41474University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Community, Global and Public Health Division, 15851Johns Hopkins University School of Nursing, Baltimore, MD, USA.
J Interpers Violence. 2023 Jan;38(1-2):NP1920-NP1949. doi: 10.1177/08862605221093680. Epub 2022 May 5.
Economic hardship is a driver of entry into sex work, which is associated with high HIV risk. Yet, little is known about economic abuse in women employed by sex work (WESW) and its relationship to uptake of HIV prevention and financial support services. This study used cross-sectional baseline data from a multisite, longitudinal clinical trial that tests the efficacy of adding economic empowerment to traditional HIV risk reduction education on HIV incidence in 542 WESW. Mixed effects logistic and linear regressions were used to examine associations in reported economic abuse by demographic characteristics, sexual behaviors, HIV care-seeking, and financial care-seeking. Mean age was 31.4 years. Most WESW were unmarried (74%) and had less than primary school education (64%). 48% had savings, and 72% had debt. 93% reported at least one economic abuse incident. Common incidents included being forced to ask for money (80%), having financial information kept from them (61%), and being forced to disclose how money was spent (56%). WESW also reported partners/relatives spending money needed for bills (45%), not paying bills (38%), threatening them to quit their job(s) (38%), and using physical violence when earning income (24%). Married/partnered WESW (OR = 2.68, 95% CI:1.60-4.48), those with debt (OR = 1.70, 95% CI:1.04-2.77), and those with sex-work bosses (OR = 1.90, 95% CI:1.07-3.38) had higher economic abuse. Condomless sex ( = +4.43, < .05) was higher among WESW experiencing economic abuse, who also had lower odds of initiating PrEP (OR = .39, 95% CI:.17-.89). WESW experiencing economic abuse were also more likely to ask for cash among relatives (OR = 2.36, 95% CI:1.13-4.94) or banks (OR = 2.12, 95% CI:1.11-4.03). The high prevalence of HIV and economic abuse in WESW underscores the importance of integrating financial empowerment in HIV risk reduction interventions for WESW, including education about economic abuse and strategies to address it. Programs focusing on violence against women should also consider economic barriers to accessing HIV prevention services.
经济困难是从事性工作的一个驱动因素，而性工作与 HIV 高风险相关。然而，人们对从事性工作的女性（WESW）中经济虐待的情况及其与 HIV 预防和财务支持服务的采用之间的关系知之甚少。本研究使用了一项多地点、纵向临床试验的横断面基线数据，该试验测试了在 542 名 WESW 中增加经济赋权以传统 HIV 降低风险教育对 HIV 发病率的影响。使用混合效应逻辑和线性回归来检查人口统计学特征、性行为、HIV 护理寻求和财务护理寻求报告的经济虐待情况。平均年龄为 31.4 岁。大多数 WESW 未婚（74%），接受的教育程度低于小学（64%）。48%有储蓄，72%有债务。93%报告至少有一起经济虐待事件。常见的事件包括被迫要钱（80%）、经济信息被隐瞒（61%）和被迫透露钱的用途（56%）。WESW 还报告说，伴侣/亲戚会花掉用于账单的钱（45%）、不支付账单（38%）、威胁她们辞去工作（38%）和在赚取收入时使用身体暴力（24%）。已婚/伴侣关系的 WESW（OR = 2.68，95%CI：1.60-4.48）、有债务的 WESW（OR = 1.70，95%CI：1.04-2.77）和有性工作老板的 WESW（OR = 1.90，95%CI：1.07-3.38）的经济虐待更高。遭受经济虐待的 WESW 发生无保护性行为的可能性更高（ = +4.43， <.05），并且更不可能开始使用 PrEP（OR =.39，95%CI：.17-.89）。遭受经济虐待的 WESW 也更有可能向亲戚（OR = 2.36，95%CI：1.13-4.94）或银行（OR = 2.12，95%CI：1.11-4.03）索要现金。WESW 中 HIV 和经济虐待的高患病率突出表明，在针对 WESW 的 HIV 降低风险干预措施中纳入财务赋权非常重要，包括关于经济虐待和解决经济虐待的策略的教育。专注于针对妇女的暴力行为的项目也应考虑获取 HIV 预防服务的经济障碍。
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