Despite many shared goals, public health and public safety systems often do not collaborate and therefore may end up working at cross purposes. Their divergent responses to sex work are particularly striking, with public health focusing on health promotion and risk reduction in contrast to public safety's focus on criminalization of both sex work and the substance use that so often accompanies it. The need to better understand and align these approaches is evident when one considers female sex workers' (FSWs) HIV risk. To fill this gap, study aims are to: 1) to explore police culture, attitudes of, and experiences with FSWs among Baltimore city police leadership (N=15) and street-level police (N=30) working in high crime areas in Baltimore City; 2) to examine the association between the FSWs' HIV risk behaviors (e.g., unprotected sex, unsafe injection practices use, crack use) with police encounters the frequency and type (i.e., verbal and sexual harassment, sexual exploitation, condom and syringe confiscation) of police encounters, among a cohort of FSWs (N=250) over a 12-month period of time; and 3) to examine the association between HIV/STIs incidence and prevalence with the frequency and type of police encounters among a cohort of FSWs (N=250) over a 12-month period of time. In meeting Aim 1, we will conduct organizational ethnography, a multi-method approach, which will allow for an in-depth examination of police culture, police policies, as well as attitudes and experience of leadership and patrol police in their own words. Through Aim 2, we will enroll and follow a cohort of FSWs (N=250) through targeted sampling, at street-based venues that will be identified through secondary data analysis, street key informant interviews, and ethnographic mapping. Through these data, we will examine associations between risky drug and sexual behaviors (i.e., unprotected sex, injection drug use) with police encounters over time. Data will be collected at baseline, 3-, 6-, 9-, and 12-months. The proposal is innovative in responding to an emerging, global evidence base illustrating the centrality of police in FSWs' HIV/STI risk behaviors and infection.1,2,9,19,20 The study blends organizational ethnography, prospective quantitative research, and biological outcomes and represents the first US-based effort to better understand how and why police function as a structural HIV/STI driver among FSWs, and in turn lay the foundation for future interventions. The study will be guided by a multi-sectorial community advisory board (CAB) comprised of police, legal, public health, FSW, and community stakeholders. The CAB and support of the Police Commissioner will be central to the development of sustainable and realistic interventions stemming from this work.

Public Health Relevance

We propose examining the role of police in the HIV risk environment of female sex workers (FSWs) in Baltimore Maryland; to this end, we will collect a series of qualitative data with police including key-informant interviews (N=15) with police leadership, participant observations through ride-alongs (n=40) and walk-alongs, and in-depth interviews with patrol police (N=30). Through targeted sampling, we will also recruit and enroll FSWs (N=250) in a cohort and collect data at baseline, 3-, 6-, 9- and 12-months follow-up to ascertain the relationship between different types and the frequency of police encounters with HIV, gonorrhea and chlamydia as well as risk behaviors. The study aims to uncover an important yet understudied structural aspect of FSWs HIV risk environment.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA038499-02
Application #
8995642
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Hartsock, Peter
Project Start
2015-02-01
Project End
2018-11-30
Budget Start
2015-12-01
Budget End
2016-11-30
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Sherman, Susan G; Brantley, Meredith R; Zelaya, Carla et al. (2017) The Development of an HIV Risk Environment Scale of Exotic Dance Clubs. AIDS Behav 21:2147-2155
Footer, Katherine Ha; Silberzahn, Bradley E; Tormohlen, Kayla N et al. (2016) Policing practices as a structural determinant for HIV among sex workers: a systematic review of empirical findings. J Int AIDS Soc 19:20883