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Goldenberg SM, Pearson J, Moreheart S, Nazaroff H, Krüsi A, Braschel M, Bingham B, Shannon K. Prevalence and structural correlates of HIV and STI testing among a community-based cohort of women sex workers in Vancouver Canada. PLoS One 2023; 18:e0283729. [PMID: 36996154 PMCID: PMC10062647 DOI: 10.1371/journal.pone.0283729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In light of the stark inequities in HIV and sexually transmitted infections (STIs) experienced by women sex workers, empirical evidence is needed to inform accessible and sex worker-friendly models of voluntary, confidential and non-coercive HIV and STI testing. We evaluated the prevalence and structural correlates of HIV/STI testing in the last 6 months in a large, community-based cohort of women sex workers in Vancouver, Canada. METHODS Data were drawn from an open community-based open cohort of women sex workers (January 2010-August 2021) working across diverse street, indoor, and online environments in Vancouver, Canada. Using questionnaire data collected by experiential (sex workers) and community-based staff, we measured prevalence and used bivariate and multivariable logistic regression to model correlates of recent HIV/STI testing at enrollment. RESULTS Of 897 participants, 37.2% (n = 334) identified as Indigenous, 31.4% as Women of Color/Black (n = 282), and 31.3% (n = 281) as White. At enrollment, 45.5% (n = 408) reported HIV testing, 44.9% (n = 403) reported STI testing, 32.6% (n = 292) reported receiving both HIV and STI testing, and 57.9% (n = 519) had received an HIV and/or STI test in the last 6 months. In adjusted multivariable analysis, women accessing sex worker-led/specific services had higher odds of recent HIV/STI testing, (Adjusted Odds Ratio (AOR): 1.91, 95% Confidence Interval (CI): 1.33-2.75), whereas Women of Color and Black women (AOR: 0.52, 95%CI: 0.28-0.98) faced significantly lower odds of recent HIV/STI testing. CONCLUSIONS Scaling-up community-based, sex worker-led and tailored services is recommended to enhance voluntary, confidential, and safe access to integrated HIV/STI testing, particularly for Women of Color and Black Women. Culturally safe, multilingual HIV/STI testing services and broader efforts to address systemic racism within and beyond the health system are needed to reduce inequities and promote safe engagement in services for racialized sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Hannah Nazaroff
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Brittany Bingham
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Indigenous Health, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018). J Immigr Minor Health 2022; 24:256-299. [PMID: 33811583 PMCID: PMC8487436 DOI: 10.1007/s10903-021-01184-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
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Affiliation(s)
- Stefanie Machado
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Argentina E Servin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
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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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Logie CH, White RH, Galai N, Tomko C, Sherman SG. Brief Report: Longitudinal Associations Between Place of Sex Work and Client Condom Coercion Among Sex Workers in Baltimore, Maryland. J Acquir Immune Defic Syndr 2020; 85:579-583. [PMID: 32925362 DOI: 10.1097/qai.0000000000002494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The sex work environment influences sex workers' control over enforcing condom use. Sex work in outdoor and public spaces, compared with indoor spaces, may inhibit condom negotiation. We examined longitudinal associations between public place of sex work and condom coercion among female sex workers. METHODS This cohort study involved 5 data collection points over 1 year among female sex workers (N = 246) in Baltimore, Maryland, recruited by targeted sampling. We conducted bivariate analyses to examine associations between currently conducting any sex work in a public place (PPSW, eg, car, abandoned house, street, park/forest, and public bathroom) vs. exclusively indoor sex work (eg, house, motel, and dance club) with sociodemographic, substance use (eg, injection drug use, crack use), and past 3-month condom coercion (eg, client condom refusal/removal). We used logistic regressions with generalized estimating equations and exchangeable correlation structure to examine longitudinal associations between PPSW and subsequent condom coercion, adjusting for sociodemographic and substance use variables. FINDINGS Among participants (race/ethnicity: White: 67.5%; Black/African American: 22.8%; Latina/other ethnicity: n = 9.8%; age range: 18-61), most reported daily injection drug use (58.5%), daily crack use (62.2%), and homelessness (62.2%). Most (88.6%) reported any PPSW at baseline. Current PPSW was associated with increased odds of past 3-month condom coercion (adjusted odds ratio [aOR]: 1.85, 95% confidence interval: 1.16 to 2.94, P = 0.01) compared with indoor sex work, as was daily crack use (aOR 1.67, 95% confidence interval: 1.18 to 2.37). CONCLUSIONS Public sex work environments were associated with client condom coercion and confer additional sexual health risks in contexts of illegality. Interventions should address risk disparities in social geographies of sex work.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Rebecca H White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
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Goldenberg S, Liyanage R, Braschel M, Shannon K. Structural barriers to condom access in a community-based cohort of sex workers in Vancouver, Canada: influence of policing, violence and end-demand criminalisation. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:301-307. [PMID: 32184290 PMCID: PMC7850467 DOI: 10.1136/bmjsrh-2019-200408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Sex workers (SWs) face a disproportionate burden of HIV/sexually transmitted infections (STIs), violence and other human rights violations. While recent HIV prevention research has largely focused on the HIV cascade, condoms remain a cornerstone of HIV prevention, requiring further research attention. Given serious concerns regarding barriers to condom use, including policing, violence and 'end-demand' sex work criminalisation, we evaluated structural correlates of difficulty accessing condoms among SWs in Vancouver over an 8-year period. METHODS Baseline and prospective data were drawn from a community-based cohort of women SWs (2010-2018). SWs completed semi-annual questionnaires administered by a team that included lived experience (SWs). Multivariable logistic regression using generalised estimating equations (GEE) modelled correlates of difficulty accessing condoms over time. RESULTS Among 884 participants, 19.1% reported difficulty accessing condoms during the study. In multivariable GEE analysis, exposure to end-demand legislation was not associated with improved condom access; identifying as a sexual/gender minority (adjusted odds ratio (aOR) 1.62, 95% CI 1.16 to 2.27), servicing outdoors (aOR 1.52, 95% CI 1.17 to 1.97), physical/sexual workplace violence (aOR 1.98, 95% CI 1.44 to 2.72), community violence (aOR 1.79, 95% CI 1.27 to 2.52) and police harassment (aOR 1.66, 95% CI 1.24 to 2.24) were associated with enhanced difficulty accessing condoms. CONCLUSIONS One-fifth of SWs faced challenges accessing condoms, suggesting the need to scale-up SW-tailored HIV/STI prevention. Despite the purported goal of 'protecting communities', end-demand criminalisation did not mitigate barriers to condom access, while sexual/gender minorities and those facing workplace violence, harassment or those who worked outdoors experienced poorest condom accessibility. Decriminalisation of sex work is needed to support SWs' labour rights, including access to HIV/STI prevention supplies.
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Affiliation(s)
- Shira Goldenberg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Ruchi Liyanage
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Sou J, Shannon K, Shoveller J, Duff P, Braschel M, Dobrer S, Goldenberg SM. Impacts of im/migration experience on work stress among sex workers in Vancouver, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:344-353. [PMID: 30565164 PMCID: PMC6551268 DOI: 10.17269/s41997-018-0161-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Despite the precarious and unsafe working conditions frequently experienced by sex workers (SWs) and im/migrant workers, there remains a paucity of research on work-related stress and links to duration of im/migration residency among SWs. This study analyzes the relationship between duration of residency and two dimensions of work stress among SWs in Metro Vancouver. METHODS Data were drawn from a longitudinal cohort of women SWs across Metro Vancouver (2010-2014). Multivariable confounder models with generalized estimating equations were developed to examine the independent effects of duration of residency on decision authority and job demands, after adjusting for confounders. RESULTS Of 545 SWs, 9.7% were recent im/migrants, 13.9% were long-term im/migrants, and 76.2% were non-migrants. In comparison to non-migrant SWs, recent (β coefficient - 1.02, 95% CI - 1.57 to - 0.47) and long-term im/migrants (β coefficient - 0.87, 95% CI - 1.36 to -0.38) faced decreased work stress related to job demands after adjustment for key confounders. Decision authority did not retain a significant independent association after adjusting for the same factors. CONCLUSION Job demands varied significantly by duration of residency. This may be explained by changing working conditions and experiences over the course of arrival and settlement among im/migrant SWs, as well as the role of formal work environments in supporting im/migrant SWs' well-being. Given high rates of work stress related to job demands and low decision authority among all SWs, decriminalization of sex work, improved occupational standards, and culturally sensitive interventions to promote collectivization and improved access to working conditions remain needed.
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Affiliation(s)
- Julie Sou
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sabina Dobrer
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira M Goldenberg
- Centre for Gender & Sexual Health Equity, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Argento E, Goldenberg S, Shannon K. Preventing sexually transmitted and blood borne infections (STBBIs) among sex workers: a critical review of the evidence on determinants and interventions in high-income countries. BMC Infect Dis 2019; 19:212. [PMID: 30832596 PMCID: PMC6399876 DOI: 10.1186/s12879-019-3694-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
Background Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries. Methods We searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited. Results Research demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted. Conclusions The high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.
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Peltzer K. Longitudinal analysis of HIV risk behaviour patterns and their predictors among public primary care patients with tuberculosis in South Africa. SAHARA J 2018; 15:1-6. [PMID: 29402184 PMCID: PMC5804809 DOI: 10.1080/17290376.2018.1433057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The goal of this study was to identify various HIV risk behaviours among tuberculosis (TB) patients in a longitudinal study design in South Africa. In 42 public primary healthcare facilities in three districts in three provinces, adult new TB and TB retreatment patients with hazardous or harmful alcohol use were interviewed within 1 month of initiation of anti-TB treatment and were followed up at 6 months. The total sample with a complete 6-month follow-up assessment was 853. At the follow-up assessment, several HIV risk behaviours significantly reduced from baseline to follow-up. In multivariate Generalized Estimating Equations logistic regression analyses, high poverty (odds ratio (OR): 2.68, 95% confidence interval (CI): 1.56–4.62), Posttraumatic Stress Disorder (PTSD) symptoms (OR = 1.55, 95% CI = 1.03–2.36), and sexual partner on antiretroviral therapy (ART) (OR = 1.84, 95% CI = 1.09–3.10) were associated with a higher odds, and excellent/very good perceived health status (OR: 0.61, 95% CI: 0.37–0.98), severe psychological stress (OR = 0.51, 95% CI = 0.34–0.77), and HIV non-disclosure to most recent sexual partner (OR = 0.40, 95% CI = 0.25–0.65) were associated with a lower odds of inconsistent condom use. Being HIV positive (OR = 4.18, 95% CI = 2.68–6.53) and excellent/very subjective health status (OR = 2.98, 95% CI = 1.73–5.13) were associated with a higher odds, and having PTSD symptoms (OR = 0.60, 95% CI = 0.36–0.99), being on ART (OR = 0.48, 95% CI = 0.25–0.95), having a sexual partner on ART (OR = 0.41, 95% CI = 0.18–0.96), and HIV status non-disclosure (OR = 0.25, 95% CI = 0.15–0.41) were associated with a lower odds of having sex with an HIV-positive or HIV status unknown person. High poverty index (OR = 1.97, 95% CI = 1.19–3.25) and having a sexual partner on ART (OR = 4.37, 95% CI = 1.82–10.48) were associated with a higher odds, and having a partner with HIV-negative status (OR = 0.29, 95% CI = 0.16–0.51) and inconsistent condom use (OR = 0.39, 95% CI = 0.24–0.64) were associated with a lower odds of HIV status non-disclosure at last sex. The study found that among TB patients with problem drinking over a 6-month TB treatment period, the frequency of some HIV risk behaviours (inconsistent condom use) declined (OR = 0.64, 95% CI = 0.41–0.98), but also persisted at a high-level calling for a strengthening and integration of HIV prevention into TB management.
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Affiliation(s)
- Karl Peltzer
- a HIV/AIDS/STIs and TB (HAST) , Human Sciences Research Council , Pretoria , South Africa.,b Department of Research & Innovation , University of Limpopo, Turfloop Campus , Sovenga , South Africa
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Selvey LA, Hallett J, McCausland K, Bates J, Donovan B, Lobo R. Declining Condom Use Among Sex Workers in Western Australia. Front Public Health 2018; 6:342. [PMID: 30547024 PMCID: PMC6278845 DOI: 10.3389/fpubh.2018.00342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/05/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction: Since the emergence of the HIV pandemic in the 1980s, high rates of condom use for penetrative sex have been reported among sex workers in Australia. The sex industry in Australia and elsewhere has changed over the previous decade with increasing proportions of sex workers working privately and lower proportions of sex workers working in brothels. There has also been some evidence of reductions in condom use, particularly during penetrative oral sex. We therefore decided to investigate sex workers' use of condoms during penetrative sex with clients. Methods: This was a cross-sectional mixed methods study of sex workers in Western Australia. The study involved an environmental scan of the sex industry in Western Australia, visits to brothels and other sexual services premises, a survey of sex workers and in-depth interviews. Results: We surveyed 354 male, female, and transgender sex workers in Western Australia. We found unexpectedly low rates of reported condom use with clients for all forms of penetrative sex. Of respondents who reported providing this type of service, 33% reported that all clients used condoms during oral sex, 69% during vaginal sex and 59% during anal sex. High levels of client demand for condomless sex was also reported, with 42% of sex workers reporting that all or most clients requested condomless oral sex. Increasing client demand, fear of losing clients and the ability to charge more for condomless sex were reported reasons for providing this service. Conclusions: There has been an apparent increase in sex workers reporting condomless penetrative sex with clients in Western Australia compared to a previous cross-sectional study. An increase in private sex work and client demand for condomless sex together with an economic downturn leading to increased competition for clients may be important contributing factors.
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Affiliation(s)
- Linda A Selvey
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Julie Bates
- Urban Realists Planning & Health Consultants, Sydney, NSW, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
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Goldenberg SM, Rocha Jiménez T, Brouwer KC, Morales Miranda S, Silverman JG. Influence of indoor work environments on health, safety, and human rights among migrant sex workers at the Guatemala-Mexico Border: a call for occupational health and safety interventions. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:9. [PMID: 29394893 PMCID: PMC5797417 DOI: 10.1186/s12914-018-0149-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Migrant women are over-represented in the sex industry, and migrant sex workers experience disproportionate health inequities, including those related to health access, HIV and sexually transmitted infections (STIs), and violence. Despite calls for occupational sex work interventions situated in labour rights frameworks, there remains a paucity of evidence pertaining to migrant sex workers' needs and realities, particularly within Mexico and Central America. This study investigated migrant sex workers' narratives regarding the ways in which structural features of work environments shape vulnerability and agency related to HIV/STI prevention and violence at the Guatemala-Mexico border. METHODS Drawing on theoretical perspectives on risk environments and structural determinants of HIV in sex work, we analyzed in-depth interviews, focus groups, and ethnographic fieldwork conducted with 39 migrant sex workers in indoor work environments between 2012 and 2015 in Tecún Umán, Guatemala. RESULTS Participant narratives revealed the following intersecting themes to be most closely linked to safety and agency to engage in HIV/STI prevention: physical features of indoor work environments (e.g., physical layout of venue, proximity to peers and third parties); social norms and practices for alcohol use within the workplace; the existence and nature of management practices and policies on health and safety practices; and economic influences relating to control over earnings and clients. Across work environments, health and safety were greatly shaped by human rights concerns stemming from workplace interactions with police, immigration authorities, and health authorities. CONCLUSIONS Physical isolation, establishment norms promoting alcohol use, restricted economic agency, and human rights violations related to sex work policies and immigration enforcement were found to exacerbate risks. However, some establishment policies and practices promoted 'enabling environments' for health and safety, supporting HIV/STI prevention, economic agency, and protection from violence and exploitation; these practices and policies were especially crucial for recent migrants. Policy reforms and structural workplace interventions tailored to migrant sex workers' needs are recommended to promote improved working conditions and migrant sex workers' health, safety, and human rights.
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Affiliation(s)
- Shira M Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 0507, La Jolla, CA, 92093-0507, USA.
| | - Teresita Rocha Jiménez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 0507, La Jolla, CA, 92093-0507, USA
| | - Kimberly C Brouwer
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 0507, La Jolla, CA, 92093-0507, USA
| | - Sonia Morales Miranda
- Instituto Mesoamericano para la Gobernanza (IMAG), 53 Calle 42-74, Vista Hermosa IV, Caledonia 4D, Zona 16, Guatemala City, Guatemala
| | - Jay G Silverman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 0507, La Jolla, CA, 92093-0507, USA
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11
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Zoboli F, Martinelli D, Di Stefano M, Fasano M, Prato R, Santantonio TA, Fiore JR. Correlation between knowledge on transmission and prevention of HIV/STI and proficiency in condom use among male migrants from Africa and Middle East evaluated by a Condom Use Skills score using a wooden penile model. BMC Res Notes 2017. [PMID: 28629409 PMCID: PMC5477424 DOI: 10.1186/s13104-017-2520-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants in Italy are prevalently young adults, with a higher risk of sexual transmitted infections (STI) and HIV infection. Promoting consistent as well as correct use of condoms could reduce failure rate due to their improper use. The aim of our study was to evaluate Condom Use Skills among a migrant population recently landed in Italy, hosted in a government center for asylum seekers. METHODS The study sample was composed of 80 male migrants. Sanitary trained interviewers submitted a questionnaire to participants to investigate age, provenience, marital status, educational level and knowledge about transmission and prevention of HIV/STI. Then, we assessed participants' level of condom use skill with the Condom Use Skills (CUS) measure by using a wooden penile model. The interviewer filled in a checklist and assigned 1 point for correct demonstration of each behavior that may prevent condom failure during sex. RESULTS Participants' median age was 26 years and the sample was composed of 54 migrants from sub-Saharan Africa and 26 from Middle East. Most of them were married, with a lower middle level of education, up to 8 or 5 years. Half of the sample achieved the highest score in the questionnaire and our CUS showed a large number of people with middle high score classes. The Spearman's rho was 0.30, therefore answers to the questionnaire and CUS score appeared correlated (p < 0.05). In the multivariate model, to have a higher CUS score resulted to be associated to be older than 26 years (p < 0.05), with a higher level of education (p = 0.001), and a higher score in the questionnaire (p < 0.05). There were no significant differences in the level of CUS between single or married men and between African and Middle Asian migrants of the sample. CONCLUSIONS Our study shows that educational level influences the quality of knowledge and awareness about STI/AIDS and contribute to correct condom use. Since the half of participants had a low educational level and linguistic problems, the risk of missing campaigns messages or misunderstanding informative materials increases. Direct observation of condom-application on penile model may offer realistic assessment of application skills in these individuals.
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Affiliation(s)
- Fabio Zoboli
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Domenico Martinelli
- Sector of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mariantonietta Di Stefano
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Massimo Fasano
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Rosa Prato
- Sector of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Teresa Antonia Santantonio
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Jose' Ramòn Fiore
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy.
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12
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Goldenberg SM, Krüsi A, Zhang E, Chettiar J, Shannon K. Structural Determinants of Health among Im/Migrants in the Indoor Sex Industry: Experiences of Workers and Managers/Owners in Metropolitan Vancouver. PLoS One 2017; 12:e0170642. [PMID: 28141835 PMCID: PMC5283672 DOI: 10.1371/journal.pone.0170642] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 01/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background Globally, im/migrant women are overrepresented in the sex industry and experience disproportionate health inequities. Despite evidence that the health impacts of migration may vary according to the timing and stage of migration (e.g., early arrival vs. long-term migration), limited evidence exists regarding social and structural determinants of health across different stages of migration, especially among im/migrants engaged in sex work. Our aim was to describe and analyze the evolving social and structural determinants of health and safety across the arrival and settlement process for im/migrants in the indoor sex industry. Methods We analyzed qualitative interviews conducted with 44 im/migrant sex workers and managers/owners working in indoor sex establishments (e.g., massage parlours, micro-brothels) in Metropolitan Vancouver, Canada in 2011; quantitative data from AESHA, a larger community-based cohort, were used to describe socio-demographic and social and structural characteristics of im/migrant sex workers. Results Based on quantitative data among 198 im/migrant workers in AESHA, 78.3% were Chinese-born, the median duration in Canada was 6 years, and most (86.4%) serviced clients in formal indoor establishments. Qualitative narratives revealed diverse pathways into sex work upon arrival to Canada, including language barriers to conventional labour markets and the higher pay and relative flexibility of sex work. Once engaged in sex work, fear associated with police raids (e.g., immigration concerns, sex work disclosure) and language barriers to sexual negotiation and health, social and legal supports posed pervasive challenges to health, safety and human rights during long-term settlement in Canada. Conclusions Findings highlight the critical influences of criminalization, language barriers, and stigma and discrimination related to sex work and im/migrant status in shaping occupational health and safety for im/migrants engaged in sex work. Interventions and policy reforms that emphasize human rights and occupational health are needed to promote health and wellbeing across the arrival and settlement process.
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Affiliation(s)
- Shira M. Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
- * E-mail:
| | - Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Emma Zhang
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
| | - Jill Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, B.C., Canada
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