"A condom is compulsory": A qualitative study of condom use and negotiation strategies among female sex workers in Nepal

Sharing Culture and Management of Sex Work Information on Mobile Phones by Female Sex Workers in Nepal: Implications for mHealth Practice and Research

Female sex workers (FSWs) in Nepal continue to be disproportionately at risk for Sexually Transmitted Infections (STIs), including HIV. Due to stigma related to sex work and HIV, FSWs keep their sex work information hidden, which poses a barrier to seeking health services. Emerging research indicates a high uptake of mobile phones among FSWs in Nepal. Mobile health (mHealth) interventions can provide health information and linkage to care. However, largely missing from the literature is FSWs' experience of managing the information about their involvement in sex work in a culture where sharing personal information and belongings is a part of the social norm, and maintaining privacy could have negative social repercussions. The current study aims to understand how FSWs perceive and manage privacy when they share their mobile phones. Using the Communication Privacy Management theory, we explore FSWs' perception of the threat to their privacy posed by mobile phones. We conducted 30 in-depth interviews among FSWs in Kathmandu, Nepal. Results showed that all participants owned mobile phones, and sharing devices was common. Mobile phones pose a considerable challenge in keeping sex work information private, and FSWs use various communication strategies to circumvent privacy threats. The findings highlight the mental and emotional burden FSWs face trying to conceal their private information in a sharing culture. The study discusses the importance of theorizing privacy in the cultural context of the Global South and the practical implications for developing mHealth interventions for this population.

Oral health and health care in female sex workers: concomitant quantitative and qualitative approaches

Sex workers, including female ones, have a higher risk of developing cancer and oral diseases due to the overlapping of risk factors. To characterize oral health status and healthcare practices and behaviors in female sex workers. Both quantitative and qualitative concomitant approaches were used. A closed-ended questionnaire, clinical examination, and semi-structured interview were administered, from July 2017 to August 2018, to 21 intentionally selected participants, in the city of Itajaí, southern Brazil. Although the participants reported having good oral health and healthcare habits, some oral diseases and harmful habits were observed. Poor oral hygiene and habits such as smoking, alcohol, and illicit drug use were found. Most of the participants had undergone gynecological follow-up in the last 12 months. Qualitative analysis gave rise to six categories: Social aspects of working as a sex worker, Work routine, Sexual practices and behaviors and protection from sexually transmitted infections, Practices and behaviors (including unprotected sun exposure, smoking, and alcohol use at work), Use of illicit drugs at work, and General and oral health care and perceptions about their oral health. Oral health status of the participants was variable, and most of them smoked cigarettes, drank alcohol, and consumed illicit drugs at work. Preventive condom use was reported. Most of them underwent recent serological tests for sexual diseases and gynecological follow-up, incentivized by the community health workers that facilitate access to public services.