AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #178 - The impact of early sex work initiation on victimization, mental health and risk for HIV
Authors: Presenting Author: Dr. Hilary Surratt - Nova Southeastern University
Additional Authors: Dr. Steven Kurtz, Ms. Leah Varga,
Aim: Early entry into sex work has been identified as a significant predictor of HIV infection in recent studies. Initiation of sex work before the age of 18 confers multiple risks, including increased physical and sexual victimization, which likely contribute to higher levels of sexual risk behaviors among adolescent sex workers. In addition, biological differences in the developing female genital tract also increase vulnerability to HIV infection in young women. These findings suggest that sex work involvement during the adolescent years may represent a critical period with regard to HIV acquisition. Within this context, the present study examines the associations between age of sex work onset, victimization, mental health, patterns of sexual risk behaviors and HIV infection among a highly vulnerable group of African American female sex workers.
Method / Issue: Using targeted sampling, we recruited and interviewed 562 drug-involved African American female sex workers. Data were collected through confidential face-to-face interviews using standardized instrumentation.
Results / Comments: Median age at first sex work was 18 years; 18.2% of the sample reported being HIV-positive. Lifetime prevalence of abuse was extremely elevated at 88%. Nearly half of the sample reported abuse before the age of 18, while 34% reported violent encounters with clients in the past 90 days. Serious mental health problems were common, with 74% reporting severe symptoms of depression, anxiety, or traumatic stress in the past year. Initiation of sex work prior to age 18 was associated with significantly higher odds of HIV seropositivity (OR=1.77; p=.012).
Discussion: Among this sample of African American women already disadvantaged by poverty and discrimination, the accumulation of violence, trauma, and instability drove women into the sex trade very early, on average by age 18. Younger age at sex work onset was associated with a substantial increase in HIV acquisition, which warrants further investigation to examine the precise mechanisms that exacerbate risk. From a public health perspective, it appears critical that HIV prevention interventions be designed and tailored for vulnerable young women in the sex trade.
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