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      The ‘Stolen Generations' of Mothers and Daughters: Child Apprehension and Enhanced HIV Vulnerabilities for Sex Workers of Aboriginal Ancestry

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          Abstract

          Objectives

          The number of children in care of the state continues to grow in BC, Canada with a historical legacy of child apprehension among criminalized and marginalized populations, particularly women of Aboriginal ancestry and sex workers. However, there is a paucity of research investigating child apprehension experiences among marginalized mothers. The objective of the current analysis is to examine the prevalence and correlates of child apprehensions among female sex workers in Vancouver, Canada.

          Methods

          Analyses were drawn from the AESHA (An Evaluation of Sex Workers Health Access, 2010-present), a prospective cohort of street and off-street SWs, through outreach and semi-annual visits to the research office. Bivariate and multivariate logistic regression were used to examine correlates of child apprehension.

          Results

          Of a total of 510 SWs, 350 women who had given birth to at least one child were included in the analyses (median age = 37 yrs: IQR: 31–44 yrs). The prevalence of child apprehension among mothers was 38.3%, with 37.4% reporting having been apprehended themselves by child welfare services. In multivariable analysis, servicing clients in outdoor public spaces (versus formal sex work establishments or informal indoor settings) (adjusted odds ratio, (aOR) = 2.73; 95%CI 1.27–5.90), history of injecting drugs (aOR = 2.53; 95%CI 1.42–4.49), Aboriginal ancestry (aOR = 1.66; 95%CI 1.01–2.74) were associated with increased odds of child apprehension.

          Discussion/Conclusions

          Child apprehension rates are high, particularly among the most marginalized sex workers, including sex workers who use drugs and sex workers of Aboriginal ancestry. Structural reforms to child protection are urgently needed, that support family-based care address the historical legacy of colonization affecting Aboriginal peoples.

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          Most cited references15

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          Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers

          Objective To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution. Design Prospective observational study. Setting Vancouver, Canada during 2006-8. Participants Female sex workers 14 years of age or older (inclusive of transgender women) who used illicit drugs (excluding marijuana) and engaged in street level sex work. Main outcome measure Self reported gender based violence. Results Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aORphysicalviolence) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aORrape) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aORclientviolence) 2.13, 1.26 to 3.62; aORphysicalviolence 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aORclientviolence 1.50, 1.08 to 2.57); prior assault by police (aORclientviolence 3.45, 1.98 to 6.02; aORrape 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aORphysicalviolence 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aORclientviolence 2.13, 1.26 to 3.62). Conclusions Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender based violence against street based female sex workers. Socio-legal policy reforms, improved access to housing and drug treatment, and scale up of violence prevention efforts, including police-sex worker partnerships, will be crucial to stemming violence against female sex workers.
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            Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work.

            Within street-based sex work and substance-using populations, there is growing evidence to support the role of place, both physical setting and social meanings attached to place, in mediating the effectiveness and reach of health and harm reduction services. Social mapping was used to explore how health service and syringe availability may be impacted at the geographic level by avoidance of physical settings due to violence and policing among women in street-level sex work. Through a community-based research partnership and extensive peer-led outreach over a 6-month period, women were invited to participate in interview-questionnaires and mapping of their community, working conditions, and access to resources. Results were compiled used ArcGIS software and GIS street maps. In secondary analysis, logistic regression was used to model the geographic association (using likelihood ratio and significance at p<0.05) and stratified models were run to assess differential patterns of avoidance based on age, ethnicity and drug use. The findings reveal a significant geographic relationship between a heavily concentrated core area of health and syringe availability and avoidance of physical settings due to violence and policing by 198 women in street-level sex work in Vancouver, Canada. Of particular concern, this correlation is significantly elevated among younger and Aboriginal women, active injection drug users, and daily crack cocaine smokers, suggesting significant environmental-structural barriers to interventions among these vulnerable populations. The resultant displacement of sex work to primarily industrial settings and side streets pushes women further from health and social supports and reduces access to safer injection and drug use paraphernalia. This study offers important evidence for environmental-structural level prevention and safer environment interventions, supported by legal reforms, that facilitate safer sex work environments, including spatial programming, peer-based prevention, outreach and mobile resources, and peer-supervised safer sex work settings.
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              Prevalence of psychiatric disorders among older youths in the foster care system.

              To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates. Using the Diagnostic Interview Schedule for DSM-IV, interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003. : Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families. Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                13 June 2014
                : 9
                : 6
                : e99664
                Affiliations
                [1 ]Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
                [2 ]School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
                [3 ]Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
                [4 ]Sex Workers United Against Violence (SWUAV), Vancouver, British Columbia, Canada
                [5 ]School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
                [6 ]Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                Indiana University and Moi University, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: PD BB KS. Performed the experiments: KS. Analyzed the data: AS. Wrote the paper: PD KS BB AS DJ CR. Wrote the first draft and integrated suggestions from all authors: PD. Made significant contributions to the interpretation of the data, drafting of the manuscript: PD KS BB AS DJ CR. Approved the final manuscript: PD KS BB AS DJ CR.

                Article
                PONE-D-13-28120
                10.1371/journal.pone.0099664
                4057198
                24927324
                a4f552ed-1377-4f16-b993-e8879dacf5ad
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 July 2013
                : 16 May 2014
                Page count
                Pages: 6
                Funding
                This research was supported by operating grants from the US National Institutes of Health (R01DA028648) and Canadian Institutes of Health Research (HHP-98835). PD is supported by PHIRNET (Population Health Interventions Network), an initiative of the Canadian Institutes for Health Research (CIHR) KS is supported by US National Institutes of Health (R01DA028648). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Epidemiology
                Health Care
                Health Care Policy
                Child and Adolescent Health Policy
                Infectious Diseases
                Viral Diseases
                Pediatrics
                Child Health
                Public and Occupational Health
                People and Places
                Demography
                Indigenous Populations
                Social Sciences
                Sociology
                Sexual and Gender Issues

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