Tag Archives: economic vulnerability

Gender-based violence, sexual assault, and HIV

10 Mar

National Women and Girls HIV/AIDS Awareness Day Image from UNDP

National Women and Girls HIV/AIDS Awareness Day
Image from UNDP

Today (March 10) is National Women and Girls HIV/AIDS Awareness Day. This day is especially important to me, as a racial minority who works with HIV prevention and research. This day capitalizes on the growing need to focus attention toward newly emerging populations that are often overlooked in HIV discourse and rhetoric, particularly racial/ethnic minorities, and especially women of color.

Currently, the highest rise in HIV incidence rates are being observed among heterosexual Black women, comprising a three-way shift in race, gender, and sexual orientation from the group initially observed with having the highest HIV incidence rates in the early 1980’s: White homosexual men. Overall, Black and Latina women are disproportionately affected by HIV when compared to women of other races, highlighting a principal disparity in women’s health.

HIV is often viewed by the general public as its own isolated issue, directly linked to “promiscuity” or needle-use. In addition to contributing to unwarranted stigma surround HIV, these labels dismiss and discount other important factors that affect HIV transmission. Gender-based domestic violence and economic vulnerability (lack of financial means) are two factors that are often neglected in HIV discussions, yet they are integral players in the transmission of HIV, particularly among women of color.

Recently, in an effort to raise awareness around these issues, I published a composition of tweets linking gender-based domestic violence and economic vulnerability to rape/sexual assault and the predisposition to HIV.

Violence limits a woman’s ability to demand condom use & establishes and unfair power dynamic

On the flip side, even if a woman is not physically coerced into unprotected sex, she may forgo condom use with her partner or neglect to mention it out of fear that her partner will become violent with her.

Economic vulnerability also predisposes women, especially women of color, to HIV transmission. Financial dependence on a partner creates an imbalance in power dynamics that limits a woman’s ability to make decisions regarding condom use. A woman who is financially-dependent on her partner may feel pressured to meet the needs of her partner or “repay” her partner with sex, oftentimes unprotected, if it suits her partner’s needs.

 
There are many factors that predispose someone to HIV. Gender, violence, and one’s financial situation are three key players in this equation that we should not discount. Today, on National Women and Girls HIV/AIDS Awareness Day, I hope to raise awareness of these issues among the general public. As a healthcare worker and aspiring physician, I recognize that the application of medicine is not limited to diagnosis and treatment. I believe that it is important to have an understanding of the socio-economic factors that predispose populations to poor health. These factors, the “social determinants of health“, should be acknowledged and addressed first, as ultimately, prevention of the onset of disease is the most effective way to eradicate it.

–Rachel Safeek

Email me at rachel.safeek@duke.edu
Tweet at me: @RachSafeek

Advertisements

HIV Prevention Among Female Sex Workers (Honors Thesis in Brasil)

15 Sep


In response to the number of requests I’ve gotten from current Duke students/study abroad students who are interested in reading about my work in Brazil with female sex workers, I’ve dedicated this post to focusing on the details of my research project.  If you are interested in my motivations for working with HIV prevention and sex workers, you can read more about my experiences in the field in one of my previous postings. And for those who are interested in the socio-cultural backdrop of the project, you can read here about why I selected Salvador (Bahia), Brazil as my site for undergraduate research and why the HIV/AIDS prevention model is so unique in Brazil.

Talking to one of the coordinators about disease prevention among Female Sex Workers

Talking to one of the coordinators about disease prevention among Female Sex Workers

I want to address the issue of culturally-competent community engagement briefly. For anyone who is working with marginalized groups, it is ALWAYS important to bear in mind that you should approach your research in the most non-intrusive way possible. You never want to come off as exploiting the persons with whom you are working for the benefit of your research and publications. Because Female Sex Workers (FSWs) are a marginalized and stigmatized group, many of the women with whom I worked were initially unwilling to participate in my project.  I was American, “over-privileged”, and it didn’t help that I had a rudimentary and “textbook” knowledge of Portuguese at the time of my first visit to the organization where I worked, O Projeto Força Feminina–The Female Force (Empowerment) Project (September 2011).

To overcome any cultural/linguistic barriers and earn the trust of the women at O Projeto Força Feminina, I dedicated the first few weeks of my project to establishing a relationship with the women. I taught basic English classes and engaged the women in belly dance and makeup classes (eyebrow threading), which they loved! It was truly a beautiful exchange of cross-cultural interests: I shared aspects of my Middle-Eastern culture. In exchange, the FSWs taught me some forms of Brazilian dance and helped me with my Portuguese. Ultimately, we established a firm sense of camaraderie that allowed them to trust me and have me interview them about their work and sexual behaviors. I also demonstrated my commitment to working with the group by returning to my project site again last summer (May-August 2012). While I will not be able to return to Salvador until next summer, I still maintain contact with many of the women at the organization.

Below is my finalized research abstract with some pictures from my time at O Projeto Força Feminina. Please email me at rachel.safeek@gmail.com with any questions.

“Who Cares about Us–We are Just Women of the Street”–Combating HIV Transmission and Gender Disempowerment among Female Sex Workers in Salvador, Brazil 
Authors: Rachel Safeek, Sherman James, Ph.D
Duke University 
ABSTRACT

BACKGROUND: While Brazil is lauded for its exemplary HIV prevention model, the majority of HIV prevention programs promote safe sex through education, ignoring the realities of gender disempowerement and inequality, which increase the susceptibility of female sex workers (FSWs) to instances of violence and disease. This paper analyzes factors associated with gender disempowerment and lack of condom use among FSWs in Salvador (Bahia), Brazil who engage in heterosexual interactions with male clients. An understanding of the sources of gender disempowerment is key to developing culturally-appropriate and effective policy interventions.

METHODS: Over a seven-month period, formal interviews were conducted with sixteen female sex workers and focus group discussions were conducted with 35 female sex workers at Projeto Força Feminina. The latter is an organization located in Pelourinho, the Historic District of Salvador, that works with FSWs to promote safe sexual practices and combat gender-based violence. Three life histories were also conducted with three of the sex workers. Additionally, Dr. Edivania Landim, the former head of the HIV/AIDS program of Bahia, was also interviewed.

RESULTS: Interviews and focus groups revealed that economic vulnerability (financial instability), drug use, and instances of gender-based violence (structural violence) and rape/sexual assault from police and clients disempower FSWs, increasing their susceptibility to the transmission of disease. In each case of disempowerment, the factors contributing to women’s decision to engage in intercourse without condoms or other types of risky or unsafe sex were influenced by their inability to defend themselves as women and as FSWs, a social group of women isolated on the bottom rung of Brazil’s social and economic ladder. The respondents were clear that their gender was a definite factor in the many difficulties they faced.

DISCUSSION: Increased emphasis should be placed upon female-specific forms of protection, e.g. female condoms, microbicides. Unionization among sex workers is necessary to gain political acknowledgement of sex worker rights through legalization of the profession.

KEY TERMS: HIV/AIDS, Female Sex Workers (Profissionais Do Sexo), Race, Economic Vulnerability, Disempowerment, Gender-Based Violence, Structural Violence, Health Disparities, Human Rights, Salvador, Brazil

–Rachel Safeek

"Empower women in the situation of prostition"

“Work in solidarity with women in the situation of prostition”

Colorful sitting room

Working on art projects

Working on art projects

Mission Statment

Mission Statment

In focus group discussion

In focus group discussion