title: Alcohol use among female sex workers and male clients: an integrative review of global literature.
abstract: OBJECTIVE
  To review the patterns, contexts and impacts of alcohol use associated with commercial sex reported in the global literature.
  
  
  METHODS
  We identified peer-reviewed English-language articles from 1980 to 2008 reporting alcohol consumption among female sex workers (FSWs) or male clients. We retrieved 70 articles describing 76 studies, in which 64 were quantitative (52 for FSWs, 12 for male clients) and 12 qualitative.
  
  
  RESULTS
  Studies increased over the past three decades, with geographic concentration of the research in Asia and North America. Alcohol use was prevalent among FSWs and clients. Integrating quantitative and qualitative studies, multilevel contexts of alcohol use in the sex work environment were identified, including workplace and occupation-related use, the use of alcohol to facilitate the transition into and practice of commercial sex among both FSWs and male clients, and self-medication among FSWs. Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive.
  
  
  CONCLUSIONS
  Alcohol use in the context of commercial sex is prevalent, harmful among FSWs and male clients, but under-researched. Research in this area in more diverse settings and with standardized measures is required. The review underscores the importance of integrated intervention for alcohol use and related problems in multilevel contexts and with multiple components in order to effectively reduce alcohol use and its harmful effects among FSWs and their clients.
authors.affiliation: Prevention Research Center, Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Hutzel Building, 4707 St Antoine, 5th Floor/Suite w534, Detroit, MI 48201, USA. youliqing@hotmail.com
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.forename: Bonita
authors.initials: B
authors.lastname: Stanton
mesh_terms: D000437:Alcoholism / Q000453:epidemiology*; D001208:Asia; D015897:Comorbidity; D019548:Crime Victims / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009656:North America; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex; D014754:Violence / Q000706:statistics & numerical data*
chemical_list: D013287:Illicit Drugs