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Gender Based Violence as a Risk Factor for HIV-Associated Risk Behaviors Among Female Sex Workers in Armenia

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Abstract

This cross-sectional study identified the prevalence of gender based violence (GBV) and examined its association with sexual risk behavior among female sex workers (FSWs). Among 120 participants between ages 20 and 52, a total of 56.7 % reported lifetime GBV. Multivariate analyses revealed that GBV was significantly associated with inconsistent condom use, unprotected sex, condom misuse, fear of client reaction to requests of condom use, self-reported history of STIs, and earlier age of initiation of sex work. GBV must be considered an urgent public health priority among FSWs in Armenia. Interventions addressing FSWs, in addition to targeting skill-based, sexual risk reduction must also introduce a discourse among FSWs, sexual partners, clients and community members about the role of GBV in HIV-associated risk behaviors and infection. Structural level initiatives must address economic opportunities for women, health-sector policies and responses to FSWs’ health needs, law enforcement training and societal norms toward women.

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References

  1. UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS; 2010.

  2. NCAP. HIV/AIDS epidemic in the Republic of Armenia. Yerevan: NCAP; 2011. http://www.armaids.am/main/free_code.php?lng=1&parent=3.

  3. Shatvoryan E. Report on some aspects of commercial sex work in Armenia. Yerevan: UNFPA; 2001.

    Google Scholar 

  4. Grigoryan S, Mkrtchyan A, Davidyants V. HIV surveillance in the Republic of Armenia, 2000–2002. Yerevan: Armenia National AIDS Foundation; 2002.

    Google Scholar 

  5. Grigoryan S, Hakobyan A, Papoyan A, Manukyan A, Ohanyan R, Asatryan A. HIV epidemiological surveillance in the Republic of Armenia 2007. Yerevan: Armenian National AIDS Foundation; 2008.

    Google Scholar 

  6. Melikyan GL. HIV infection among commercial sex workers in Yerevan: findings and policy recommendations. J Contemp Aff. 1999;2:1–16.

    Google Scholar 

  7. UNAIDS. Joint United Nations Programme on HIV/AIDS. Estimating the size of populations of sex workers, men who have sex with men, and injecting drug users in Armenia in 2010. Geneva: UNAIDS; 2010.

  8. Kelly JA, Amirkhanian YA. The newest epidemic: a review of HIV/AIDS in Central and Eastern Europe. Int J STD/AIDS. 2003;14:361–71.

    Article  Google Scholar 

  9. Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet. 2006;368:1260–9.

    Article  PubMed  Google Scholar 

  10. Silverman JG, Raj A, Cheng DM, et al. Sex trafficking and initiation-related violence, alcohol use, and HIV risk among HIV-infected females sex workers in Mumbai, India. J Infect Dis. 2011;2004(Suppl 5):S1229–34.

    Article  Google Scholar 

  11. UNAIDS/World Health Organization. AIDS epidemic update 2005. Geneva: UNAIDS; 2005.

    Google Scholar 

  12. Zierler S, Krieger N. Reframing women’s risk: social inequalities and HIV infection. Annu Rev Public Health. 1997;18:401–36.

    Article  PubMed  CAS  Google Scholar 

  13. van der Straten A, King R, Grinstead O, Vittinghoff E, Serufilira A, Allen S. Sexual coercion, physical violence, and HIV infection among women in steady relationships in Kigali, Rwanda. AIDS Behav. 1998;2:61–73.

    Article  Google Scholar 

  14. Maman S, Campbell J, Sweat MD, Gielen AC. The intersections of HIV and violence: directions for future research and interventions. Soc Sci Med. 2000;50:459–78.

    Article  PubMed  CAS  Google Scholar 

  15. Garcia-Moreno C, Watts C. Violence against women: its importance for HIV/AIDS. AIDS. 2000;14(Suppl 3):S253–65.

    PubMed  Google Scholar 

  16. Maman S, Mbwambo JK, Hogan NM, et al. HIV-positive women report more lifetime partner violence: findings from a voluntary counselling and testing clinic in Dar es Salaam, Tanzania. Am J Public Health. 2002;92:1331–7.

    Article  PubMed  Google Scholar 

  17. Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med. 2003;56:125–34.

    Article  PubMed  Google Scholar 

  18. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntyre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363:1415–21.

    Article  PubMed  Google Scholar 

  19. Jewkes R, Dunkle K, Nduna M, et al. Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. Int J Epidemiol. 2006;35:1461–8.

    Article  PubMed  CAS  Google Scholar 

  20. Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376:41–8.

    Article  PubMed  Google Scholar 

  21. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntyre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59:1581–92.

    Article  PubMed  Google Scholar 

  22. Choi K-H, Binson D, Adelson M, Catania JA. Sexual harassment, sexual coercion, and HIV risk among US adults 18–49 years. AIDS Behav. 1998;2:33–40.

    Article  Google Scholar 

  23. Lang DL, Salazar LF, Wingood GM, et al. Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiations of sexual practices among HIV-positive women. J Acquir Immune Defic Syndr. 2007;46(2):216–21.

    Article  PubMed  Google Scholar 

  24. Kalichman SC, Williams EA, Cherry C, Belcher L, Nachimson D. Sexual coercion, domestic violence, and negotiating condom use among low-income African-American women. J Womens Health. 1998;7:371–8.

    Article  PubMed  CAS  Google Scholar 

  25. Zhan W, Hansen NB, Shaboltas AV, et al. Partner violence perpetration and victimization and HIV risk behaviors in St. Petersburg, Russia. J Trauma Stress. 2012;25(1):86–93.

    Article  PubMed  Google Scholar 

  26. Gilbert L, El-Bassel N, Schilling RF, Wada T, Bennet B. Partner violence and sexual HIV risk behaviors among women in methadone treatment. AIDS Behav. 2000;4:261–9.

    Article  Google Scholar 

  27. Gielen AC, McDonnell KA, O’Campo P. Intimate partner violence, HIV status and sexual risk reduction. AIDS Behav. 2002;6:107–16.

    Article  Google Scholar 

  28. El-Bassel N, Gilbert L, Krishnan S, et al. Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department. Violence Vict. 1998;13:377–93.

    PubMed  CAS  Google Scholar 

  29. El-Bassel N, Gilbert L, Schilling RF, Wada T. Drug abuse and partner violence among women in methadone treatment. J Fam Violence. 2000;15:209–28.

    Article  Google Scholar 

  30. Silverman JG. Adolescent female sex workers: invisibility, violence and HIV. Arch Dis Child. 2011;96:478–81.

    Article  PubMed  Google Scholar 

  31. Blanchard JF, O’Neil J, Ramesh BM, et al. Understanding the social and cultural contexts of female sex workers in Karnataka India: implications for prevention of HIV infection. J Infect Dis. 2005;191(Suppl 1):139–46.

    Article  Google Scholar 

  32. Sarkar K, Bal B, Mukherjee R, et al. Sex-trafficking, violence, negotiating skill, and HIV infection in brothel-based sex workers of eastern India, adjoining Nepal, Bhutan, and Bangladesh. J Health Popul Nutr. 2008;26:223–31.

    PubMed  Google Scholar 

  33. Shannon K, Kerr T, Strathdee SA, et al. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009;339:b2939.

    Article  PubMed  Google Scholar 

  34. Wechsberg WM, Luseno WK, Lam WK, Parry CD, Morojele NK. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria. AIDS Behav. 2006;10(2):131–7.

    Article  PubMed  Google Scholar 

  35. Beattie TS, Bhattacharjee P, Ramesh BM, et al. Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program. BMC Public Health. 2010;10:476.

    Article  PubMed  Google Scholar 

  36. Decker MR, McCauley HL, Phuengsamran D, et al. Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand. Sex Transm Infect. 2010;86:236–40.

    Article  PubMed  Google Scholar 

  37. Church S, Henderson M, Barnard M, Hart G. Violence by clients towards female prostitutes in different work settings: questionnaire survey. BMJ. 2001;322:524–5.

    Article  PubMed  CAS  Google Scholar 

  38. Wechsberg WM, Luseno WK, Lam WK. Violence against substance-abusing South African sex workers: intersection with culture and HIV risk. AIDS Care. 2005;17(4):55–64.

    Article  Google Scholar 

  39. Surratt HL, Inciardi JA, Kurtz SP, Kiley MC. Sex work and drug use in a subculture of violence. Crime Delinquency. 2004;50:43–59.

    Article  Google Scholar 

  40. El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care STDs. 2001;15(1):41–51.

    Article  PubMed  CAS  Google Scholar 

  41. Decker MR, McCauley HL, Phuengsamran D, et al. Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand. J Epidemiol Community Health. 2011;65(4):334–9.

    Article  PubMed  Google Scholar 

  42. Gielen AC, Ghandour RM, Burke JG, et al. HIV/AIDS and intimate partner violence: intersecting women’s health issues in the United States. Trauma Violence Abuse. 2007;8:178–98.

    Article  PubMed  Google Scholar 

  43. Wingood GM, DiClemente RJ, McCree DH, Harrington K, Davies SL. Dating violence and the sexual health of black adolescent females. Pediatrics. 2001;107:E72.

    Article  PubMed  CAS  Google Scholar 

  44. Upchurch DM, Kusunoki Y. Associations between forced sex, sexual and protective practices, and sexually transmitted diseases among a national sample of adolescent girls. Womens Health Issues. 2004;14(3):75–84.

    Article  PubMed  Google Scholar 

  45. Cavanaugh CE, Hansen NB, Sullivan TP. HIV sexual risk behavior among low-income women experiencing intimated partner violence: the role of posttraumatic stress disorder. AIDS Behav. 2010;14:318–27.

    Article  PubMed  Google Scholar 

  46. Heckathorn DD. Deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49(1):11–34.

    Article  Google Scholar 

  47. Hosmer DW, Lemeshow SL. Applied logistic regression. New York: Wiley; 1989.

    Google Scholar 

  48. Watts C, Zimmerman C. Violence against women: global scope and magnitude. Lancet. 2002;359:1232–7.

    Article  PubMed  Google Scholar 

  49. Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis. 1992;19:61–77.

    PubMed  CAS  Google Scholar 

  50. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999;75:3–17.

    Article  PubMed  CAS  Google Scholar 

  51. Centers for Disease Control, Prevention. Sexually transmitted diseases treatment guidelines 2002. Morb Mort Weekly Rep. 2002;51:1–60.

    Google Scholar 

  52. Crosby RA, DiClemente RF, Holtgrave DR, Wingood GM. Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non viral STIs. Sex Transm Infect. 2002;78:228–31.

    Article  PubMed  CAS  Google Scholar 

  53. Crosby RA, Sanders SA, Yarber WL, Graham CA. Condom use errors and problems: a neglected aspect of studies assessing condom effectiveness. Am J Prev Med. 2003;24:367–70.

    Article  PubMed  Google Scholar 

  54. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Org. 2004;82:454–61.

    PubMed  Google Scholar 

  55. Crosby RA, DiClemente RJ, Wingood GM, et al. Condom failure among adolescents: implications for STD prevention. J Adolesc Health. 2005;36:534–6.

    Article  PubMed  Google Scholar 

  56. Limpakarnjanarat K, Mastro TD, Saisorn S, et al. HIV-1 and other sexually transmitted infections in a cohort of female sex workers in Chiang Rai. Thailand Sex Transm Infect. 1999;75:30–5.

    Article  CAS  Google Scholar 

  57. Abdul-Quader AS, Heckathorn DD, Sabin K, Saidel T. Implementation and analysis of respondent driven sampling: lessons learned from the field. J Urban Health. 2006;83:i1–5.

    Article  PubMed  Google Scholar 

  58. Johnston LG, Sabin K, Mai TH. Assessment of respondent driven sampling for recruiting female sex workers in two Vietnamese cities: reaching the unseen sex worker. J Urban Health. 2006;83:i16–28.

    Article  PubMed  Google Scholar 

  59. DiClemente RJ. Looking forward: future directions for HIV prevention research. In: Peterson JL, DiClemente RJ, editors. Handbook of HIV prevention. New York: Plenum; 2000.

    Google Scholar 

  60. Silverman J. Key to prevent HIV in women: reduce gender-based violence. Lancet. 2010;376:6–7.

    Article  PubMed  Google Scholar 

  61. Colombini M, Mayhew S, Watts C. Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunities. Bull World Health Org. 2008;86(8):635–42.

    Article  PubMed  Google Scholar 

  62. Dunkle KL, Jewkes R. Effective HIV prevention requires gender-transformative work with men. Sex Transm Infect. 2007;83:173–4.

    Article  PubMed  Google Scholar 

  63. Jewkes R, Nduna M, Levin J, et al. Impact of Stepping Stones on HIV, HSV-2 and sexual behavior in rural South Africa: cluster randomized controlled trial. BMJ. 2008;337:a506.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by the US Civil Research and Development Foundation (ARX1-2719-YE-06) and the NIH/FIC AIDS International Training and Research Program of the Emory University (2D43TWO1042). We would like to thank the women who participated in this study as well as Drs. Nora Mnatsakanyan and Marina Khachaturyan of Hope and Help NGO for their dedication to this study and to the women of Yerevan, Armenia.

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Authors and Affiliations

  1. Rollins School of Public Health, Emory University, 1518 Clifton Rd., #548, Atlanta, GA, 30322, USA

    Delia L. Lang & Ralph J. DiClemente

  2. Emory Center for AIDS Research, Emory University, Atlanta, GA, USA

    Delia L. Lang & Ralph J. DiClemente

  3. Institute of Public Health, Georgia State University, Atlanta, GA, USA

    Laura F. Salazar

  4. Division of Infectious Diseases, Epidemiology and Immunology, Department of Medicine (Infectious Diseases) and Department of Pediatrics, Emory University, Atlanta, GA, USA

    Ralph J. DiClemente

  5. College of Health Sciences, American University of Armenia, Yerevan, Armenia

    Karine Markosyan

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  1. Delia L. Lang
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  4. Karine Markosyan
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Correspondence to Delia L. Lang.

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Lang, D.L., Salazar, L.F., DiClemente, R.J. et al. Gender Based Violence as a Risk Factor for HIV-Associated Risk Behaviors Among Female Sex Workers in Armenia. AIDS Behav 17, 551–558 (2013). https://doi.org/10.1007/s10461-012-0245-7

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