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Learn More. Fehrenbacher developed and conducted the data analysis plan and wrote the original and revised draft of the article. Park provided analytic and data management support. Footer provided content expertise on study measures. Allen provided content expertise on study recruitment and targeted sampling. Park, K. Footer, B. Silberzahn, S. Allen, and S.
Sherman provided content expertise and feedback on the analysis, interpretation, and drafting of the article. Sherman conceptualized the study. All contributors provided final approval for the article.
To determine the rate and correlates of incarceration among street-based female sex workers FSWs. We analyzed baseline data and used zero-inflated negative binomial regression to model the incarceration rate. In the multivariable analysis, incarceration rate was higher for FSWs exposed to police violence, non-Hispanic White FSWs, and women who used injection drugs daily. Risk for ever being incarcerated was higher for FSWs exposed to police or client violence, non-Hispanic Black FSWs, women who used injection or noninjection drugs daily, and those with longer time in sex work.
Incarceration was associated with exposure to violence from both police and clients. Daily drug use and time in sex work appeared to amplify these risks. Although non-Hispanic Black women were at greater risk for ever being incarcerated, non-Hispanic White women were incarcerated more frequently. Public Health Implications. Decriminalization of sex work and drug use should be prioritized to reduce violence against FSWs.
Women are the fastest growing population in the US prison system 1 attributable largely to punitive approaches to regulating nonviolent behaviors perceived as deviations from societal and moral values, such as drug use and sex work. FSWs are exposed to myriad structural, interpersonal, and individual risk factors that contribute to incarceration and violence victimization.
To avoid police, FSWs sometimes rush negotiations with clients or move to unfamiliar places with less police presence to work. Drug use among FSWs can amplify risks of violence and incarceration. For the current study, we used baseline data from a cohort of street-based FSWs in Baltimore City, Maryland, to examine the association between violence and incarceration, adjusting for other drivers of arrest including demographic characteristics, illicit sex work and drug use behaviors, and mental health.
We hypothesized that incarceration among FSWs would be associated with exposure to violence and that higher rates of incarceration would be correlated with more egregious forms of violence e. Participants were recruited through targeted sampling in 14 locations across Baltimore with street-based sex work activity. Individuals who identified as male were not eligible to participate. Participants provided informed consent and completed HIV and STI testing and an interviewer-administered computer-assisted personal interview survey to gather data on demographic characteristics, sex work and drug use behaviors, exposure to violence, and criminal justice system involvement.
Follow-up surveys and testing were conducted at 4 additional visits 3, 6, 9, and 12 months. If ever incarcerated, participants were asked how many times, the longest time incarcerated, and amount of time since last release in months. Ever-incarcerated FSWs were asked the reasons for incarceration among arrest types grouped into 4 mutually exclusive : 1 sex work—related arrests only, 2 drug-related arrests only, 3 both sex work— and drug-related arrests, or 4 neither sex work— nor drug-related arrests. Sex work—related arrests included solicitation or prostitution, indecent exposure, sodomy or perversion, disorderly conduct, loitering, or trespassing.
Drug-related arrests included possession for personal use; possession with intent to distribute, deal, or traffic; and possession of drug paraphernalia. Arrests unrelated to sex work or drugs included assault, battery, burglary, no reason given by officer, or other. The dependent variable for this analysis was the of times incarcerated modeled as a count ranging from 0 to times. Participants were asked about lifetime exposure to physical and sexual violence from intimate partners, clients, pimps or managers, and police, as well as violence at different life stages not perpetrator-specificsuch as child abuse and forced sex as an adult.
These egregious police behaviors were reduced into 3 variables: 1 police physical or sexual violence; 2 police verbal harassment, bullying, or intimidation; and 3 police damage of personal property. Finally, participants were asked if they had ever had sex with police out of fear to avoid arrest when the police officer was not a paying client in the past 3 months. We collected information on demographic characteristics including age, gender, race, ethnicity, education, financial instability no legal part-time or full-time employment, past 3 monthshousing instability homeless, past 3 monthsand food insecurity going to sleep at night hungry because there was not enough food more than once per week, past 3 months.
We also collected information about lifetime and recent past 3 months sex work and drug risk behaviors. Sex work variables included age of entry into sex work; time in sex work; main reasons for sex work initially and currently; ever having a pimp or manager; ever forced, coerced, or misled in sex work; sex with clients in public; condomless vaginal or anal sex; any police clients; and police avoidance tactics, such as rushing negotiations with clients, moving to an unfamiliar place to work, or not carrying condoms.
Drug variables included any recent use past 3 monthsdaily use of injection drugs heroin, speedball, or cocainedaily use of noninjection drugs smoking or snorting heroin, smoking crack cocaine, or sniffing or snorting powder cocaineand any lifetime participation and completion of drug treatment or diversion programs.
Finally, we asked about lifetime mental health diagnoses for major depressive disorder, bipolar disorder, anxiety, phobia, obsessive—compulsive disorder, and posttraumatic stress disorder. We included these demographic, behavioral, and health characteristics as controls to test for alternative explanations for incarceration. We calculated univariate frequencies and proportions Black women for sex in Baltimore Maryland sample characteristics overall and stratified by incarceration history. We used bivariate zero-inflated negative binomial ZINB regression to model the incarceration rate.
The 2 portions of the model are then combined to distinguish the underlying processes that predict membership in the not-at-risk group yes or no versus the incarceration rate count. Individuals who are certain zeros are considered not at risk for incarceration because they do not have the necessary conditions for incarceration e. Individuals who are not certain zeros are considered at risk because they have the necessary conditions for incarceration and could have either a zero or Black women for sex in Baltimore Maryland count for of incarcerations.
We used this ZINB modeling procedure to identify distinct risk profiles for incarceration, such as 1 group with no or limited police contact and another group with frequent police interactions and arrests. ZINB regression was also statistically justified because of excess zeros and overdispersion. We identified excess zeros by plotting the individual fitted probabilities of the observed data under the zero-inflated and noninflated models against each other. As a sensitivity analysis, a ificant Vuong test indicated that ZINB was preferable to standard negative binomial regression because certain zeros could be modeled independently from count values.
Ordinary least squares regression was not appropriate, as the Shapiro—Wilk test demonstrated the nonnormality of the count data.
Because incarceration rates are dependent on time, we included age as the exposure variable constrained to 1. We determined the best-fitting model with the Bayesian information criterion. Exponentiated coefficients for the negative binomial portion of the model are reported as adjusted incidence rate ratios IRRs and for the logit portion as adjusted odds ratios AORs. The most parsimonious model is discussed in the.
Overall sample characteristics across a wide range of study variables are reported in Footer et al. There were no ificant bivariate differences by race, housing instability, food insecurity, or mental health status. There were no ificant differences in starting sex work as a minor; ever having a pimp or manager; being forced, coerced, or misled in sex work; doing sex work for drugs currently; or condomless sex with clients.
However, there were no differences in the proportions who ever completed any treatment or diversion programs. Approximately half of those who had ever been in drug treatment and a third in diversion never completed a program, regardless of the of times in treatment or diversion.
Table 2 displays the distribution of violence exposures and incarceration history. There were no ificant differences in child abuse or intimate partner violence. All except 6 ever-incarcerated FSWs were detained multiple times. FSWs who experienced police physical or sexual violence were incarcerated at 1. Non-Hispanic Black women were incarcerated at 0. FSWs who used injection drugs daily were incarcerated at 1.
In this study, we examined the frequency and correlates of lifetime histories of incarceration among cisgender FSWs in Baltimore and found a very high incarceration rate. Ever-incarcerated FSWs reported a mean of 15 incarcerations, primarily owing to sex work— and drug-related arrests. When comparing ever- versus never-incarcerated FSWs, both had high rates of child abuse, intimate partner violence, housing instability, food insecurity, drug use, and mental health disorders, consistent with studies.
Our key findings demonstrate severe negative impacts of criminalization on FSWs. Furthermore, incarceration rate was strongly correlated with police violence. These findings complement our analysis on police-related correlates of client-perpetrated violence.
For example, a new law coauthored by sex workers and legislators in California, SBprovides sex workers with immunity from arrest when reporting violence and outlaws the widespread practice of using condoms as evidence for sex work—related arrests. We found that ever-incarcerated Black women for sex in Baltimore Maryland in the sample engaged in several police avoidance behaviors, which likely increased their vulnerability to violence and incarceration.
FSWs in criminalized environments often engage in these behaviors in an attempt to stay safe, but these tactics likely exacerbate cycles of violence and incarceration.
Studies conducted in countries in which new client criminalization laws were recently implemented, such as Canada and France, suggest that violence against FSWs increases when clients also feel more pressure to rush negotiations, thwart screening, and evade police. In examining racial differences, we found that White women in the sample were at lower risk of ever being incarcerated i. However, White women were incarcerated more frequently than Black women, contrary to known trends in racial profiling.
The elevated incarceration rate among White women in the sample was likely attributable to disparities in frequency of drug use. Our also demonstrated that FSWs who reported both daily injection and noninjection drug use were at higher risk of ever being incarcerated, and those who reported daily injection drug use were incarcerated more frequently. These findings highlight the need to address frequent drug use within interventions targeting street-based FSWs.
As such, we expect that the arrest trajectories of never- and ever-incarcerated FSWs will likely converge with time. These study findings are subject to limitations. Third, considering the sensitive subject matter and interview de, participants might have underreported stigmatized and criminalized behaviors.
It is also possible that participants might have had difficulty or recall bias disentangling their experiences to fit into specific violence we created. Finally, the data for this analysis were cross-sectional, limiting our ability to draw causal inferences. Despite these limitations, the findings provide a crucial addition to literature on the harmful impacts of criminalization on FSWs and complement our analysis of police-related correlates of client-perpetrated violence, in which we found that frequent abusive police encounters contribute to an environment in which client violence is commonly experienced.
The dual criminalization of sex work and drug use contributes to a revolving door of violence and incarceration, especially among street-based FSWs who use injection drugs daily.
We acknowledge the statistical support provided by Noya Galai, W. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health or other funders. National Center for Biotechnology InformationU.
Am J Public Health. Published online January. Anne E. SilberzahnMA, Sean T. ShermanPhD. Author information Article notes Copyright and information Disclaimer.Black women for sex in Baltimore Maryland
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Exposure to Police and Client Violence Among Incarcerated Female Sex Workers in Baltimore City, Maryland