Prevalence and Health Correlates of Prostitution Among Patients Entering Treatment for Substance Use Disorders

Sierra Pacific Mental Illness Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
Archives of general psychiatry (Impact Factor: 14.48). 04/2008; 65(3):337-44. DOI: 10.1001/archpsyc.65.3.337
Source: PubMed


Studies of prostitution have focused largely on individuals involved in the commercial sex trade, with an emphasis on understanding the public health effect of this behavior. However, a broader understanding of how prostitution affects mental and physical health is needed. In particular, the study of prostitution among individuals in substance use treatment would improve efforts to provide comprehensive treatment.
To document the prevalence of prostitution among women and men entering substance use treatment, and to test the association between prostitution, physical and mental health, and health care utilization while adjusting for reported history of childhood sexual abuse, a known correlate of prostitution and poor health outcomes.
Cross-sectional, secondary data analysis of 1606 women and 3001 men entering substance use treatment in the United States who completed a semistructured intake interview as part of a larger study.
Self-reported physical health (respiratory, circulatory, neurological, and internal organ conditions, bloodborne infections) and mental health (depression, anxiety, psychotic symptoms, and suicidal behavior), and use of emergency department, clinic, hospital, or inpatient mental health services within the past year.
Many participants reported prostitution in their lifetime (50.8% of women and 18.5% of men) and in the past year (41.4% of women and 11.2% of men). Prostitution was associated with increased risk for bloodborne viral infections, sexually transmitted diseases, and mental health symptoms. Prostitution was associated with use of emergency care in women and use of inpatient mental health services for men.
Prostitution was common among a sample of individuals entering substance use treatment in the United States and was associated with higher risk of physical and mental health problems. Increased efforts toward understanding prostitution among patients in substance use treatment are warranted. Screening for prostitution in substance use treatment could allow for more comprehensive care to this population.

Download full-text


Available from: Mandi L Burnette,
    • "The findings from the current study lend support to the suggestion based on studies in other countries that males may tend to engage in more risky commercial sexual transactions, putting them at greater risk for sexually acquired infections including HIV (Burnette et al., 2008; Kuyper et al., 2004). For men entering drug treatment, lower mental wellbeing was independently associated with sex trading in the last year. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study estimates the past year prevalence of and factors associated with sex trading (offering sex for money, drugs or something else) among 1796 men and women presenting to 342 drug misuse treatment agencies in England, and identifies service development and delivery implications. Secondary analysis of baseline data from a prospective cohort was conducted. Short Form-12 measured mental and physical wellbeing, psychiatric diagnoses were self-reported and the circumstances, motivation and readiness tool assessed readiness for/pressure to enter treatment. Logistic regression models determined associations with sex trading separately by sex. Inverse probability population weights were calculated, utilising demographics from the National Drug Treatment Monitoring System and agency specific data collection windows. The estimated prevalence rate of sex trading in the past 12 months was 5.1% (15.0% for women and 2.1% for men). For women, adjusted models identified crack use (aOR 1.83, 95% CI 1.22-2.74, p=0.004), previous treatment (aOR 3.00, 95% CI 1.31-6.86, p=0.010) and greater readiness for treatment (aOR 1.12, 95% CI 1.01-1.24, p=0.027) as independently associated with sex trading. For men, lower mental wellbeing (aOR 0.97, 95% CI 0.94-0.99, p=0.030) was independently associated and marginal effects were identified for syringe sharing (aOR 2.89, 95% CI 0.94-8.86, p=0.064) and unprotected sex (aOR 2.23, 95% CI 0.95-5.26, p=0.065). Sex trading among drug misusers is associated with additional health risks and specific treatment needs. Given the scale of the problem it is important that treatment providers have the competencies to adequately address the issue and provide accessible and appropriate services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 04/2015; 152. DOI:10.1016/j.drugalcdep.2015.04.017 · 3.42 Impact Factor
  • Source
    • "A study among people entering treatment for substance misuse in the US showed just over half (51%) of women and 11% of men had a history of prostitution (Bernette et al, 2008). Factors associated with a history of prostitution were: mental health problems and service use, suicidal behaviour and physical health problems among men, and use of emergency care and hepatitis services among women. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Women involved in street-based prostitution who misuse drugs and/or alcohol are one of the most marginalised and stigmatised groups in our society. However, they are rarely discussed in these terms, and too often they are absent from policy and practice addressing the needs of the most vulnerable. At a time when 'sex work' can be normalised, and even glamourised, the reality is that women involved in prostitution often use drugs and/or alcohol to cope with selling sex (and the violence and abuse in their lives) and often sell sex to support addiction. It is a vicious circle. The focus of this research study has been on policy and practice to address the drug and alcohol treatment needs of women involved in street-based prostitution. Tackling substance misuse is fundamental to reducing harm and supporting women to exit prostitution. So, what kinds of interventions work best? How widely are they available? And, critically, what do the women themselves say about their expectations and experiences of services. A report published by DrugScope and AVA Funded by The Pilgrim Trust
  • Source
    • "Childhood sexual and physical abuse histories are common among male and female sex workers [32–35]. Moreover, throughout the world, including Australia, South Africa, Thailand, Turkey, the United States, and Zambia, sex workers report being raped and physically assaulted during the course of their work. "
    [Show abstract] [Hide abstract]
    ABSTRACT: People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.
    01/2013; 2013(47):690386. DOI:10.1155/2013/690386
Show more