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Zemlak JL, Alexander KA, Wilson D, Singer R, Williams JS, Sherman SG. Sex Workers' Experiences of Screening for Intimate Partner Violence. J Obstet Gynecol Neonatal Nurs 2024; 53:397-405. [PMID: 38490264 PMCID: PMC11246806 DOI: 10.1016/j.jogn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To examine experiences of intimate partner violence (IPV) screening among women who sell sex. DESIGN A qualitative descriptive study. SETTING Telephone interviews during the COVID-19 pandemic (June 2020 to October 2020). PARTICIPANTS Women aged 18 to 49 years who sold or traded sex for food, drugs, money, or shelter at least three times during the past 3 months before recruitment (N = 22). METHODS We used individual, semistructured telephone interviews to collect data about participants' experiences with IPV and IPV screening during health care encounters. We used reflexive thematic analysis to examine these data. RESULTS We identified two overarching themes related to IPV screening experiences: Preferences for IPV Screening and Barriers to Disclosure of IPV Experiences. Participants described a preference for IPV screening done face-to-face with providers who show a genuine interest in their responses. Stigma was a barrier of IPV disclosure. CONCLUSION Health care providers are a trusted safety net for disclosure of IPV experiences. Providing screening in a trauma-informed, nonstigmatizing manner may facilitate disclosure of IPV by women who sell sex. Future research among marginalized populations is needed to examine ways to address IPV in clinical settings with a harm reduction empowerment lens.
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Birger L, Peled E, Benyamini Y. Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization - A scoping review. J Adv Nurs 2024; 80:2273-2289. [PMID: 38069507 DOI: 10.1111/jan.16010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIM To systematically map the extent, range and nature of qualitative studies that explored female sex workers' own perspectives on barriers to accessing reproductive healthcare services. DESIGN A scoping review of the literature utilizing Arksey and O'Malley's method. DATA SOURCES/REVIEW METHODS A search of the electronic databases MEDLINE/ PubMed, PsycNET, Sociological Abstracts, ProQuest, ScienceDirect, HeinOnline, Scopus, Web of Science and Google Scholar was conducted for items published in English between 2001 and 2021. RESULTS Twenty-one studies were included in the review, the majority of which were conducted in lower-middle-income countries. RHC themes studied were diverse, with a few more studies focusing on STI/HIV, contraceptive use and pregnancy than those focusing on childbirth and postnatal care. The findings indicate barriers in four main domains: socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. Stigma was a major multifaceted barrier. CONCLUSION Female sex workers experience exclusion in utilizing reproductive healthcare services globally. As such, healthcare services are advised to adopt a nonjudgemental approach, to enhance physical accessibility and to train nurses and other healthcare professionals on reproductive health needs of female sex workers. Finally, knowledge production processes on the RHC of FSW should adopt a holistic view of FSW, by exploring their needs and barriers related to childbirth and maternity care and by including the perspectives of FSW in high-income countries. IMPACT The review offered an in-depth understanding of female sex workers' own perspectives regarding needs and barriers in utilizing reproductive healthcare services. Findings indicated socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. The review could inform the training of nurses and other healthcare professionals in reproductive healthcare services globally. Researchers should adopt a holistic view of female sex workers, by exploring their family planning needs, including barriers related to childbirth, maternity and postpartum care. REPORTING METHOD We adhered to the EQUATOR guidelines PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.
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Affiliation(s)
- Lior Birger
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Peled
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Benyamini
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
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3
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Darebo TD, Spigt M, Teklewold B, Badacho AS, Mayer N, Teklewold M. The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis). BMC Public Health 2024; 24:520. [PMID: 38373954 PMCID: PMC10877851 DOI: 10.1186/s12889-024-17916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. METHODS We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. RESULTS We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. CONCLUSION To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.
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Affiliation(s)
- Tadele Dana Darebo
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Mark Spigt
- Research Institute CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromso, Norway
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Correa-Salazar C, Braverman-Bronstein A, Bilal U, Groves AK, Page KR, Amon JJ, Vera A, Ballesteros L, Martínez-Donate A. The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001571. [PMID: 36963089 PMCID: PMC10021609 DOI: 10.1371/journal.pgph.0001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.
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Affiliation(s)
- Catalina Correa-Salazar
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ariela Braverman-Bronstein
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Usama Bilal
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ali K. Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Kathleen R. Page
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph J. Amon
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Alejandra Vera
- Corporación Mujer Denuncia y Muévete NGO, Cúcuta, Colombia
| | | | - Ana Martínez-Donate
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
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5
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Pesantes MA, Cortez L, Scaramutti C, Portocarrero J, Haghparast-Bidgoli H, Miranda JJ. [Responding to the sexual and reproductive health needs of Venezuelan migrant women in LimaResposta às necessidades de saúde sexual e reprodutiva de migrantes venezuelanas em Lima]. Rev Panam Salud Publica 2023; 47:e69. [PMID: 37089788 PMCID: PMC10115188 DOI: 10.26633/rpsp.2023.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/21/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.
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Affiliation(s)
- M Amalia Pesantes
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Leonardo Cortez
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carolina Scaramutti
- University of Miami Miami Estados Unidos de América University of Miami, Miami, Estados Unidos de América
| | - Jill Portocarrero
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
- University of Miami Miami Estados Unidos de América University of Miami, Miami, Estados Unidos de América
- University College London Londres Reino Unido University College London, Londres, Reino Unido
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6
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Springfield O, Brouwer KC, Avila-Rios S, Morales-Miranda S, Mehta SR. Molecular epidemiology of HIV-1 among adult female sex workers at the Guatemala-Mexico border. Glob Public Health 2023; 18:2278873. [PMID: 37944916 PMCID: PMC10808948 DOI: 10.1080/17441692.2023.2278873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
ABSTRACTSex workers have been demonstrated to have increased vulnerabilities to HIV and a high population prevalence of the disease. Despite their increased risk, sex workers have been underrepresented in molecular epidemiology studies assessing HIV in Mesoamerica. This study aims to describe the sociodemographic characteristics and phylogenetic profile of HIV-1 within a cohort of HIV-positive female sex workers (FSW) situated at the Guatemala-Mexico border. HIV viral sequences were collected from a cohort of FSW ≥18 years of age from San Marcos, Guatemala (n = 6) and compared to viral sequences collected as part of the Mesoamerican Drug Resistance Monitoring Programme to assess HIV viral diversity in Mexico and Guatemala (n = 3956). All of the FSW sampled were determined to have genetically unrelated HIV infections, suggesting multiple introductions of the virus and/or the potential existence of populations not captured by current surveillance efforts. Many reported numerous vulnerabilities that may have heightened their risk of acquiring and transmitting HIV through sex work activities. Our phylogenetic analysis indicated that national surveillance programmes may not fully capture the viral diversity among FSW and their clients within this region. Additional research is needed to fully capture HIV diversity and transmission in Mesoamerica, especially in the Guatemala-Mexico border region.
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Affiliation(s)
- Olivia Springfield
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kimberly C. Brouwer
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Santiago Avila-Rios
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Sonia Morales-Miranda
- Consorcio de Investigación sobre VIH SIDA TB Consorcio de Investigación en Salud, Cuernavaca, Morelos, México
| | - Sanjay R. Mehta
- University of California San Diego School of Medicine, La Jolla, California, USA
- San Diego Veterans Affairs Medical Center, San Diego, California, USA
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Garbett A, de Oliveira Tavares NC, Riggirozzi P, Neal S. The paradox of choice in the sexual and reproductive health and rights challenges of south-south migrant girls and women in Central America and Mexico: A scoping review of the literature. J Migr Health 2022; 7:100143. [PMID: 36568827 PMCID: PMC9768374 DOI: 10.1016/j.jmh.2022.100143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The last decade has seen high levels of displacement in Central America and Mexico, with women and girls representing a growing share of this flow. Women and girls face a unique set of sexual and reproductive health risks, both as a direct result of the migration process, and as a consequence of violence, conflict and oppressive gender norms in the region. This scoping review adopts a five-stage process to search for, identify, and review selected literature to answer two questions: (1) what sexual and reproductive health and rights risks, challenges, and needs do women and girls face before and during displacement; and (2) how do issues of sexual and reproductive health and rights influence women and girls' coping mechanisms and decisions in displacement in the region? Extracted data from intersecting literature on migration, gender, and health in the corridors of migration in Central America and Mexico are mapped and analyzed against a framework adapted from the Guttmacher-Lancet Commission on components of sexual and reproductive health and rights. Many Central American and Mexican women and girls flee conditions of gang-related conflict, gender-based violence, poverty, and other situations of extreme disadvantage. Findings from this study demonstrate they face further deprivation and suffering from the denial of health and rights throughout the migratory cycle. This review finds that migrant women and girls encounter considerable barriers to accessing services of sexual and reproductive health, are vulnerable to sexually transmitted infections, and face many violations of sexual and reproductive rights. Young migrants and sex workers, who are often connected with irregular migration in border areas, appear to be particularly vulnerable. Findings also reveal that the literature tends to focus on sexual health and rights, with a relative paucity of evidence on wider reproductive health issues. Of critical importance is how women and girls must constantly balance risk and opportunity in situations of constrained choice, and how their coping strategies and decisions define and influence their migration trajectories and broader wellbeing. This review identifies a gap in the literature around comprehensive studies that define sexual and reproductive health and rights beyond the confines of disease and sexual behavior, as well as a need for greater focus on under-represented migrant groups such as adolescent girls.
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Mulikaburt T, Apidechkul T, Wongnuch P, Kitchanapaibul S, Udplong A, Srichan P, Upala P, Chomchoei C, Yeemard F, Tamornpark R, Singkhorn O. Components of stigma and its impact on maternal and child health service and outcomes: perspective of Akha hill tribe women in Thailand. BMC Health Serv Res 2022; 22:1263. [PMID: 36261838 PMCID: PMC9583464 DOI: 10.1186/s12913-022-08622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and child health (MCH) is crucial to the well-being of mothers and children. Stigma regarding access to MCH services is a major challenge, especially for hill tribe people in Thailand. The study aimed to understand the components of stigma and its impact on MCH service and outcomes including experiences and expectations to address the stigma in perspective of Akha hill tribe women in Thailand. METHODS A phenomenological qualitative approach was used to gather information from Akha women who had attended MCH service one year prior and had an experience with stigma. A validated question guide was used in the study. The interview was conducted in private and confidential rooms in the Akha hill tribe villages between June and September 2021. A thematic analysis was used to extract the major and minor themes and develop the findings. RESULTS A total of 61 Akha postdelivery participants were recruited to provide information; the average age was 28.9 years, 32.8% had no Thai ID card, and 93.4% were married. Language, traditional clothing, poverty, and name were identified as drivers of stigma, while health care providers' background, gender differences between clients and health care providers, and knowledge gaps facilitated the stigma. Being a member of a hill tribe acted as the stigma marker. Stigma manifestation was presented in the forms of verbal or physical abuse, refusal to provide treatment, and intentional disclosure of personal information to the public. Accepting the situation with no better option, defending oneself to receive better care and services, and using a private care service were experiences in addressing the stigma. Gender matching, active MCH service, mobile emergency clinics, and appropriate, permanent medical equipment in health care facilities located in their villages were the expectations. CONCLUSION Akha women face a variety of stigmas in access to MCH services, with substantial impacts on health outcomes, especially the rate of services in women and child health. Creating laws to prevent the occurrence of any forms of stigma and implementing gender matching in MCH services should be considered.
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Affiliation(s)
| | - Tawatchai Apidechkul
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand. .,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand. .,School of Health Science, Mae Fah Luang University, 333 Moo 1, Ta Sud Subdistrict, Muang District, 57100, Chiang Rai Province, Thailand.
| | - Pilasinee Wongnuch
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Siwarak Kitchanapaibul
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Anusorn Udplong
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand
| | - Peeradone Srichan
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Panupong Upala
- Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Chalitar Chomchoei
- Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Fartima Yeemard
- Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Ratipark Tamornpark
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Onnalin Singkhorn
- Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand.,School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
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Chawhanda C, Levin J, Ibisomi L. Factors associated with sexual and reproductive health service utilisation in high migration communities in six Southern African countries. BMC Public Health 2022; 22:876. [PMID: 35501749 PMCID: PMC9063360 DOI: 10.1186/s12889-022-13308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migration among women has significant health consequences on their access to and utilisation of health services, particularly sexual and reproductive health services. Despite the large quantity of research on migrant health, there is a paucity of research on the factors associated with utilization of modern methods of contraception, intimate partner violence services and sexual and reproductive health (SRH) referral services among non-migrants, internal and international migrant women. Consequently, understanding the factors associated with utilisation of SRH services among women in Southern Africa motivates this study. METHODS The study uses secondary data from a cross sectional survey conducted in 2018. Logistic regression models were fitted to investigate the factors associated with utilisation of sexual and reproductive health services among 2070 women aged 15-49 years in high migrant communities in six Southern African countries. RESULTS Factors found to be associated with current non-use of modern contraceptive methods were country, employment status, educational level, comprehensive knowledge about SRH, comprehensive knowledge about HIV, desire for another child, partner's age and partner's educational level. Regarding utilisation of SRH services, important factors were ever denied access to a public healthcare facility, country, marital status and comprehensive knowledge about HIV. Factors associated with utilising IPV services were migration status, age and attitude towards wife beating. CONCLUSION The findings highlight that migration status is associated with utilisation of IPV services. Comprehensive knowledge about SRH and partner characteristic variables were associated with current non-use of modern contraceptive methods. There is a need for SRH programs that can disseminate accurate information about SRH and encourage male involvement in SRH related issues. In addition, the SRH programs should target all women regardless of their migration status, age, educational level and marital status.
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Affiliation(s)
- Christine Chawhanda
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Jonathan Levin
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Latifat Ibisomi
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Nigerian Institute of Medical Research, Lagos, Nigeria
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Rocha-Jiménez T, Morales-Miranda S, Fernández-Casanueva C, Silverman JG, Zúñiga ML, Goldenberg SM, Crespo N, Brouwer KC. Migration and Mobility: Correlates of Recent HIV Testing Among Substance Using Female Sex Workers at the Mexico-Guatemala Border. AIDS Behav 2022; 26:1467-1476. [PMID: 34982320 PMCID: PMC9001206 DOI: 10.1007/s10461-021-03501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/04/2022]
Abstract
The goal of this paper is to determine the association between traveling to engage in sex work in another country and recent access to HIV testing among substance-using female sex workers (FSWs) in the Mexico-Guatemala border region. From 2012 to 2015, through modified time-location sampling and peer referral, 255 FSWs were recruited at Mexico's southern border. Participants completed questionnaires on sociodemographics, migration and mobility experiences, work environment factors, and substance use. A conceptual framework, as depicted by a directed acyclic graph (DAG), guided our analysis. Crude and adjusted logistic regression models were used to evaluate the relationships between mobility experiences and HIV testing in the past year. Overall HIV testing was low (41%); after considering relevant covariates (i.e., interaction with health services and organizations, and sex work characteristics) traveling to engage in sex work in another country was found to be positively associated with HIV testing in the past year. Future efforts need to consider voluntary and non-stigmatizing prevention HIV services and focus on reaching out to less mobile women.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- Society and Health Research Center, Faculty of Humanities, Universidad Mayor, Santiago, Chile
| | | | - Carmen Fernández-Casanueva
- Centro de Investigaciones y Estudios Superiores en Antropología Social CIESAS, San Cristóbal de las Casas, Chiapas Mexico
| | - Jay G. Silverman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | | | - Shira M. Goldenberg
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- Division of Epidemiology and Biostatistics, San Diego State, San Diego, CA USA
| | - Noe Crespo
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Kimberly C. Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA USA
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11
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Logie CH. Sexual rights and sexual pleasure: Sustainable Development Goals and the omitted dimensions of the leave no one behind sexual health agenda. Glob Public Health 2021; 18:1953559. [PMID: 34278957 DOI: 10.1080/17441692.2021.1953559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This commentary explores the missing discourse of sexual rights and sexual pleasure in the Sustainable Development Goals (SDG) that purport to leave no one behind. The SDG propose a welcome focus on sexual health and human rights for all, expanding beyond the Millennium Development Goals. While promising in many ways for advancing global sexual and reproductive health, and reproductive rights, the omission of sexual rights is troubling. So too is the erasure of lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and sex workers, from the SDG discussions of social inequities. Illustrative examples are provided to demonstrate how a sexual rights focus could advance SDG 3 focused on healthy lives and well-being for all. First, sexual rights are presented as integral to realizing Target 3.3's focus on ending the HIV pandemic among LGBTQ persons and sex workers (and LGBTQ sex workers). Second, sexual pleasure is introduced as an integral component of sexual health and sexual rights that could facilitate the realization of Target 3.7's aim to provide universal access to sexual and reproductive health information and education. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Centre for Gender & Sexual Health Equity, Vancouver, Canada
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12
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McBride B, Shannon K, Strathdee SA, Goldenberg SM. Structural determinants of HIV/STI prevalence, HIV/STI/sexual and reproductive health access, and condom use among immigrant sex workers globally. AIDS 2021; 35:1461-1477. [PMID: 34185713 PMCID: PMC8351786 DOI: 10.1097/qad.0000000000002910] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Given stark health inequities among precarious and criminalized workers, we aimed to apply a structural determinants framework to systematically review evidence on HIV/sexually transmitted infection (STI) prevalence, access to HIV/STI/SRH services, and condom use among im/migrant sex workers (ISWs) globally. METHODS Systematic search of peer-reviewed studies published in English (2009-2019). Eligible studies reported HIV/STI, access to HIV/STI/SRH services, and/or condom use outcomes and/or lived experiences among ISWs. Quantitative and qualitative data were synthesized using a structural determinants framework. RESULTS Of 425 studies screened, 29 studies from 15 countries were included. HIV prevalence ranged from 0.3 to 13.6% and varied across settings, with highest prevalence among undocumented ISWs in a high-income country (Portugal). Precarious immigration status was a structural factor associated with poorer HIV/STI outcomes, whereas qualitative narratives showed ISWs' lived experiences as strongly shaped by policing and stigma. Despite disparities, in some settings, HIV and STI prevalence were lower and odds of condom use with clients were higher among ISWs relative to non-im/migrant sex workers. This review identified a paucity of research on SRH and male and gender-diverse ISWs. Across legislative settings, criminalization of SW and im/migrant status, policing, and migration-related marginalization were prominent structural barriers to ISWs' HIV/STI/SRH access. CONCLUSION This review identified important inequities and variation in HIV/STI prevalence among ISWs globally. Our findings highlight impacts of the intersections of migration and criminalization, and suggest a need to reform criminalized sex work laws; address punitive policing and immigration enforcement; enable safer indoor work environments; and expand community-based interventions towards promoting HIV/STI/SRH access and health equity among ISWs.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender & Sexual Health Equity, c/o St Paul's Hospital
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, c/o St Paul's Hospital
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, Canada
| | - Steffanie A Strathdee
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Shira M Goldenberg
- Centre for Gender & Sexual Health Equity, c/o St Paul's Hospital
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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13
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Llangarí-Arizo LM, Sadiq ST, Márquez C, Cooper P, Furegato M, Zhou L, Aranha L, Mateo MM, Romero-Sandoval N. Sexually transmitted infections and factors associated with risky sexual practices among female sex workers: A cross sectional study in a large Andean city. PLoS One 2021; 16:e0250117. [PMID: 33956840 PMCID: PMC8101946 DOI: 10.1371/journal.pone.0250117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are limited published data on factors related to risky sexual practices (RSP) affecting sexually transmitted infections (STIs) among female sex workers (FSWs) in Ecuador. METHODS Cross-sectional study of FSWs presenting for a consultation in a primary health care centre during 2017. A questionnaire was administered to collect information on RSP and potential risk factors including age, membership of an FSW association, self-report of previous STI diagnosis, previous treatment for suspected STI and temporary migration for sex work. Associations between RSP and potential risk factors were estimated by logistic regression. The proportion of STI was estimated from vaginal swabs by real-time PCR for four sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and Mycoplasma genitalium). RESULTS Of 249 FSWs recruited, 22.5% had reported RSPs at least once during sex work. Among FSWs reporting unprotected vaginal sex in the previous three months, 25.5% had at least one other RSP type. 17.6% (95%CI 13.3-22.8) had at least one active STI. Prevalence of co-infections was 2.4% (95%CI 1.1-5.2). In multivariable analysis, RSP was associated with age (adjusted OR 1.06; 95%CI 1.02-1.10), membership of an FSWs association (aOR 3.51; 95%CI 1.60-7.72) and self-reported previous STI (aOR 3.43; 95%CI 1.28-9.17). CONCLUSIONS Among a population of female sex workers with high proportion of STIs, increasing age and belonging to an FSWs association was associated with a higher likelihood of engaging in RSP with clients. Engaging with FSWs organisations may reduce the burden of STI among sex workers.
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Affiliation(s)
- Luz Marina Llangarí-Arizo
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
- Red Internacional Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain
| | - S. Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Cynthia Márquez
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
| | - Philip Cooper
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Martina Furegato
- Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
| | - Liqing Zhou
- Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Luisa Aranha
- Ministerio de Salud Pública de Ecuador, Quito, Ecuador
| | - Miguel Martín Mateo
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
- Red Internacional Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain
| | - Natalia Romero-Sandoval
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Red Internacional Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain
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14
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Brizuela V, Kapilashrami A, Bonet M, Khosla R, Kobeissi L, Say L, Thorson A. Sexual and reproductive health and rights of migrants: strengthening regional research capacity. Bull World Health Organ 2021; 99:402-404. [PMID: 33958830 PMCID: PMC8061669 DOI: 10.2471/blt.20.270447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Essex, England
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Rajat Khosla
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Loulou Kobeissi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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15
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Rocha-Jiménez T, Fernández-Casanueva C, Suárez-Lopéz JR, Zúñiga ML, Crespo N, Morales-Miranda S, Goldenberg SM, Silverman JG, Brouwer KC. Intercepted journeys: Associations between migration and mobility experiences and depressive symptoms among substance using migrants at the Mexico-Guatemala border. Glob Public Health 2021; 17:297-312. [PMID: 33430720 DOI: 10.1080/17441692.2020.1866637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Substance use and depressive psychiatric symptoms have been associated with migration and mobility. The Mexico-Guatemala border is a key transit point for internal, regional, and international migration flows. However, there is limited knowledge of the role of substance use, migration, and mobility on mental health among migrants at this border. Our paper explores the association of migration and mobility patterns with possible major depressive symptoms among migrants at this key geographic region. We recruited 392 substance-using migrants using modified time-location sampling. Crude and adjusted logistic regression models were developed. We found that 12% of the sample had possible major depressive symptoms. After adjusting for relevant covariates, including gender, income, and perceived homelessness, we found that recent rural-urban and short-term migrants had higher odds of possible major depressive symptoms, whereas international migrants had lower odds. Findings of this paper suggest that although migrants experience hardship and uncertainty, they may respond with complex and nuanced forms of coping and planning.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.,Society and Health Research Center, Faculty of Humanities, Universidad Mayor, Las Condes, Santiago de Chile
| | - Carmen Fernández-Casanueva
- Centro de Investigaciones y Estudios Superiores en Antropología Social CIESAS, San Cristóbal de las Casas, Chiapas, México
| | - José R Suárez-Lopéz
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | - Noe Crespo
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Shira M Goldenberg
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.,Faculty of Health Sciences, Simon Fraser University, Burnabay, Canada
| | - Jay G Silverman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Kimberly C Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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16
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Rocha-Jiménez T, Morales-Miranda S, Fernández-Casanueva C, Brouwer KC. The influence of migration in substance use practices and HIV/STI-related risks of female sex workers at a dynamic border crossing. J Ethn Subst Abuse 2020; 19:503-520. [PMID: 30795721 PMCID: PMC8638352 DOI: 10.1080/15332640.2018.1556763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We explored the association of international migration with substance use and HIV/STI risk factors among female sex workers (FSW). Using modified time-location sampling, we recruited 266 FSW at the Mexico-Guatemala border. Crude and adjusted logistic regression models were used to evaluate the relationships. HIV risks, such as frequent hard drug use and drug use in another country, were greater for migrant compared to nonmigrant FSW. However, more migrant versus nonmigrant FSW reported consistent condom use with clients and having a health card. Our study highlights regional patterns of substance use among FSW and risk or protective behaviors related to migration status.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
- Graduate School of Public Health, San Diego State University, Center for U.S.-Mexican Studies, University of California, San Diego, California
| | | | - Carmen Fernández-Casanueva
- Centro de Investigaciones y Estudios Superiores en Antropología Social CIESAS, San Cristóbal de las Casas, Chiapas, México
| | - Kimberly C Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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17
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Zemlak JL, Bryant AP, Jeffers NK. Systematic Review of Contraceptive Use Among Sex Workers in North America. J Obstet Gynecol Neonatal Nurs 2020; 49:537-548. [PMID: 32931732 DOI: 10.1016/j.jogn.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To systematically review the literature regarding contraceptive use by sex workers in North America and to understand factors that limit reproductive agency and affect contraceptive use and decision making. DATA SOURCES We searched PubMed, CINAHL, and Embase databases using the search terms "sex work(ers)," "transactional sex," "exchange sex," "prostitution," "contraception," "contraceptive agents," "birth control," "female," and "women." STUDY SELECTION Articles were eligible for inclusion in this review if they (a) reported quantitative or qualitative studies based in North America, (b) were written in English, (c) included sex workers (self-identified sex workers or engaged in sex work behavior) as the primary or secondary population of the study, (d) included a population assigned female sex at birth, (e) reported contraceptive outcomes for sex workers, and (f) were published in peer-reviewed journals. The initial search yielded 2,455 articles, and seven met the inclusion criteria. DATA EXTRACTION Two authors independently reviewed the articles and organized data in a table to capture study design, sample size and study population, study aims, and contraceptive use. We applied Connell's theory of gender and power as an analytic framework to further identify factors that limited reproductive agency. DATA SYNTHESIS Condoms were the most common method of contraceptive used across studies. The use of contraceptives varied by partner type (client vs. nonpaying intimate partners). Access to highly effective contraception was limited by perceived stigma, financial constraints, and substance use. Reproductive and harm reduction services that were co-located where women worked improved contraceptive use. Contraceptive use was affected by factors that limited reproductive agency, including stigma, substance use, intimate partner violence, and condom coercion. CONCLUSION The reliance of sex workers on partner-dependent contraception, such as condoms, combined with factors that limit reproductive agency over contraceptive use and decision making contribute to high potential for contraceptive failure and unintended pregnancy. More research is needed to understand the influence of different sexual partner types, pregnancy intention, and contraceptive decision making on the reproductive agency of sex workers.
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18
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Febres-Cordero B, Brouwer KC, Rocha-Jimenez T, Fernandez-Casanueva C, Morales-Miranda S, Goldenberg SM. Influence of peer support on HIV/STI prevention and safety amongst international migrant sex workers: A qualitative study at the Mexico-Guatemala border. PLoS One 2018; 13:e0190787. [PMID: 29304164 PMCID: PMC5755897 DOI: 10.1371/journal.pone.0190787] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Migrant women engaged in precarious employment, such as sex work, frequently face pronounced social isolation alongside other barriers to health and human rights. Although peer support has been identified as a critical HIV and violence prevention intervention for sex workers, little is known about access to peer support or its role in shaping health and social outcomes for migrant sex workers. This article analyses the role of peer support in shaping vulnerability and resilience related to HIV/STI prevention and violence among international migrant sex workers at the Mexico-Guatemala border. METHODS This qualitative study is based on 31 semi-structured interviews conducted with international migrant sex workers in the Mexico-Guatemala border communities of Tapachula, Mexico and Tecún Umán and Quetzaltenango, Guatemala. RESULTS Peer support was found to be critical for reducing social isolation; improving access to HIV/STI knowledge, prevention and resources; and mitigating workplace violence, particularly at the initial stages of migration and sex work. Peer support was especially critical for countering social isolation, and peers represented a valuable source of HIV/STI prevention knowledge and resources (e.g., condoms), as well as essential safety supports in the workplace. However, challenges to accessing peer support were noted, including difficulties establishing long-lasting relationships and other forms of social participation due to frequent mobility, as well as tensions among peers within some work environments. Variations in access to peer support related to country of work, work environment, sex work and migration stage, and sex work experience were also identified. CONCLUSIONS Results indicate that peer-led and community empowerment interventions represent a promising strategy for promoting the health, safety and human rights of migrant sex workers. Tailored community empowerment interventions addressing the unique migration-related contexts and challenges faced by migrant sex workers should be a focus of future community-based research, alongside promotion of broader structural changes.
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Affiliation(s)
- Belen Febres-Cordero
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kimberly C. Brouwer
- Division of Global Public Health, University of California, La Jolla, California, United States of America
| | - Teresita Rocha-Jimenez
- Division of Global Public Health, University of California, La Jolla, California, United States of America
| | | | | | - Shira M. Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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