STRUCTURAL VULNERABILITY AND HIV/STI RISK BEHAVIOR AMONG NEW EXOTIC DANCERS IN BALTIMORE, MARYLAND

HIV/STI;women;HIV risk environment;structural vulnerability;socioeconomic disadvantage;Social & Behavioral Sciences

Brantley, MeredithJennings, Jacky M. ;

Johns Hopkins University

关键词: HIV/STI;    women;    HIV risk environment;    structural vulnerability;    socioeconomic disadvantage;    Social & Behavioral Sciences;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/59383/BRANTLEY-DISSERTATION-2016.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: Structurally vulnerable women often face an accumulation of social and economic disadvantage that can shape a context of HIV/STI risk.Women who are structurally vulnerable and working in HIV/STI risk environments such as exotic dance clubs may have an added risk for infection when engaging in sexual and drug-related activity.However, not all structurally vulnerable women engage in risk behaviors, which may be reflective of the intensity at which certain social and economic factors cluster together.This study aims to explore the nature and progression of structural vulnerability experienced by female exotic dancers, and to examine how different experiences of structural vulnerability shape sexual risk behavior and drug use.Methods: Qualitative and quantitative data from a cohort of female exotic dancers (n=117) working in Baltimore, Maryland followed for three months were used for a series of three separate analyses.First, thematic analysis was applied to qualitative data from a sub-sample of 24 dancers interviewed about experiences of structural vulnerability and sex- and drug-related behaviors.Using data collected through a survey of the entire cohort, latent class analysis was used to classify women into subgroups of structural vulnerability, and latent class regression was used to determine whether sexual risk behavior and drug use varied by subgroup.Lastly, trajectories of structural vulnerability were examined over time and logistic regression models were used to estimate the odds of sexual risk behaviors at follow-up, compared across vulnerability trajectories.Results: Thematic analysis uncovered both early and recent experiences of structural vulnerability, emphasizing experiences of social and economic hardship that related to housing, education, finances, and arrest history.Narratives revealed how the effects of structural vulnerability, substance abuse, interpersonal relationships, and opportunities for economic gain through sexual services in the workplace converged to produce varying levels of HIV/STI risk.Latent class analysis revealed two subgroups of structural vulnerability, classified into ;;low” and ;;high” vulnerability.One-third of participants were expected to belong to the high vulnerability subgroup, and were more likely to report sex exchange, multiple sex partners, and illicit drug use.The final analyses indicated that dancers who transitioned from low to high vulnerability were more likely to report inconsistent condom use at follow-up compared to women with low vulnerability, and chronically vulnerable women were more likely to report having a high-risk sex partner at follow-up.Conclusions: Findings consistently indicated that social and economic effects of structural vulnerability play a key role in shaping sexual risk behavior.Integrating efforts to improve access to housing, legal aid, and educational opportunities into HIV/STI intervention programs may help to further mitigate HIV/STI risk.Reshaping public policy that holistically addresses structural drivers across sectors is also critical to achieving widespread impact and successfully eliminating disparities in HIV/STI among vulnerable populations living in the United States.