Research Article: Age Differences among Female Sex Workers in the Philippines: Sexual Risk Negotiations and Perceived Manager Advice

Date Published: July 17, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Lianne A. Urada, Robert M. Malow, Nina C. Santos, Donald E. Morisky.

http://doi.org/10.1155/2012/812635

Abstract

Consistent condom use among high risk groups such as female sex workers (FSWs) remains low. Adolescent female sex workers are especially at higher risk for HIV/STI infections. However, few published studies have compared the sexual risk negotiations among adolescent, emerging adult, and older age groups or the extent a manager’s advice about condom use is associated with an FSW’s age. Of 1,388 female bar/spa workers surveyed in the southern Philippines, 791 FSW who traded sex in the past 6 months were included in multivariable logistic regression models. The oldest FSWs (aged 36–48) compared to adolescent FSWs (aged 14–17) were 3.3 times more likely to negotiate condoms when clients refused condom use. However, adolescent FSWs received more advice from their managers to convince clients to use condoms or else to refuse sex, compared to older FSWs. Both adolescent and the oldest FSWs had elevated sexually transmitted infections (STIs) and inconsistent condom use compared to other groups. Having a condom rule at the establishment was positively associated with condom negotiation. Factors such as age, the advice managers give to their workers, and the influence of a condom use rule at the establishment need to be considered when delivering HIV/STI prevention interventions.

Partial Text

Approximately 40% of new HIV infections worldwide occur among those aged 15–24 years [1], with females representing approximately half of all infections [2]. Although HIV prevalence is low in the Philippines (under 1% of the general population), consistent condom use among high-risk groups such as female sex workers (FSWs) remains low as well (<30%) [3]. Therefore, FSWs working in night clubs/bars and spa/saunas remain at high risk of becoming exposed to HIV and other sexually transmitted infections (STIs) [4]. Approximately 40% of FSWs worldwide have entered the sex trade before the age of 18 [5]. Adolescent female sex workers are especially at higher risk for HIV/STI infections [6] because their genital tracts are not fully developed and consequently may tear more easily during penetrative sexual intercourse [7]. Studies have also revealed that FSWs who enter the sex industry as minors are more likely to experience sexual and physical abuse compared to FSWs who were not minors when they entered sex work [5]. However, few published studies have compared the sexual risk negotiations of older FSWs with younger FSWs, for example, adolescents (under 18 years old) and emerging adults (18–25 years old, an age marked by increased risk-taking and identity exploration) [8–10]. Furthermore, the extent a manager's advice is associated with age of an FSW is unknown for this region. The present study used cross-sectional follow-up data with 1,388 female entertainers involved in a longitudinal study in the southern Philippines. Only those entertainers who reported having paid sex in the previous 6 months (N = 791) were included in this analysis in order to restrict the sample to female sex workers. Participating city sites were originally randomized to intervention and comparison groups in the southern Philippines. To control for intervention effects, a city variable was included in this analysis. In this study of female sex workers in the southern Philippines, nearly 1 in 4 reported having an STI in the past 6 months and nearly half said they used condoms consistently. However, those in the adolescent category (aged 14–17) and the oldest age group (aged 35–48) reported having more STIs and less consistent condom use than the 18–25 and 26–47-year-old age categories. Adolescent FSWs were less likely to negotiate condoms, compared to older FSWs. However, adolescent FSWs received more reinforcement from their managers to engage in safer sex compared to the older age groups. Findings from this study reinforce the need for interventions to target young female sex workers at risk for HIV/STI, as described in the literature due to the heightened susceptibility of younger FSWs to infections and violence [5]. However, this study's findings also illustrate the need to target the oldest FSW category (aged 35–48), a group less described in the existing literature. This study's findings suggest that adolescent female sex workers (aged 14–17) in the Philippines negotiated safer sex less with clients who refused to use condoms, compared to older sex workers, in particular those in the highest age bracket (aged 35–48). However, this oldest group of sex workers experienced less positive safer sex advice given by their managers. Also, both adolescent and 35–48-year-old FSWs engaged in the highest levels of risky behavior in terms of STIs and inconsistent condom use. A presence of a condom rule at the current establishment was also a significant covariate for condom negotiation. Findings from this study imply that interventions need to occur at organizational and structural levels [26, 32] to address safer sex negotiation among the FSWs, taking into consideration factors such as age, the advice managers give to their workers, and the influence of a condom use rule at the establishment. More studies are needed that compare whether the youngest and oldest FSWs experience violence differently, especially for those who entered the sex trade under 18 and were forced/coerced into sex work acts. Comparisons between the emerging adulthood and older age categories for FSWs may particularly warrant further investigation because of the heightened risks normally associated with emerging adulthood.   Source: http://doi.org/10.1155/2012/812635

 

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