231786 Reconceptualizing Safer Sex: Women's Protective Health Strategies During Transactional Sexual Exchanges

Monday, November 8, 2010 : 3:30 PM - 3:50 PM

Alexis M. Roth, MPH , Center for Sexual Health Promotion, Indiana University, Bloomington, IN
Joshua G. Rosenberger, MPH , Center for Sexual Health Promotion, Indiana University, Bloomington, IN
Michael Reece, PhD, MPH , Center for Sexual Health Promotion, Indiana University, Bloomington, IN
Barbara Van Der Pol, PhD, MPH , Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
Background: Transactional sex has been associated with increased risk of adverse health outcomes, including STI, physical and sexual violence. Understanding the factors that impact women's ability to protect themselves during transactional sexual encounters is necessary in order to design effective sexual healthcare programs. STI reduction can only occur by addressing the larger contexts of violence, drug use, and dependence on men for economic survival. Objectives: To examine health protective strategies among women engaging in transactional sex in Indianapolis, Indiana. Methods: Women who recently engaged in transactional sex were recruited utilizing incentivized snowball sampling, completed an interview that included open-ended questions about protective health behaviors, and were offered STI testing. Interviews were recorded and analyzed for thematic content. Results: 25 participants aged 19-65 were interviewed. Most reported intermittent condom use however a variety of other protective strategies were utilized. These included: visually assessing johns, avoiding men who are perceived as dangerous, preselecting sex locations, carrying condoms, and avoiding ejaculate. 15/25 (60%) tested positive for at least one STI. Conclusions: Interventions to increase sex worker safety may be improved by recognizing that women engaging in transactional sex routinely utilize risk-reduction techniques in addition to condom use. It is critical to understand how self-protective behaviors are assigned monetary values during the negotiation of these interactions. Despite being motivated to use condoms, this group's ability to consistently negotiate condoms was low. Increased understanding of other protective strategies will improve STI control efforts for this population by encouraging alternative methods for promoting health.

Learning Areas:
Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Social and behavioral sciences

Learning Objectives:
Discuss the issues associated with acceptability, comfortability, and facilitators of/barriers to STI testing among a diverse group of women, a particularly high risk group. Describe the factors associated with sexual health protective factors among transactional sex workers

Keywords: HIV Risk Behavior, Challenges and Opportunities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conduct research and provide sexual health services for women engaging in transactional sex work.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.