Research paper
Experiences of structural vulnerability among exotic dancers in Baltimore, Maryland: Co-occurring social and economic antecedents of HIV/STI risk

https://doi.org/10.1016/j.drugpo.2017.09.002Get rights and content

Abstract

Background

Women who grow up in economic scarcity often face limited opportunities for upward mobility, as a result of challenges securing stable housing, quality education, and steady employment. Chronic instability may limit the capacity of women to protect themselves against HIV/STI-related harm when engaging in sexual activity or drug use. Characterizing the structural contexts that facilitate HIV/STI risk among women are critical to effective design and implementation of drug and sexual harm reduction interventions.

Methods

Semi-structured in-depth interviews were completed with 25 female exotic dancers working in Baltimore City and County exotic dance clubs July 2014–May 2015. Using thematic analysis, interviews were examined to understand the nature of structural vulnerability experienced by dancers during their early lives through the initial months of exotic dancing, including an examination of the roles of drug use and social relationships in engagement of sexual risk behavior.

Results

Dancers depicted early experiences of social and economic disadvantage, which accumulated through early adulthood. Substance use emerged as an important subject for the majority of women, operating cyclically as both precursor to and product of accumulating social and economic hardship. Dancers revealed social strategies that buffered the effects of structural vulnerability and minimized exposure to workplace-related drug and sexual harms.

Conclusion

This study provides insight on an understudied group of at-risk women with a unique demographic profile. Findings illustrate how the effects of structural vulnerability, substance abuse, social strategies, and opportunities for economic gain through sexual services in the workplace converge to produce varying levels of HIV/STI risk among exotic dancers.

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.

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