"No party hat, no party": successful condom use in sex work in Mexico and the Dominican Republic

Assessing Human Immunodeficiency Virus (HIV) Prevention Through Knowledge and Condom Use Among Female Sex Workers at the Border of Haiti and Dominican Republic

Geographic border studies are relatively scare, but have the potential to inform bilateral health policies that affect the well-being of female sex workers (FSWs) who work at these borders as well as those individuals who solicit their services, both groups being at high risk for human immunodeficiency virus (HIV). We applied bivariate and multivariate techniques to examine FSWs' HIV knowledge and condom use across three partner types, at the Haiti Dominican Republic border, using data from the Study on Sex Workers (n = 241, 2014). Condom use was significantly lower among FSWs on the Haitian side of the border compared to the Dominican side, yet levels of HIV knowledge were similar; specifically, 81% of respondents on the Dominican side reported using condoms every time they had sex with a client, compared to 38% of peers in Haiti (p < 0.001). After introducing controls, FSWs in Haiti continued to have lower odds of using condoms with clients (p < 0.001), noncommercial partners (p < 0.001), and regular partners (p < 0.05) compared to peers in the Dominican Republic. This unique border study highlights disparities in FSWs' condom use regardless of HIV knowledge. The lack of consistent condom use by FSWs in Haiti has the potential to exacerbate the HIV epidemic at the border and impact both nations' HIV incidence rates.

The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept

How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.

Predictive factors of unprotected sex for female sex workers: first study in French Guiana, the French territory with the highest HIV prevalence

French Guiana is the French territory that is most affected by HIV. AIDS incidence is much higher than in mainland France and sex work seems to be an important driver of the epidemic. The objective of this study was to describe consistent condom use among female sex workers with their clients and their intimate partners and to identify determinants of non-use of condoms. An HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey was conducted in 2009-2010 among sex workers in French Guiana. A total of 477 sex workers were interviewed. Female sex workers were more likely to use condoms with their clients (97%) than with their intimate partners (45%). The factors associated with non-consistent condom use with the intimate partner were having had an abortion, feeling at risk for HIV, not evaluating one's own risk for HIV, living as a couple, being Dominican, and not feeling comfortable asking intimate partners to use condoms. Although a high proportion of female sex workers declared using condoms with commercial partners, there is still room for improvement in the prevention of transmission with both commercial and intimate partners.

Health discourse and within-group stigma in professional BDSM

This article directly deals with health and stigma within practices of erotic labor. Scant previous literature has focused on erotic laborers' perceptions of stigma and the ways in which regimes of stigmatization operate within their particular social worlds. I use the commercial BDSM (Bondage, Discipline, Sadism, Masochism) "dungeon" as a strategic research site to investigate these workers' conceptions and management of their own stigma, and I find that discourses about stigma are inextricably entwined with concerns about health and wellbeing. Data are derived from ethnographic fieldwork with professional dominatrices ("pro-dommes") who work in New York City and San Francisco as well as in-depth interviews conducted between September 2007 and April 2008. Counter to stereotypes of erotic laborers as violent or as vectors of disease, BDSM workers are in fact not only concerned about safety but professionally invested in it, reinforcing it through an identity politics of hierarchies of erotic labor. There are multiple implications of this work for public perception and policy-implications that could only be brought to light through the ethnographic method.

Condom access: Associations with consistent condom use among female sex workers in two northern border cities of Mexico

To determine whether condom access is associated with consistent condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, between 2004 and 2006 we administered a questionnaire to 924 FSWs who reported unprotected sex with a client in the past 2 months. Of these women, 43% reported consistent ("often" or "always") condom use, 74% said condoms were available, and 38% reported having access to free condoms. In a logistic regression, factors positively associated with consistent condom use were condom availability (adjusted odds ratio [AOR] = 2.00; 95% confidence interval [CI]: 1.32-3.03), condom affordability (AOR = 1.72; 95% CI: 1.25-2.38) and self-efficacy (AOR = 2.16; 95% CI: 1.54-3.04). Factors inversely associated with consistent condom use included poor financial status (AOR = 0.65; 95% CI: 0.47-0.90), methamphetamine use (AOR = 0.58; 95% CI: 0.40-0.83), alcohol use (AOR = 0.68; 95% CI: 0.49-0.96), and recent injection drug use (AOR = 0.62; 95% CI: 0.39-0.97). While increased condom availability may improve condom use among FSWs in general, interventions to broaden condom use among lower income and drug-using FSWs are critically needed.

Sexual and drug use behaviors associated with HIV and other sexually transmitted infections among female sex workers in the Mexico-US border region

PURPOSE OF REVIEW

The purpose of this review is to summarize the latest research regarding HIV/sexually transmitted infection (STI) risk among female sex workers (FSWs) along the Mexico-US border. Although Mexico has a low prevalence of HIV overall, HIV prevalence among FSWs in Tijuana is quite high, and even higher among FSWs who inject drugs (FSW-IDUs). Efforts to better understand and curtail the HIV epidemic among FSWs in this region are greatly needed.

RECENT FINDINGS

A brief HIV/STI risk reduction intervention for FSWs was successful in decreasing HIV/STI sexual risk behavior with clients among FSWs in Tijuana and Ciudad Juarez, Mexico. However, the intervention was less effective among FSW-IDUs, and had no effect on FSWs' condom use with their noncommercial partners. Whereas the majority of research thus far has focused on FSWs' individual-level risk factors, comparatively less is known about their clients and noncommercial sexual partners who may heavily influence their behavior, and engage in high-risk behaviors themselves.

SUMMARY

Further studies including FSWs' intimate partners and clients are needed as well as interventions specific to FSW-IDUs. Targeting the most at-risk populations and reducing both sexual and injection-risk behaviors simultaneously may curb the growing HIV epidemic in the Mexico-US border region.