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      Factors influencing women’s sex work in a Lebanese sample: results of a case-control study

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          Abstract

          Background

          Many constituents contribute to the rise of sex work in Lebanon such as the socio-economic situation in the country (poverty, increased unemployment rates, and religious divisions), as well as the political and social instability. Several emotional and psychological factors such as depression, stress, anxiety, low self-esteem, emotional abuse, may force some people to rely on trading sex as a coping strategy for persevering. Therefore, it was deemed interesting to explore and understand factors that are correlated with sex work in Lebanon where no study, to our knowledge, has been written on this critical point. The objective of the study was to assess factors (such as trauma, child abuse, partner abuse, depression, anxiety, and stress) associated with women joining sex work among a sample of the Lebanese population.

          Methods

          A case-control study was conducted on a group of women (60 sex workers recruited from a prison for women) involved in sex work matched for age and sex with a control group (60 non-sex workers). Controls were chosen from the same prison population as the sex workers.

          Results

          A logistic regression was conducted, taking being a sex worker vs not as the dependent variable; independent factors were sociodemographic characteristics, child (psychological, neglect, physical and verbal) and inter partner violence (physical and non-physical), depression, anxiety and stress. Higher anxiety (aOR = 1.08) and higher inter partner physical violence (aOR = 1.02) were altogether related with higher chances of being a sex worker.

          Conclusion

          This study proposes an association between child abuse, inter partner violence, alcohol consumption, anxiety, and sex work. Future research may also need to contemplate other factors not examined here, including parental substance use, personality traits, and many others.

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          Most cited references40

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          Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy.

          We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers. We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse. In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73). Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.
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            Development of a brief measure of intimate partner violence experiences: the Composite Abuse Scale (Revised)—Short Form (CASR-SF)

            Objectives Approaches to measuring intimate partner violence (IPV) in populations often privilege physical violence, with poor assessment of other experiences. This has led to underestimating the scope and impact of IPV. The aim of this study was to develop a brief, reliable and valid self-report measure of IPV that adequately captures its complexity. Design Mixed-methods instrument development and psychometric testing to evolve a brief version of the Composite Abuse Scale (CAS) using secondary data analysis and expert feedback. Setting Data from 5 Canadian IPV studies; feedback from international IPV experts. Participants 31 international IPV experts including academic researchers, service providers and policy actors rated CAS items via an online survey. Pooled data from 6278 adult Canadian women were used for scale development. Primary/secondary outcome measures Scale reliability and validity; robustness of subscales assessing different IPV experiences. Results A 15-item version of the CAS has been developed (Composite Abuse Scale (Revised)—Short Form, CASR-SF), including 12 items developed from the original CAS and 3 items suggested through expert consultation and the evolving literature. Items cover 3 abuse domains: physical, sexual and psychological, with questions asked to assess lifetime, recent and current exposure, and abuse frequency. Factor loadings for the final 3-factor solution ranged from 0.81 to 0.91 for the 6 psychological abuse items, 0.63 to 0.92 for the 4 physical abuse items, and 0.85 and 0.93 for the 2 sexual abuse items. Moderate correlations were observed between the CASR-SF and measures of depression, post-traumatic stress disorder and coercive control. Internal consistency of the CASR-SF was 0.942. These reliability and validity estimates were comparable to those obtained for the original 30-item CAS. Conclusions The CASR-SF is brief self-report measure of IPV experiences among women that has demonstrated initial reliability and validity and is suitable for use in population studies or other studies. Additional validation of the 15-item scale with diverse samples is required.
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              Alcohol use among female sex workers and male clients: an integrative review of global literature.

              To review the patterns, contexts and impacts of alcohol use associated with commercial sex reported in the global literature. We identified peer-reviewed English-language articles from 1980 to 2008 reporting alcohol consumption among female sex workers (FSWs) or male clients. We retrieved 70 articles describing 76 studies, in which 64 were quantitative (52 for FSWs, 12 for male clients) and 12 qualitative. Studies increased over the past three decades, with geographic concentration of the research in Asia and North America. Alcohol use was prevalent among FSWs and clients. Integrating quantitative and qualitative studies, multilevel contexts of alcohol use in the sex work environment were identified, including workplace and occupation-related use, the use of alcohol to facilitate the transition into and practice of commercial sex among both FSWs and male clients, and self-medication among FSWs. Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive. Alcohol use in the context of commercial sex is prevalent, harmful among FSWs and male clients, but under-researched. Research in this area in more diverse settings and with standardized measures is required. The review underscores the importance of integrated intervention for alcohol use and related problems in multilevel contexts and with multiple components in order to effectively reduce alcohol use and its harmful effects among FSWs and their clients.
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                Author and article information

                Contributors
                souheilhallit@hotmail.com
                Journal
                BMC Womens Health
                BMC Womens Health
                BMC Women's Health
                BioMed Central (London )
                1472-6874
                5 September 2020
                5 September 2020
                2020
                : 20
                : 193
                Affiliations
                [1 ]GRID grid.411324.1, ISNI 0000 0001 2324 3572, Faculty of Philosophy and Human Sciences, , Lebanese University, ; Fanar, Lebanon
                [2 ]Research and Psychology Departments, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
                [3 ]GRID grid.444434.7, ISNI 0000 0001 2106 3658, Faculty of Medicine and Medical Sciences, , Holy Spirit University of Kaslik (USEK), ; Jounieh, Lebanon
                [4 ]Department of Pediatrics, Notre-Dame des Secours University Hospital, Byblos, Lebanon
                [5 ]GRID grid.411324.1, ISNI 0000 0001 2324 3572, Faculty of Science, , Lebanese University, ; Fanar, Lebanon
                [6 ]INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie- Liban, Beirut, Lebanon
                [7 ]GRID grid.444434.7, ISNI 0000 0001 2106 3658, Faculty of Arts and Sciences, , Holy Spirit University of Kaslik (USEK), ; Jounieh, Lebanon
                Author information
                http://orcid.org/0000-0001-6918-5689
                Article
                1062
                10.1186/s12905-020-01062-x
                7487794
                32891151
                a2bcbbbf-3e91-405d-92d1-2706489c96bd
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 9 October 2019
                : 30 August 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Obstetrics & Gynecology
                sex workers,sex work,child abuse,partner abuse,alcohol drinking,anxiety
                Obstetrics & Gynecology
                sex workers, sex work, child abuse, partner abuse, alcohol drinking, anxiety

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