Exposed and unprotected: Sex worker vulnerabilities during the COVID-19 health emergency in Mozambique

What research evidence is required on violence against women to inform future pandemic preparedness? A scoping review of the research evidence and gaps

INTRODUCTION

Violence against women (VAW) during the COVID-19 pandemic was described as the 'shadow pandemic' with an increase in reports of VAW. As countries now focus on becoming more resilient to future pandemics, it is critical to understand what we learnt about evidence on VAW burden, prevention, and response during the COVID-19 pandemic. The WHO commissioned this scoping review to gain an understanding of the research evidence on VAW during COVID-19 and to inform future pandemic preparedness efforts.

METHODS

Terms relating to VAW and COVID-19 were used to search six databases between 1 January 2020 and 11 February 2023, inclusive of all study designs. Data on thematic focus (ie, burden of violence and/or interventions/services), types of violence, study design, study setting and participant characteristics were synthesised.

RESULTS

Of 25 080 identified records, 694 publications were reviewed in full text and 419 publications were included. The majority (>95%) of the published research was devoted to documenting the burden of VAW, while only 6.2% studied solutions (interventions/services), with even less emphasis on identifying how to prevent VAW in a pandemic context (1%). Gaps in research on VAW that existed prior to the pandemic on women who face multiple intersecting forms of disadvantage endured. Outstanding also was the gap in research on digital-mediated violence (<5%), even as reports of online facilitated violence soared. Additionally, gaps in evidence on specific types of violence such as femicide, forced marriage and acid attacks persisted.

CONCLUSION

That VAW will be a critical concern, and its impacts worsened during pandemics in the future is certain. The research community does not need to spend more on understanding the burden of forms of VAW but pivot to research to adapt and innovate how to deliver prevention and support services, especially to populations who are disproportionately impacted. In addition to addressing this broader gap in prevention and response during pandemics, further evidence is required on the specific area of technology-mediated violence, femicide, forced marriage and acid attacks.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic

The COVID-19 pandemic profoundly affected physical, mental, and economic well-being across the globe and has disproportionately affected certain vulnerable groups. This paper provides a scoping review of literature on the impact of the COVID-19 pandemic on sex workers, published between December 2019 and December 2022. Six databases were systematically searched, identifying 1009 citations; 63 studies were included in the review. Thematic analysis revealed eight main themes: financial issues; exposure to harm; alternate ways of working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, mental health, and coping; access to support; access to health care; and the impact of COVID-19 on research with sex workers. COVID-associated restrictions led to reduced work and income, leaving many sex workers struggling to cover basic needs; additionally, government protections excluded those working in the informal economy. Fearing the loss of their already reduced number of clients, many felt compelled to compromise both prices and protective measures. Although some engaged in online sex work, this raised concerns about visibility and was impossible for those without technological access or skills. Many feared COVID-19, but felt pressure to continue working, often with clients who refused to wear masks or share exposure history. Other negative impacts on well-being related to the pandemic included reduced access to financial support or health care. Marginalized populations (and especially those in professions which require close contact like sex workers) need further support and capacity-building within the community to recover from the impact of COVID-19.

[Impact of COVID-19 on public health in sub-Saharan Africa]

Objective

This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa.

Method

A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years.

Results

The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system.

Conclusion

Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.

Intersectional vulnerabilities and differential impacts of COVID-19 responses on young people who sell sex in Zimbabwe

The varying impact of the COVID-19 pandemic on different populations has brought into focus the pre-existing inequalities which shape vulnerabilities amongst marginalised and key populations. More nuanced approaches which understand intersectional vulnerabilities and differential impacts of the pandemic on gender and sexuality diversity within these groups are required. We investigated the economic, social and health impacts of COVID-19 on young people of diverse genders and sexualities who sell sex (16-24 years) in Zimbabwe. We found that all groups had heightened vulnerability to economic and social hardship during the first two COVID waves in Zimbabwe. However, vulnerability was unequally distributed by geography and socio-economic position, as well as by gender and age, both within and between groups of participants. With limited funding resources for the promotion of sexual and reproductive health and rights in the push for universal health coverage, nuanced approaches which include analysis of multidimensional vulnerabilities between and within groups is required to develop the most cost effective and impactful policy and programme interventions.