Research paperExperiences of structural vulnerability among exotic dancers in Baltimore, Maryland: Co-occurring social and economic antecedents of HIV/STI risk
Section snippets
Background
Women who grow up in communities with scarce social and economic resources are at a disadvantage for future upward mobility (i.e., moving from lower to higher socioeconomic status) and often remain “stuck” within a cycle of poverty (DeNavas-Walt and Proctor, 2014, Isaacs and Sawhill, 2008). Compared to men, women in poverty have fewer opportunities for higher paying occupations and spend more time and money caring for children or other family members (Cawthorne, 2008). Experiences of trauma and
Data collection
We conducted semi-structured in-depth interviews with female exotic dancers working in Baltimore City and County EDCs during July 2014 and May 2015, as part of the STILETTOS (STudying the Influence of Location and Environment – Talking Through Opportunities for Safety) Study, which characterized the HIV risk environment of exotic dance clubs. For the first phase of the STILETTOS Study, conducted in summer 2013, EDC-level risk (i.e., high vs. low HIV risk) was classified using data collected via
Results
The thematic analysis uncovered both early and recent experiences of structural vulnerability shared during the first and second set of interviews, providing insight into how dancers’ social and economic circumstances evolved over time, how they managed these experiences, and how different trajectories of structural vulnerability shaped HIV/STI risk.
Discussion
Participants revealed a convergence of scarce social and economic resources, early independence, and limited opportunities that not only funneled the women into exotic dancing, but. compelled them to stay. The cost of accumulated vulnerability – perpetual scarcity of resources and an inability to plan beyond daily needs – further constrained their reach toward stability. The most highly vulnerable women were particularly disposed to work-related sexual risk behavior such as engaging in
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
The STILETTOS Study was supported by the National Institute of Drug Abuse (NIDA R21 DA033855) and the Johns Hopkins Center for AIDS Research (JHU CFAR; NIAID 1P30AI094189). M.L. Brantley was supported by the National Institute of Allergy and Infectious Disease (T32 AI050056-12) and the National Institute on Drug Abuse (F31 DA038540). S. Lim was supported by the National Institute of Allergy and Infectious Disease (T32 AI050056-12).
Acknowledgements
We are grateful for the support of the Baltimore City Health Department Syringe Exchange Program staff, recruitment and data collection by the STILETTOS study team, and for the women who participated.
References (46)
- et al.
Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans
The Lancet
(2008) - et al.
Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis
Lancet Infectious Diseases
(2012) - et al.
Transactional sex among women in Soweto, South Africa: Prevalence, risk factors and association with HIV infection
Social Science & Medicine
(2004) - et al.
Structural approaches to HIV prevention
The Lancet
(2008) - et al.
Closing the gap in a generation: Health equity through action on the social determinants of health
The Lancet
(2008) Social determinants of health inequalities
The Lancet
(2005)- et al.
More than a dance: The production of sexual health risk in the exotic dance clubs in Baltimore, USA
Social Science & Medicine
(2011) - et al.
Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD
Drug and Alcohol Dependence
(2011) Version 1.0.x
(2015)- et al.
Housing status and HIV risk behaviors: Implications for prevention and policy
AIDS and Behavior
(2005)
Addressing social drivers of HIV/AIDS for the long-term response: Conceptual and methodological considerations
Global Public Health
Modified social ecological model: A tool to guide the assessment of the risks and risk contexts of HIV epidemics
BMC Public Health
Structural interventions for HIV prevention among women who use drugs: A global perspective
Journal of Acquired Immune Deficiency Syndromes
The straight facts on women in poverty
Poverty interrupted: Applying behavioral science to the context of chronic scarcity
Estimating the size and structure of the underground commercial sex economy in eight major US cities
U.S. census bureau, current population reports, income and poverty in the United States: 2013
Advancing a federal fair chance hiring agenda
Social stability and health: Exploring multidimensional social disadvantage
Journal of Urban Health
Social stability and HIV risk behavior: Evaluating the role of accumulated vulnerability
AIDS and Behavior
Moving forward on women’s gender-related HIV vulnerability: The good news, the bad news and what to do about it
Global Public Health
Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions
American Journal of Public Health
The many faces of sex work
Sexually Transmitted Infections
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