Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand.
BACKGROUND
The trafficking of women and girls for sexual exploitation is an internationally recognised form of gender-based violence, and is thought to confer unique sexual and reproductive health vulnerabilities. To date, little research has compared sexual risk or health outcomes among female sex workers (FSWs) on the basis of experiences of sex trafficking.


OBJECTIVE
To compare experiences of sexual risk and sexual and reproductive health outcomes among FSWs on the basis of experiences of trafficking as an entry mechanism to sex work.


METHODS
Data from a national sample of FSWs in Thailand (n=815) was used to assess (a) the prevalence of sex trafficking as an entry mechanism into sex work and (b) associations of sex trafficking with sexual risk and health outcomes.


RESULTS
Approximately 10% of FSWs met criteria for trafficking as an entry mechanism to sex work. Compared with their non-trafficked counterparts, sex-trafficked FSWs were more likely to have experienced sexual violence at initiation to sex work (adjusted risk ratio (ARR) 2.29, 95% CI 1.11 to 4.72), recent workplace violence or mistreatment (ARR 1.38, 95% CI 1.13 to 1.67), recent condom failure (ARR 1.80, 95% CI 1.15 to 2.80), condom non-use (ARR 3.35, 95% CI 1.49 to 7.52) and abortion (ARR 2.83, 95% CI 1.48 to 5.39).


CONCLUSIONS
Both the prevalence of sex trafficking as an entry mechanism to sex work and the threats to sexual and reproductive health observed on the basis of trafficking status show the need for comprehensive efforts to identify and support this vulnerable population. Moreover, existing STI/HIV-prevention programming may be stymied by the limited condom-use capacity and high levels of violence observed among those trafficked into sex work.
Decker
Michele R
MR
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA. mdecker@jhsph.edu
McCauley
Heather L
HL
Phuengsamran
Dusita
D
Janyam
Surang
S
Silverman
Jay G
JG
D022126:Access to Information; D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018456:Reproductive Medicine; D018570:Risk Assessment; D011477:Sex Work / Q000706:statistics & numerical data; D015231:Sexually Transmitted Diseases, Bacterial / Q000175:diagnosis; D015229:Sexually Transmitted Diseases, Viral / Q000175:diagnosis; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult