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Adapting the Risk Environment Framework to Understand Substance Use, Gender-Based Violence, and HIV Risk Behaviors Among Female Sex Workers in Tanzania

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Abstract

Female sex workers (FSWs) in sub-Saharan Africa are disproportionately affected by HIV and gender-based violence (GBV). Substance use overlaps with these co-occurring epidemics to further increase FSWs’ risk for negative health outcomes. We explored the relationship between substance use, GBV, and consistent condom use utilizing baseline data from a cohort of 496 FSWs in Tanzania. Results demonstrate high levels of alcohol use and GBV, and low levels of consistent condom use. Frequent intoxication during sex work was associated with increased odds of recent GBV (aOR 1.64, 95% CI 1.07, 2.49; p value 0.02) and reduced odds of consistent condom use with clients (aOR 0.58, 95% CI 0.37, 0.92; p-value 0.02). We adapt the risk environment framework to contextualize our findings in the social and structural context and to gain insight into intervention approaches to address the intersecting challenges of substance use, GBV, and HIV among FSWs in Tanzania and similar settings.

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Acknowledgements

We would like to thank the women who participated in the study and the efforts of the research staff. This work was supported by the National Institutes of Mental Health R01MH104044 and F31MH110303. The content in this paper is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors.

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Author notes

  1. Anna M. Leddy

    Present address: Division of Prevention Sciences, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA

  2. Deanna Kerrigan

    Present address: Department of Sociology, American University, Washington, DC, USA

Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Anna M. Leddy, Carol Underwood & Deanna Kerrigan

  2. Johns Hopkins Center for Communication Programs, Baltimore, MD, USA

    Carol Underwood

  3. Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Michele R. Decker

  4. Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Jessie Mbwambo & Samuel Likindikoki

  5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Noya Galai

  6. University of Haifa, Haifa, Israel

    Noya Galai

  7. 550, 16th Street, 3rd Floor, San Francisco, CA, 94158, USA

    Anna M. Leddy

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  1. Anna M. Leddy
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Correspondence to Anna M. Leddy.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Leddy, A.M., Underwood, C., Decker, M.R. et al. Adapting the Risk Environment Framework to Understand Substance Use, Gender-Based Violence, and HIV Risk Behaviors Among Female Sex Workers in Tanzania. AIDS Behav 22, 3296–3306 (2018). https://doi.org/10.1007/s10461-018-2156-8

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