The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India

Quaife, Matthew; Lépine, Aurélia; Deering, Kathleen; Terris‐Prestholt, Fern; Beattie, Tara; Isac, Shajy; Paranjape, Ramesh; Vickerman, Peter

doi:10.1093/heapol/czz100

Cited by 13 publications

(12 citation statements)

References 47 publications

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“…HIV burdens among people who sell/trade sex are elevated due, in part, to the conditions in which exchange sex occurs. For instance, transactional sex motivated by financial instability may disincentivize condom use or constrain condom negotiation capacity altogether [ 2 , 3 ]. In the context of criminalized sex work and drug use, these same conditions also amplify the risk environment for condom coercion, violence, and acquisition of HIV and other sexually transmitted infections [ 4 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

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Background Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men’s selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. Methods Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. Results Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97–0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81–7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05–3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02–3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. Conclusions Synergistic sources of social and structural marginalization—from sexuality to hunger, homelessness, and injection drug use—are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.

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Section: Introductionmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

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“…even if you have a gun inside your home, you still must guard your home because maybe the gun is I decided to get a man for love not as a client. (FSW, age27)…”

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confidence: 99%

HIV self‐testing and oral pre‐exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda

et al. 2021

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Introduction: HIV self-testing (HIVST) and oral pre-exposure prophylaxis (PrEP) are complementary, evidence-based, selfcontrolled HIV prevention tools that may be particularly appealing to sex workers. Understanding how HIVST and PrEP are perceived and used by sex workers and their intimate partners could inform prevention delivery for this population. We conducted qualitative interviews to examine ways in which HIVST and PrEP use influence prevention choices among sex workers in Uganda. Methods: Within a randomized trial of HIVST and PrEP among 110 HIV-negative cisgender women, cisgender men and transgender women sex workers (NCT03426670), we conducted 40 qualitative interviews with 30 sex workers and 10 intimate partners (June 2018 to January 2020). Sex worker interviews explored (a) experiences of using HIVST kits; (b) how HIVST was performed with sexual partners; (c) impact of HIVST on PrEP pill taking; and (d) sexual risk behaviours after HIVST. Partner interviews covered (i) introduction of HIVST; (ii) experiences of using HIVST; (iii) HIV status disclosure; and (iv) HIVST's effect on sexual behaviours. Data were analysed using an inductive content analytic approach centering on descriptive category development. Together, these categories detail the meaning of HIVST and PrEP for these qualitative participants. Results: Using HIVST and PrEP was empowering for this group of sex workers and their partners. Three types of empowerment were observed: (a) economic; (b) relational; and (c) sexual health. (i) Using HIVST and PrEP made sex without condoms safer. Sex workers could charge more for condomless sex, which was empowering economically. (ii) Self-testing restored trust in partners' fidelity upon being reunited after a separation. This trust, in combination with condomless sex made possible by PrEP use, restored intimacy, empowering partnered relationships. (iii) HIVST and PrEP enabled sex workers to take control of their HIV prevention efforts and avoid the stigma of public clinic visits. In this way they were empowered to protect their sexual health. Conclusions: In this sample, sex workers' use of HIVST and PrEP benefitted not only prevention efforts, but also economic and relational empowerment. Understanding these larger benefits and communicating them to stakeholders could strengthen uptake and use of combination prevention interventions in this marginalized population.

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“…While it is likely that victims of sexual exploitation cannot refuse to perform certain sex services, it is also true that many independent sex workers offer risky sex services. Unprotected sex is in high-demand among clients and thus offers an economic premium to those sex workers willing to provide it (Eccles & Clarke, 2014;Gertler et al, 2005;Quaife et al, 2019). As aforesaid however, this indicator is solely based on advertisements, and sex workers may refuse to perform unprotected or violent sex when meeting clients.…”

Section: Discussionmentioning

confidence: 99%

Identifying human trafficking indicators in the UK online sex market

Giommoni

Ikwu

2021

Trends Organ Crim

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This study identifies the presence of human trafficking indicators in a UK-based sample of sex workers who advertise their services online. To this end, we developed a crawling and scraping software that enabled the collection of information from 17, 362 advertisements for female sex workers posted on the largest dedicated platform for sex work services in the UK. We then established a set of 10 indicators of human trafficking and a transparent and replicable methodology through which to detect their presence in our sample. Most of the advertisements (58.3%) contained only one indicator, while 3,694 of the advertisements (21.3%) presented 2 indicators of human trafficking. Only 1.7% of the advertisements reported three or more indicators, while there were no advertisements that featured more than four. 3, 255 advertisements (19.0%) did not contain any indicators of human trafficking. Based on this analysis, we propose that this approach constitutes an effective screening process for quickly identifying suspicious cases, which can then be examined by more comprehensive and accurate tools to identify if human trafficking is occurring. We conclude by calling for more empirical research into human trafficking indicators.

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The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India

Cited by 13 publications

References 47 publications

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

HIV self‐testing and oral pre‐exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda

Identifying human trafficking indicators in the UK online sex market

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