Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon

Background: In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs’ experiences with sexual violence and consisten...

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Veröffentlicht in:International journal of social psychiatry 2019-09, Vol.65 (6), p.445-457
Hauptverfasser: Abelson, Anna, Lyons, Carrie, Decker, Michele, Ketende, Sosthenes, Mfochive Njindam, Iliassou, Fouda, Ghislaine, Ndonko, Flavien, Levitt, Daniel, Tamoufe, Ubald, Billong, Serge, Bissek, Anne-Cecile Zoung-Kanyi, Baral, Stefan D
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container_issue 6
container_start_page 445
container_title International journal of social psychiatry
container_volume 65
creator Abelson, Anna
Lyons, Carrie
Decker, Michele
Ketende, Sosthenes
Mfochive Njindam, Iliassou
Fouda, Ghislaine
Ndonko, Flavien
Levitt, Daniel
Tamoufe, Ubald
Billong, Serge
Bissek, Anne-Cecile Zoung-Kanyi
Baral, Stefan D
description Background: In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs’ experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. Methods: In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. Results: Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2–1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p 
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We examined the relationship between FSWs’ experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. Methods: In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. Results: Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2–1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p &lt; .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3–2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2–2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. Conclusion: Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.</description><identifier>ISSN: 0020-7640</identifier><identifier>EISSN: 1741-2854</identifier><identifier>DOI: 10.1177/0020764019858646</identifier><identifier>PMID: 31234685</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Cameroon - epidemiology ; Condoms - statistics &amp; numerical data ; Confidence intervals ; Cross-Sectional Studies ; Depression - epidemiology ; Female ; Gender ; Gender-based violence ; Gender-Based Violence - statistics &amp; numerical data ; Health behavior ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility ; HIV ; HIV Infections - prevention &amp; control ; HIV Infections - psychology ; Human immunodeficiency virus ; Humans ; Mental depression ; Mental health ; Mental health services ; Nonuse ; Prevalence ; Prostitution ; Regression Analysis ; Risk behavior ; Risk Factors ; Sampling ; Sex crimes ; Sex Factors ; Sex industry ; Sex workers ; Sex Workers - psychology ; Sex Workers - statistics &amp; numerical data ; Sexual Partners - psychology ; Sexual violence ; Violence ; Women ; Workplace Violence - statistics &amp; numerical data ; Young Adult</subject><ispartof>International journal of social psychiatry, 2019-09, Vol.65 (6), p.445-457</ispartof><rights>The Author(s) 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-e6e6a191c54adfa2cdacd7616a6aa5f54167c7d91b52080eff8c7241e366943e3</citedby><cites>FETCH-LOGICAL-c407t-e6e6a191c54adfa2cdacd7616a6aa5f54167c7d91b52080eff8c7241e366943e3</cites><orcidid>0000-0002-1595-147X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0020764019858646$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0020764019858646$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>315,782,786,21826,27931,27932,31006,33781,43628,43629</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31234685$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abelson, Anna</creatorcontrib><creatorcontrib>Lyons, Carrie</creatorcontrib><creatorcontrib>Decker, Michele</creatorcontrib><creatorcontrib>Ketende, Sosthenes</creatorcontrib><creatorcontrib>Mfochive Njindam, Iliassou</creatorcontrib><creatorcontrib>Fouda, Ghislaine</creatorcontrib><creatorcontrib>Ndonko, Flavien</creatorcontrib><creatorcontrib>Levitt, Daniel</creatorcontrib><creatorcontrib>Tamoufe, Ubald</creatorcontrib><creatorcontrib>Billong, Serge</creatorcontrib><creatorcontrib>Bissek, Anne-Cecile Zoung-Kanyi</creatorcontrib><creatorcontrib>Baral, Stefan D</creatorcontrib><title>Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon</title><title>International journal of social psychiatry</title><addtitle>Int J Soc Psychiatry</addtitle><description>Background: In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs’ experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. Methods: In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. Results: Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2–1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p &lt; .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3–2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2–2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. Conclusion: Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. 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Lyons, Carrie ; Decker, Michele ; Ketende, Sosthenes ; Mfochive Njindam, Iliassou ; Fouda, Ghislaine ; Ndonko, Flavien ; Levitt, Daniel ; Tamoufe, Ubald ; Billong, Serge ; Bissek, Anne-Cecile Zoung-Kanyi ; Baral, Stefan D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-e6e6a191c54adfa2cdacd7616a6aa5f54167c7d91b52080eff8c7241e366943e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Cameroon - epidemiology</topic><topic>Condoms - statistics &amp; numerical data</topic><topic>Confidence intervals</topic><topic>Cross-Sectional Studies</topic><topic>Depression - epidemiology</topic><topic>Female</topic><topic>Gender</topic><topic>Gender-based violence</topic><topic>Gender-Based Violence - statistics &amp; numerical data</topic><topic>Health behavior</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>Health Services Accessibility</topic><topic>HIV</topic><topic>HIV Infections - prevention &amp; 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Abstracts (ASSIA)</collection><collection>Social Services Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>Sociological Abstracts</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of social psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abelson, Anna</au><au>Lyons, Carrie</au><au>Decker, Michele</au><au>Ketende, Sosthenes</au><au>Mfochive Njindam, Iliassou</au><au>Fouda, Ghislaine</au><au>Ndonko, Flavien</au><au>Levitt, Daniel</au><au>Tamoufe, Ubald</au><au>Billong, Serge</au><au>Bissek, Anne-Cecile Zoung-Kanyi</au><au>Baral, Stefan D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon</atitle><jtitle>International journal of social psychiatry</jtitle><addtitle>Int J Soc Psychiatry</addtitle><date>2019-09</date><risdate>2019</risdate><volume>65</volume><issue>6</issue><spage>445</spage><epage>457</epage><pages>445-457</pages><issn>0020-7640</issn><eissn>1741-2854</eissn><abstract>Background: In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs’ experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. Methods: In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. Results: Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2–1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p &lt; .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3–2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2–2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. Conclusion: Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31234685</pmid><doi>10.1177/0020764019858646</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-1595-147X</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Cameroon - epidemiology
Condoms - statistics & numerical data
Confidence intervals
Cross-Sectional Studies
Depression - epidemiology
Female
Gender
Gender-based violence
Gender-Based Violence - statistics & numerical data
Health behavior
Health Knowledge, Attitudes, Practice
Health Services Accessibility
HIV
HIV Infections - prevention & control
HIV Infections - psychology
Human immunodeficiency virus
Humans
Mental depression
Mental health
Mental health services
Nonuse
Prevalence
Prostitution
Regression Analysis
Risk behavior
Risk Factors
Sampling
Sex crimes
Sex Factors
Sex industry
Sex workers
Sex Workers - psychology
Sex Workers - statistics & numerical data
Sexual Partners - psychology
Sexual violence
Violence
Women
Workplace Violence - statistics & numerical data
Young Adult
title Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon
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