Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA.
Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA.
Soc Sci Med. 2020 Sep;261:113189. doi: 10.1016/j.socscimed.2020.113189. Epub 2020 Jul 11.
Natural disasters, such as hurricanes, often negatively affect the economic wellbeing of affected individuals. Under such conditions, women may engage in transactional sexual behaviors in order to compensate for lost income and provide for their households. In this study, we evaluated the relationship between hurricane impact and transactional sex and if this relationship was moderated, or mediated, through economic factors. Between December 2017 and February 2018, approximately one year after the area was hit by a category 4 hurricane (Hurricane Matthew), we interviewed a random sample of female microfinance members (n = 304) in Okay, Haiti. We estimated the association between hurricane impact and transactional sex using log-binomial regression. Next, we tested for economic moderation of this relationship by incorporating interaction terms between hurricane impact and food insecurity, poverty, and loss of income generating materials in three separate log-binomial models. Finally, we assessed possible mediation of this relationship by loss of income generating resources and a latent variable, economic stress, using a structural equation model. We found participants who had experienced hurricane impact were 58% more likely to have engaged in transactional sex [prevalence ratio (95% confidence interval): 1.58 (1.19-2.09)]. This relationship was significant and strongly positive among women who were food insecure and had high poverty but not so among women who were food secure and had low poverty, respectively. The final structural equation model (with fit: χ = 19.700, degrees of freedom = 15; CFI = 0.958; TLI = 0.941; RMSEA = 0.040) revealed that the relationship was not mediated through economic factors. However, the association between hurricane impact and transactional sex remained significant while controlling for these economic factors. Notably, the findings that the relationship between hurricane impact and transactional sex was moderated, but not mediated, by economic factors implies populations at-risk of experiencing natural disasters should be preemptively targeted with economic interventions to build capacity and resilience before such a disaster hits.
自然灾害，如飓风，往往会对受灾个人的经济福祉产生负面影响。在这种情况下，女性可能会从事交易性行为，以弥补收入损失并为家庭提供经济支持。在这项研究中，我们评估了飓风影响与交易性行为之间的关系，以及这种关系是否通过经济因素而得到调节或中介。2017 年 12 月至 2018 年 2 月，也就是该地区遭受四级飓风（马修飓风）袭击大约一年后，我们在海地的奥卡随机采访了 304 名女性小额信贷成员。我们使用对数二项式回归估计了飓风影响与交易性行为之间的关联。接下来，我们通过在三个单独的对数二项式模型中纳入飓风影响与食物不安全、贫困和丧失创收材料之间的交互项，检验了这种关系是否存在经济调节作用。最后，我们通过收入来源损失和经济压力的潜在变量，使用结构方程模型评估了这种关系的可能中介作用。我们发现，经历过飓风影响的参与者从事交易性行为的可能性要高出 58%[流行率比（95%置信区间）：1.58（1.19-2.09）]。这种关系在食物不安全且贫困程度高的女性中显著且呈正相关，但在食物安全且贫困程度低的女性中则不然。最终的结构方程模型（拟合：χ=19.700，自由度=15；CFI=0.958；TLI=0.941；RMSEA=0.040）显示，这种关系并非通过经济因素来中介。然而，在控制了这些经济因素后，飓风影响与交易性行为之间的关联仍然显著。值得注意的是，飓风影响与交易性行为之间的关系受到经济因素的调节，但不是中介，这意味着应预先针对易受自然灾害影响的人群进行经济干预，在灾难发生之前增强其能力和恢复力。
