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Residential Instability & Women’s Risk for Violence and HIV

Prevention and Community Health George Washington University. Residential Instability & Women’s Risk for Violence and HIV. Findings from a Study among Women Working as Sex Workers in Andhra Pradesh, India. Elizabeth Reed, ScD, MPH.

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Residential Instability & Women’s Risk for Violence and HIV

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  1. Prevention and Community Health George Washington University Residential Instability & Women’s Risk for Violence and HIV Findings from a Study among Women Working as Sex Workers in Andhra Pradesh, India Elizabeth Reed, ScD, MPH

  2. Recent findings suggest that sexual risk for HIV is greater among those most vulnerable to risky social or environmental contexts (poverty, homelessness). One potential contextual challenge experienced by FSW residing in Andhra Pradesh, India is acquisition of stable housing. Residential Instability Adimora et al., 2002, 2006; Raj et al., 2008; Elifson et al., 2007; Sevelius et al, 2009; Surrat & Inciardi, 2004

  3. Study among Female Sex Workers in Andhra Pradesh, India • Gates-Funded Project Parivartan: aims to evaluate the impact of a community mobilization intervention on HIV risk among FSW in Rajahmundry (PI: Kim Blankenship, PhD) • Survey participants were recruited via respondent driven sampling (RDS) • Survey with FSW at least 18 years of age and reported having sex in exchange for money in the year prior to the survey (N=673) • We examined residential instability (defined as a high frequency of reported evictions) and relation to experiences of violence and sexual risk factors for HIV

  4. Proportions Reporting Violence and Sexual Risk 12% sexual violence 31% physical violence 20% accepting more money for sex with no condom, past 30 days 60% at least one STI symptom, past 6 months

  5. Residential instability in relation to violence and HIV sexual risk factors • recent sexual violence (AOR=3.4; 95% CI:2.0-5.6) • recent physical violence (AOR=3.1; 95% CI:2.1-4.7) • accepting more money for sex with no condom (AOR=2.4; 95% CI:1.5-3.8) • at least one STI symptom in the past six months (AOR=2.7; 95% CI:1.7-4.2). High residential instability -> Reed et al., under review

  6. Residential instability in relation to violence and HIV sexual risk factors High residential instability -> Recent STI symptom --- further adjusted for unprotected sex (AOR=2.5; 95% CI:1.6-3.9). --- further adjusted for physical and sexual violence (AOR= 1.9; 95% CI: 1.2-3.2) • violence attenuated the effect estimate by 24% (i.e. violence contributed to the association between residential instability/evictions and reports of STI symptoms). Reed et al., under review

  7. Conclusions • Findings showcase the violence and HIV related vulnerability of FSW who report residential instability • Supports the need for future research and programming to address violence against women as a primary factor contributing to HIV risk among populations of women globally • Highlights how contexts affect risk above and beyond individual behavior • Supports the need for further research and prevention programming addressing women’s life contexts Reed et al., 2010; Reed et al., under review

  8. Research Team Kim Blankenship, PhD (American University), Principal Investigator Monica Biradavolu, PhD (American University) Jhumka Gupta, MPH, ScD (Yale School of Public Health) VasaviDevireddy, B.S. (Duke Global Health Institute) Funding Funded by the Bill & Melinda Gates Foundation, as part of Avahan, the India AIDS Initiative Acknowledgements

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