Prostitution Stigma and Its Effect on the Working Conditions, Personal Lives, and Health of Sex Workers

Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model

Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.

Sexual health beliefs and prevention of sexually transmitted infections among cisgender women sex workers in Colombia

INTRODUCTION

The stigma and social discrimination against cisgender women sex workers lead many of them to live in conditions characterized by social inequality, marginalization, persecution, and limited opportunities for sexual health literacy. Consequently, they are often compelled to establish a framework of preventive beliefs with little scientific validity, which they use to identify, mitigate, or avoid sexual health risks arising from their interactions with clients. This study investigates the sexual health beliefs that influence self-care practices aimed at preventing sexually transmitted infections among cisgender women sex workers in Colombia.

METHODS

We conducted a qualitative study framed in Hermeneutic Phenomenology. In-depth interviews and discussion groups were conducted with 34 cisgender women sex workers over 18 years of age in the center of the cities of Bogotá and Barranquilla in Colombia.

RESULTS

Seven themes emerged from the reflective and inductive thematic analysis of the narratives: (1) popular habits for the prevention of contagion, (2) ocular assessment of genitals, (3) condom lubrication, (4) suspicion of a hidden infection in the client, (5) saliva and oral contact as a source of contagion, (6) avoidance of semen contact, (7) and trust in God as protection.

CONCLUSIONS

The findings reflect the need for health and social professionals to promote participatory and inclusive cooperation with sex workers to update the framework of preventive beliefs that help them guide sexual health self-care with autonomy and self-efficacy, strengthening favorable beliefs and negotiating unfavorable ones. It is also essential to have a sex worker-informed sexual health policy that guides the promotion of sexual health that is sensitive to the needs and consistent with the risks of sex work and ensures friendly and non-oppressive preventive care environments for sex workers.

Crossroads of Choice: A qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda

Background

Women Engaged in commercial Sex Work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk to HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs.

Methods

Semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within a larger study-Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 HIV hotspots in the Southern region of Uganda. Participants were selected based on their intervention attendance (high/medium/low attendance). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to from transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?". All interviews were audio-recorded, transcribed verbatim and translated into English. Thematic analysis in Dedoose software was used to analyze the data.

Results

Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and continuing sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to leave sex work. Individual level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the structural level, factors which include interpersonal stigma and discrimination (from immediate family and community members), physical and sexual violence and income related factors were identified as facilitators and barriers to leaving sex work.

Conclusion

Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.

The guilt that guides me: religiosity, sex guilt, and the demonization of sex workers

Religiosity and sex-related attitudes are often correlated, and on occasion negatively. That is, as religiosity increases, sexual attitudes tend to become more conservative or generally more disapproving in valence. Recent research suggests that one's own sex guilt may be the mediating influence in this relationship. A series of two studies sought to extend that research and examine the extent to which an individual's religiosity and sex guilt influences their perspective of pornography and sex workers. A survey containing relevant measures was distributed to undergraduate participants as well as individuals from Amazon.com's MTurk. Results indicate that individuals high in religiosity have more negative views of pornography in general, and more demonizing views toward sex workers. However, it was their own sex guilt that mediated that relationship. This study replicates and adds to our current understanding of how religiosity and disparaging views of sex are related, but also shows the importance of including sex guilt as an influential individual difference.

I'm a 45-year-old woman in the body of an 80-year-old: The multiple losses of living and aging in the shadow of prostitution

INTRODUCTION

Research on aging women who are involved in prostitution is currently limited, both in terms of the number of studies conducted and their scope. Nevertheless, the available research suggests that women who are aging while involved in prostitution may confront some unique challenges. Thus, the study aims to explore the experiences of aging as narrated by Arab women in prostitution, using Intersectionality as a theoretical framework.

METHOD

Interpretive phenomenological analysis was used, and semistructured interviews were performed with 12 participants.

FINDINGS

Four themes emerged: "I'm a 45-year-old woman in the body of an 80-year-old:" Loss of physical and mental health; "There is no retirement plan in prostitution: Economic and social losses; As they were taken, my soul went with them too: The loss of the parenting experience and motherhood"; and "I'm going to get older with the disgust clinging to me:" The loss of authentic identity and dignity.

CONCLUSION

The findings demonstrate how aging serves to exacerbate overlapping forms of discrimination and marginalization.

CLINICAL RELEVANCE

Healthcare professionals, including nurses caring for older women in prostitution, should be aware of their unique circumstances, considering the social, economic, and healthcare obstacles they face. By being cognizant of these factors, healthcare practitioners can provide meaningful assistance in their pursuit of improved quality of life.

The impact of an economic empowerment intervention on intimate partner violence among women engaged in sex work in southern Uganda: A cluster randomized control trial

Women engaged in sex work (WESW) are at heightened risk of experiencing intimate partner violence (IPV) compared to women in the general population. This study examines the impact of an economic empowerment intervention on IPV among WESW in Southern Uganda. We used data from 542 WESW in Southern Uganda recruited from 19 HIV hotspots between June 2019 and March 2020. Eligible participants were 18+ years old, engaged in sex work-defined as vaginal or anal sexual intercourse in exchange for money, alcohol, or other goods, reported at least one episode of unprotected sexual intercourse in the past 30 days with a paying, casual, or regular sexual partner (spouse, main partner). We analyzed data collected at baseline, 6, and 12months of follow up. To examine the impact of the intervention on IPV, separate mixed-effects logistic regression models were run for each type of IPV (physical, emotional, and sexual) as experienced by participants in the last 90 days. Results show that the intervention was efficacious in reducing emotional and physical IPV as evidenced by a statistically significant intervention main effect for emotional IPV, χ2(1) = 5.96, p = 0.015, and a significant intervention-by-time interaction effect for physical IPV, χ2(2) = 13.19, p < 0.001. To qualify the intervention impact on physical IPV, pairwise comparisons showed that participants who received the intervention had significantly lower levels of physical IPV compared to those in the control group at six months (contrasts = -0.12 (95% CI: -0.22, -0.02), p = 0.011). The intervention, time, and intervention-by-time main effects for sexual IPV were not statistically significant. Our findings suggest economic empowerment interventions as viable strategies for reducing emotional IPV among WESW. However, it is also essential to understand the role of interventions in addressing other forms of IPV especially for key populations at high risk of violence, HIV, and STI. The study was registered at ClinicalTrials.gov, ID: NCT03583541.

When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach

Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.

Construction and Validation of a Scale to Assess Social Judgments Toward Sex Work from the Stereotype Content Model

Sex workers (SW) are subject to social judgment and the associated attitudes, ranging from admiration to contempt. The presence of stereotypical attitudes toward SW is common and can be analyzed using the Stereotype Content Model (SCM), where the concepts of warmth and competence play a central role. The interweaving of both dimensions allows the identification of four emotions and corresponding political positions toward SW: admiration (non-interventionism), pity (abolitionism), contempt (prohibitionism), and fear (regulationism). From the SCM framework, this study offers the construction, validation and performance of a 25-item scale with a snowball sample of 1,543 participants residing in Spanish-speaking countries. The four-factor hypothesized model yielded adequate values. Internal consistency was sufficient on all factors, as was model-based reliability and convergent validity. The scale also showed measurement invariance between gender and age groups, suggesting that the measure is interpreted in a conceptually similar manner by respondents representing different genders or ages. Further analysis revealed that male participants scored significantly higher on admiration. Baby boomers showed less pity and contempt while Millennials showed more fear and less admiration. SW and those who know or work with SW showed less fear and pity and more admiration. The SCM and the process of developing social judgments offer us a way to understand the differences that underlie irreconcilable policy positions. Overcoming these differences requires mutual understanding from scientific frameworks instead of from ideological perspectives.

Expanding access to healthcare for people who use drugs and sex workers: hepatitis C elimination implications from a qualitative study of healthcare experiences in British Columbia, Canada

BACKGROUND

Hepatitis C virus (HCV) is a major health threat in Canada. In British Columbia (BC) province, 1.6% of the population had been exposed to HCV by 2012. Prevalence and incidence of HCV are very high in populations of people who use drugs (PWUD) and sex workers (SW), who may experience unique barriers to healthcare. Consequently, they are less likely to be treated for HCV. Overcoming these barriers is critical for HCV elimination. This research sought to explore the healthcare experiences of PWUD and SW and how these experiences impact their willingness to engage in healthcare in the future, including HCV care.

METHODS

Interpretive Description guided this qualitative study of healthcare experiences in BC, underpinned by the Health Stigma and Discrimination framework. The study team included people with living/lived experience of drug use, sex work, and HCV. Twenty-five participants completed in-depth semi-structured interviews on their previous healthcare and HCV-related experiences. Thematic analysis was used to identify common themes.

RESULTS

Three major themes were identified in our analysis. First, participants reported common experiences of delay and refusal of care by healthcare providers, with many negative healthcare encounters perceived as rooted in institutional culture reflecting societal stigma. Second, participants discussed their choice to engage in or avoid healthcare. Many avoided all but emergency care following negative experiences in any kind of healthcare. Third, participants described the roles of respect, stigma, dignity, fear, and trust in communication in healthcare relationships.

CONCLUSIONS

Healthcare experiences shared by participants pointed to ways that better understanding and communication by healthcare providers could support positive change in healthcare encounters of PWUD and SW, who are at high risk of HCV infection. More positive healthcare encounters could lead to increased healthcare engagement which is essential for HCV elimination.

When does "no" mean no? Insights from sex robots

Although sexual assault is widely accepted as morally wrong, not all instances of sexual assault are evaluated in the same way. Here, we ask whether different characteristics of victims affect people's moral evaluations of sexual assault perpetrators, and if so, how. We focus on sex robots (i.e., artificially intelligent humanoid social robots designed for sexual gratification) as victims in the present studies because they serve as a clean canvas onto which we can paint different human-like attributes to probe people's moral intuitions regarding sensitive topics. Across four pre-registered experiments conducted with American adults on Prolific (N = 2104), we asked people to evaluate the wrongness of sexual assault against AI-powered robots. People's moral judgments were influenced by the victim's mental capacities (Studies 1 & 2), the victim's interpersonal function (Study 3), the victim's ontological type (Study 4), and the transactional context of the human-robot relationship (Study 4). Overall, by investigating moral reasoning about transgressions against AI robots, we were able to gain unique insights into how people's moral judgments about sexual transgressions can be influenced by victim attributes.

Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

Migrants facing intersectional vulnerability to HIV and AIDS in Switzerland: an exploratory study

An emerging body of evidence suggests that a significant number of HIV-positive migrants to Europe acquire HIV after arriving in their host country. There is an urgent need to rethink HIV and AIDS prevention for migrant populations and to acknowledge the specific vulnerability to HIV and AIDS that migrants face. This article uses empirical data collected in a qualitative sociological study conducted in Switzerland. We provide evidence for the heuristic value of articulating an intersectional approach within a multilevel (biographical, interactional and contextual) framework to capture the complexity of the vulnerability to HIV and AIDS. We show that migrants' specific vulnerability to HIV and AIDS results from social vulnerabilities related to many social and cultural dimensions, including migration status, socioeconomic conditions, gender and sexual identity, sexual norms, the relational context in which sex occurs, power relations and sociocultural structures of the receiving country. The three case studies presented illustrate how HIV-related processes of intersectional vulnerability are embedded in sexism, cisgenderism, and racism, and how they are closely linked to social inequalities in health. Effective HIV and AIDS prevention for migrants must take greater account of these power relations and sociocultural structures.

Dimensional Reduction in Barriers and Facilitators to Pre-exposure Prophylaxis (PrEP) Uptake Willingness for Full-Service Sex Workers

Full-Service Sex Workers (FSSWs) face heightened risk of acquiring HIV, yet exhibit relatively low adoption of pre-exposure prophylaxis (PrEP)-an antiviral that substantially reduces HIV acquisition risk. Little work examines barriers and facilitators to PrEP uptake willingness among FSSWs. This study aimed to identify the distinct components of barriers and facilitators to PrEP uptake willingness for FSSWs. Here, we subjected 19 PrEP barriers and facilitators identified in the literature to a principal component analysis (PCA) among a sample of 83 FSSWs. Preliminary statistics supported factorability of data. PCA revealed three distinct components of barriers and facilitators that explained 62.80% of the total variance in survey responses. We labeled these components Behavioral and Social Concerns (α = 0.93), Access and Affordability (α = 0.67), and Biologically Based Health Concerns (α = 0.79). This study shows promise for future clinical and research utility of these factors and provides a basis for future psychometric studies of barriers and facilitators to PrEP uptake willingness among FSSWs.

Navigating Stigma in Romantic Relationships Where One or Both Partners Sell Sexual Services

Romantic relationships are an important part of our social identities and well-being. In this paper, we report on qualitative findings with thirty Canadian couples, interviewed together, where it was known that one or both partners sell sexual services for a living. We asked a series of open-ended questions related to the background of the couple's relationship, their day-to-day interactions and work-related stressors. Participants talked about the ongoing negotiations they engage in as a couple, the benefits of being open to each other about working in the sex industry, and how they manage its emotional toll on their partnership. We conclude that there are various ways that sex workers are able to maintain intimacy in their romantic relationships after sex work has been disclosed. Widespread social stigma attached to sex work, complicated by criminalization in countries such as Canada, nevertheless threatens relationship quality in the long run.

Centering PrEP: utilizing ADAPT-ITT to inform group PrEP care for sex workers in Chicago

BACKGROUND

Sex workers, those who trade sex for monetary or nonmonetary items, experience high rates of HIV transmission but have not been adequately included in HIV prevention and Pre-Exposure Prophylaxis (PrEP) adherence program development research. Community-empowered (C.E.) approaches have been the most successful at reducing HIV transmission among sex workers. Centering Healthcare (Centering) is a C.E. model proven to improve health outcomes and reduce health disparities in other populations, such as pregnant women, people with diabetes, and sickle cell disease. However, no research exists to determine if Centering can be adapted to meet the unique HIV prevention needs of sex workers.

OBJECTIVE

We aim to explain the process by which we collaboratively and iteratively adapted Centering to meet the HIV prevention and PrEP retention needs of sex workers.

METHODS

We utilized the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, Testing (ADAPT-ITT) framework, a model for adapting evidence-based interventions. We applied phases one through six of the ADAPT-ITT framework (Assessment, Decision, Adaptation, Production, Topical Experts, Integration) to the design to address the distinct HIV prevention needs of sex workers in Chicago. Study outcomes corresponded to each phase of the ADAPT-ITT framework. Data used for adaptation emerged from collaborative stakeholder meetings, individual interviews (n = 36) and focus groups (n = 8) with current and former sex workers, and individual interviews with care providers (n = 8). In collaboration with our community advisory board, we used a collaborative and iterative analytical process to co-produce a culturally adapted 3-session facilitator's guide for the Centering Pre-exposure Prophylaxis (C-PrEP +) group healthcare model.

RESULTS

The ADAPT-ITT framework offered structure and facilitated this community-empowered innovative adaptation of Centering Healthcare. This process culminated with a facilitator's guide and associated materials ready for pilot testing.

CONCLUSIONS

In direct alignment with community empowerment, we followed the ADAPT-ITT framework, phases 1-6, to iteratively adapt Centering Healthcare to suit the stated HIV Prevention and PrEP care needs of sex workers in Chicago. The study represents the first time the first time Centering has been adapted to suit the HIV prevention and PrEP care needs of sex workers. Addressing a gap in HIV prevention care for sex workers, Centering PrEP harnesses the power of community as it is an iteratively adapted model that can be piloted and replicated regionally, nationally, and internationally.

"I Was Worshiped and in Control": Sugar Arrangements Involving Transactional Sex from the Perspective of Both Sugar Babies and Sugar Benefactors

Sugar dating arrangements involve an older partner ("sugar daddy/mommy") who provides financial support to a younger partner ("sugar baby") in exchange for intimacy. The current study recruited a U.S. and Canadian sample of sugar babies (n = 45) and sugar benefactors (n = 32) through social media sources to survey them about perceived power in their sugar arrangement, gender roles, and stigma. Sugar benefactors did not differ in perceived power from sugar babies, nor in endorsement of traditional gender roles or stigma. Directed content analysis analyzing open-ended responses about associated outcomes indicated that both partners placed strong emphasis on companionship despite the importance of sex within arrangements. Sugar babies reported that money drives participation, although arrangements fulfill other needs, such as pleasure. Other benefits include having an arrangement with clear boundaries and expectations. Disadvantages include concerns for safety, that being physical safety for babies, and reputation and being used for money for daddies. Notably, both groups perceived sugar babies as having equal or more power than sugar benefactors, although this was often attributed to sugar babies' attractiveness and youth. Findings include insights from both babies and benefactors, and support perspectives that sugar dating is distinct from traditional sex work.

Access to Sexual Rights for People Living with Disabilities: Assumptions, Evidence, and Policy Outcomes

Sexuality scholars have historically understudied the link between disability, sexual exclusion, and social justice, including equal rights for people living with disabilities (PLWD) to enjoy a sexual and intimate life in adulthood. There have been some recent efforts to rectify this situation, with studies emerging concerning strategies for promoting their sexual rights. Our Target Article explores one contentious service option-the possibility of "sexual assistance" for PLWD, which ranges in meaning across countries from sex surrogacy to physical contact with paid sexual assistants. We conducted a knowledge synthesis using a scoping review methodology to identify the breadth of the academic scholarship available and assess its alignment with current ethical and moral debates and recent policies and practices surrounding the sexual scripts of PLWD as they relate to sexual assistance. We categorized the relevant articles in our scoping review into two broad classes: those that support sex-negative perspectives (i.e., framing sexuality as risky, adversarial, etc.) and those that support sex-positive perspectives (i.e., framing sexuality as normative, consensual, etc.). Our results show that sex-negative cultural scripts call for limitations of the sexual rights of PLWD due to their inherent vulnerability as having disabled sexualities and/or due to their heightened risk of exploiting sexual partners, especially cis women who sell sexual services. The sex-positive cultural scripts understand PLWD as having the same rights to sexual citizenship as non-disabled individuals and that to achieve this, equitable access to sexual health services in decriminalized and regulated service environments is needed. We conclude with limitations of our investigation and recommendations for further research on this understudied topic, including the possible integration of positive disabled sexuality and abuse prevention.

Sex workers' peer support during the COVID-19 pandemic: Lessons learned from a study of a Portuguese community-led response

To respond to the consequences felt by the COVID-19 pandemic, a community-led intervention was developed by the Portuguese national Movement of Sex Workers. With this exploratory study, we aimed to document their work and analyze their perceptions of this impact. To do so, we interviewed them individually, between May and August of 2020. Additionally, we analysed an Excel Sheet that contained the needs assessment and the support provided by the Movement. The content analysis of both suggests that the impact of the pandemic might have been exacerbated by the social inequalities caused by the prostitution stigma and characteristics such as gender, migration status, race, and socioeconomic status. This study calls for the inclusion of sex workers' voices in the design of policies and responses related to the commerce of sex. The consolidation of a Portuguese Movement of Sex Workers is also noted.

Motivation of sex workers who provide camming services to engage in sex with their real-life and virtual partners

In this study, the motivations of 80 sex workers who provide camming services (76 females and 4 non-binary/trans/gender fluid individuals; aged from 20 to 49 years, M = 30.68, SD = 6.43; 56.2% married or in a committed relationship, 18.8% in a non-committed relationship and 25% - single) were compared in terms of engaging in sexual activity with their real-life partners versus their virtual partners (predominantly kink-oriented clients). Presented with 16 reasons to engage in sexual activity, the respondents rated the frequency to engage in sex for each of these reasons with their real-life and virtual partners. Results showed that there were five reasons in which there were differences in motivation to engage in sex with real-life versus virtual partners and 11 reasons showed no differences. Specifically, respondents reported engaging in sex more often with their virtual partners to get resources and to experience a specific type of sex (kink), while they reported engaging in sex more often with their real-life partners to experience physical pleasure, motivated by physical desirability of a partner and to express love and commitment. However, for all other reasons that motivate people to engage in sex, including stress reduction, experience seeking, self-esteem boost, social status, revenge, utilitarian reasons, emotional expression, duty or pressure, thrill of the forbidden, mate guarding, and desire to have sex with a person of other gender, respondents engaged in sex equally frequently with their real-life and virtual partners (clients) and there were no statistical differences. This study adds to the existing research on sex work by providing insights into the motivations of sex workers to engage in sex with different partners and demonstrates that apart from common sense differences the reasons to engage in sex with clients and real-life partners are vastly similar.

Occupational Health and Safety among Female Commercial Sex Workers in Ghana: A Qualitative Study

The topic of occupational health and safety (OHS) has been investigated for many years and continues to be a concept often researched today. Generally speaking, OHS research has been centered around food safety, construction safety, transportation safety, fire safety, drug and alcohol testing, health and medical management, and industrial hygiene, to name a few. However, the concept of OHS concerning female commercial sex workers (FCSWs) has rarely been investigated, often neglected, seldom discussed, and is lacking in sound research. Although regarded as the “oldest profession”, commercial sex work (CSW) has consistently been ignored, disregarded, and under-researched due to the illegality and stigmatization of prostitution. This paper reviews occupational safety and health issues faced by FCSWs in Tema and Accra, Ghana, through in-depth interviews, visits to women’s homes, fieldwork, informal conversations, and observations with FCSWs during the summer of May 2012–July 2012. Facets of OHS that emerged among FCSWs included: sexually transmissible infections, risks associated with harassment and violence from police and clients, alcohol and drug use, irregular hospital visits or lack of hospital visits, immigration issues, legal hazards, and working conditions. We argue that CSW be viewed as an occupation in great need of interventions to reduce workplace risks.

Validation of a Brief Internalized Sex-work Stigma Scale among Female Sex Workers in Kenya

Female sex workers (FSW) often face severe stigma and discrimination and are extremely vulnerable to HIV and other sexually transmitted infections. In the fields of HIV and mental health, internalized stigma is associated with poor health care engagement. Due to the lack of valid, standardized measures for internalized sex work-related stigma, its dimensions and role are not well-understood. This study aimed to validate the six-item Internalized AIDS-Related Stigma Scale adapted to capture internalized sex work-related stigma by examining the scale's psychometric properties and performance among a cross-sectional, snowball sample of FSW (N = 497) in Kenya. While the original pre-hypothesized six-item model yielded acceptable CFI and SRMR values (CFI = 0.978 and SRMR = 0.038), the RMSEA was higher than desirable (RMSEA = 0.145). Our final four-item model demonstrated improved goodness of fit indices (RMSEA = 0.053; CFI = 0.999; and SRMR = 0.005). Both the pre-hypothesized six-item and reduced final four-item model demonstrated good internal consistency (Cronbach's alphas of 0.8162 and 0.8754, respectively). Higher levels of internalized stigma were associated with depression, riskier sexual behavior, and reduced condom use. This very brief measure will allow for reliable assessment of internalized stigma among FSW. Further investigation of internalized stigma among male sex workers, particularly the intersection of sex work-related and same-sex behavior-related stigmas, is needed.

Female sex workers and police violence during the Covid-19 health crisis in 2020-2021: results from the EPIC multi-country community-based research program in Argentina

BACKGROUND

Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina.

METHODS

EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020-April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models.

RESULTS

Among 173 respondents, median age was 34 [IQR 27-42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence.

CONCLUSIONS

FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.

HIV- and sex work-related stigmas and quality of life of female sex workers living with HIV in South Africa: a cross-sectional study

BACKGROUND

Environmental quality of life (QoL) assesses individually perceived factors such as physical safety and security, accessibility, quality of healthcare, and physical environment. These factors are particularly relevant in the context of sex work and HIV, where stigma has been identified as an important barrier across several prevention and treatment domains. This study aims to examine the association between different types of HIV- and sex work-related stigmas and environmental QoL among female sex workers (FSW) living with HIV in Durban, South Africa.

METHODS

We conducted cross-sectional analyses using baseline data from the Siyaphambili randomized controlled trial. FSW who reported sex work as their primary source of income and had been diagnosed with HIV for ≥ 6 months were enrolled from June 2018-March 2020, in eThekwini, South Africa. We evaluated the association between environmental QoL, dichotomizing the environmental domain score collected by the WHO Quality of Life HIV Brief (WHOQOL-HIV BREF) questionnaire at the median, and stigma using modified robust Poisson regression models. Five stigma subscales were assessed: sex work-related (anticipated, enacted, or internalized stigma) and HIV-related (anticipated or enacted stigma).

RESULTS

Among 1373 FSW, the median environmental QoL was 10.5 out of 20 [IQR: 9.0-12.5; range 4.0-19.0], while the median overall QoL was 3 out of 5 [IQR: 2-4; range 1-5]. One-third of FSW (n = 456) fell above the median environmental QoL score, while 67% were above the median overall QoL (n = 917). Reporting anticipated sex work stigma was associated with lower environmental QoL (adjusted prevalence ratio [aPR] 0.74 [95% CI 0.61, 0.90]), as was severe internalized sex work stigma (aPR: 0.64, 95% CI 0.48, 0.86). Reporting enacted HIV stigma versus none was similarly associated with lower environmental QoL (aPR: 0.65, 95% CI 0.49, 0.87). Enacted sex work stigma and anticipated HIV stigma were not statistically associated with environmental QoL.

CONCLUSIONS

This study highlights the need to consider the impact of multiple stigmas on FSW's non-HIV related clinical outcomes, including safety and physical well-being. Moreover, these results suggest that addressing underlying structural risks may support the impact of more proximal HIV prevention and treatment interventions. Trial registration NCT03500172 (April 17, 2018).

Sex work stigma and the recuperation of moral personhood through gendered labour: sex worker diaries in Ukraine

Based on a diary writing exercise, this paper illuminates the complex ways in which sex workers in Ukraine actively work through and manage stigma in their daily lives. Pushing beyond the notion of stigma as a static and fixed psychosocial designation that can be readily measured, we argue that stigma is actively confronted by sex workers through various forms of gendered emotional and physical labour that enable them to recuperate a sense of moral personhood. This notion of moral personhood is often tied to wider gender-specific values pertaining to caregiving and motherhood.

Business like any other? New Zealand's brothel industry post-decriminalisation

Sex work is decriminalised in Aotearoa New Zealand and so brothels are deemed a 'businesses like any other' in the eyes of the law. We interviewed 14 brothel operators in this study to understand whether they were able to run their 'business like any other'. Similar to any other business owners, local authorities require brothel operators to run their businesses in accordance with the local district plan. Institutions such as banks and insurance companies, however, have policies which discriminate against brothel owners, and this presents a barrier to running their business like any other. Brothels continue to be seen as discreditable businesses in a decriminalised context and brothel operators internalise this stigma. More effort is needed to reduce stigma and discriminatory practices. The inclusion of the prevention of discrimination on the basis of occupation in New Zealand's Human Rights Act should be the first step. This could better allow brothel operators to run their business like any other in the 'mainstream' economy.

The meaning of fatherhood to men in relationships with female sex workers in Kampala, Uganda: The struggle to model the traditional parameters of fatherhood and masculinity

Many women who engage in sex work in sub-Saharan Africa become pregnant, often unintentionally. There is limited attention paid to the experiences of fathers of children born to women engaged in sex work. We examine the meaning of fatherhood to these men, the significance of children, and how they navigate the economic and cultural challenges of fatherhood in this context. Analysis is based on ethnographic data from 13 men who identified as intimate long-term partners of female sex workers (FSW) in Kampala City, Uganda. Our findings illustrate how men who have children with FSW struggled to model the traditional parameters of fatherhood and masculinity. We found that men who had children with FSW faced hurdles fitting within the social construction of ideal fatherhood. Accepting fatherhood often started with doubts over the pregnancy because of the multiple partnerships of women. Men who only saw themselves as clients struggled to adjust to being fathers because of their perceptions of the social implications of fathering a child with a FSW. Integration of mothers who were also sex workers into the man's extended family was a challenge because of the fear of negative reactions from family members. However, when men accepted their roles as fathers, they started seeing value in their children. Due to poverty, most of the men fell short of the societal measures of masculinity, but children transformed their social status before their society and family. The provider role often used to define good fathering was a challenge for men. However, the financial support from FSW partners softened the burden and facilitated the creation of a family environment constructed to the perceived standards of the broader society. Our findings provide insights into the state of parenting among FSW and their partners which can guide interventions that are tailored to their unique circumstances.

External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland

Background

Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships. This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience.

Methods

WWUD-SS (N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). WWUD-SS were queried about recent difficult experiences with a focus on how they did or did not use social support or formal resources (e.g., clinic, crisis hotline) in response.

Results

Participants were a median age of 37 years, 50% identified as Black, and 50% reported currently injecting drugs. Participants described reluctance to ask for support and often felt resigned to address problems alone. Participants also distinguished between transactional relationships (help is contingent upon receiving something in return) versus genuine (non-transactional or altruistic) support, including the role of family members who do and do not use drugs. Resource utilization was rare, and “self-medication” through substance use was common absent other perceived options for help.

Conclusions

External resilience appears limited among WWUD-SS and shaped by the social and economic contexts of a street-involved life. WWUD-SS’ ability to exercise external resilience may be undercut by experiencing structural vulnerabilities and competition for material resources that create transactional relationships and diminish the perceived value of social support. Internalized stigma, reflecting the larger society’s stigmatized views of drug use, sex work, and poverty, left WWUD-SS eschewing help from outside sources. Focus on internal resilience alone offers an incomplete picture of the construct in drug-using populations. Improving connections to community resources may be a targeted way to strengthen external resilience, as are policies addressing structural vulnerabilities for marginalized communities.

“We Knew No One Else Had Our Back except Us”: Recommendations for Creating an Accountability Care Framework with Sex Workers in Eastern Canada

The authors report findings from a 15-month project that focused on the experiences of sex workers who live and work in an Eastern Canadian province. As part of a larger multi-phased study, 15 adults who identified as women, transgender, or non-binary, and received money or goods for sexual services, participated in photo-elicitation interviews. Drawing on a critical framing analysis, findings indicated supports—as identified and experienced by sex workers—encompassed three categories of care: self, community, and collective. These categories are described, with a particular focus on the latter two. Continuing with the care-based framework, recommendations to structure interventions draw on the role of accountability care in identifying how best to operationalize policies that promote health, well-being, and dignity of Canadian sex workers. The paper begins with a brief overview of the Canadian context and the role of supports. It follows with a discussion on the materials and methods and the results. It concludes with recommendations, limitations, and future considerations.

Challenges and Benefits of Disclosure of Sex Work to Intimate Partners

Sex workers' noncommercial intimate partnerships are marginalized on two counts - they are non-monogamous and at least one partner is in sex work, an occupation with much stigma. We asked a heterogeneous sample of Canadian sex workers (N = 218) about their decisions to reveal/not reveal their sex work to intimate partners, and the resulting challenges and benefits. A minority (58/183) of participants who had been or were currently involved in an intimate relationship kept their work secret from at least one partner or disclosed limited information, shielding them from stigma but resulting in a burden of secrecy. The majority of participants (151/183) who had been/were currently involved in an intimate relationship chose to disclose their sex work to at least one partner, which for most, had one or more negative consequences. A small group of participants related that disclosure resulted in acceptance, support, and understanding from their intimate partner. Some participants avoided the disclosure dilemma by forming intimate relationships from social connections where sex work status was already known. These relationships were generally supportive. We conclude that intimate relationships provide positive experiences for many people who sell sexual services and that these relationships could be stronger if societal stigma was reduced.

Perceived Stigma and Stigma Management Strategies Among Online Male Sex Workers

Technological advances like the Internet and Internet-enabled devices, such as smartphones, and the dating and hookup websites and apps available to the users of them, have transformed the nature, organization, and practice of sex work in fundamental ways. Some scholars have argued that these changes have contributed to a normalization of male exchange sex (i.e., providing sex in exchange for money, drugs, shelter, or goods), and in so doing, have diminished the stigma historically associated with it. However, little empirical research has focused on how male sex workers (MSWs), including those engaged in what might be called informal or incidental or casual sex work and primarily use dating/hookup websites and apps not designed for commercial to meet clients experience and manage stigma. To help fill this gap, we analyzed interview data from 180 MSWs who engaged in exchange sex and met their client on dating/hookup websites and apps. Most participants felt that sex work was still highly stigmatized in society at large, but many also felt it was generally accepted-if not completely normalized-within the gay community. Nevertheless, many struggled with the emotional impact of engaging in a stigmatized practice and most employed one or more of the following stigma management strategies: information management, distancing, discrediting the discreditors, asserting no other option existed, and challenging or reframing stereotypes and narratives. These findings indicate that MSWs, even those engaged in informal or incidental sex work, who meet clients on dating/hookup websites and apps are still strongly affected by sex work-related stigma and seek to manage it in various ways. Future research should investigate the sources of internalized stigma among this under-studied population of sex workers.

Autonomy and Care in Context: The Paradox of Sex Workers' Acceptability of HIV Self-Tests in São Paulo, Brazil

Cisgender female sex workers (CFSW) continue to face structural barriers to HIV prevention. We analyzed the acceptability of the oral HIV self-test (HIV-ST) among CFSW as part of a pragmatic trial on HIV prevention in Brazil. Data from in-depth interviews conducted with 12 women from diverse sex worker contexts and participant observation were analyzed using thematic analysis. CFSW valued autonomy in their workplaces and saw the HIV-ST as a possibility for self-care. Some feared clients' reactions, manager reprimands, and a positive result. HIV and sex work stigma largely drove self-care practices and perceived acceptability of the self-test. We argue that the autonomy offered by the self-test presents a paradox: increasing autonomy on the one hand while risking sidestepping structural dimensions of HIV vulnerability on the other. These nuances must be considered in interventions promoting the HIV-ST by considering the specificities of sex worker contexts, addressing stigma, and effectively involving CFSW and their organizations in intervention development.

The needs and preferences of Eastern Canadian sex workers in mitigating occupational health and safety risks through the use of Information and Communication Technologies: A qualitative study

Sex workers may use Information and Communication Technology (ICT) as a means to mitigate occupational health and safety (OHS) risks by exchanging harm reduction techniques (e.g., screening) on blogs and social media. ICTs can also assist sex workers in creating online communities, where community members can act as each other’s safety check-ins, an additional harm reduction technique. In Canada, there is a paucity of research around ICT usage by sex workers for managing occupational health and safety. The objective of this study was to qualitatively examine the needs and preferences of Canadian sex workers when using ICTs in the delivery of strategies for occupational health and safety. Using a theoretical framework derived from a Social Ecological Model perspective, semi-structured interviews were conducted via phone, with a mixed gender sample (N = 22) of sex workers, between April and July 2020. OHS risks were found to be related to structural determinants, client behaviours, and lack of experience and knowledge when newly entering sex work. Participant accounts revealed a socially cohesive online community; however, sex workers reported difficulties in finding these communities, particularly when entering sex work. Such barriers to supportive communities were attributed to the criminalized, hidden nature of sex work that resulted in the fragmentation of harm reduction techniques across several online platforms, such as blogs, YouTube videos, closed electronic chat groups, and open online sex worker supportive communities. Moreover, these platforms and/or their content could potentially disappear without warning, either due to the platform provider seeking to evade possible prosecution, or because new legislation was introduced banning such content. Recommendations for further research include the co-design with sex workers of an innovative, secure, easily accessible, sex worker-only ICT OHS tool, utilizing a web hosting service located in a country where sex work has been either legalized or decriminalized.

'I miss being honest': sex workers' accounts of silence and disclosure with health care providers in Ireland

In this paper, female sex workers tell stories of their interactions with health care providers (HCP) in four cities in the Republic of Ireland. While Irish society has made great progress in listening to the sexual stories of women that were historically silenced (e.g. stories of abortion, sexual abuse), sex workers have not benefited from this new climate. Regularly silenced by parliamentarians and non-governmental organisations who speak upon their behalf, sex workers are consigned within a narrative of victimhood and coercion. This paper draws from a participant action research study conducted in 2019-20 and explores women's motivations in whether to disclose their sex work, and the strategies deployed to conceal it while seeking access to sexual health care. These strategies included traveling beyond their own communities for health care and STI home testing. The paper identifies women, particularly, migrants who felt their precarious position made it impossible for them to be truthful about their sex work to health care providers, exposing them to greater health risk. The paper understands this marginality within a context of structural violence where sex worker health is shaped by institutional power relations creating unequal health outcomes but is also challenged by stories of solidarity.

Prevalence of Substance Use and Its Association with Sociodemographic and Behavioral Factors among Women Who Conduct Sex Work in Kenya

Female sex workers (FSWs) in sub-Saharan Africa are a marginalized group with an increased morbidity risk. Psychoactive substance use among this group is common and increases the risk of adverse health consequences. The type of substance used, extent, and nature of use varies with different settings and regions. We examine the use of specific psychoactive substances among FSWs residing in an urban informal settlement in Nairobi. This cross-sectional study was conducted between April and August 2017. Structured questionnaires were administered in face-to-face interviews. Descriptive statistics and logistic regression were undertaken to examine prevalence, patterns, and factors associated with use of specific substances. Out of 301 FSWs, 98% reported current psychoactive substance use. The most used substance was alcohol with 95.6% of the study population reporting use in the past year. Of these, 151 (50.2%) met criteria for very high-risk drinkers. Reported current use was 61.5% for cannabis, 47.2% for khat, and 30.9% for tobacco. Factors independently associated with hazardous and harmful alcohol use included earning a higher monthly income (>USD50) and disclosure of sex work to close family and friends. There is an urgent need for preventive and curative interventions to address the high prevalence of substance use among FSW residing in high-risk urban informal settlements in Kenya.

Why Men (Don't) Buy Sex: Purity Moralization and Perceived Harm as Constraints on Prostitution Offending

This study explores the moralization of purity and perceptions of harm as constraints on sex buying among men. Purchasing sex has long been considered an offense against public morality. While personal morality provides a powerful constraint on offending, and people may vary in the extent to which they experience moral intuitions about bodily and spiritual purity, research has so far neglected the role of purity moralization in understanding sex buying behavior. We hypothesize specifically that moral intuitions about purity constrain sex buying by leading people to perceive it as inherently wrong and by eliciting perceptions that sex buying is harmful to prostitutes. We test these hypotheses in a nationally representative survey of U.S. men (N = 2,525). Results indicate that purity moralization is associated with reduced sex buying, and that this relationship is mediated fully by perceptions of sex buying as harming prostitutes.

'It is stigma that makes my work dangerous': experiences and consequences of disclosure, stigma and discrimination among sex workers in Western Australia

Western Australia criminalises sex work whilst some other Australian jurisdictions have decriminalised the industry. This article examines the role of Western Australia's legislation in reinforcing stigma and discrimination of sex workers. It draws on stigma and discrimination-specific results from open-ended survey responses and interview data collected as part of a larger cross-sectional mixed-methods study. Experiences and/or anticipation of stigma and discrimination resulted in some sex workers concealing their involvement in sex work from family, friends and their home communities. This was a major barrier to accessing health care and protective services and impacted negatively on their mental health and wellbeing. There is a need for policy change and support to shift society's perception of sex work to that of a legitimate occupation to decrease sex workers' experiences of stigma and discrimination and improve their access to and utilisation of health care and protective services. These findings highlight the need for the decriminalisation of the Western Australian sex industry and the development of training programmes for police and healthcare workers to reduce the stigma and discrimination experienced by sex workers in these settings.

COVID-19, Stigma, and the Ongoing Marginalization of Sex Workers and their Support Organizations

Primary or first-hand stigma, associated with sex work, sometimes disparagingly referred to as "prostitution" or "whore" stigma, was a fundamental cause of social inequities for sex workers before the COVID-19 pandemic. In addition, courtesy stigma, or stigma by association linked with involvement with a stigmatized group, has long limited the ability of sex worker organizations to secure adequate funds to meet the needs of sex workers in their communities. In reaction to the pandemic, sex worker organizations quickly responded and in a variety of ways have been helping to ease the impact of the pandemic on sex workers in their communities. In November 2020, we interviewed 10 members of sex worker organizations from seven different communities across Canada about how they have been dealing with the immediate and longer-term impacts of the COVID-19 pandemic in their communities. Three strategic actions stood out in the interviews: (1) challenging stigma to help sex workers access government emergency funding; (2) reorganizing and adapting services to provide outreach to sex workers in their communities; and (3) advocating for continuous organizational funding. The findings show that primary stigma and courtesy stigma have further marginalized sex worker organizations and their clients during the pandemic. We conclude with participants' recommendations to address avoidable harms of COVID-19 among sex workers and to better support sex worker organizations in Canada.

Which psychosocial interventions improve sex worker well-being? A systematic review of evidence from resource-rich countries

OBJECTIVE

To establish the state of the evidence base around psychosocial interventions that support well-being in sex workers in order to inform policy and practice within a resource-rich geographical context.

METHODS

Published and unpublished studies were identified through electronic databases (PsychINFO, CINHAL Plus, MEDLINE, EMBASE, The Cochrane Library and Open Grey), hand searching and contacting relevant organisations and experts in the field. Studies were included if they were conducted in high-income settings with sex workers or people engaging in exchange or transactional sex, and evaluated the effect of a psychosocial intervention with validated psychological or well-being measures or through qualitative evaluation.

RESULTS

A total of 19 202 studies were identified of which 10 studies met the eligibility criteria. The heterogeneity found dictated a narrative synthesis across studies. Overall, there was very little evidence of good quality to make clear evidence-based recommendations. Despite methodological limitations, the evidence as it stands suggests that peer health initiatives improve well-being in female street-based sex workers. Use of ecological momentary assessment (EMA), a diary-based method of collecting real-life behavioural data through the use of twice-daily questionnaires via a smartphone, increased self-esteem and behaviour change intentions.

CONCLUSIONS

Work with sex workers should be based on an evidence-based approach. Limitations to the existing evidence and the constraints of this work with vulnerable groups are recognised and discussed.

Harm Reduction and Decriminalization of Sex Work: Introduction to the Special Section

INTRODUCTION

This special section of Sexuality Research and Social Policy, edited by Belinda Brooks-Gordon, Max Morris and Teela Sanders, has its origins in a colloquium sponsored by the University of Cambridge Socio-Legal Group in 2020. The goal was to promote the exchange of ideas between a variety of disciplinary research fields and applied perspectives on harm reduction and the decriminalization of sex work. The colloquium took place during the emergence of the coronavirus pandemic in February 2020.

METHODS

We explore the impact of Covid-19 on understandings of sex work, outline the basic underpinning legal philosophical question, explore the intersectional politics of decriminalization, summarize contemporary international health and human rights campaigns, explore contemporary public opinion trends on the issue, and illustrate the universal principles. Finally, we summarize the special section papers (N=12).

RESULTS

The Covid pandemic provided a lens through which to analyse the changes that have occurred in sex work and sex work research in the past decade and it also exacerbated intersecting inequalities, accelerated many social shifts already in motion whilst changing the course of others. In combination the papers in this special issue examine sex work policy and research across 12 countries in four continents to provide and important space for international and cross-cultural comparison.

CONCLUSIONS

We present the timely contributions of diverse authors and comment on the significance of their research projects which support a decriminalization policy agenda for the benefit of academics, policymakers and practitioners to improve public health strategies and international responses.

POLICY IMPLICATIONS

The research here amplifies the focus on harm reduction and strengthens the case for public policy that decriminalizes commercial sex between consenting adults as the best strategy to reduce harm.

Findommes, Cybermediated Sex Work, and Rinsing

INTRODUCTION

Financial domination involves the payment of cash or gifts from a wish list by a money slave to a money mistress, financial dominatrix, or findomme. Boundaries for findommes working through webcam and video-call services may be more fluid than via text-based modes since the domme engages in more visible displays, and modification of language, voice, and feelings to fulfil the fantasy for a client. We explore the nature of findomme work and its relationship to BDSM to understand how the interaction progresses and how the boundaries, of reasonable and permissible behaviour which affect both incoming and outgoing interactions between people, are maintained.

METHODS

The study was in two stages. The first stage was a survey of online findommes (n = 56) in UK and the USA. For the second stage, we explored the experience of findommes (n = 195) on money-slavery websites and social media feeds using netnography as an observation method with cisgender male, female, and transgender participants.

RESULTS

Our analysis reveals how findomme interaction progresses from text-based interaction to virtual face-to-face and voice communication. We show financial domination to be on a continuum from being a lifestyle choice in the BDSM community that reaps financial benefits to a purely economic and legitimate form of commercial labour. Although financial domination clearly elicits sexual arousal for clients, the relationship can also be exclusively psychological and focus on the relinquishing of control to a money mistress for a prescribed period.

CONCLUSION

The findings also show how personal boundaries are negotiated and enhance understanding of how the microculture of findomming interacts with other microcultures. By demystifying the process of financial domination, we clarify its relationship with other microcultures and add to the growing body of literature that destigmatizes consensual erotic labour.

IMPLICATIONS

These findings show how online support, in a decriminalised environment, enabled new and 'instadommes' to set and maintain healthy boundaries for enhanced physical and psychological well-being, and the research provides valuable insight into sex work that is safely carried out in online spaces by a large number of participants so adding to the growing body of work on decriminalization.

Why Report? Sex Workers who Use NUM Opt out of Sharing Victimisation with Police

BACKGROUND

National Ugly Mugs (NUM) is a UK-wide violence prevention and victim support charity that provides a mechanism for sex workers to share safety information and obtain support for harms that they may experience during the course of their work. Over the past several years, NUM has witnessed a decline in sex workers willing to access police as part of their recovery journeys after experiencing victimisation. In 2012, 28% of those reporting to NUM chose to engage with the legal system; in 2020, this was down to 7.7% amongst off-street independent workers. Statistics for 2021 indicate a continuation of this downward trend. Furthermore, anonymous consent to share information with police also declined from 95% in 2012 to 69% in 2020.

METHODS

NUM conducted a survey of 88 sex working members in 2020. This information combined with our data on victimisation provides insights of the factors that deter sex workers from involving police as part of their justice-seeking efforts.

RESULTS

Survey results reveal that sex workers feel alienated and untrusting of police and courts.

CONCLUSIONS

The implications of sex workers not sharing information about dangerous individuals with police and choosing not to participate in court processes signal significant flaws in our legal system regarding safe and inequitable access and pose dangers for all of us.

Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers

BACKGROUND

Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population.

METHODS

Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia).

RESULTS

Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion.

CONCLUSIONS

More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs.

"They look at you like you're contaminated": how HIV-related stigma shapes access to care for incarcerated women living with HIV in a Canadian setting

OBJECTIVES

Given the gender disparities in HIV outcomes for women living with HIV (WLWH) who experience incarceration, and the impact of HIV-related stigma on HIV care, this qualitative study investigated how HIV-related stigma within prison settings shapes HIV care for WLWH.

METHODS

Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research project with cisgender and transgender WLWH in Metro Vancouver, peer and community interviewers conducted 19 qualitative interviews (May 2017-February 2018) with recently incarcerated WLWH focused on factors that shape incarceration trajectories. Drawing on socio-ecological frameworks and using participatory analysis, this analysis sought to characterize how HIV-related stigma shapes experiences and access to care for incarcerated WLWH.

RESULTS

Participants' responses focused predominately on experiences in provincial correctional facilities and the ways through which HIV-related stigma within correctional settings was linked to access to HIV care. Experiences of HIV-related stigma within prisons led to isolation and discrimination for WLWH which was reinforced through institutional processes, compromised privacy, and uncertainty about confidentiality. Experiences of HIV-related stigma informed decisions for some participants to withhold HIV status from healthcare staff, compromising access to HIV treatment during incarceration.

CONCLUSION

Amid ongoing efforts to improve healthcare delivery within Canadian correctional facilities, these findings have important implications for the provision of HIV care for incarcerated WLWH. Culturally safe, trauma-informed programming focused on reducing HIV-related stigma, improved communication regarding medical privacy, and interventions to change processes that compromise privacy is critical to improve healthcare access in correctional facilities.

Exploring the dynamics of workplace typologies for sex workers in Eastern Ukraine

We examine the typologies of workplaces for sex workers in Dnipro, Ukraine as part of the larger Dynamics Study, which explores the influence of conflict on sex work. We conducted a cross-sectional survey with 560 women from September 2017 to October 2018. The results of our study demonstrate a diverse sex work environment with heterogeneity across workplace typologies in terms of remuneration, workload, and safety. Women working in higher prestige typologies earned a higher hourly wage, however client volume also varied which resulted in comparable monthly earnings from sex work across almost all workplace types. While sex workers in Dnipro earn a higher monthly wage than the city mean, they also report experiencing high rates of violence and a lack of personal safety at work. Sex workers in all workplaces, with the exception of those working in art clubs, experienced physical and sexual violence perpetrated by law enforcement officers and sex partners. By understanding more about sex work workplaces, programmes may be better tailored to meet the needs of sex workers and respond to changing work environments due to ongoing conflict and COVID-19 pandemic.

Prostitution Policies and Attitudes Toward Prostitutes

The present study examined whether regulatory attitudes toward prostitution are related to agency attributed to prostitutes and moral outrage. A Spanish sample (N = 391, aged 18-53 years old) completed a questionnaire that included two separate parts. In the first part, participants answered a scale on regulatory attitudes toward prostitution; in the second part, after reading one of two scenarios, participants answered questions about agency and moral outrage. Results showed a different pattern in the link between regulatory attitudes and social perception when participants perceived prostitutes as victims of sexual slavery (Scenario 1) or as women who freely choose to sell sexual services (Scenario 2). This study provides empirical evidence of how some regulatory attitudes toward prostitution are linked to mind attributions and negative feelings toward sex workers, and how it depends on the type of prostitute who practices it. These findings contribute to our knowledge of attitudes toward prostitution, which could inform future policy-making.

Identity Construction of Men Who Pay Women for Sex: A Qualitative Meta-Synthesis

This interpretive qualitative meta-synthesis (QMS) aims to systematically review what we know about identity construction of men who pay women for sex (MPWS). A corpus of 54 qualitative studies about the experiences and perceptions of MPWS was synthesized, using the theoretical framework of symbolic interaction and QMS guidelines. This synthesis yielded novel insights into the meanings that MPWS attribute to their involvement in the sex industry, within a range of interpersonal interactions and social discourses. We identified and expanded on six social discourses that affect the identity construction of MPWS: sexuality; intimacy; consumerism; power; deviancy and normativity; and masculinity. The findings demonstrate that paying for sex (and in particular, the stigma associated with it) permeates many life spheres of MPWS, and affects their gendered, sexual, cultural, intimate, consumerist and social identities, and self-perceptions. The discussion centers on four major understandings derived from the QMS: paying for sex is central to the lives of MPWS; paying for sex generates conflict in the identities of MPWS; discourses of masculinity are prominent in the identity construction processes of MPWS; and the literature on MPWS needs further social and cultural contextualization. These understandings have profound implications for sex-industry-related policy and social interventions.

Examining hopes, aspirations, and future plans of women in non-brothel-based sex work in Kolkata, India

Sex work can offer a quick way of making money and is the only profession in which women may earn more in fewer hours when compared to other available jobs. However, most studies with sex workers in India are based on socially biased assumptions about sex work; that is, women are either coerced or trafficked into sex work. Limited attention has been paid to the voices of non-brothel-based sex workers in India. Drawing data from a larger ethnographic study conducted between December 2009 and July 2010, this paper analyses how women sex workers operating from non-brothel-based sex work settings in Kolkata, India, foresee their future. Unlike the popular 'victim imagery' of women sex workers in the Global South, this study found that women are not passive recipients of the trade; instead, they employ agency - sometimes transgressing the normative boundaries and at times reinscribing these boundaries to secure a future for themselves and their families. Therefore, to promote HIV preventive behaviour programmes reaching out to sex workers, non-governmental organisations (NGOs) must proactively inquire about women's future plans and assist them in materialising their future goals, which are mostly concerned with their children's future, a life free of stigma/shame, and financial security in old age.