Condom negotiation at a heavy price: violence experienced by female sex workers who inject drugs in the context of condom use negotiation
J.K. Stockman1, R. Lozada1, M.L. Zuniga1, M.D. Ulibarri1, M.L. Rusch1, A. Vera1, T.L. Patterson2,3, S.A. Strathdee1
1University of California, San Diego, Division of Global Public Health, Department of Medicine, La Jolla, United States, 2University of California, San Diego, Department of Psychiatry, La Jolla, United States, 3University of California, San Diego, VA Medical Center, La Jolla, United States
Background: HIV prevalence among female sex workers who inject drugs (FSW-IDUs) is increasing in northern Mexico. We studied the prevalence and correlates of physical violence or threats toward FSW-IDUs in the context of condom use negotiation.
Methods: FSW-IDUs ≥18 years old who reported injecting drugs and recent unprotected sex with clients participated in an ongoing behavioral intervention in Tijuana and Ciudad Juarez, Mexico. At baseline, participants underwent surveys and biological testing for HIV/STIs. Logistic regression was used to identify correlates of physical violence/threats during condom use negotiation by regular and non-regular clients.
Results: To date, among 462 FSW-IDUs with regular clients, 9.3% ever experienced physical violence/threats when proposing condom use; of 465 FSW-IDUs with non-regular clients, 11.8% experienced a similar event. FSW-IDUs who used home remedies to treat STIs and had a lifetime history of forced/coerced sex were at least 3 times more likely to experience physical violence/threats from regular and non-regular clients in the context of condom negotiation. There was also an 11% increase in the odds of experiencing physical violence/threats when proposing condom use for every non-commercial sex partner who injected drugs. Other factors independently associated with experiencing physical violence/threats from non-regular clients in the context of condom negotiation were having a steady sex partner who had a concurrent sex partner (AdjOR: 3.34; 95% CI:1.32-8.47) and injecting drugs two or more times per day (AdjOR: 0.32; 95% CI:0.14-0.73), which was inversely associated.
Conclusions: Among FSW-IDUs, condom negotiation with regular and non-regular clients involves inherent physical risks. Histories of violence also appear to represent barriers to seeking care for STIs; the use of home remedies for STI treatment could even elevate HIV transmission risks. It is imperative to address condom negotiation in the context of potential violence within structural and environmental HIV prevention interventions for FSW-IDUs and clients.
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