TY - JOUR
T1 - Syndemic Psychosocial Health Conditions Associated with Recent Client-Perpetrated Violence Against Female Entertainment and Sex Workers in Cambodia
AU - Couture, Marie Claude
AU - Evans, Jennifer L.
AU - Draughon Moret, Jessica
AU - Stein, Ellen S.
AU - Muth, Sokunny
AU - Phou, Maly
AU - Len, Aynar
AU - Ngak, Song
AU - Sophal, Chhit
AU - Neak, Yuthea
AU - Carrico, Adam W.
AU - Maher, Lisa
AU - Page, Kimberly
N1 - Funding Information:
We would like to express our gratitude to the FHI360 field team for their dedication to the research. The authors would like to acknowledge the gracious and considerate involvement of the following organizations who supported the study and the participants: Provincial Health Departments, Provincial AIDS and STI program, Pre-ART/ART clinics in 10 provinces, Chouk Sar Association, and AID Health Foundation. The authors are indebted and grateful for the ongoing support of numerous non-governmental organizations who made the implementation of this project possible: Cambodian Women for Peace and Development, Phnom Srey Organization for Development, Poor Family Development, and KHEMERA. Finally, this research would not be possible without the support from the Cambodia National Ministry of Health Department Mental Health and Substance Abuse, the National Authority for Combating Drugs, and the National Center for HIV, AIDS, Dermatology, and STDs.
Funding Information:
The study was funded by the US National Institutes of Health and the National Institute on Drug Abuse (1R01 DA033672; Page & Stein, PIs).
Funding Information:
We would like to express our gratitude to the FHI360 field team for their dedication to the research. The authors would like to acknowledge the gracious and considerate involvement of the following organizations who supported the study and the participants: Provincial Health Departments, Provincial AIDS and STI program, Pre-ART/ART clinics in 10 provinces, Chouk Sar Association, and AID Health Foundation. The authors are indebted and grateful for the ongoing support of numerous non-governmental organizations who made the implementation of this project possible: Cambodian Women for Peace and Development, Phnom Srey Organization for Development, Poor Family Development, and KHEMERA. Finally, this research would not be possible without the support from the Cambodia National Ministry of Health Department Mental Health and Substance Abuse, the National Authority for Combating Drugs, and the National Center for HIV, AIDS, Dermatology, and STDs.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Female entertainment and sex workers (FESW) are vulnerable to violence, which impedes safer sex behaviors and increases risk of HIV. FESW are also disproportionately affected by co-occurring psychosocial health conditions, including substance use, depression, and economic insecurity, which increased risk of exposure to violence. We used a syndemic framework to examine the effects of co-occurring psychosocial conditions on the risk of client-perpetrated physical and sexual violence against FESW. Data were collected among 1198 Cambodian FESW on recent client–perpetrated physical and sexual violence, and psychosocial conditions (psychological distress, alcohol consumption, amphetamine-type stimulant (ATS) use, debts, housing, and food insecurity). Bivariate and multivariate logistic regressions were conducted. Prevalence of physical and sexual violence from clients was 4.8% and 6.9%, respectively. Client-perpetrated physical violence was associated with housing insecurity, ATS use, and psychological distress. All psychosocial conditions, except ATS, were associated with exposure to sexual violence. In multivariable models, odds of client-perpetrated physical violence were twice higher among women with ≥ 4 compared to ≤ 3 psychosocial conditions. Risk of sexual violence increased with the number of psychosocial conditions. Compared to those with ≤ 1 condition, FESW with two psychosocial conditions had twice the odds (AOR = 2.08; 95% CI 1.00–4.31) and women with 5–6 psychosocial conditions had eightfold higher odds (AOR = 8.10; 95% CI 3.4–19.31) of sexual violence from clients. Our findings support a syndemic model of co-occurring psychosocial conditions among FESW that are associated with increased risk of violence. Violence prevention interventions targeting FESW should adopt comprehensive approaches that address co-occurring psychosocial conditions.
AB - Female entertainment and sex workers (FESW) are vulnerable to violence, which impedes safer sex behaviors and increases risk of HIV. FESW are also disproportionately affected by co-occurring psychosocial health conditions, including substance use, depression, and economic insecurity, which increased risk of exposure to violence. We used a syndemic framework to examine the effects of co-occurring psychosocial conditions on the risk of client-perpetrated physical and sexual violence against FESW. Data were collected among 1198 Cambodian FESW on recent client–perpetrated physical and sexual violence, and psychosocial conditions (psychological distress, alcohol consumption, amphetamine-type stimulant (ATS) use, debts, housing, and food insecurity). Bivariate and multivariate logistic regressions were conducted. Prevalence of physical and sexual violence from clients was 4.8% and 6.9%, respectively. Client-perpetrated physical violence was associated with housing insecurity, ATS use, and psychological distress. All psychosocial conditions, except ATS, were associated with exposure to sexual violence. In multivariable models, odds of client-perpetrated physical violence were twice higher among women with ≥ 4 compared to ≤ 3 psychosocial conditions. Risk of sexual violence increased with the number of psychosocial conditions. Compared to those with ≤ 1 condition, FESW with two psychosocial conditions had twice the odds (AOR = 2.08; 95% CI 1.00–4.31) and women with 5–6 psychosocial conditions had eightfold higher odds (AOR = 8.10; 95% CI 3.4–19.31) of sexual violence from clients. Our findings support a syndemic model of co-occurring psychosocial conditions among FESW that are associated with increased risk of violence. Violence prevention interventions targeting FESW should adopt comprehensive approaches that address co-occurring psychosocial conditions.
KW - Client-perpetrated violence
KW - HIV risk
KW - Psychosocial health conditions
KW - Sex workers
KW - Syndemic
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U2 - 10.1007/s10508-020-01705-y
DO - 10.1007/s10508-020-01705-y
M3 - Article
C2 - 32342257
AN - SCOPUS:85084234304
VL - 49
SP - 3055
EP - 3064
JO - Archives of Sexual Behavior
JF - Archives of Sexual Behavior
SN - 0004-0002
IS - 8
ER -