Factors associated with violence against female sex workers in ten Brazilian cities

Lima, Francisca Sueli da Silva; Merchán-Hamann, Edgar; Urdaneta, Margarita; Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann

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ARTICLE • Cad. Saúde Pública 33 (2) • 2017 • https://doi.org/10.1590/0102-311X00157815 copy

Factors associated with violence against female sex workers in ten Brazilian cities

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Few studies in Brazil have focused on violence against female sex workers, a theme that has attracted researchers' attention worldwide, especially due to possible associations with HIV. The current study aims to estimate the prevalence of violence against female sex workers according to type and perpetrator and to identify associated factors. A cross-sectional study was conducted with data on 2,523 female sex workers from ten Brazilian cities, and with the respondent-driven sampling (RDS). Prevalence of verbal violence was 59.5%, physical violence 38.1%, sexual violence 37.8%, intimate partner physical violence 25.2%, and violence by clients 11.7%. Factors associated with physical violence were age < 30 years (aOR = 2.27; 95%CI: 1.56-3.29), drug use (aOR = 2.02; 95%CI: 1.54-2.65), and price of trick ≤ BRL 29.00 or USD 9.00 (aOR = 1.51; 95%CI: 1.07-2.13). In conclusion, Brazilian female sex workers suffer a disproportional burden of violence. The identification of vulnerability factors is essential for interventions to safeguard human rights and control HIV.

Keywords:
Sex Workers; Workplace Violence; Violence Against Women; HIV

Variable	n (N = 2,523)	%
Age (years)
18-24	858	34.0
25-29	516	20.5
30-34	412	16.3
35-39	272	10.8
40-49	292	11.6
50-59	143	5.7
≥ 60	30	1.2
Schooling
Incomplete primary	1,493	59.2
Incomplete secondary	599	23.7
Complete secondary or more	431	17.1
Race/Color
White	604	23.9
Black	717	28.4
Brown	962	38.1
Other	240	9.5
Monthly income (Brazilian Reais)
1.00-299.00	471	18.6
300.00-599.00	665	26.4
600.00-1,199.00	600	23.8
1,200.00-2,999.00	373	14.8
≥ 3,000.00	73	2.9
Doesn't know/No answer	341	13.5
Conjugal status
Never married	1,332	52.8
Married/Lives with partner	514	20.3
Separated/divorced	545	21.6
Widow	132	5.2
Other work besides sex work
Employed with formal work papers	113	4.5
Employed without formal work papers	256	10.1
Self-employed	524	20.8
None	1,630	64.6
Housing status
Own house or apartment	863	34.2
Rented house or apartment	804	31.9
Other (boarding house/workplace)	856	33.9

Variable	n (N = 2,523)	%
Place of sex work
Streets	966	38.7
Indoor premises	1,557	61.3
Time in sex work (years)
< 1	185	7.3
1-3	755	29.9
4-9	763	30.2
10-19	493	19.5
≥ 20	314	12.4
No information	14	0.7
Cost of trick (Brazilian Reais)
1.00-29.00	841	33.3
30.00-49.00	626	24.8
50.00-99.00	592	23.5
≥ 100.00	464	18.4
Tricks/day
1-5	948	77.2
6-10	406	16.1
≥ 11	169	7.7
Alcohol consumption
Several times a week/Every day	700	27.7
Once a week or less	1,160	46.0
Never	663	26.3
Any type of drug use (marijuana, cocaine, crack, merla etc.)
Once a month or more	779	30.9
Never	1,745	69.1
Cocaine
Once a month or more	494	19.6
Never	2,029	80.9
Crack or merla
Once a month or more	211	8.4
Never	2,312	91.6

Factors	Verbal violence					Physical violence by any aggressor
	Bivariate			Multivariate			Bivariate			Multivariate
	PR	95%CI	p-value	aOR	95%CI	p-value	PR	95%CI	p-value	aOR	95%CI	p-value
Age (years)
18-29	1.09	0.99-1.20	0.063	1.73	1.22-2.45	0.002	1.49	1.27-1.73	0.000	2.27	1.56-3.29	0.000
30-39	0.92	0.83-1.02	0.121	1.88	1.30-2.71	0.001	1.04	0.88-1.22	0.650	1.72	1.16-2.55	0.007
≥ 40	1.00
Race/Color
Black	1.06	0.95-1.17	0.314	1.04	0.79-1.37	0.785	1.28	1.09-1.49	0.002	1.37	1.03-1.83	0.031
Non-black	1.00
Schooling
Incomplete primary	0.99	0.89-1.09	0.797	0.94	0.73-1.22	0.663	1.16	1.00-1.35	0.045	1.32	1.01-1.73	0.044
Complete primary or more	1.00
Place of sex work
Streets	0.88	0.76-1.01	0.070	0.83	0.63-1.08	0.164	1.01	0.92-1.11	0.796	1.15	0.88-1.49	0.306
Indoor premises	1.00
Cost of trick (Brazilian Reais)
1.00-29.00	1.14	1.03-1.27	0.016	2.16	1.52-3.08	0.000	1.18	1.00-1.39	0.048	1.51	1.07-2.13	0.019
30.00-99.00	0.96	0.87-1.06	0.405	1.52	1.15-2.01	0.003	1.05	0.91-1.21	0.510	1.13	0.85-1.50	0.415
≥ 100.00	1.00
Alcohol consumption
Yes	1.16	1.03-1.30	0.010	1.31	1.11-1.55	0.002	1.48	1.23-1.77	0.000	1.48	1.24-1.77	0.000
No	1.00
Drug use
Yes	1.29	1.18-1.42	0.000	1.64	1.24-2.17	0.001	1.81	1.58-2.09	0.000	2.02	1.54-2.65	0.000
No	1.00
Inconsistent condom use
Yes	1.24	1.07-1.44	0.002	1.44	1.03-2.02	0.036	1.18	1.07-1.30	0.003	1.37	0.96-1.94	0.079
No	1.00
HIV serological status
Positive	1.01	0.74-1.40	0.926	0.96	0.51-1.82	0.899	1.26	0.97-1.64	0.050	1.59	0.88-2.89	0.128
Negative	1.00

Factors	Intimate partner physical violence					Physical violence by family member of known person
	Bivariate			Multivariate			Bivariate			Multivariate
	PR	95%CI	p-value	aOR	95%CI	p-value	PR	95%CI	p-value	aOR	95%CI	p-value
Age (years)
18-29	1.30	1.07-1.59	0.008	1.92	1.23-2.99	0.004	1.71	1.30-2.26	0.000	2.80	1.71-4.61	0.000
30-39	0.98	0.79-1.21	0.875	1.63	1.04-2.55	0.032	1.19	0.87-1.63	0.279	1.83	1.08-2.09	0.024
≥ 40	1.00
Race/Color
Black	1.21	0.99-1.49	0.071	1.16	0.85-1.58	0.343	1.41	1.07-1.85	0.015	1.34	0.94-1.90	0.101
Non-black	1.00
Schooling
Incomplete primary	1.22	0.99-1.49	0.053	1.33	0.98-1.79	0.067	1.38	1.05-1.83	0.022	1.62	1.11-2.36	0.012
Complete primary or more	1.00
Place of sex work
Streets	1.01	0.83-1.24	0.085	1.11	0.83-1.48	0.479	0.91	0.75-1.28	0.891	1.06	0.76-1.48	0.729
Indoor premises	1.00
Cost of trick (Brazilian Reais)
1.00-29.00	1.21	0.971-1.51	0.096	1.33	0.90-1.97	0.152	1.04	0.76-1.43	0.793	1.05	0.67-1.64	0.834
30.00-99.00	1.05	0.86-1.28	0.623	1.11	0.80-1.54	0.524	1.01	0.78-1.31	0.934	1.04	0.72-1.51	0.825
≥ 100.00	1.00
Alcohol consumption
Yes	1.53	1.20-1.99	0.000	1.47	1.21-1.80	0.000	1.32	0.97-1.81	0.075	1.20	0.95-1.51	0.126
No	1.00
Drug use
Yes	1.85	1.53-2.24	0.000	1.68	1.25-2.26	0.001	1.94	1.50-2.49	0.000	1.72	1.21-2.43	0.002
No	1.00
Inconsistent condom use
Yes	1.85	1.30-2.60	0.000	1.99	1.27-3.11	0.003	1.25	0.85-1.83	0.253	1.10	0.69-1.77	0.690
No	1.00
HIV serological status
Positive	1.36	0.94-1.97	0.119	1.46	0.80-2.68	0.218	1.41	0.86-2.29	0.184	1.52	0.75-3.09	0.246
Negative	1.00

Factors	Physical violence by clients					Physical violence by police
	Bivariate			Multivariate			Bivariate			Multivariate
	PR	95%CI	p-value	aOR	95%CI	p-value	PR	95%CI	p-value	aOR	95%CI	p-value
Age (years)
18-29	1.38	1.01-1.87	0.040	2.24	1.24-3.75	0.002	1.36	0.96-1.94	0.084	2.03	1.09-3.79	0.026
30-39	1.08	0.78-1.50	0.643	1.60	0.94-2.72	0.081	0.99	0.67-1.46	0.962	1.72	0.92-3.20	0.089
≥ 40	1.00
Race/Color
Black	1.47	1.00-1.99	0.016	1.38	0.95-2.01	0.093	1.64	1.15-2.36	0.007	1.51	0.98-2.34	0.063
Non-black	1.00
Schooling
Incomplete primary	1.39	1.02-1.91	0.034	1.30	0.88-1.93	0.193	2.17	1.43-3.31	0.000	2.21	1.34-3.51	0.001
Complete primary or more	1.00
Place of sex work
Streets	1.07	1.02-1.11	0.002	1.86	1.31-2.66	0.001	1.64	1.15-2.34	0.006	1.80	1.15-2.82	0.010
Indoor premises	1.00
Cost of trick (Brazilian Reais)
1.00-29.00	1.86	1.36-2.54	0.000	2.09	1.29-3.38	0.003	1.39	0.96-2.01	0.081	0.97	0.57-1.66	0.905
30.00-99.00	1.22	0.91-1.63	0.178	1.13	0.75-1.71	0.546	1.23	0.86-1.76	0.262	0.83	0.51-1.37	0.465
≥ 100.00	1.00
Alcohol consumption
Yes	1.47	1.00-2.15	0.042	1.57	1.19-2.06	0.001	1.75	1.16-2.62	0.006	1.32	0.99-1.75	0.052
No	1.00
Drug use
Yes	1.95	1.44-2.65	0.000	1.47	1.02-2.18	0.041	2.99	2.07-4.31	0.000	2.54	1.61-3.99	0.000
No	1.00
Inconsistent condom use
Yes	1.26	0.82-1.94	0.283	1.22	0.74-2.01	0.443	1.06	0.64-1.74	0.834	0.88	0.49-1.57	0.656
No	1.00
HIV serological status
Positive	1.79	1.04-3.08	0.043	1.67	0.79-3.54	0.183	1.82	1.05-3.16	0.036	1.57	0.78-3.13	0.205
Negative	1.00

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[1] * Correspondence F. S. S. Lima SQN 307, bloco F, apto. 307, Brasília, DF 70746060, Brasil. suelisabinocarneiro@gmail.com