Associations Between Methamphetamine Use and Sex Work Involvement Among Female Bar/Spa Workers 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.