Identifying Patterns of Social and Economic Hardship Among Structurally Vulnerable Women: A Latent Class Analysis of HIV/STI Risk
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Women who are structurally vulnerable are at heightened risk for HIV/STIs. Identifying typologies of structural vulnerability that drive HIV/STI risk behavior is critical to understanding the nature of women’s risk. Latent class analysis (LCA) was used to classify exotic dancers (n = 117) into subgroups based on response patterns of four vulnerability indicators. Latent class regression models tested whether sex- and drug-related risk behavior differed by vulnerability subgroup. Prevalence of vulnerability indicators varied across housing instability (39%), financial insecurity (39%), limited education (67%), and arrest history (36%). LCA yielded a two-class model solution, with 32% of participants expected to belong to a “high vulnerability” subgroup. Dancers in the high vulnerability subgroup were more likely to report sex exchange (OR = 8.1, 95% CI, 1.9–34.4), multiple sex partnerships (OR = 6.4, 95% CI, 1.9–21.5), and illicit drug use (OR = 17.4, 95% CI, 2.5–123.1). Findings underscore the importance of addressing inter-related structural factors contributing to HIV/STI risk.
KeywordsHIV Sexually transmitted infections Social determinants Exotic dance club
We are grateful for the support of the Baltimore City Health Department, recruitment and data collection by the STILETTO study team, and for the women who participated.
The STILETTO Study was supported by the National Institute of Drug Abuse (NIDA R21 DA033855) and the Johns Hopkins Center for AIDS Research (JHU CFAR; NIAID 1P30AI094189). M.L. Brantley was supported by the National Institute of Allergy and Infectious Disease (T32 AI050056-12) and the National Institute on Drug Abuse (F31 DA038540). S. Lim was supported by the National Institute of Allergy and Infectious Disease (T32 AI050056-12).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Study procedures were in accordance with the ethical standards of the Johns Hopkins Bloomberg School of Public Health and with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
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