title: "Eyes that don't see, heart that doesn't feel": coping with sex work in intimate relationships and its implications for HIV/STI prevention.
abstract: Partner communication about HIV sexual risk behaviors represents a key area of epidemiologic and social importance in terms of infection acquisition and potential for tailored interventions. Nevertheless, disclosing sexual risk behaviors often presents myriad challenges for marginalized couples who engage in stigmatized behaviors. Using qualitative data from a social epidemiology study of risk for HIV and other sexually transmitted infections (STIs) among female sex workers and their intimate, non-commercial male partners along the Mexico-U.S. border, we examined both partners' perspectives on sex work and the ways in which couples discussed associated HIV/STI risks in their relationship. Our thematic analysis of individual and joint interviews conducted in 2010 and 2011 with 44 couples suggested that broader contexts of social and economic inequalities profoundly shaped partner perspectives of sex work. Although couples accepted sex work as an economic contribution to the relationship in light of limited alternatives and drug addiction, it exacted an emotional toll on both partners. Couples employed multiple strategies to cope with sex work, including psychologically disconnecting from their situation, telling "little lies," avoiding the topic, and to a lesser extent, superficially discussing their risks. While such strategies served to protect both partners' emotional health by upholding illusions of fidelity and avoiding potential conflict, non-disclosure of risk behaviors may exacerbate the potential for HIV/STI acquisition. Our work has direct implications for designing multi-level, couple-based health interventions.
authors: Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA. jsyvertsen@ucsd.edu
authors: Jennifer L
authors: JL
authors: Syvertsen
authors: Angela M
authors: AM
authors: Robertson
authors: María Luisa
authors: ML
authors: Rolón
authors: Lawrence A
authors: LA
authors: Palinkas
authors: Gustavo
authors: G
authors: Martinez
authors: M Gudelia
authors: MG
authors: Rangel
authors: Steffanie A
authors: SA
authors: Strathdee
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003142:Communication; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008800:Mexico; D036301:Qualitative Research; D012309:Risk-Taking; D060386:Sex Workers / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014342:Truth Disclosure
references: Cult Health Sex. 2011 Mar;13(3):267-81
references: 21049313
references: J Sex Res. 2014;51(6):711-20
references: 23659340
references: JAMA. 2008 Aug 6;300(5):571-3
references: 18677029
references: Subst Use Misuse. 2004;39(10-12):1907-69
references: 15587954
references: Salud Publica Mex. 2003;45 Supp 5:S594-607
references: 14974270
references: PLoS One. 2011 Apr 25;6(4):e19048
references: 21541349
references: AIDS Behav. 2012 May;16(4):969-81
references: 22012147
references: Soc Sci Med. 2008 Aug;67(3):380-8
references: 18410986
references: J Acquir Immune Defic Syndr. 2010 Dec;55 Suppl 2:S98-101
references: 21406997
references: Qual Health Res. 2000 May;10(3):378-95
references: 10947483
references: AIDS Care. 2008 Nov;20(10):1266-75
references: 18608080
references: Int J STD AIDS. 2012 Apr;23(4):229-34
references: 22581944
references: Health (London). 2009 Jan;13(1):25-46
references: 19103714
references: Cult Health Sex. 2013;15(5):540-54
references: 23473586
references: AIDS Care. 2013;25(4):459-65
references: 22963518
references: BMC Public Health. 2012 Feb 20;12:136
references: 22348625
references: Am J Public Health. 2010 Mar;100(3):435-45
references: 20075321
references: AIDS Educ Prev. 2004 Oct;16(5):459-75
references: 15491957
references: J Infect Dis. 2008 Mar 1;197(5):728-32
references: 18260766
references: Soc Sci Med. 1998 Jan;46(2):157-69
references: 9447640
references: Int J Drug Policy. 2010 Nov;21(6):466-70
references: 20956076
references: Soc Sci Med. 2003 Jul;57(1):13-24
references: 12753813
references: Annu Rev Clin Psychol. 2007;3:377-401
references: 17716061
references: Health Place. 2009 Dec;15(4):999-1005
references: 19464228
references: BMC Med Res Methodol. 2003 Oct 31;3:24
references: 14594457
references: Med Anthropol. 2011 Jul;30(4):339-62
references: 21777121
references: Am J Public Health. 2007 Jun;97(6):986-96
references: 17463368