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HIV Prevention Among Women Who Use Substances And Report Sex Work: Risk Groups Identified Among South African Women

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This cross-sectional study presents baseline data from women (n = 641) in a community-based randomized trial in Pretoria, South Africa. Women were eligible if they reported recent alcohol or other drug (AOD) use and condomless sex. Latent class analyses were conducted separately for those who reported sex work and those who did not. Among those who reported sex work, a Risky Sex class (n = 72, 28%) and Low Sexual Risk class (n = 190, 73%) emerged. Those in the Risky Sex class were more likely to report that their last episode of sexual intercourse was with their boyfriend (vs. a client/other partner) compared with the Low Sexual Risk class (p < 0.001). Among participants who did not report sex work, a Drug-Using, Violence-Exposed, and Impaired Sex class (n = 53; 14%) and Risky Sex and Moderate Drinking class (n = 326; 86%) emerged. The findings suggest that interventions for women who engage in sex work should promote safer sexual behavior and empowerment with main partners. Women who use AODs, experience physical or sexual violence, and have impaired sex may be a key population at risk for HIV and should be considered for tailored behavioral interventions in conjunction with South Africa’s plan to disseminate HIV prevention methods to vulnerable women. Trial Registration: registration NCT01497405.


Este estudio transversal presenta datos sobre referencia de mujeres (n = 641 basados) en un ensayo controlado aleatorio en la comunidad de Pretoria, Sudáfrica. Las mujeres fueron elegibles si reportaron el consumo reciente de alcohol o drogas y practicaron sexo sin condón. Se realizaron análisis de clase latente por separado para aquellas que reportaron ser trabajadoras sexuales y aquellas que no. Entre aquellas mujeres que reportaron ser trabajadoras sexuales, se encontró que (n = 72, 28%) tuvieron Prácticas Sexuales Riesgosas y (n = 190, 73%) Tuvieron Prácticas Sexuales de Bajo Riesgo. Aquellas mujeres que tuvieron Prácticas Sexuales Riesgosas, reportaron más frecuentemente que su último intercambio sexual fue con su novio y no con un cliente u otro compañero, comparado con las que tuvieron Prácticas Sexuales de Bajo Riesgo (p < 0.001). También se encontró consumo de drogas, violencia y algunos trastornos sexuales (n = 53, 14%) así como Prácticas Sexuales Riesgosas y consumo moderado de alcohol (n = 326; 86%), entre las participantes que no reportaron ser trabajadoras sexuales. Los hallazgos sugieren que las intervenciones en mujeres que están involucradas como trabajadoras sexuales podría promover las prácticas sexuales más seguras y el empoderamiento con su pareja principal. Las mujeres que usan sustancias alucinógenas, que están expuestas a violencia física y sexual, y que tienen trastornos sexuales podrían ser la población clave con riesgo de contagiarse de VIH, por lo tanto; deberían ser consideradas en las intervenciones de comportamiento adaptativo, en conjunto con el plan de Sudáfrica para diseminar los métodos de prevención de VIH entre mujeres vulnerables.

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This research was supported by the U.S. National Institutes of Health, National Institute on Drug Abuse (NIDA) Grant R01DA032061 PI: Wechsberg. The views and conclusions are those of the authors and do not necessarily reflect the views of NIDA. The funding agency had no role in the research design; in the collection, analysis, and interpretation of the data; in the writing of this article, or in the decision to submit the article for publication. We wish to thank all of our project staff, the women participants, and our editor, Mr. Jeffrey Novey, for their contribution to this project and Dr. Sreelatha Meleth for her statistical review.

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Correspondence to Wendee M. Wechsberg.

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All procedures performed in studies involving human participants 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. This includes obtaining informed consent from all participants.

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Wechsberg, W.M., Peasant, C., Kline, T. et al. HIV Prevention Among Women Who Use Substances And Report Sex Work: Risk Groups Identified Among South African Women. AIDS Behav 21 (Suppl 2), 155–166 (2017).

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