Mitigating circumstances: A model-based analysis of associations between risk environment and infrequent condom use among Chinese street-based sex workers

<div><p>Background</p><p>Little is known about how freelance street-based sex workers navigate condom use while soliciting. Traditional behavioural model may fail to account for the complex risk environment that most street-based sex workers work within. We examine first the association of self-efficacy and the infrequent condom use, then we investigated the roles of clients and venues frequented on this association.</p><p>Method</p><p>Using a purposive chain-referral sampling method, we surveyed 248 street-based sex workers in Shanghai. The survey focused on sex workers HIV risk factors, sex work patterns, HIV knowledge, and related HIV self-efficacy. Clients types and behaviours, and characteristics of the venues frequented by these commercial sex workers were also collected. We conducted a series of multiple logistic regression models to explore how the association between a sex worker’s self-efficacy with infrequent condom use change as client and venue characteristics were added to the models.</p><p>Results</p><p>We find that within the basic model, low self-efficacy was marginally associated with infrequent condom use (54.9% vs. 45.1%, AOR = 1.70, 95% CI = 0.95–3.03). As client- and venue- characteristics were added, the associations between self-efficacy and condom use were strengthened (AOR = 2.10 95% CI = 1.12–3.91 and 2.54 95% CI = 1.24–5.19 respectively). Those who reported middle-tiered income were more likely to report infrequent condom use compared to their peers of high income (AOR = 3.92 95% CI = 1.32–11.70) whereas such difference was not found between low income and high income sex workers. Visiting multiple venues and having migrant workers as clients were also associated with infrequent condom use.</p><p>Conclusion</p><p>Our findings suggest sex worker’s self-efficacy matters in their HIV risk behaviours only when environment characteristics were adjusted. Risk environment for street-based sex workers are complex. Programming addressing behavioural changes among female sex workers should adopt holistic, multilevel models with the consideration of risk environments.</p></div

Adjusted ORs and the 95% confident intervals of the individual-, client-, and venue-level factors on the street-based sex workers’ infrequent condom use with clients in Shanghai, China.

<p>Adjusted ORs and the 95% confident intervals of the individual-, client-, and venue-level factors on the street-based sex workers’ infrequent condom use with clients in Shanghai, China.</p

Theoretical map of factors influencing condom use among street-based sex workers.

<p>Theoretical map of factors influencing condom use among street-based sex workers.</p

Self-efficacy and demographic characteristics and their associations to condom use among street-based female street based sex worker, Shanghai, China.

<p>Self-efficacy and demographic characteristics and their associations to condom use among street-based female street based sex worker, Shanghai, China.</p

Client and venue characteristics by condom use status among street-based sex workers in Shanghai, China.

<p>Client and venue characteristics by condom use status among street-based sex workers in Shanghai, China.</p

Socio-demographic characteristics of street-based female sex workers experiencing intimate partner violence and client-initiated violence in Shanghai, China 2011–2012 (N = 218).

<p>All p-values were greater than 0.05 using chi-square, ANOVA (means), and Fisher Exact test when comparing socio-demographic characteristics between those who reported IPV vs. no IPV, and CIV vs. no CIV.</p><p>Socio-demographic characteristics of street-based female sex workers experiencing intimate partner violence and client-initiated violence in Shanghai, China 2011–2012 (N = 218).</p

Deaths in young people after contact with the youth justice system: A retrospective data linkage study

Introduction: Young people who have contact with the youth justice system are distinguished by a high prevalence of complex, co-occurring health problems, including known risk factors for preventable mortality. However, almost nothing is known about health outcomes for these young people after separation from the youth justice system. Objectives and Approach: We aimed to examine the incidence, timing, causes and risk factors for death in justice-involved young people. We linked youth justice records in Queensland, Australia 1993-2016 (N=48,963) with adult correctional records and the National Death Index. We split the cohort into three subgroups: those who had ever been in detention (n=7,643), those supervised in the community but never detained (n=12,953), and those charged with an offence but never convicted (n=28,367). We calculated all-cause and cause-specific crude mortality rates (CMRs), and indirectly standardised mortality ratios (SMRs). We used Cox regression to identify static and time-varying risk factors for death. Results: During a median of 13.6 years of follow-up there were 1,452 deaths (3.0%). The all-cause CMR was 2.2 (95%CI 2.1-2.3) per 1000 person-years, and the all-cause SMR was 3.1 (95%CI 3.0-3.3). The leading external causes of death were suicide (32% of all deaths), transport accidents (16%), accidental drug-related causes (13%), and violence (3%). In adjusted analyses, independent risk factors for all-cause mortality included being male (HR=1.4, 95%CI 1.2-1.6) and older (>=15 vs. vs. charge only; HR=1.6, 95%CI 1.2-2.0) and subsequent incarceration as an adult (HR=1.8, 95%CI 1.4-2.4). Conclusion/Implications: Young people who have contact with the youth justice system are at markedly increased risk of preventable death, after separation from that system. Efforts to improve long-term health outcomes for justice-involved youth have the potential to reduce preventable deaths in these highly vulnerable young people