Associations Between Violence and HIV Risk Behaviors Differ by Perpetrator Among Russian Sex Workers

  • Sarah M. PeitzmeierEmail author
  • Andrea L. Wirtz
  • Alena Peryshkina
  • Susan Sherman
  • Elizabeth Colantuoni
  • Chris Beyrer
  • Michele R. Decker
Original Paper


Violence is associated with HIV and HIV risk behaviors among female sex workers (FSW). However, few studies assess multiple forms of violence and multiple HIV risk behaviors to build a comprehensive picture of how violence is implicated in HIV risk. Using respondent-driven sampling, 754 FSW were recruited in the Russian Federation. Surveys collected data on lifetime exposure to client, police, intimate partner, and pimp violence, as well as recent HIV risk behavior in the forms of injecting drug use (IDU), and inconsistent condom use with intimate partners and clients. Multivariable log-binomial and Poisson regression were used to assess associations between violence and HIV risk behavior outcomes. Lifetime client (31.7%), police (16.0%), intimate partner (15.7%), and pimp (11.4%) violence were prevalent. IDU (10.7%) and inconsistent condom use with intimate partners (45.1%) and clients (22.5%) were common. Intimate partner violence (IPV) and client violence were associated with IDU (ARRIPV 2.12, 95% CI 1.10, 4.10; ARRClient 2.75, 95% CI 1.19, 6.32), IPV and police violence were associated with inconsistent condom use with intimate partners (ARRIPV 1.10, 95% CI 1.01, 1.19; ARRPolice 1.11, 95% CI 1.01, 1.21), and IPV and police violence were associated with inconsistent condom use with clients (ARRIPV 1.49, 95% CI 1.02, 2.17; ARRPolice 1.65, 95% CI 1.19, 2.29). Each perpetrator-specific type of violence was associated with a unique set of HIV risk behaviors. Comprehensive violence prevention programming that addresses multiple perpetrators of violence against FSW, including clients, intimate partners and police, is critical for reducing sexual and drug-related HIV risk in FSW.


Sex work HIV Violence Russia Condoms Injection drug use 



We thank the sex workers who participated in this study, Svetlana Sadretdinova and her team at the Simona Clinic (Kazan, Russia), Marina Malisheva and Julia Burdina and their team at the Krasnyi Yar program (Krasnoyarsk, Russia), Nadezhda Ziryanova and Anna Petrova and their team at the Belaya Siren Project (Tomsk, Russia). We thank TuQuynh K. Le for her assistance creating Fig. 1.


This work was supported by the Global Fund (Open Health Institute). Research reported in this publication was supported by NIDA of the National Institutes of Health under Award Number F31 DA040558. This publication resulted in part from research supported by the Johns Hopkins University Center for AIDS Research, an NIH funded Program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


  1. 1.
    Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.CrossRefPubMedGoogle Scholar
  2. 2.
    Strathdee SA, Philbin MM, Semple SJ, Pu M, Orozovich P, Martinez G, et al. Correlates of injection drug use among female sex workers in two Mexico—US border cities. Drug Alcohol Depend. 2008;92(1):132–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Platt L, Jolley E, Rhodes T, Hope V, Latypov A, Reynolds L, et al. Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis. BMJ Open. 2013;3(7):e002836.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Prüss-Ustün A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV due to female sex work: regional and global estimates. PLoS ONE. 2013;8(5):e63476.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rusakova M, Rakhmetova A, Strathdee SA. Why are sex workers who use substances at risk for HIV? Lancet. 2014;14:211–2.Google Scholar
  6. 6.
    El-Bassel N, Shaw SA, Dasgupta A, Strathdee SA. Drug use as a driver of HIV risks: re-emerging and emerging issues. Curr Opin HIV AIDS. 2014;9(2):150–5.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lau JT, Tsui HY, Zhang Y, Cheng F, Zhang L, Zhang J, et al. Comparing HIV-related syringe-sharing behaviors among female IDU engaging versus not engaging in commercial sex. Drug Alcohol Depend. 2008;97(1):54–63.CrossRefPubMedGoogle Scholar
  8. 8.
    Tang Z, Zhang C, Li X, Liu Y, Su S, Zhou Y, et al. HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study. AIDS Care. 2014;27:293–300.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Wirtz A, Peryshkina A, Moguilnyi V, Beyrer C, Decker M. Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation. Int J Drug Policy. 2015;26:755–63.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Decker MR, Crago A-L, Chu SK, Sherman SG, Seshu MS, Buthelezi K, et al. Human rights violations against sex workers: burden and effect on HIV. Lancet. 2014;385:186–99.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Decker MR, Wirtz AL, Pretorius C, Sherman SG, Sweat MD, Baral SD, et al. Estimating the impact of reducing violence against female sex workers on HIV epidemics in Kenya and Ukraine: a policy modeling exercise. Am J Reprod Immunol. 2013;69(s1):122–32.CrossRefPubMedGoogle Scholar
  12. 12.
    Decker MR, Pearson E, Illangasekare SL, Clark E, Sherman SG. Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator. BMC Public Health. 2013;13(1):876.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Shannon K, Csete J. Violence, condom negotiation, and HIV/STI risk among sex workers. JAMA. 2010;304(5):573–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Choudhury SM, Anglade D, Park K. From violence to sex work: agency, escaping violence, and HIV risk among establishment-based female sex workers in Tijuana, Mexico. J Assoc Nurses AIDS Care. 2013;24(4):368–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Ratinthorn A, Meleis A, Sindhu S. Trapped in circle of threats: violence against sex workers in Thailand. Health Care Women Int. 2009;30(3):249–69.CrossRefPubMedGoogle Scholar
  16. 16.
    Shannon K, Strathdee SA, Shoveller J, Rusch M, Kerr T, Tyndall MW. Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy. Am J Public Health. 2009;99(4):659.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Zhang C, Li X, Hong Y, Chen Y, Liu W, Zhou Y. Partner violence and HIV risk among female sex workers in China. AIDS Behav. 2012;16(4):1020–30.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Mooney A, Kidanu A, Bradley HM, Kumoji EK, Kennedy CE, Kerrigan D. Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia. BMC Public Health. 2013;13(1):771.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359(9314):1331–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med. 2003;56(1):125–34.CrossRefPubMedGoogle Scholar
  21. 21.
    Panchanadeswaran S, Johnson SC, Sivaram S, Srikrishnan AK, Latkin C, Bentley ME, et al. Intimate partner violence is as important as client violence in increasing street-based female sex workers’ vulnerability to HIV in India. Int J Drug Policy. 2008;19(2):106–12.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Erausquin JT, Reed E, Blankenship KM. Police-related experiences and HIV risk among female sex workers in Andhra Pradesh, India. J Infect Dis. 2011;204(suppl 5):S1223–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Decker MR, McCauley HL, Phuengsamran D, Janyam S, Silverman JG. Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand. J Epidemiol Commun Health. 2010;65:334–9.CrossRefGoogle Scholar
  24. 24.
    Decker MR, Wirtz AL, Baral SD, Peryshkina A, Mogilnyi V, Weber RA, et al. Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers. Sex Transm Infect. 2012;88(4):278–83.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    El-Bassel N, Gilbert L, Wu E, Go H, Hill J. Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone. Am J Public Health. 2005;95(3):465–70.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015;385(9962):55–71.CrossRefGoogle Scholar
  27. 27.
    Shannon K, Rusch M, Shoveller J, Alexson D, Gibson K, Tyndall MW. Mapping violence and policing as an environmental–structural barrier to health service and syringe availability among substance-using women in street-level sex work. Int J Drug Policy. 2008;19(2):140–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Kenya FIDA. Documenting human rights violations of sex workers in Kenya. Nairobi: Open Society Foundation; 2008.Google Scholar
  29. 29.
    Crago A. Arrest the violence: human rights abuses against sex workers in Eastern Europe and Central Asia. Budapest: Sex Workers’ Rights Advocacy network (SWAn); 2009.Google Scholar
  30. 30.
    Ulibarri MD, Strathdee SA, Ulloa EC, Lozada R, Fraga MA, Magis-Rodríguez C, et al. Injection drug use as a mediator between client-perpetrated abuse and HIV status among female sex workers in two Mexico-US border cities. AIDS Behav. 2011;15(1):179–85.CrossRefPubMedGoogle Scholar
  31. 31.
    Goldenberg SM, Rangel G, Vera A, Patterson TL, Abramovitz D, Silverman JG, et al. Exploring the impact of underage sex work among female sex workers in two Mexico–US border cities. AIDS Behav. 2012;16(4):969–81.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Silverman JG, Raj A, Cheng DM, Decker MR, Coleman S, Bridden C, et al. Sex trafficking and initiation-related violence, alcohol use, and HIV risk among HIV-infected female sex workers in Mumbai, India. J Infect Dis. 2011;204(suppl 5):S1229–34.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Peitzmeier SM, Wirtz AL, Beyrer C, Peryshkina A, Sherman SG, Colantuoni E, et al. Polyvictimization among Russian sex workers: intimate partner, police, and pimp violence cluster with client violence. J Interpers Violence. 2019. Scholar
  34. 34.
    Decker MR, Wirtz AL, Moguilnyi V, Peryshkina A, Ostrovskaya M, Nikita M, et al. Female sex workers in three cities in Russia: HIV prevalence, risk factors and experience with targeted HIV prevention. AIDS Behav. 2014;18(3):562–72.CrossRefPubMedGoogle Scholar
  35. 35.
    USAID. HIV/AIDS Health Profile: Europe and Eurasia Region. Geneva: USAID; 2012.Google Scholar
  36. 36.
    UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS; 2012.Google Scholar
  37. 37.
    Clark F. Gaps remain in Russia’s response to HIV/AIDS. Lancet. 2016;388(10047):857.CrossRefPubMedGoogle Scholar
  38. 38.
    Pokrovskiy V, Ladnaya N, Tushina O, Buravtsova E. HIV-Infection. Informational Bulletin #40 (BИЧ-Инфeкция. Инфopмaциoнный бюллeтeнь №40). Moscow: Federal Scientific and Methodological Center for AIDS Prevention and Control (Фeдepaльный нayчнo-мeтoдичecкий цeнтp пo пpoфилaктикe и бopьбe co CПИДoм), 2015.Google Scholar
  39. 39.
    European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2015. Stockholm: 2016.Google Scholar
  40. 40.
    Beyrer C, Wirtz AL, O’Hara G, Léon N, Kazatchkine M. The expanding epidemic of HIV-1 in the Russian Federation. PLoS Med. 2017;14(11):e1002462.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Odinokova V, Rusakova M, Urada LA, Silverman JG, Raj A. Police sexual coercion and its association with risky sex work and substance use behaviors among female sex workers in St. Petersburg and Orenburg, Russia. Int J Drug Policy. 2014;25(1):96–104.CrossRefPubMedGoogle Scholar
  42. 42.
    Smolskaya T, Yakovleva A, Kasumov V, Gheorgitsa S. HIV sentinel surveillance in high-risk groups in Azerbaijan, Republic of Moldova and in the Russian Federation. Geneva: World Health Organisation (WHO); 2004.Google Scholar
  43. 43.
    United States Department of State. International Narcotics Control Strategy Report. 2014.Google Scholar
  44. 44.
    Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–99.CrossRefGoogle Scholar
  45. 45.
    Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The revised conflict tactics scales (CTS2) development and preliminary psychometric data. J Fam Issues. 1996;17(3):283–316.CrossRefGoogle Scholar
  46. 46.
    Szwarcwald CL, de Souza Júnior PRB, Damacena GN, Junior AB, Kendall C. Analysis of data collected by RDS among sex workers in 10 Brazilian cities, 2009: estimation of the prevalence of HIV, variance, and design effect. JAIDS J Acquir Immune Defic Syndr. 2011;57:S129–35.CrossRefPubMedGoogle Scholar
  47. 47.
    Ditmore M. When sex work and drug use overlap. London: Harm Reduction International; 2013.Google Scholar
  48. 48.
    Bourgois P, Prince B, Moss A. The everyday violence of hepatitis C among young women who inject drugs in San Francisco. Hum Organ. 2004;63(3):253–64.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Abdala N, Hansen NB, Toussova OV, Krasnoselskikh TV, Verevochkin S, Kozlov AP, et al. Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia. J Fam Plann Reprod Health Care. 2013;39(3):179–85.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Gray RH, Wawer MJ, Brookmeyer R, Sewankambo NK, Serwadda D, Wabwire-Mangen F, et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet. 2001;357(9263):1149–53.CrossRefPubMedGoogle Scholar
  51. 51.
    Baggaley RF, Boily M-C, White RG, Alary M. Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis. Aids. 2006;20(6):805–12.CrossRefPubMedGoogle Scholar
  52. 52.
    Baggaley RF, White RG, Boily M-C. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39:1048–63.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Swan H, O’Connell DJ. The impact of intimate partner violence on women’s condom negotiation efficacy. J Interpers Viol. 2012;27(4):775–92.CrossRefGoogle Scholar
  54. 54.
    Strathdee SA, Crago A-L, Butler J, Bekker L-G, Beyrer C. Dispelling myths about sex workers and HIV. Lancet. 2015;385(9962):4–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Solomon F. Vladimir putin just signed off on the partial decriminalization of domestic abuse in Russia. Time. 2017.Google Scholar
  56. 56.
    Lesur M, Stelmaszek B, Golden I. Country report 2013: Reality Check on European Services for Women and Children Survivors of Violence. Vienna: 2014.Google Scholar
  57. 57.
    Beattie TS, Isac S, Bhattacharjee P, Javalkar P, Davey C, Raghavendra T, et al. Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India. BMC Publ Health. 2016;16(1):660.CrossRefGoogle Scholar
  58. 58.
    Beattie TS, Bhattacharjee P, Ramesh B, Gurnani V, Anthony J, Isac S, et al. Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program. BMC Publ Health. 2010;10(1):476.CrossRefGoogle Scholar
  59. 59.
    Beksinska A, Prakash R, Isac S, Mohan H, Platt L, Blanchard J, et al. Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open. 2018;8(9):e021389.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    World Health Organization UNPF, Joint United Nations Programme on HIV/AIDS, Global Network, of Sex Work Projects TWB. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions. Geneva: World Health Organization; 2013.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Sexuality and Health DisparitiesUniversity of Michigan School of NursingAnn ArborUSA
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.AIDS InfoshareMoscowRussia

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