title: Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand.
abstract: OBJECTIVE
  Commercial sex work is a primary context for heterosexual HIV/AIDS transmission. Violence victimisation is considered to compromise women's ability to protect against HIV and other sexually transmitted infections (STI); little research has investigated violence as it relates to sexual risk and STI among female sex workers (FSW). This study sought to compare sexual risk and STI symptoms among FSW based on recent violence exposure.
  
  
  METHODS
  Data from 815 FSW in Thailand were used to assess the prevalence of physical or sexual violence within the context of sex work, and associations of victimisation with sexual risk and STI symptoms.
  
  
  RESULTS
  Approximately one in seven FSW (14.6%) had experienced violence in the week before the survey. Compared with their unexposed counterparts, FSW exposed to violence demonstrated a greater risk of condom failure (19.6% vs 12.3%, ARR 1.92, 95% CI 1.24 to 2.95) and client condom refusal (85.7% vs 69.0%, ARR 1.24, 95% CI 1.14 to 1.35). In analyses adjusted for sexual risk, violence related to STI symptoms collectively (ARR 1.11, 95% CI 1.02 to 1.21) and genital lesions as an individual STI symptom (ARR 1.78, 95% CI 1.20 to 2.66).
  
  
  CONCLUSIONS
  Physical and sexual violence against FSW in Thailand appears to be common, with women experiencing such violence demonstrating diminished capacity for STI/HIV harm reduction and greater prevalence of STI symptoms. Efforts to reduce violence towards this vulnerable population must be prioritised, as a means of protecting the health and wellbeing of FSW, and as a key component of STI/HIV prevention and control.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA. mdecker@hsph.havard.edu
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.forename: Heather L
authors.initials: HL
authors.lastname: McCauley
authors.forename: Dusita
authors.initials: D
authors.lastname: Phuengsamran
authors.forename: Surang
authors.initials: S
authors.lastname: Janyam
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D019548:Crime Victims / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015995:Prevalence; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013785:Thailand; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult
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