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Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers.

Authors
  • Sherman, Susan G1
  • Tomko, Catherine1
  • White, Rebecca Hamilton1
  • Nestadt, Danielle Friedman1
  • Silberzahn, Bradley E2
  • Clouse, Emily1
  • Haney, Katherine1
  • Galai, Noya3
  • 1 From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • 2 Department of Sociology, The University of Texas at Austin, Austin, TX.
  • 3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Type
Published Article
Journal
Sexually transmitted diseases
Publication Date
Sep 01, 2021
Volume
48
Issue
9
Pages
648–653
Identifiers
DOI: 10.1097/OLQ.0000000000001400
PMID: 33633073
Source
Medline
Language
English
License
Unknown

Abstract

Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population. Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia). Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion. More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs. Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.

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