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Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand
  1. Michele R Decker1,
  2. Heather L McCauley1,
  3. Dusita Phuengsamran2,
  4. Surang Janyam3,
  5. George R Seage III4,
  6. Jay G Silverman1
  1. 1Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
  3. 3SWING, Bangkok, Thailand
  4. 4Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Michele R Decker, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E4142, Baltimore, MD 21205, USA; mdecker{at}


Background/Objectives Commercial sex work is a primary context for heterosexual HIV/AIDS transmission. Violence victimisation is considered to compromise women's ability to protect against HIV and other sexually transmitted infections (STI); little research has investigated violence as it relates to sexual risk and STI among female sex workers (FSW). This study sought to compare sexual risk and STI symptoms among FSW based on recent violence exposure.

Methods Data from 815 FSW in Thailand were used to assess the prevalence of physical or sexual violence within the context of sex work, and associations of victimisation with sexual risk and STI symptoms.

Results Approximately one in seven FSW (14.6%) had experienced violence in the week before the survey. Compared with their unexposed counterparts, FSW exposed to violence demonstrated a greater risk of condom failure (19.6% vs 12.3%, ARR 1.92, 95% CI 1.24 to 2.95) and client condom refusal (85.7% vs 69.0%, ARR 1.24, 95% CI 1.14 to 1.35). In analyses adjusted for sexual risk, violence related to STI symptoms collectively (ARR 1.11, 95% CI 1.02 to 1.21) and genital lesions as an individual STI symptom (ARR 1.78, 95% CI 1.20 to 2.66).

Conclusion Physical and sexual violence against FSW in Thailand appears to be common, with women experiencing such violence demonstrating diminished capacity for STI/HIV harm reduction and greater prevalence of STI symptoms. Efforts to reduce violence towards this vulnerable population must be prioritised, as a means of protecting the health and wellbeing of FSW, and as a key component of STI/HIV prevention and control.

  • Condoms
  • sex work
  • sexual assault
  • sexual risk
  • STD
  • STI symptoms
  • Thailand
  • violence

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  • Funding Support for analyses and manuscript development was provided to MRD via the Harvard University Center for AIDS Research (HU CFAR NIH/NIAID fund P30-AI060354). Other funders: National Institutes of Health. Collection of the original survey data was initiated and funded by the United Nations Population Fund, Thailand.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.