Mental health and HIV risk differs by co-occurring structural vulnerabilities among women who sell sex

ABSTRACT

Female sex workers (FSW) experience many structural vulnerabilities (SV; e.g., violence, economic insecurity) which contribute to increased risk of HIV and mental distress. However, little research has examined how SV co-occur to shape HIV risk, and none have studied mental distress. Among FSW (n = 385) in Baltimore, Maryland, latent class analysis of five binary indicators (housing insecurity; financial dependence on others; client-perpetrated physical or sexual violence; food insecurity) determined classes of SV and differential HIV risk behavior and mental health outcomes. A 3-class model fit the data best: minimal SV (i.e., low probabilities of all indicators); material needs (i.e., housing, food insecurity); and high SV (i.e., high probability of all indicators). Compared to minimal SV, high SV and material needs had significantly greater adjusted probability of drug injection and poorer adjusted depression, post-traumatic stress disorder, and mental distress scores. The high SV class had significantly higher probability of reporting condomless sex with clients compared to material needs and minimal SV. Results show the deleterious effect of co-occurring SV on HIV risk behaviors among FSW with particular emphasis on co-occurring food and housing insecurities. This is the first study of co-occurring SV on mental health outcomes in this key population.

KEYWORDS:

• Sex workers
• mental health
• HIV infections
• housing
• food insecurity

Acknowledgements

The authors would like to thank EMERALD participants and EMERALD field staff, without whom this project would not be possible.

Disclosure statement

Dr. Sherman is an expert witness in ongoing opioid litigation. All other authors have no conflicts of interest.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse under Grant R01DA041243; National Institute of Mental Health under Grant F31MH118817; and Johns Hopkins University Center for AIDS Research, a National Institutes of Health Funded Program under Grant P30AI094189.