Street-based female sex workers "are often enmeshed in chronic patterns of substance use, sexual risk, homelessness, and violent victimization," the authors wrote, causing them to be vulnerable to HIV infection. The team set out to assess the contributions of a history of victimization and "abuse-related traumagenic factors" to these women's mental health functioning and their sexual risk behaviors, in addition to the impact of risk factors in the environment.
Targeted sampling strategies were employed to enroll 562 female sex workers based in Miami in an intervention trial designed to test "the relative effectiveness of two alternative case management conditions in establishing linkages with health services and reducing risk for HIV," the authors reported.
An "extremely elevated" 88 percent lifetime prevalence of abuse was noted. Almost half the women reported abuse had occurred before age 18. In the past 90 days, 34 percent said they had had violent encounters with "dates" or clients. Among the women, 74 percent reported severe symptoms of anxiety, depression or traumatic stress.
"For those with histories of abuse, [serious mental illness] appeared to mediate the association between abuse-related trauma and unprotected sex behaviors," the authors concluded. "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."
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