Associations Between Methamphetamine Use and Sex Work Involvement Among Female Bar/Spa Workers in the Philippines

Purpose: This study describes sex work activity among female bar/spa workers in Metro Manila and examines the association between alcohol/drug use, particularly methamphetamine use, and sex work among this population. Few studies of entertainment workers have differentiated between entertainers who are sex workers and those who are not, an important distinction in terms of risk for HIV/STI and violence. Understanding the prevalence of sex work and its correlates among female bar/spa workers is important to guide broader health considerations for this group, given the heightened physical and mental health issues faced by sex workers globally. Findings may also offer a more nuanced way of understanding who is actively involved in sex work and how to identify them to inform the development of interventions and policies that address commercial sex-related health risks in the Philippines.

Methods: This study used a cross-sectional study design with 498 female bar/spa workers recruited from 54 night clubs/bars and spas/saunas in Quezon City, Metro Manila, the Philippines. Venues were randomly sampled, representing 70% of 78 venues listed in the two largest Quezon City clinics. The interviewer-administered surveys were conducted from April 2009 - January 2010 for baseline data collection as part of a larger HIV prevention intervention study. Data collected included demographics, substance use, physical and sexual abuse history, and sex work. Substance use variables included drug and alcohol use, drinking with bar/spa patrons, and intoxication during sex with patrons. Logistic regression was conducted to assess the associations between substance use and sex work.

Results: Participants had median age (23 years) and duration as a bar/spa worker (17 months). Sex work was reported by 35%; alcohol use during sex (53% of drinkers); methamphetamine use (9%) and other drugs (12%). Substance use factors that were independently associated with sex work were lifetime methamphetamine use (AOR=2.88, 95% CI=1.33-6.23), drinking with venue patrons (AOR=1.93, 95%CI=1.10-3.42), and being intoxicated while having sex with venue patrons (AOR=2.02, 95%CI=1.18-3.45). Daily alcohol use was inversely associated with sex work involvement (AOR=0.23, 95%CI=0.10-0.54). Sex work was associated with a history of sexual abuse (AOR=3.47; 95% CI=2.06-5.86), younger age (AOR=0.94 per year, 95%CI=0.90-0.98) and having a high school degree or less (AOR=0.50, 95%CI=0.30-0.82).

Implications for Practice/Policy: Sex work involvement is common but not ubiquitous among Metro Manila bar/spa workers. Interventions should target bar/spa workers who use methamphetamines, those who drink with patrons, and those intoxicated during sex with patrons to reduce harms associated with sex work such as HIV/STI and client-perpetrated violence.