Sex Trading and Intimate Partner Violence Among a Sample of Substance-Involved Women in New York City

Background and Purpose: Recent evidence points to a growing HIV epidemic among women engaged in sex trading, facilitated by client and police violence, drug use, and restricted economic and social opportunities. Yet, little is known about the prevalence of intimate partner violence (IPV), which has demonstrated associations to HIV, experienced by women who engage in sex trading, compared to other, similarly vulnerable, women. Recent evidence suggests that women who engage in sex trading may be doubly burdened by violence. Guided by the ecological systems theory and intersectionality, this paper examines the relationship between IPV and sex trading among a sample of women in relationships. 

Methods: 346 substance-involved, HIV-negative couples were enrolled into an HIV risk reduction study in New York City. Data reported here are from the baseline assessment. Participants were asked a range of questions pertaining to their socio-demographics, social support, history of childhood sexual abuse, drug and alcohol use, partner drug and sexual risk behaviors, among others. Using a modified version of the Revised Conflict Tactics Scale (CTS-2), participants also responded to a series of questions about their exposure to IPV by their main study partner (lifetime and recent). Using descriptive statistics, this paper examines lifetime and recent prevalence of IPV among the female participants, by recent engagement in sex trading. Then, using multivariate logistic regression analyses, this paper examines the association between sex trading and IPV, and individual, interpersonal, and socio-structural factors that exacerbate or attenuate risk of IPV.

Results: Consistent with the main hypothesis, findings from this paper showed that women who reported sex trading had a higher prevalence of lifetime and recent IPV. Analyses indicated that 40.7% and 35.82% of the women in the sample reported any lifetime or recent IPV by their main study partner, respectively, with significant differences by sex trading status (p < .01). The most common forms of IPV reported were physical and sexual violence. Multivariate analyses showed that women with a recent history of sex trading had a three-fold-odds (p < .01) of reporting exposure to recent severe physical or sexual intimate partner violence, compared to similarly vulnerable women. Findings from the multivariate analyses also highlighted a range of individual, interpersonal, and socio-structural risks associated with IPV: depression, marital status, child sexual abuse, and income maintained their associations with IPV (p < .05), when sex trading was in the model. Further, Interaction analyses indicated that women who experienced both childhood trauma (sexual abuse) and recent sex trading had a seven-fold-odds (p < .01) in reporting severephysical or sexual IPV than those who did not.

Conclusions and Implications: Findings from this paper suggest an urgent need for more research on IPV and its relationship to sex trading and HIV outcomes. Findings also point to a number of practical implications including expansion of screening tools to assess for IPV as well as non-intimate partner violence among women who trade sex, as well as the importance of addressing multiple traumas, mental health, and partner risk among this HIV key-affected population.