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A brief, trauma-informed intervention increases safety behavior and reduces HIV risk for drug-involved women who trade sex.
BMC Public Health. 2017 08 01; 18(1):75.BP

Abstract

BACKGROUND

Female sex workers (FSWs) are an important population for HIV acquisition and transmission. Their risks are shaped by behavioral, sexual network, and structural level factors. Violence is pervasive and associated with HIV risk behavior and infection, yet interventions to address the dual epidemics of violence and HIV among FSWs are limited.

METHODS

We used participatory methods to develop a brief, trauma-informed intervention, INSPIRE (Integrating Safety Promotion with HIV Risk Reduction), to improve safety and reduce HIV risk for FSWs. A quasi-experimental, single group pretest-posttest study evaluated intervention feasibility, acceptability and efficacy among FSWs in Baltimore, MD, most of whom were drug-involved (baseline n = 60; follow-up n = 39 [65%]; non-differential by demographics or outcomes). Qualitative data collected at follow-up contextualizes findings.

RESULTS

Based on community partnership and FSW input, emergent goals included violence-related support, connection with services, and buffering against structural forces that blame FSWs for violence. Qualitative and quantitative results demonstrate feasibility and acceptability. At follow-up, improvements were seen in avoidance of client condom negotiation (p = 0.04), and frequency of sex trade under the influence of drugs or alcohol (p = 0.04). Women's safety behavior increased (p < 0.001). Participants improved knowledge and use of sexual violence support (p < 0.01) and use of intimate partner violence support (p < 0.01). By follow-up, most respondents (68.4%) knew at least one program to obtain assistance reporting violence to police. Over the short follow-up period, client violence increased. In reflecting on intervention acceptability, participants emphasized the value of a safe and supportive space to discuss violence.

DISCUSSION

This brief, trauma-informed intervention was feasible and highly acceptable to FSWs. It prompted safety behavior, mitigated sex trade under the influence, and bolstered confidence in condom negotiation. INSPIRE influenced endpoints deemed valuable by community partners, specifically improving connection to support services and building confidence in the face of myths that falsely blame sex workers for violence. Violence persisted; prevention also requires targeting perpetrators, and longer follow-up durations as women acquire safety skills. This pilot study informs scalable interventions that address trauma and its impact on HIV acquisition and care trajectories for FSWs.

CONCLUSION

Addressing violence in the context of HIV prevention is feasible, acceptable to FSWs, and can improve safety and reduce HIV risk, thus supporting FSW health and human rights.

Authors+Show Affiliations

Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mdecker@jhu.edu. Women's Health & Rights Program, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E4142, Baltimore, MD, 21205, USA. mdecker@jhu.edu. Johns Hopkins School of Nursing, Baltimore, MD, USA. mdecker@jhu.edu.Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Baltimore City Health Department, Baltimore, MD, USA.Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Johns Hopkins School of Nursing, Baltimore, MD, USA.Women's Health & Rights Program, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E4142, Baltimore, MD, 21205, USA. Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28764681

Citation

Decker, Michele R., et al. "A Brief, Trauma-informed Intervention Increases Safety Behavior and Reduces HIV Risk for Drug-involved Women Who Trade Sex." BMC Public Health, vol. 18, no. 1, 2017, p. 75.
Decker MR, Tomko C, Wingo E, et al. A brief, trauma-informed intervention increases safety behavior and reduces HIV risk for drug-involved women who trade sex. BMC Public Health. 2017;18(1):75.
Decker, M. R., Tomko, C., Wingo, E., Sawyer, A., Peitzmeier, S., Glass, N., & Sherman, S. G. (2017). A brief, trauma-informed intervention increases safety behavior and reduces HIV risk for drug-involved women who trade sex. BMC Public Health, 18(1), 75. https://doi.org/10.1186/s12889-017-4624-x
Decker MR, et al. A Brief, Trauma-informed Intervention Increases Safety Behavior and Reduces HIV Risk for Drug-involved Women Who Trade Sex. BMC Public Health. 2017 08 1;18(1):75. PubMed PMID: 28764681.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A brief, trauma-informed intervention increases safety behavior and reduces HIV risk for drug-involved women who trade sex. AU - Decker,Michele R, AU - Tomko,Catherine, AU - Wingo,Erin, AU - Sawyer,Anne, AU - Peitzmeier,Sarah, AU - Glass,Nancy, AU - Sherman,Susan G, Y1 - 2017/08/01/ PY - 2016/08/22/received PY - 2017/07/24/accepted PY - 2017/8/3/entrez PY - 2017/8/3/pubmed PY - 2018/2/21/medline SP - 75 EP - 75 JF - BMC public health JO - BMC Public Health VL - 18 IS - 1 N2 - BACKGROUND: Female sex workers (FSWs) are an important population for HIV acquisition and transmission. Their risks are shaped by behavioral, sexual network, and structural level factors. Violence is pervasive and associated with HIV risk behavior and infection, yet interventions to address the dual epidemics of violence and HIV among FSWs are limited. METHODS: We used participatory methods to develop a brief, trauma-informed intervention, INSPIRE (Integrating Safety Promotion with HIV Risk Reduction), to improve safety and reduce HIV risk for FSWs. A quasi-experimental, single group pretest-posttest study evaluated intervention feasibility, acceptability and efficacy among FSWs in Baltimore, MD, most of whom were drug-involved (baseline n = 60; follow-up n = 39 [65%]; non-differential by demographics or outcomes). Qualitative data collected at follow-up contextualizes findings. RESULTS: Based on community partnership and FSW input, emergent goals included violence-related support, connection with services, and buffering against structural forces that blame FSWs for violence. Qualitative and quantitative results demonstrate feasibility and acceptability. At follow-up, improvements were seen in avoidance of client condom negotiation (p = 0.04), and frequency of sex trade under the influence of drugs or alcohol (p = 0.04). Women's safety behavior increased (p < 0.001). Participants improved knowledge and use of sexual violence support (p < 0.01) and use of intimate partner violence support (p < 0.01). By follow-up, most respondents (68.4%) knew at least one program to obtain assistance reporting violence to police. Over the short follow-up period, client violence increased. In reflecting on intervention acceptability, participants emphasized the value of a safe and supportive space to discuss violence. DISCUSSION: This brief, trauma-informed intervention was feasible and highly acceptable to FSWs. It prompted safety behavior, mitigated sex trade under the influence, and bolstered confidence in condom negotiation. INSPIRE influenced endpoints deemed valuable by community partners, specifically improving connection to support services and building confidence in the face of myths that falsely blame sex workers for violence. Violence persisted; prevention also requires targeting perpetrators, and longer follow-up durations as women acquire safety skills. This pilot study informs scalable interventions that address trauma and its impact on HIV acquisition and care trajectories for FSWs. CONCLUSION: Addressing violence in the context of HIV prevention is feasible, acceptable to FSWs, and can improve safety and reduce HIV risk, thus supporting FSW health and human rights. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/28764681/A_brief_trauma_informed_intervention_increases_safety_behavior_and_reduces_HIV_risk_for_drug_involved_women_who_trade_sex_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4624-x DB - PRIME DP - Unbound Medicine ER -