Health Implications and Health Care Challenges Associated with Prostitution
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1 Health Implications and Health Care Challenges Associated with Prostitution Cathie Ingram Fogel, PhD, RNC, FAAN Professor & Coordinator, Women s Health University of North Carolina School of Nursing
2 Session Objectives This session will focus on: The health problems and concerns of women prostitutes. Women prisoners-an example Recommendations for health care services
3 Health Problems Violence and Abuse Substance Abuse Mental Health Problems Infections Survival Needs & Health Care
4 Violence and Abuse Violence is a hallmark of past and current lives Threat and reality of violence are common and constant Majority have a history of childhood abuse, especially sexual abuse
5 Substance Abuse Alcohol and drug addiction Marijuana Cocaine Crack Heroin Methamphetamine
6 Mental Health Problems Stigma Depression PTSD Dissociation
7 Infections STDs & HIV/AIDS Gonorrhea Syphilis Chlamydia Herpes HPV Hepatitis Other infections Tuberculosis Pneumonia Scabies Drug-resistant
8 HIV Risk Factors Sex work Substance Abuse Depression, dissociation Interrelationship of physical, emotional & sexual abuse; drug use; and multiple partners + women s perceptions of self
9 Other Health Problems Injuries: fractures, burns Gynecological Obstetrical Cardiac Chronic liver disease Excess mortality Other
10 Survival Needs Shelter Safety Economic stability Adequate health care
11 Women in Prison
12 Women in Prison Over 95,000 women currently in United States federal and state prisons Short sentences & recidivism = lots of movement between prison and home Poor, uneducated, unskilled with sporadic employment histories
13 Women in Prison Disproportionately women of color Childbearing age and mothers of children (85%) Chronically chaotic lives
14 Women in Prison Experienced abuse physical, emotional, sexual (~75%) Numerous STD/HIV risk factors Depression, PTSD, anxiety
15 WCRR Intervention INFLUENCING FACTORS Depression Violence Relationships Social Support Substance Abuse LABELING BEHAVIOR HIV/STD Knowledge Risk Perception COMMITTING to CHANGE Protective Practices Attitudes Prioritizing Enactment Skills Communication & Negotiation Technical Skills INFLUENCING FACTORS Depression Violence Relationships Social Support Drugs & ETOH PROTECTIVE PRACTICES Unprotected sex More condoms use Fewer partners
16 Experimental Design 3-Group randomized control design to compare the WCRRI with NIDA Standard Intervention for HIV Prevention Proven standard HIV prevention intervention with focus on IV drug use Stay Fit and Health Intervention replicate the number and duration of contacts and health-related content of the WCRRI Central theme: developing & maintaining healthy lifestyle habits for life
17 Experimental Design Total Sample Size = 324 women (108 in each group); recruited in cohorts In prison: Baseline interview (T1), Intervention, T2 interview, Pre-release session In community: Booster phone calls (WCRRI & Stay Fit) 1-month out T3 interview 3-months out T4 interview 6-months out T5 interview 9 months out T6 interview
18
19 Violence Experiences in HOPE Women Feel unsafe Husband Stranger Forced sex No SE 56.7% 35.7% 8.8% 35.3 SE 75.7% 29%
20 Confluence of Events and Factors Contributing to Victimization Initial mistreatment or violence/abuse Recognition of mistreatment as abusive and wrong; sources of help Escape/leave/ run away Further vulnerability Unclear roles and relationships with individuals Other negative effects on well being Attempt to tell someone; seek help Control/power issues Drug and/or alcohol use Self-blame Self-harm/self-abuse/ Self-injury
21 Substance Abuse Early age at initiation of use-trend toward earlier use by SE subjects First drug ever used: Alcohol & Marijuana Most commonly used drugs in month prior to incarceration: Alcohol, Marijuana, Crack
22 Total Drug Use in Month prior Incarceration Number of Women Days
23 Alcohol Use in Month prior Incarceration Frequency Days
24 Marijuana Use in Month prior Incarceration Number of Women Days
25 Crack Use in Month prior Incarceration Number of Women Days
26 Use in Month prior Incarceration Number of Women Days
27 Mental Health Problems Depression Dissociation Sadness, low selfesteem Hopelessness
28 Infections Gonorrhea Trichomoniasis Chlamydia Syphilis HCV HPV NSE 13.5% 15.6% 21.8% 3.7% 5.3% 3.8% SE 41.3% 39.1% 35.2% 17.4% 13.0% 8.3%
29 Additional Health Problems Common Self-Reported Conditions Asthma, Bronchitis, Sinusitis Back pain Hypertension & other cardiac conditions Diabetes Arthritis Headaches-fractures, head injuries Seizures Traumatic injuries
30 Challenges for Health Care Providers and Services Address health care within the context of women s lives Know your patient Available & accessible services Primary Care OB-Prenatal care
31 Health Care Challenges Gender-based substance abuse treatment Reduction of dependence on survival sex
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