1
|
Evagora-Campbell M, Zahidie A, Buse K, Rabbani F, Hawkes S. Promoting labour migrant health equity through action on the structural determinants: a systematic review. J Migr Health 2022; 5:100082. [PMID: 35199076 PMCID: PMC8851278 DOI: 10.1016/j.jmh.2022.100082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Labour migrants, who represent over sixty per cent of international migrants globally, frequently have poorer health status than the population of host countries. These health inequities are determined in a large part by structural drivers including political, commercial, economic, normative and social factors, including living and working conditions. Achieving health equity for migrant workers requires structural-level interventions to address these determinants. Methods We undertook a systematic review of peer-reviewed literature designed to answer the question “what is the evidence for the effectiveness of interventions to address the structural determinants of health for labour migrants?” using the Ovid Medline electronic database. Findings We found only two papers that evaluated structural interventions to improve the health of labour migrants. Both papers evaluated the impact of insurance – health or social. In contrast, we found 19 evaluations of more proximal, small-scale interventions focused on changing the knowledge, attitudes and behaviours of labour migrants. Interpretation Despite the rise in international migration, including for work, and evidence that labour migrants have some higher health risks, there is a paucity of research addressing the structural determinants of health inequities in labour migrants. The research community (including funders and academic institutions) needs to pay greater attention to the structural determinants of health – which generally requires working across disciplines and sectors and thinking more politically about health and health inequities. Funding Wellcome Trust (208712/Z/17/Z).
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
McCann J, Crawford G, Hallett J. Sex Worker Health Outcomes in High-Income Countries of Varied Regulatory Environments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083956. [PMID: 33918688 PMCID: PMC8070506 DOI: 10.3390/ijerph18083956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 01/01/2023]
Abstract
There is significant debate regarding the regulation of the sex industry, with a complex range of cultural, political and social factors influencing regulatory models which vary considerably between and within countries. This systematic review examined the available evidence on the relationship between different approaches to sex industry regulation in high-income countries, and associated effects on sex worker health status. Objectives included identification of sex worker health outcomes, including sexual health, substance use and experience of stigma and violence. A search was performed electronically in eight scholarly databases which yielded 95 articles which met the criteria for inclusion. Findings suggested that sex workers in legalised and decriminalized countries demonstrated greater health outcomes, including awareness of health conditions and risk factors.
Collapse
Affiliation(s)
- Jessica McCann
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; (G.C.); (J.H.)
- Correspondence:
| | - Gemma Crawford
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; (G.C.); (J.H.)
- Collaboration for Evidence, Research and Impact in Public Health, Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Jonathan Hallett
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; (G.C.); (J.H.)
- Collaboration for Evidence, Research and Impact in Public Health, Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| |
Collapse
|
4
|
Lim RBT, Tham DKT, Cheung ON, Adaikan PG, Wong ML. A Public Health Communication Intervention Using Edutainment and Communication Technology to Promote Safer Sex among Heterosexual Men Patronizing Entertainment Establishments. JOURNAL OF HEALTH COMMUNICATION 2019; 24:47-64. [PMID: 30698082 DOI: 10.1080/10810730.2019.1572839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It is a challenge to reach out, develop and implement a communication intervention for heterosexual men (HSM) patronizing entertainment establishments (EEs) to promote safer sex. We described the theoretical basis and process from assessment to implementation where edutainment (talk shows) and communication technology (interactive web portal) was implemented. A female comedian hosted the talk shows. The portal contained an HIV risk profile calculator with individually tailored strategies to lower risk; two videos on real-life stories of unsafe sex and exit strategies to avoid casual or paid sex; as well as online support. We integrated edutainment, social cognitive theory (SCT) and the elaboration likelihood model (ELM). Edutainment techniques like humor through jokes, fun through games, and narrative persuasion through real-life accounts were applied. The SCT focused on modifying attitudes and social norm on sexual well-being, increasing self-perceived HIV/STI risk as well as building self-efficacy and skills in condom use. We applied the ELM to guide communication strategies and message development. For peripheral processing, we used cues like comedian delivery and charisma. For central processing, we focused on argument framing, issue involvement, argument quality, and modeling. The intervention was effective in promoting condom use with casual partners among the target group in Singapore.
Collapse
Affiliation(s)
- Raymond Boon Tar Lim
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Dede Kam Tyng Tham
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Olive Ny Cheung
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - P Ganesan Adaikan
- b Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore city , Singapore
| | - Mee Lian Wong
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| |
Collapse
|
6
|
Lim RBT, Cheung ONY, Tham DKT, La HH, Win TT, Chan R, Wong ML. Using qualitative and community-based engagement approaches to gain access and to develop a culturally appropriate STI prevention intervention for foreign female entertainment workers in Singapore. Global Health 2018; 14:36. [PMID: 29661249 PMCID: PMC5902891 DOI: 10.1186/s12992-018-0358-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background There is an increasing global movement of foreign female entertainment workers (FEWs), a hard-to-reach population vulnerable to HIV/STIs. This paper described the needs assessment phase before intervention implementation where the socio-organisation, sexual risk behaviours and access to health services of foreign FEWs in Singapore were explored. We also highlighted how qualitative inquiry, census enumeration technique and community-based engagement approaches were used to gain access and to develop a culturally appropriate STI prevention intervention. Methods In-depth interviews, observations, informal conversational interviews, mystery client and critical incident technique were used. We estimated the size of FEW population using the census enumeration technique. The findings were used to inform intervention development and implementation. Results We estimated 376 Vietnamese and 330 Thai FEWs in 2 geographical sites where they operated in Singapore. Their reasons for non-condom use included misconceptions on the transmission and consequences of STI/HIV, low risk perception of contracting HIV/STI from paid/casual partner, lack of skills to negotiate or to persuade partner to use condom, unavailability of condoms in entertainment establishments and fear of the police using condom as circumstantial evidence. They faced difficulties in accessing health services due to fear of identity exposure, stigmatisation, cost and language differences. To develop the intervention, we involved FEWs and peer educators, and ensured that the intervention was non-stigmatising and met their needs. To foster their participation, we used culturally-responsive recruitment strategies, and ensured that the trial was anonymous and acceptable to the FEWs. These strategies were effective as we achieved a participation rate of 90.3%, a follow-up rate of 70.5% for the comparison and 66.8% for the intervention group. The interventions group reported a significant increase in consistent condom use with a reduction in STI incidence compared to no significant change in the comparison group. Conclusions The qualitative inquiry approaches to gain access, to foster participation and to develop a culturally appropriate intervention, along with the census enumeration technique application to estimate the FEW population sizes has led to successful intervention implementation as well as safer sexual behaviour and STI incidence reduction. Trial registration ClinicalTrials.gov, NCT02780986. Registered 23 May 2016 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12992-018-0358-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Olive N Y Cheung
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Dede Kam Tyng Tham
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Hanh Hao La
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Thein Than Win
- Humanitarian Organisation for Migration Economics (HOME), 304 Orchard Road, #06-22, Lucky Plaza, Singapore, Singapore city, 238863, Singapore
| | - Roy Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore.,Department of Sexually Transmitted Infections Control, National Skin Centre, 31 Kelantan Lane, #01-16, Singapore, Singapore city, 200031, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore.
| |
Collapse
|