TY - JOUR
T1 - Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon
AU - Abelson, Anna
AU - Lyons, Carrie
AU - Decker, Michele
AU - Ketende, Sosthenes
AU - Mfochive Njindam, Iliassou
AU - Fouda, Ghislaine
AU - Ndonko, Flavien
AU - Levitt, Daniel
AU - Tamoufe, Ubald
AU - Billong, Serge
AU - Bissek, Anne Cecile Zoung Kanyi
AU - Baral, Stefan D.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The contents are the responsibility of Johns Hopkins University and do not necessarily reflect the views of USAID, PEPFAR or the U.S. Government. CHAMP, a 5-year cooperative agreement (AID-624-A-14-00003), is a large-scale HIV prevention, care and treatment program for key populations in Cameroon. CHAMP is led by CARE Cameroon in partnership with Johns Hopkins School of Public Health, Global Viral and MotoAction. S.B.’s effort was funded in part from the Johns Hopkins University Center for AIDS Research, an NIH-funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ.
Funding Information:
The authors are grateful to all who supported this work. This study was conducted through Continuum of Prevention, Care and Treatment of HIV/AIDS with Most-at-risk Populations in Cameroon (CHAMP). The program is implemented by CARE International in Cameroon in collaboration with Johns Hopkins University (JHU), Global Viral (GV) and eight local community-based organizations (MotoAction, Alternatives Cameroun, CMWA, Horizons Femmes, Humanity First, ASAD, CAMNAFAW and SWAA Littoral) and in coordination with the National AIDS Control Committee and the Ministry of Public Health. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID) and the U.S. President?s Emergency Plan for AIDS Relief (PEPFAR). The contents are the responsibility of Johns Hopkins University and do not necessarily reflect the views of USAID, PEPFAR or the U.S. Government. CHAMP, a 5-year cooperative agreement (AID-624-A-14-00003), is a large-scale HIV prevention, care and treatment program for key populations in Cameroon. CHAMP is led by CARE Cameroon in partnership with Johns Hopkins School of Public Health, Global Viral and MotoAction. S.B.?s effort was funded in part from the Johns Hopkins University Center for AIDS Research, an NIH-funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - 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 <.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.
AB - 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 <.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.
KW - HIV
KW - depression
KW - female sex work
KW - gender-based violence
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U2 - 10.1177/0020764019858646
DO - 10.1177/0020764019858646
M3 - Article
C2 - 31234685
AN - SCOPUS:85068250202
VL - 65
SP - 445
EP - 457
JO - International Journal of Social Psychiatry
JF - International Journal of Social Psychiatry
SN - 0020-7640
IS - 6
ER -