Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks.

This study examines the prevalence of physical and sexual abuse by intimate and commercial sexual partners among street-based sex workers and explores correlates of partner abuse by commercial partners using the following factors: sociodemographics, substance abuse, sexual behavior, and physical and sexual childhood abuse. One hundred thirteen street sex workers were recruited from December 1996 through May 1997 while receiving services from the Foundations for Research on Sexually Transmitted Diseases (FROST'D), a nonprofit organization based in New York City. Partner abuse is a common occurrence among street sex workers. Two of three street prostitutes have experienced lifetime physical or sexual abuse by either an intimate or commercial partner. In addition, one of eight reported physical and sexual abuse by both intimate and commercial partners during her lifetime. Women who were homeless in the last year, those who reported exchanging for drugs and money as their main source of income, used injection drugs in the past year and had sex in crack houses, and who were human immunodeficiency virus (HIV)-positive were more likely to be report combined physical and sexual abuse. Understanding the relationship between partner violence, victim's substance abuse, and HIV-risk behavior is important for the development of public policies and treatment and prevention strategies to address the constellation of problems that drug-using female street sex workers face.

Predictors of female condom use among women exchanging street sex in New York City.

BACKGROUND: Alternative female-initiated barrier methods, such as the female condom, are needed among women exchanging street sex to enhance their ability to protect themselves from HIV and STD infection. OBJECTIVE: To describe predictors of female condom use among 96 women exchanging sex for money and drugs on the streets of New York City. STUDY DESIGN: A total of 113 sex workers received a baseline interview, a demonstration on proper female condom use, and 10 female condoms. A total of 101 sex workers received a followed-up evaluation at 2 weeks, of which 96 were included in data analysis. Predictors of condom use were analyzed for (1) any type of use; and (2) use with commercial partners. RESULTS: The strongest predictors of female condom use among this sample of sex workers were (1) living with someone with a drug or alcohol problem; (2) having heard of the female condom; and (3) homelessness. Current physical or sexual abuse by a commercial partner and marriage decreased the probability of female condom use. CONCLUSIONS: Female condom distribution encouraged sex workers who may be most vulnerable or who reported characteristics or behaviors associated with the highest sexually transmitted disease and HIV risk to try female condoms with commercial partners. Implications for intervention development include the need to develop innovative programs provided on the street (e.g., through peers) that can access homeless, drug-using sex workers in the most at-risk environments.

PIP: This study investigated the characteristics of street sex workers that influence the initial use of the female condom in New York City. Interviews, demonstration of proper female condom use and distribution of 10 female condoms were conducted among 113 female sex workers. Only 96 respondents were included in the study after a 2-week follow-up evaluation. Measure variables used in the study included sociodemographic characteristics, drug history, sexual risk behavior, and victimization, while dependent variables were female condom use for any reason and female condom use with commercial sexual partners. Results revealed that the 3 strongest variables associated with female condom use were the following: 1) living with anyone with a drug-alcohol problem; 2) having heard of the female condom; and 3) physical or sexual abuse by a commercial partner. This study emphasized the need to develop innovative programs that focus on street workers, with information promotion carried out in areas of sex work strolls which addresses the issues of accessibility and ease of use among sex workers.

Acceptability of female condom use among women exchanging street sex in New York City.

Greater access to alternative female-initiated barrier methods, such as the female condom, is needed among women exchanging street sex. This study describes knowledge of and experience with the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV/STD prevention among this population. Female condom use among this sample of sex workers was found to be related to having a regular sexual partner, living with someone who is a drug or alcohol abuser, not being homeless, using alcohol or intravenous heroin, having heard of the device, and having discussed the device with other women or with a regular sexual partner. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.

PIP: This study describes the knowledge and experience of the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV and sexually transmitted disease (STD) prevention among this population. Samples included were African American, never married, and with an average age of 35.9 years. The result shows that women who were single and never married were more likely to use the female condom than those who were married, separated, divorced, or widowed. Moreover, those who lived with someone having drug or alcohol problems were more likely to use female condoms than their counterparts than those who were homeless, women with a place to live were more likely to use female condoms. These suggest that the female condom may be feasible alternative barrier method for STD and HIV prevention among women engaging in commercial sex work. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.

Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department.

This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1%, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.

Clinical nutrition management position: responsibilities and skill development strategies.

OBJECTIVE: To determine the duties of clinical nutrition managers, the factors associated with the performance of the duties, the job specifications for the position, and the skill development strategies used by clinical nutrition managers. DESIGN: Clinical nutrition managers from 700 randomly selected, acute-care hospitals in the United States (with 300 or more beds) received a survey questionnaire. Respondents were asked to indicate performance or nonperformance, perceived importance, and methods used to develop skills for 54 duties related to clinical nutrition management. We requested additional information about position requirements, position characteristics, and demographic information. STATISTICAL ANALYSES PERFORMED: An 82% response rate with 67% usable responses (n = 472) was achieved. Frequencies for performance and nonperformance, mean importance, and frequencies for methods of skill development were determined for each duty. chi 2 Analysis with P < .10 was used to determine if an association existed between performance of a duty and time allotted to the position, number of personnel supervised, and type of personnel supervised. RESULTS: This study validated 46 of the duties as responsibilities of practicing clinical nutrition manager. Three duties not validated were related to financial management. The duty performed least often was conducting research/investigative studies. The number and type of personnel supervised was found to influence performance of duties, but time allotted to position was not an influence. The major strategies used for skill development were continuing education, networking, work experience in clinical dietetics, work experience in management dietetics, and their present job. APPLICATIONS: These results can be used by clinical nutrition managers to assess the characteristics of their current position and develop a plan for enhancing their scope of responsibility. The identification of duties actually performed by clinical nutrition managers can also be used to develop standards of practice with performance indicators and recommended thresholds. Information regarding the skill development strategies of clinical nutrition managers can be used by practitioners to enhance their current skills and knowledge and by others to prepare for career opportunities in clinical nutrition management.