Although most of my work is on technology, I have a deep concern for gender equality in the Caucasus.

In my Google Scholar alerts today, there was a new article entitled: Gender Based Violence as a Risk Factor for HIV-Associated Risk Behaviors Among Female Sex Workers in Armenia

Authors are: Delia L. Lang, Laura F. Salazar, Ralph J. DiClemente, Karine Markosyan.

A friend of mine helped work on this project, so I was already familiar with some of it, but I wanted to share some of the findings in a way more accessible to those not statistically-inclined.

Here’s the official abstract:

This cross-sectional study identified the prevalence of gender based violence (GBV) and examined its association with sexual risk behavior among female sex workers (FSWs). Among 120 participants between ages 20 and 52, a total of 56.7 % reported lifetime GBV. Multivariate analyses revealed that GBV was significantly associated with inconsistent condom use, unprotected sex, condom misuse, fear of client reaction to requests of condom use, self-reported history of STIs, and earlier age of initiation of sex work. GBV must be considered an urgent public health priority among FSWs in Armenia. Interventions addressing FSWs, in addition to targeting skill-based, sexual risk reduction must also introduce a discourse among FSWs, sexual partners, clients and community members about the role of GBV in HIV-associated risk behaviors and infection. Structural level initiatives must address economic opportunities for women, health-sector policies and responses to FSWs’ health needs, law enforcement training and societal norms toward women.

Translation:

* gender-based violence or GBV, is the more politically correct term or perhaps more all-inclusive way to say “domestic violence” — it isn’t that it takes place in the home, but it involves gender power dynamics.

* cross-sectional means that a representative sample was taken from the population (in this case Armenian female sex workers). 120 Armenian female sex workers took their survey.

* there are 6200-8100 female sex workers in Armenia (4600-6100 of those are based in Yerevan).

* over half of the sex workers had experienced “lifetime” gender based violence – so perhaps in their childhood or young womanhood.

* multivariate analysis means that they didn’t just do a correlation between X and Y (like more TV watching makes you fat… there are other factors, right? Diet, exercise… a multivariate analysis considers the other factors and then tests to see if the factor you’re interested in – in this case gender-based violence, actually matters toward the outcome.) And in this study those sex workers that had experienced gender-based violence (controlling for other possible contributing factors) were more likely to:
– engage in inconsistent condom use
– have unprotected sex
– engage in condom misuse
– have a fear of client reaction to requests of condom use
– self-report a history of STIs
– start sex work at a younger age

A bit of a critique:

* it isn’t easy to get sex workers in Armenia to take these kind of surveys. In the paper they talk about how they recruited the participants. With this sort of sample, it is incredibly difficult to get people, so the results must be taken with a grain of salt. They talked about some of how they recruited the participants but they didn’t mention if they specifically advertised with a gender-based violence frame.

* the only statistically significant demographic difference between female sex workers that had experienced gender-based violence and not was education level. Yet they didn’t ask about parental (growing up) social/economic status or if they were in a rural or an urban family. I would venture a guess that this would matter as well.

* educational attainment was the only variable controlled for in the “multivariate” analysis. That’s not very multi- to me.

* The differences between gender-based violence experienced sex workers and those without a history of gender-based violence in terms of condom misuse and STI experience wasn’t very strongly statistically significant, especially considering how small the sample was. And again, I think that there are probably some other demographic traits at play that might explain more of this.

So all-in-all, while I applaud the study, I think that the biggest takeaway is that a lot (50%+) of female sex workers in Armenia have experienced lifetime (again, that means childhood) gender-based violence. But it would be important to sample from the broader Yerevan and national female population to see if sex workers differ from the average woman. I would guess yes, sex workers are more likely to have experienced childhood gender-based violence, but who knows?
As far as the influence that gender-based violence has on sex worker behaviors – like using condoms and the like… well… I don’t really buy it.

For example, let’s say that a young girl was beaten by her father and brothers for her entire life… this certainly has a psychological effect on her. And then later in life she goes into sex work. And then she’s more likely to engage in unprotected sex. This study claims that it is the gender-based violence factor that matters. I’d argue that it might be INDIRECTLY effecting outcomes like unprotected sex, but that the psychological effect of the abuse (or self-esteem or something…) is the more direct factor.

If you’re interested in reading the full study and don’t have access to it, please let me know!