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

Susan G. Sherman, Catherine Tomko, Bradley E. Silberzahn, Rebecca Hamilton White, Danielle Friedman Nestadt, Emily Clouse, Katherine Haney, Noya Galai

Research output: Contribution to journalArticlepeer-review

Abstract

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 on inconsistent condom use with clients of female sex workers. Methods: This study uses baseline data from the EMERALD study, a community empowerment intervention with FSW. We recruited a sample of 361 FSW in Baltimore, Maryland using targeted sampling techniques in ten zones characterized by high rates of sex work, located 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 and 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, aRR = 1.42, 95% CI = 1.08, 1.86) and business owners (vs. never, aRR = 1.36, 95% CI = 1.05, 1.76) increased risk of inconsistent condom use, as did monthly verbal or physical threats by community members (vs. never, aRR = 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.

Original languageEnglish
Article number2265
JournalBMC Public Health
Volume21
Issue number1
DOIs
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
National Institute on Drug Abuse (R01DA041243); National Institute of Mental Health (F31MH118817); and Johns Hopkins University Center for AIDS Research, a National Institutes of Health funded program (P30AI094189). The funders had no role in the design of the study, collection, analysis, or interpretation of data, or writing the manuscript.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Condom use
  • Female sex work
  • HIV
  • Risk environment

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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