Katherine Footer Coauthors Ju Nyeong Park Sean T Allen Michele R Decker Brad E Silberzahn Steve Huettner Noya Galai Susan G Sherman July 2018 International AIDS ID: 816381
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Slide1
Police related correlates of client violence among female sex workers in Baltimore City, Maryland, USA
Katherine
Footer
Co-authors:
Ju
Nyeong
Park, Sean T. Allen, Michele R. Decker Brad E.
Silberzahn
, Steve
Huettner
,
Noya
Galai
, Susan G. Sherman
July
2018
International AIDS
conference
Slide2Background
Between 45%-75% of female sex workers experience violence in the workplace (Deering, 2014)Includes physical, verbal and sexual abuseViolence linked to long-term risk of: Substance use Depression Post-traumatic stress disorder, Suicide Acquisition of STI/HIV
Slide3P
olice should have custodial role in protecting womenHowever, FSW potentially vulnerable to: Human rights abuse by policeAggressive enforcement approachesQuantitative evidence base limitedRole of police
Slide4Baltimore
city
Population
: 600,000
66% black
51 murders per
100,000 in 2016 (Amsterdam had 2)
Highest heroin addiction rate in the country
3rd
highest HIV rate of any major US cityStrained police community relations
Slide5Baltimore City
Targeted SamplingCohort n=250 FSW
Slide6Eligibility
criteria were: Age ≥ 15 years; Sold or traded oral, vaginal or anal sex Picked up clients in the past 3 monthsResults based on CAPI questionnaire from baselineClient Violence – Revised Conflict Tactic Scale(Straus, 1996)
Slide7Police measures
Slide8Types of police interactions
Asking FSW to move alongRoutine stopOffering assistanceConfiscating drugs or drug paraphernalia and confiscating condomsConducting a search of a person or propertyArrest
Patrol practices
Slide9Types of police interactions
Asking FSW to move alongRoutine stopOffering assistanceConfiscating drugs or drug paraphernalia and confiscating condomsConducting a search of a person or propertyArrest
Patrol practices
Abusive practices
Verbal/emotional harassment
Sexual harassment/assault
Damage of property
Physical violence
Pressuring the woman into having sex
Acceptance of money for no arrest
Police as clients
Slide10Results
250 individualsMean age 36 (range 18-61)52% did not complete high school66% non-Hispanic white62 % homeless in last 3 months66% engaged in sex-work daily70% use heroin dailyExperiences of violence:22% had experienced violence in past 3 months:19% physical violence16% sexual violence12% both sexual and physical violence
Slide11Frequency of patrol practices
Slide12Frequency of abusive practices
Slide13Link to client violence
Slide14Regression results
Bivariate logistic regressionMultivariate
OR (95% CI)
p
Adjusted OR
P
Age
0.96 (0.92, 0.99)
0.013
0.96 (0.92, 1.00)
0.068
Non-white (
vs. White)
0.35 (0.13, 0.92)
0.034
0.44 (0.19, 1.01)
0.053
Daily sex work
2.10 (1.34, 3.29)
0.001
1.99 (0.94, 4.20)
0.072
Daily heroin use
2.58 (1.37, 4.84)
0.003
1.26 (0.65, 2.44)
0.495
Patrol/enforcement
practices
Arrested
3.29 (1.06, 10.21)
0.039
Moved
along
3.67 (1.35, 9.97)
0.011
Routine stop
9.93 (1.88, 52.47)
0.007
Search
of
person/property
1.91 (1.01-3.61)
0.048
Drug confiscation
1.62 (0.90, 2.93)
0.111
Condoms confiscated
2.20 (0.37, 13.13)
0.388
Offered assistance
1.45 (0.86, 2.43)
0.161
Number of
patrol
practices
1.42 (1.18, 1.70)
<0.001
1.27 (0.96, 1.69)
0.089
Abusive practices, ever
Verbal/emotional
harassment
1.95 (1.32, 2.88)
0.001
Sexual harassment/assault
2.48 (1.54, 3.99)
<0.001
Damaged property
3.06 (2.52, 3.71)
<0.001
Physical violence
2.01 (1.03, 3.94)
0.042
Sex
in exchange for no arrest
3.62 (1.69, 7.77)
0.001
Money/goods
to avoid trouble
1.16 (0.41, 3.24)
0.782
Had police as clients
2.74 (1.53, 4.90)
0.001
Number of abusive practices
1.46 (1.22, 1.75)
<0.001
1.29 (1.09, 1.54)
0.005
Slide15Regression results
Bivariate logistic regression
Multivariate
OR (95% CI)
p
Adjusted OR
P
Age
0.96 (0.92, 0.99)
0.013
0.96 (0.92, 1.00)
0.068
Non-white (
vs. White)
0.35 (0.13, 0.92)
0.034
0.44 (0.19, 1.01)
0.053
Daily sex work
2.10 (1.34, 3.29)
0.001
1.99 (0.94, 4.20)
0.072
Daily heroin use
2.58 (1.37, 4.84)
0.003
1.26 (0.65, 2.44)
0.495
Patrol/enforcement
practices
Arrested
3.29 (1.06, 10.21)
0.039
Moved
along
3.67 (1.35, 9.97)
0.011
Routine stop
9.93 (1.88, 52.47)
0.007
Search
of
person/property
1.91 (1.01-3.61)
0.048
Drug confiscation
1.62 (0.90, 2.93)
0.111
Condoms confiscated
2.20 (0.37, 13.13)
0.388
Offered assistance
1.45 (0.86, 2.43)
0.161
Number of
patrol
practices
1.42 (1.18, 1.70)
<0.001
1.27 (0.96, 1.69)
0.089
Abusive practices, ever
Verbal/emotional
harassment
1.95 (1.32, 2.88)
0.001
Sexual harassment/assault
2.48 (1.54, 3.99)
<0.001
Damaged property
3.06 (2.52, 3.71)
<0.001
Physical violence
2.01 (1.03, 3.94)
0.042
Sex
in exchange for no arrest
3.62 (1.69, 7.77)
0.001
Money/goods
to avoid trouble
1.16 (0.41, 3.24)
0.782
Had police as clients
2.74 (1.53, 4.90)
0.001
Number of abusive practices
1.46 (1.22, 1.75)
<0.001
1.29 (1.09, 1.54)
0.005
Slide16Regression results
Bivariate logistic regressionMultivariate
OR (95% CI)
p
Adjusted OR
P
Age
0.96 (0.92, 0.99)
0.013
0.96 (0.92, 1.00)
0.068
Non-white (
vs. White)
0.35 (0.13, 0.92)
0.034
0.44 (0.19, 1.01)
0.053
Daily sex work
2.10 (1.34, 3.29)
0.001
1.99 (0.94, 4.20)
0.072
Daily heroin use
2.58 (1.37, 4.84)
0.003
1.26 (0.65, 2.44)
0.495
Patrol/enforcement
practices
Arrested
3.29 (1.06, 10.21)
0.039
Moved
along
3.67 (1.35, 9.97)
0.011
Routine stop
9.93 (1.88, 52.47)
0.007
Search
of
person/property
1.91 (1.01-3.61)
0.048
Drug confiscation
1.62 (0.90, 2.93)
0.111
Condoms confiscated
2.20 (0.37, 13.13)
0.388
Offered assistance
1.45 (0.86, 2.43)
0.161
Number of
patrol
practices
1.42 (1.18, 1.70)
<0.001
1.27 (0.96, 1.69)
0.089
Abusive practices, ever
Verbal/emotional
harassment
1.95 (1.32, 2.88)
0.001
Sexual harassment/assault
2.48 (1.54, 3.99)
<0.001
Damaged property
3.06 (2.52, 3.71)
<0.001
Physical violence
2.01 (1.03, 3.94)
0.042
Sex
in exchange for no arrest
3.62 (1.69, 7.77)
0.001
Money/goods
to avoid trouble
1.16 (0.41, 3.24)
0.782
Had police as clients
2.74 (1.53, 4.90)
0.001
Number of abusive practices
1.46 (1.22, 1.75)
<0.001
1.29 (1.09, 1.54)
0.005
Slide17Key role of drugs
Slide18Conclusions
FSWs in this setting are frequently exposed to both routine and abusive police interactions.Police behaviours appear to facilitate a risk environment in which client violence occursFSW who inject drugs have both more police encounters and experience greater levels of client violence
Slide19Application
of findings
Provides evidence base to help discussions with police and policy makers
Can help develop police practices that prioritize FSW safety
Motivation for FSW-focused support
Slide20Acknowledgements
Sapphire field staffSapphire participantsFunding: This project is supported by the National Institute of Health through a R01 R01DA038499 and a supplemental NIDA award (R01DA038499-02S1)