a sense of trust with regular or repeat clients, which has a direct negative impact on consistent condom use (Duff et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…Relationship intimacy or trust has been documented as a key factor that influences condom use among sex workers and clients in Jamaica (Bailey & Figueroa, 2018 ) and Uganda (Duff et al, 2018 ). One study from Uganda found that sex workers develop a sense of trust with regular or repeat clients, which has a direct negative impact on consistent condom use (Duff et al, 2018 ). The studies that do exist document large differences in consistent condom use rates between casual and regular clients (Duff et al, 2018 ; Matovu & Ssebadduka, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

“…One study from Uganda found that sex workers develop a sense of trust with regular or repeat clients, which has a direct negative impact on consistent condom use (Duff et al, 2018 ). The studies that do exist document large differences in consistent condom use rates between casual and regular clients (Duff et al, 2018 ; Matovu & Ssebadduka, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

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Female Entertainment Workers and Condom Use Negotiation in Post-100% Condom Use Era Cambodia

Brody

Reno

Chhoun³

et al. 2020

Arch Sex Behav

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Beyond the monopoly environment of the early 100% Condom Use Program in Cambodia, less is known about how current female entertainment workers negotiate condom use on their own, and what factors impact that negotiation. This study aims to understand the experiences of current female entertainment workers in negotiating condom use with clients in Cambodia. Data collection occurred over a period of 3 weeks (August-September 2017) with concurrent data transcription and translation. A total of 27 focus group discussions (FGDs) were conducted in the following groups: pilot FGD (5), karaoke bar (5), massage parlor (5), beer garden (5), on-call sex workers (3), cross-venue groups exploring parenting issues (2), and street-based sex workers (2). Female entertainment workers experience a range of control over negotiating condom use with clients. Participants reported times when they were able to take direct action and successfully insist on condom use, times when they agreed to participate in condomless sex for money in the face of economic insecurity, and times when male clients sabotaged their attempts to negotiate condom use with tricks, verbal threats or threats of violence. These experiences are influenced by alcohol use, economic shocks, trust between partners, and experiences with side effects. Our findings support the development of policies that re-invigorate the structural-level condom promotion programs while also acknowledging the many individual-level factors that shape condom use such as alcohol consumption, economic insecurity, trust, and side effects.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Female Entertainment Workers and Condom Use Negotiation in Post-100% Condom Use Era Cambodia

Brody

Reno

Chhoun³

et al. 2020

Arch Sex Behav

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“…7 Few studies considered one or more structural determinants from the heaviest or emerging HIV epidemic settings of SSA, Russia or Eastern Europe. Since 2014, a number of key studies have begun to document macro-structural factors including stigma, 22,23 migration, 24,25 and downstream products of laws and policies such as policing24, and violence 26 – 29 on HIV outcomes and access to care among sex workers in sub-Saharan Africa, with a small handful of studies from Russia and Eastern Europe. 10 Many of the published studies have been completed across Western, Central and South Africa 18 – 25 reinforcing the consistency of significance of these relationships using a combination of quantitative and qualitative methods.…”

Section: Programmatic and Scientific Advancesmentioning

confidence: 99%

The global response and unmet actions for HIV and sex workers

et al. 2018

Self Cite

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Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5-11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. Although important progress has been made in biomedical interventions with pre-exposure prophylaxis and early ART feasibility and demonstration projects, limited coverage and retention suggest that sustained investment in community and structural interventions is required for sex workers to benefit from the preventive interventions and treatments that other key populations have. Evidence-based progress on full decriminalisation grounded in health and human rights-a key recommendation in our Lancet Series-has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.

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“…Engaging with the police, whether threats (e.g., verbal harassment) or actions (e.g., arrest, sexual violence) is a number of harmful outcomes. (16,33,49) In the current study, the impact of police was re ected in the signi cant association between client inconsistent condom use with both avoiding carrying condoms and moving to unfamiliar areas in all three adjusted models, both attributed to the police. An earlier study of FSW in Baltimore found associations between abusive policing practices and client-perpetrated violence, which, in turn, has been found to increase risk for inconsistent condom use.…”

Section: Discussionmentioning

confidence: 53%

The Role of Local Business Employees and Community Members in The HIV Risk Environment of Female Sex Workers in An Urban Setting: Associations Between Negative Interactions and Inconsistent Condom Use

Sherman¹,

Tomko²,

Silberzahn³

et al. 2020

Preprint

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Background: The role of business employees and community members in the HIV risk environment of female sex workers (FSW) is underexplored, despite sex work often located in commercial and residential urban areas. We explored the effect of negative interactions between business employees and community members inconsistent condom use with clients.Methods: This study uses baseline data from the EMERALD study, a structural intervention with FSW. We recruited a sample of 361 FSW in Baltimore, Maryland using targeted sampling techniques in ten zones throughout the city. Participants were recruited between September 2017 and January 2019 and completed a survey, HIV rapid testing, and self-administered gonorrhea and chlamydia testing. The outcome, inconsistent condom use, was defined as not reporting “always” using condoms with paying clients. Poisson regressions with robust variance were used to model the effect of business employee and/or community member interactions on inconsistent condom use.Results: Over half (54%) the sample was between 18–40 years old, 44% Black or another race, and experienced a range of structural vulnerabilities such as housing instability and food insecurity. Forty-four percent of the sample reported inconsistent condom use with clients. FSW reported being reported to the police weekly or daily for selling drugs (14% by employees, 17% by community), for selling sex (19% by employees, 21% by community), and experiencing weekly or daily verbal or physical threats (18% by employees, 24% by community). In multivariable models, being reported to the police for selling sex weekly or daily by community members (vs. never, aOR = 1.42, 95% CI = 1.08, 1.86) and business owners (vs. never, aOR = 1.36, 95% CI = 1.05, 1.76) increased odds of inconsistent condom use, as did monthly verbal or physical threats by community members (vs. never, aOR = 1.43, 95% CI = 1.08, 1.91).Conclusions: Results show that both actors play important roles in FSWs’ HIV risk environment. Businesses and community members are important targets for holistic HIV prevention interventions among FSW in communities where they coexist in close proximity.

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Social and structural factors increase inconsistent condom use by sex workers’ one-time and regular clients in Northern Uganda

Cited by 20 publications

References 49 publications

Female Entertainment Workers and Condom Use Negotiation in Post-100% Condom Use Era Cambodia

Female Entertainment Workers and Condom Use Negotiation in Post-100% Condom Use Era Cambodia

The global response and unmet actions for HIV and sex workers

The Role of Local Business Employees and Community Members in The HIV Risk Environment of Female Sex Workers in An Urban Setting: Associations Between Negative Interactions and Inconsistent Condom Use

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