title: HIV risk among female sex workers in Miami: the impact of violent victimization and untreated mental illness.
abstract: Street-based female sex workers constitute a vulnerable population for HIV, as they are often enmeshed in chronic patterns of substance use, sexual risk, homelessness, and violent victimization. This study examined the specific contributions of victimization history and abuse-related traumagenic factors to mental health functioning and sexual risk behaviors, while considering the impact of environmental risk factors as well. Using targeted sampling strategies, we enrolled 562 Miami-based female sex workers into an intervention trial testing the relative effectiveness of two alternative case management conditions in establishing linkages with health services and reducing risk for HIV. Lifetime prevalence of abuse was extremely elevated at 88%. Nearly half reported abuse before the age of 18, while 34% reported violent encounters with "dates" or clients in the past 90 days. Serious mental illness (SMI) was quite common, with 74% reporting severe symptoms of depression, anxiety, or traumatic stress. For those with histories of abuse, SMI appeared to mediate the association between abuse-related trauma and unprotected sex behaviors. Mental health treatment would appear to be an important component of effective HIV prevention among this vulnerable group, and should form part of a compendium of services offered to female sex workers.
authors.affiliation: Center for Research on Substance Use & Health Disparities, Nova Southeastern University, Coral Gables, FL, USA. hlsny@aol.com
authors.forename: Hilary L
authors.initials: HL
authors.lastname: Surratt
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kurtz
authors.forename: Minxing
authors.initials: M
authors.lastname: Chen
authors.forename: Angela
authors.initials: A
authors.lastname: Mooss
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D019548:Crime Victims / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations; D055815:Young Adult
references.citation: J Acquir Immune Defic Syndr. 2004 Jul 1;36(3):845-52
references.pmid: 15213569
references.citation: J Prev Interv Community. 2010;38(2):118-31
references.pmid: 20391059
references.citation: Clin Psychol Rev. 1997;17(3):271-91
references.pmid: 9160177
references.citation: BMJ. 2001 Mar 3;322(7285):524-5
references.pmid: 11230067
references.citation: Am J Orthopsychiatry. 1985 Oct;55(4):530-541
references.pmid: 4073225
references.citation: AIDS Patient Care STDS. 2001 Jan;15(1):41-51
references.pmid: 11177587
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):593-602
references.pmid: 15939837
references.citation: AIDS Behav. 2009 Apr;13(2):207-16
references.pmid: 17968646
references.citation: Psychiatr Serv. 2001 Apr;52(4):508-13
references.pmid: 11274498
references.citation: Child Maltreat. 2000 Feb;5(1):5-17
references.pmid: 11232063
references.citation: Health Serv Res. 2001 Dec;36(6 Pt 1):987-1007
references.pmid: 11775672
references.citation: Clin Psychol Rev. 2005 Jun;25(4):433-57
references.pmid: 15914265
references.citation: AIDS Care. 2004 Jul;16(5):594-604
references.pmid: 15223529
references.citation: Drug Alcohol Depend. 2003 May 21;70(2):169-75
references.pmid: 12732410
references.citation: Child Maltreat. 2000 Feb;5(1):18-27
references.pmid: 11232059
references.citation: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references.pmid: 3806354
references.citation: Arch Sex Behav. 1995 Jun;24(3):249-69
references.pmid: 7611845
references.citation: Community Ment Health J. 2005 Jun;41(3):277-90
references.pmid: 16131007
references.citation: Psychiatr Q. 2002 Spring;73(1):17-31
references.pmid: 11780595
references.citation: Am J Public Health. 2001 Jan;91(1):31-7
references.pmid: 11189820
references.citation: J Prev Interv Community. 2007;33(1-2):1-4
references.pmid: 17298926
references.citation: J Health Care Poor Underserved. 2002 Feb;13(1):49-65
references.pmid: 11836913
references.citation: Am J Public Health. 2006 Jan;96(1):120-5
references.pmid: 16317215
references.citation: J Prev Interv Community. 2007;33(1-2):5-18
references.pmid: 17298927
references.citation: J Urban Health. 2006 Jan;83(1):59-72
references.pmid: 16736355