Exposure to Police and Client Violence among Incarcerated Female Sex Workers in Baltimore City, Maryland

Objectives. To determine the rate and correlates of incarceration among street-based female sex workers (FSWs). Methods. From April 2016 to January 2017, FSWs (n = 250) in Baltimore City, Maryland, were enrolled in a 12-month prospective cohort study. We analyzed baseline data and used zero-inflated negative binomial regression to model the incarceration rate. Results. Overall, 70% of FSWs had ever been incarcerated (mean = 15 times). In the multivariable analysis, incarceration rate was higher for FSWs exposed to police violence, non-Hispanic White FSWs, and women who used injection drugs daily. Risk for ever being incarcerated was higher for FSWs exposed to police or client violence, non-Hispanic Black FSWs, women who used injection or noninjection drugs daily, and those with longer time in sex work. Conclusions. Incarceration was associated with exposure to violence from both police and clients. Daily drug use and time in sex work appeared to amplify these risks. Although non-Hispanic Black women were at greater risk for ever being incarcerated, non-Hispanic White women were incarcerated more frequently. Public Health Implications. Decriminalization of sex work and drug use should be prioritized to reduce violence against FSWs. (Am J Public Health. 2020;110:S152-S159. doi:10.2105/AJPH.2019.305451).