‘Nobody Gives a Damn If I Live or Die’: Violence, Drugs, and Street-Level Prostitution in Inner-City Hartford, Connecticut

Hispanic Health Council, Hartford, CT, USA.
Medical Anthropology (Impact Factor: 1.88). 07/2003; 22(3):233-59. DOI: 10.1080/01459740306770
Source: PubMed


Drawing on the tenets of critical medical anthropology, this article illustrates the relation between violence, drug use, prostitution, and HIV risk in a group of 35 impoverished women living in inner-city Hartford, Connecticut. The study presented here provides an illustration of the role prostitution plays in the SAVA (Substance Abuse, Violence, and AIDS) syndemic as conceptualized by Singer (1996). By focusing on the life experiences of women engaged in street-level prostitution, this article attempts to fill the gaps in research that deals simultaneously with these mutually reinforcing epidemics. It shows that street-walkers' continuous exposure to violence, both as victims and as witnesses, often leaves them suffering from major emotional trauma. In the absence of adequate support services, women who have been victimized may turn to drug use in an attempt to deal with the harsh realities of their daily lives. In turn, the need for drugs, coupled with a lack of educational and employment opportunities, may lead women into prostitution. Life on the street increases women's risk for physical, emotional, and sexual abuse as well as their risk for HIV/AIDS. Exposure to traumatic experiences deepens the dependence on drugs, completing a vicious cycle of violence, substance abuse, and AIDS risk.

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    • "Qualitative interviews conducted in Tijuana enabled us to further contextualize the quantitative findings. Based on the Syndemic Model for Hispanics [26] and syndemic theory [19] [27], which posit that substance abuse, violence, and mental health issues such as depression interact to account for health disparities among marginalized groups, the current study hypothesized that among Mexican FSW-IDUs, there would be high rates of childhood abuse history and of client-perpetrated abuse and that history of abuse and substance use would be related to current depression symptoms. "
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    ABSTRACT: This mixed methods study examined the prevalence and characteristics of physical and sexual abuse and depression symptoms among 624 injection drug-using female sex workers (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico; a subset of 47 from Tijuana also underwent qualitative interviews. Linear regressions identified correlates of current depression symptoms. In the interviews, FSW-IDUs identified drug use as a method of coping with the trauma they experienced from abuse that occurred before and after age 18 and during the course of sex work. In a multivariate linear regression model, two factors-ever experiencing forced sex and forced sex in the context of sex work-were significantly associated with higher levels of depression symptoms. Our findings suggest the need for integrated mental health and drug abuse services for FSW-IDUs addressing history of trauma as well as for further research on violence revictimization in the context of sex work in Mexico.
    Full-text · Article · May 2013 · Journal of Environmental and Public Health
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    • "Recent studies conducted in British Columbia’s lower mainland have demonstrated that impoverished Aboriginal women involved in sex work and concomitant illicit drug use continue to be exposed to alarming levels of drug related harm, infectious disease and violent predation [22-24]. Sadly, these findings are consistent with other settings internationally where women exchanging sex for basic needs including drug dependence, are exposed to alarming levels of violence and infectious disease [25]. These data indicate the critical need for scaling up services aimed at reducing drug or sex related harm for young Aboriginal women, particularly in Northern and remote communities. "
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    ABSTRACT: Background Factors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities. Methods The Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion. Results In total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing. Conclusions This study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.
    Full-text · Article · Aug 2012 · BMC Public Health
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    • "Sex motivated by economic exchange is associated with public health problems, and presents many conceptual challenges for researchers. Women and men in prostitution are vulnerable to HIV and other sexually transmitted infections, as well as acts of violence from clients, pimps, police and other parties [1-5]. A similar set of vulnerabilities pertain amongst women who engage in transactional sex [6,7]. "
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    Full-text · Article · May 2012 · BMC Public Health
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