Association of gender-based violence with sexual and drug-related HIV risk among female sex workers who use drugs in Kazakhstan

Background Little is known about the prevalence of intimate partner violence (IPV) or client violence, and associated HIV risk among women who engage in sex work (WESW) and use drugs in Kazakhstan, despite a growing HIV epidemic. Methods Women who reported engaging in sex work and using illicit drugs were recruited from Almaty and Temirtau, Kazakhstan between 2015 and 2017. A cross-sectional analysis was conducted to determine prevalence and correlates of physical and sexual violence perpetrated by intimate partners and clients. Associations between each type of violence with sexual and drug-related HIV risk behaviors were assessed with negative-binomial and logistic regression models, respectively. Results Of the 400 women, 45% and 28% reported recent IPV and client violence, respectively. IPV and client violence was associated with a greater number of sex work clients [IPV: adjusted incidence rate ratio (aIRR)(physical): 1.86, 1.28-2.71; aIRR(sexual): 2.28, 1.56-3.35]; [client violence: aIRR(physical): 2.20, 1.44-3.42; aIRR(sexual): 2.54, 1.72-3.83], and client violence was associated with greater frequency of condomless sex with clients [aIRR(physical): 2.33, 1.41-4.03; aIRR(sexual): 2.16, 1.35-3.56]. Violence was not associated with injection drug use, despite exchanging sex for drugs being associated with higher odds of violence. Conclusion HIV prevention programs for WESW in Kazakhstan should consider multi-sectoral approaches that address economic hardship and relationship-based components, in addition to violence reduction.