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
    • "Sexual exploitation and sex trafficking result in many physical injuries such as fractures, gastrointestinal disorders, infections, dental problems, malnutrition, pregnancy, and many gynecological complications and disorders (de Chesnay, 2013, p. 132). This population also struggles with elevated rates of physical and sexual assaults (Burnette et al., 2008;Clawson et al., 2009) as well as clinical disorders and diseases requiring treatment (Hossain et al., 2010;Medrano, Hatch, Zule, & Desmond, 2003). Although extant data do not focus specifically on health costs of sexually exploited women, health cost estimates are available for women with IPV who have also experienced similarly elevated rates of trauma and abuse. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In the last 15 years, terms such as prostitution, sex trafficking, sexual exploitation, modern-day slavery, and sex work have elicited much confusion and debate as to their definitions. Consequently several challenges have emerged for both law enforcement in the prosecution of criminals and practitioners in service provision. This article reviews the state of the literature with regard to domestic, sexual exploitation among women and girls in the United States and seeks to (1) provide definitions and describe the complexity of all terms relating to domestic sexual exploitation of women and girls in the United States, (2) explore available national prevalence data according to the definitions provided, and (3) review the evidence of mental health, social, and structural risk factors at the micro-, mezzo-, and macrolevels.
    No preview · Article · Apr 2015 · Journal of Human Behavior in the Social Environment
    • "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.
    No preview · Article · Apr 2015 · Drug and alcohol dependence
    • "The prevalent associations were a result of the choice afforded to them because of low income and lack of other survival options. In addition to these individual studies, many descriptive studies of sexually exploited women and girls have showed high rates of substance abuse and addiction occurring before or as a result of sexual exploitation (Burnette et al., 2008;ElBassel, Witte, Wada, Gilbert, & Wallace, 2001;Tyler, Gervais, & Davidson, 2013;Valera et al., 2001), yet theoretical underpinnings of addiction theory with particular regard to this population remain vastly underdeveloped. Differences in the addiction process and its influence on the pathway to sexual exploitation or sex work are documented descriptively but not explored theoretically; therefore, it is important to consider how they may relate to the process. "

    No preview · Article · Jan 2015 · Journal of sociology and social welfare
Show more