Economic Abuse and Care-seeking Practices for HIV and Financial Support Services in Women Employed by Sex Work: A Cross-Sectional Baseline Assessment of a Clinical Trial Cohort in Uganda.
Economic Abuse and Care-seeking Practices for HIV and Financial Support Services in Women Employed by Sex Work: A Cross-Sectional Baseline Assessment of a Clinical Trial Cohort in Uganda.
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性别工作雇用的妇女的艾滋病毒和财务支持服务的经济虐待和寻求护理实践：乌干达临床试验队列的横断面基线评估。
DOI：
10.1177/08862605221093680
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发表时间：
2023-01
影响因子：
2.5
通讯作者：
Ssewamala, Fred M.
中科院分区：
文献类型：
--
作者：
Jennings Mayo-Wilson, Larissa;Yen, Bing-Jie;Nabunya, Proscovia;Bahar, Ozge Sensoy;Wright, Brittanni N.;Kiyingi, Joshua;Filippone, Prema L.;Mwebembezi, Abel;Kagaayi, Joseph;Tozan, Yesim;Nabayinda, Josephine;Witte, Susan S.;Ssewamala, Fred M.
经济困难是从事性工作的一个驱动因素，这与艾滋病毒高风险有关。然而，人们对性工作妇女遭受的经济虐待及其与接受艾滋病毒预防和财政支助服务的关系知之甚少。这项研究使用了一项多中心纵向临床试验的横断面基线数据，该试验测试了在542名WESW中将经济赋权添加到传统的艾滋病毒风险降低教育中对艾滋病毒发病率的有效性。采用混合效应logistic和线性回归分析，通过人口统计学特征、性行为、HIV寻求护理和经济寻求护理来研究报告的经济虐待的相关性。平均年龄为31.4岁。大多数妇女、教育和社会福利工作者未婚（74%），教育程度低于小学（64%）。48%的人有储蓄，72%的人有债务。93%的人报告了至少一次经济虐待事件。常见的事件包括被迫要钱（80%），财务信息被隐瞒（61%），以及被迫披露钱是如何花的（56%）。妇女和社会福利组织还报告说，伴侣/亲属花钱支付账单（45%），不支付账单（38%），威胁他们辞职（38%），以及在赚取收入时使用身体暴力（24%）。已婚/伴侣WESW（OR = 2.68，95%CI：1.60-4.48）、负债（OR = 1.70，95%CI：1.04-2.77）和性工作老板（OR = 1.90，95%CI：1.07-3.38）的经济虐待率较高。无安全套性行为（β =+4.43，p < .05）在经历经济虐待的WESW中较高，他们启动PrEP的几率也较低（OR = .39，95%CI：.17-.89）。遭受经济虐待的WESW也更可能向亲戚（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。饮水、环卫和社会福利机构中艾滋病毒和经济虐待的高流行率突出表明，必须将增强财政权能纳入饮水、环卫和社会福利机构减少艾滋病毒风险的干预措施，包括关于经济虐待和解决战略的教育。
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 (β = +4.43, p < .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.
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