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Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon.
Int J Soc Psychiatry. 2019 09; 65(6):445-457.IJ

Abstract

BACKGROUND

In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs' experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator.

METHODS

In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health.

RESULTS

Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2-1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3-2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2-2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use.

CONCLUSION

Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.

Authors+Show Affiliations

1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.3 CARE, Yaounde, Cameroon.3 CARE, Yaounde, Cameroon.4 CARE, New York, NY, USA.5 Metabiota, Inc., Yaounde, Cameroon.6 Groupe Technique Central du Comité National de Lutte contre le SIDA, Yaoundc, Cameroon.7 Division of Operations Research, Ministry of Health, Yaounde, Cameroon.1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31234685

Citation

Abelson, Anna, et al. "Lifetime Experiences of Gender-based Violence, Depression and Condom Use Among Female Sex Workers in Cameroon." The International Journal of Social Psychiatry, vol. 65, no. 6, 2019, pp. 445-457.
Abelson A, Lyons C, Decker M, et al. Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. Int J Soc Psychiatry. 2019;65(6):445-457.
Abelson, A., Lyons, C., Decker, M., Ketende, S., Mfochive Njindam, I., Fouda, G., Ndonko, F., Levitt, D., Tamoufe, U., Billong, S., Bissek, A. Z., & Baral, S. D. (2019). Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. The International Journal of Social Psychiatry, 65(6), 445-457. https://doi.org/10.1177/0020764019858646
Abelson A, et al. Lifetime Experiences of Gender-based Violence, Depression and Condom Use Among Female Sex Workers in Cameroon. Int J Soc Psychiatry. 2019;65(6):445-457. PubMed PMID: 31234685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. AU - Abelson,Anna, AU - Lyons,Carrie, AU - Decker,Michele, AU - Ketende,Sosthenes, AU - Mfochive Njindam,Iliassou, AU - Fouda,Ghislaine, AU - Ndonko,Flavien, AU - Levitt,Daniel, AU - Tamoufe,Ubald, AU - Billong,Serge, AU - Bissek,Anne-Cecile Zoung-Kanyi, AU - Baral,Stefan D, Y1 - 2019/06/24/ PY - 2019/6/27/pubmed PY - 2020/2/6/medline PY - 2019/6/26/entrez KW - HIV KW - depression KW - female sex work KW - gender-based violence SP - 445 EP - 457 JF - The International journal of social psychiatry JO - Int J Soc Psychiatry VL - 65 IS - 6 N2 - BACKGROUND: In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs' experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. METHODS: In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. RESULTS: Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2-1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3-2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2-2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. CONCLUSION: Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs. SN - 1741-2854 UR - https://www.unboundmedicine.com/medline/citation/31234685/Lifetime_experiences_of_gender_based_violence_depression_and_condom_use_among_female_sex_workers_in_Cameroon_ L2 - https://journals.sagepub.com/doi/10.1177/0020764019858646?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -