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. 2020 Nov;49(8):3055-3064.
doi: 10.1007/s10508-020-01705-y. Epub 2020 Apr 27.

Syndemic Psychosocial Health Conditions Associated with Recent Client-Perpetrated Violence Against Female Entertainment and Sex Workers in Cambodia

Marie-Claude Couture  1 , Jennifer L Evans  2 , Jessica Draughon Moret  3 , Ellen S Stein  2 , Sokunny Muth  4 , Maly Phou  4 , Aynar Len  4 , Song Ngak  4 , Chhit Sophal  5 , Yuthea Neak  6 , Adam W Carrico  7 , Lisa Maher  8 , Kimberly Page  9
Affiliations

Syndemic Psychosocial Health Conditions Associated with Recent Client-Perpetrated Violence Against Female Entertainment and Sex Workers in Cambodia

Marie-Claude Couture et al. Arch Sex Behav. 2020 Nov.

Abstract

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.

Keywords: Client-perpetrated violence; HIV risk; Psychosocial health conditions; Sex workers; Syndemic.

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Conflict of interest statement

Conflict of interest We declare no conflict of interests.

Figures

Fig. 1
Fig. 1
a Adjusted odds of client-perpetrated sexual violence by number of co-occurring psychosocial conditions. b Adjusted odds of client-perpetrated physical violence by number of co-occurring psychosocial conditions
See this image and copyright information in PMC

References

    1. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, … Kerrigan D (2012). Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Infectious Diseases, 12(7), 538–549. 10.1016/S1473-3099(12)70066-X. - DOI - PubMed
    1. Batchelder AW, Lounsbury DW, Palma A, Carrico A, Pachankis J, Schoenbaum E, & Gonzalez JS (2016). Importance of substance use and violence in psychosocial syndemics among women with and at-risk for HIV. AIDS Care, 28(10), 1316–1320. 10.1080/09540121.2016.1173637. - DOI - PMC - PubMed
    1. Beydoun HA, Beydoun MA, Kaufman JS, Lo B, & Zonderman AB (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75(6), 959–975. 10.1016/j.socscimed.2012.04.025. - DOI - PMC - PubMed
    1. Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC, Garofalo R, & Adolescent Medicine Trials Network for HIV/AIDS Interventions. (2012). Syndemic theory and HIV-related risk among young transgender women: The role of multiple, co-occurring health problems and social marginalization. American Journal of Public Health, 102(9), 1751–1757. 10.2105/AJPH.2011.300433. - DOI - PMC - PubMed
    1. Chirwa ED, Sikweyiya Y, Addo-Lartey AA, Ogum Alangea D, Coker-Appiah D, Adanu RMK, & Jewkes R (2018). Prevalence and risk factors of physical or sexual intimate violence perpetration amongst men in four districts in the central region of Ghana: Baseline findings from a cluster randomised controlled trial. PLoS ONE, 13(3), e0191663. 10.1371/journal.pone.0191663. - DOI - PMC - PubMed

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