1 Johns Hopkins University, Baltimore, MD, USA.
2 Futures Group, Washington, DC, USA.
J Interpers Violence. 2018 Sep;33(17):2745-2766. doi: 10.1177/0886260516629385. Epub 2016 Feb 12.
Female sex workers (FSW) have a heightened vulnerability to violence and negative sexual/reproductive health outcomes. Limited research has examined how experiencing physical and sexual violence (PSV) mediates risk for poor health outcomes among FSW in Swaziland. The present analyses aim to contribute to literature linking violence with poor health outcomes, high-risk behaviors, and reduced health service-seeking among FSW. Data were analyzed from a cross-sectional study conducted in Swaziland between July and September 2011 with 325 adult women who reported exchanging sex for money, goods, or favors in the last 12 months, recruited through respondent-driven sampling (RDS). Logistic regression was used to assess the relationship between PSV and ancillary violence/abuse exposures, risk behaviors, and sexual/reproductive and mental health outcomes. PSV was conceptualized as either ever having been beaten up as a result of selling sex or ever being forced to have sex since the age of 18, or both. Prevalence of PSV in this sample was 59.0% in crude estimation, and 48.4% (95% confidence interval [CI]:[39.2,57.6]) with RDS weighting. Separate RDS-weighted estimates of being beaten up as a result of sex work and ever being forced to have sex were 32.4% (95%CI=[24.4,40.4]) and 33.1% (95%CI =[25.0,41.2%]), respectively. Experiencing PSV was associated with being blackmailed (adjusted odds ratio [aOR]= 1.93, 95%CI= [1.07,3.52]), non-injection drug use in the last 12 months (aOR= 1.84, 95%CI= [1.02,3.33]), and feeling afraid to seek health services as a result of selling sex (aOR = 1.74, 95%CI= [1.01,2.99]). Given these findings, violence prevention strategies should be prioritized in programs that address Swazi FSW health, empowerment, and safety.
性工作者（FSW）更容易遭受暴力侵害和负面的性/生殖健康后果。有限的研究调查了在斯威士兰，性工作者经历身体和性暴力（PSV）如何导致不良健康后果。本分析旨在为将暴力与不良健康后果、高危行为以及性工作者减少寻求健康服务联系起来的文献做出贡献。这些数据来自于 2011 年 7 月至 9 月期间在斯威士兰进行的一项横断面研究，研究对象为 325 名报告在过去 12 个月内通过性交易换取金钱、物品或好处的成年女性，通过响应驱动抽样（RDS）招募。逻辑回归用于评估 PSV 与辅助暴力/虐待暴露、风险行为以及性/生殖和心理健康结果之间的关系。PSV 被定义为由于卖淫而遭受殴打或自 18 岁以来被迫发生性行为，或两者兼有。在该样本中，PSV 的粗估计患病率为 59.0%，经 RDS 加权后为 48.4%（95%置信区间[CI]：[39.2,57.6]）。分别对因性工作而遭受殴打和被迫发生性行为的 RDS 加权估计值为 32.4%（95%CI=[24.4,40.4]）和 33.1%（95%CI=[25.0,41.2%]）。经历 PSV 与被敲诈（调整后的优势比[aOR]=1.93，95%CI=[1.07,3.52]）、过去 12 个月内非注射药物使用（aOR=1.84，95%CI=[1.02,3.33]）以及因卖淫而害怕寻求卫生服务（aOR=1.74，95%CI=[1.01,2.99]）相关。鉴于这些发现，应在解决斯威士兰性工作者健康、赋权和安全问题的方案中优先考虑预防暴力策略。
