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" Factors associated with sexually transmitted infections including the human immunodeficiency virus among sex workers in Moscow, Russian Federation and Israel "
Rachel A. Weber
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Latin Dissertation
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English
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| Record Number
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55534
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TL25488
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3340019
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| Main Entry
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Rachel A. Weber
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| Title & Author
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Factors associated with sexually transmitted infections including the human immunodeficiency virus among sex workers in Moscow, Russian Federation and Israel\ Rachel A. Weber
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| College
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The Johns Hopkins University
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| Date
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2008
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| Degree
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Ph.D.
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2008
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131
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| Abstract
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Background. Sex workers are at increased risk of acquiring human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) compared to most other population groups worldwide. Sex workers have been identified as an important core group for transmission of STIs and HIV while clients and partners of sex workers have been documented with high STI and HIV infection rates, therefore making them both a source of reinfection for sex workers and a bridge group to the general population. Prevalent STI infection also increases risk of acquiring HIV. Objectives. The purpose of these two studies is to quantitatively and qualitatively explore factors mitigating STI and HIV risk among Russian speaking female sex workers in Moscow, Russian Federation (Chapter 2) and Israel (Chapter 3). Methods. One hundred and fifty female sex workers 17 to 40 years of age working in Moscow were recruited into the quantitative study. Participants completed an interviewer-administered survey, took a physician administered physical exam, and provided biological samples to be screened for HIV, gonorrhea, Chlamydia, and syphilis. Chi square tests were used to assess the bivariate and multivariable relationships of violence, working conditions, sexual and drug risk behaviors, and demographic variables to HIV and STI outcomes. Nine Russian speaking women over the age of 18 who had worked in the Israeli sex industry in the previous twelve months were recruited into the qualitative study. Participants participated in up to three in-depth interviews and a condom skills assessment at a private location. Results. Of the 147 sex workers that met inclusion criteria for the quantitative study in Moscow, almost one-third tested positive with one or more STI including HIV, syphilis, gonorrhea, and Chlamydia. In multivariable analysis, averaging three or more clients per day appeared to be associated with a bacterial STI outcome. For HIV, in multivariable analysis, the threat of physical violence by a pimp remained statistically significant and history of injection drug use remained marginally significant. The women in the qualitative study in Israel demonstrated a strong commitment to protecting themselves while working in the sex industry and participants reported always using condoms with clients for vaginal sex. However, they still faced barriers to protecting their health, which included restricted movement for victims of trafficking, physical and sexual violence, client attempts to break or remove condoms during intercourse, gaps in knowledge of correct condom use and STI symptoms, and inappropriate hygiene practices. Conclusion. Sex workers demonstrated awareness of HIV risk and motivation to use condoms. However, sex worker risk is still heightened by physical, sexual and emotional violence, lack of thorough STI and HIV knowledge, using condoms and lubricants incorrectly, misinformation about cleansing and contraceptive products, barriers and restrictions associated with trafficking and migration, drug use, stigma, and lack of protection by law enforcement. Innovative and comprehensive interventions are needed that address these issues, with particular care and attention paid to the barriers outside of sex worker control.
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| Subject
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Health and environmental sciences; Condom use; HIV; Sex workers; Sexually transmitted infections; Violence; Public health; Epidemiology; 0573:Public health; 0766:Epidemiology
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V. Go
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The Johns Hopkins University
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