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Kiyingi J, Mayo-Wilson LJ, Nabunya P, Kizito S, Nabayinda J, Nattabi J, Nsubuga E, Bahar OS, Namuwonge F, Nakabuye F, Nanteza F, Filippone PL, Mukasa D, Witte SS, Ssewamala FM. Examining the Intrapersonal, Interpersonal and Community Level Correlates of Access to Medical Care Among Women Employed by Sex Work in Southern Uganda: A cross-sectional Analysis of the Kyaterekera Study. AIDS Behav 2024; 28:2350-2360. [PMID: 38605251 PMCID: PMC11199097 DOI: 10.1007/s10461-024-04333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/13/2024]
Abstract
Women employed by sex work (WESW) experience significant gaps in accessing necessary healthcare services, leading to unmet health needs. Yet, there is a dearth of literature on the barriers to medical care access among WESW in Uganda. We used data from the Kyaterekera baseline to examine the correlates of access to medical care among WESW, defined as the ability of individuals to obtain the necessary healthcare services they require in a timely, affordable, and equitable manner. The Kyaterekera study recruited 542 WESW aged 18-58 years from Southern Uganda. We conducted a multilevel linear regression model to determine the intrapersonal (age, education level, marital status, HIV knowledge, and asset ownership), interpersonal (family cohesion and domestic violence attitudes), and community (community satisfaction, sex work stigma and distance to health facility) level correlates of access to medical care among WESW. Intrapersonal and interpersonal factors were associated with access to medical care among WESW. There was no significant association between community level factors and access to medical care. WESW with secondary education (β = 0.928, 95% CI = 0.007, 1.849) were associated with increased access to medical care. WESW with high asset ownership (β = -1.154, 95% CI= -1.903, -0.405), high family cohesion (β = -0.069, 95% CI= -0.106, -0.031), and high domestic violence attitudes (β = -0.253, 95% CI= -0.438, -0.068) were associated with decreased access to medical care. The findings emphasize the critical need for targeted family strengthening interventions to enhance family support for WESW and address domestic violence.
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Affiliation(s)
- Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Larissa Jennings Mayo-Wilson
- Department of Heath Behavior, Department of Maternal and Child Health, University of North Carolina, 316 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Fatuma Nakabuye
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Flavia Nanteza
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Prema L Filippone
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Dinah Mukasa
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Susan S Witte
- Columbia University School of Social, Work1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO, 63130, USA.
- Brown School, Washington University in St. Louis International Center for Child Health and Development (ICHAD), Goldfarb, Room 346 Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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Potter LC, Stone T, Swede J, Connell F, Cramer H, McGeown H, Carvalho M, Horwood J, Feder G, Farr M, Gaps B. Improving access to general practice for and with people with severe and multiple disadvantage: a qualitative study. Br J Gen Pract 2024; 74:e330-e338. [PMID: 38575183 PMCID: PMC11005924 DOI: 10.3399/bjgp.2023.0244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care. AIM To improve access to general practice for people with SMD by facilitating collaborative service improvement meetings between healthcare staff, people with lived experience of SMD, and those who support them; participants were then interviewed about this work. DESIGN AND SETTING The Bridging Gaps group is a collaboration between healthcare staff, researchers, women with lived experience of SMD, and a charity that supports them in a UK city. A project was co-produced by the Bridging Gaps group to improve access to general practice for people with SMD, which was further developed with three inner-city general practices. METHOD Nine service improvement meetings were facilitated at three general practices, and six of these were formally observed. Nine practice staff and four women with lived experience of SMD were interviewed. Three women with lived experience of SMD and one staff member who supports them participated in a focus group. Data were analysed inductively and deductively using thematic analysis. RESULTS By providing time and funding opportunities to motivated general practice staff and involving participants with lived experience of SMD, service changes were made in an effort to improve access for people with SMD. These included prioritising patients on an inclusion patient list with more flexible access, providing continuity for patients via a care coordinator and micro-team of clinicians, and developing an information-sharing document. The process and outcomes improved connections within and between general practices, support organisations, and people with SMD. CONCLUSION The co-designed strategies described in this study could be adapted locally and evaluated in other areas. Investing in this focused way of working may improve accessibility to health care, health equity, and staff wellbeing.
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Affiliation(s)
- Lucy C Potter
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Tracey Stone
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
| | | | | | - Helen Cramer
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Helen McGeown
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | | | - Jeremy Horwood
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol
| | - Michelle Farr
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
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Barry MP, Corcorran MA, Tsui JI, Moreno C, Buskin SE, Guthrie BL, Glick SN. High Seroprevalence of Hepatitis C Virus Among Cisgender Women Who Exchange Sex in the Seattle, Washington Area. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:81-90. [PMID: 38258855 DOI: 10.1177/29767342231208936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Injection drug use (IDU) is a risk factor for hepatitis C virus (HCV) acquisition and occurs disproportionately among women who exchange sex (WES). However, little is known about HCV epidemiology in this population. We estimated HCV seroprevalence, identified correlates of HCV seropositivity, and characterized social networks by HCV serostatus and IDU history among WES in the Seattle, Washington, area. METHODS This was a secondary analysis of data from the 2016 National HIV Behavioral Surveillance survey in the Seattle, Washington area, a cross-sectional survey that used respondent-driven sampling (RDS) to enroll WES for money or drugs (N = 291). All participants were offered rapid HCV-antibody testing. We estimated HCV seropositivity and used log regression methods to estimate crude and adjusted prevalence ratios (PRs) for correlates of HCV seropositivity among WES. Using RDS recruitment chain data, we computed homophily indices to estimate the extent to which participants were likely to recruit another participant with the same HCV serostatus and IDU history. RESULTS In the study sample of WES in the Seattle, Washington area, 79% reported lifetime IDU and 60% were HCV seropositive. HCV seropositivity was strongly associated with ever injecting drugs (PRadj: 7.7 [3.3, 18.0]). The RDS homophily scores for HCV seropositivity (0.07) and ever injecting drugs (0.02) suggested that participants did not tend to recruit others with the same characteristics beyond what would be expected by chance. CONCLUSION Among this sample of WES in Seattle, Washington area, HCV seroprevalence was high and strongly associated with a history of IDU. The high burden of HCV among WES suggests this marginalized group would benefit from additional harm reduction services and targeted HCV treatment campaigns to reduce forward transmission. We saw little evidence of preferential recruitment among WES who were HCV seropositive or reported a history of IDU, suggesting the potential futility of peer-based referrals for HCV treatment.
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Affiliation(s)
- Michael P Barry
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Courtney Moreno
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Susan E Buskin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Brandon L Guthrie
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Sara N Glick
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Squires K. Sex Workers in Canada Face Unequal Access to Healthcare: A Systems Thinking Approach. J Prim Care Community Health 2024; 15:21501319241233173. [PMID: 38504526 PMCID: PMC10953055 DOI: 10.1177/21501319241233173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Despite Canada's universal health system, sex workers across the country face an alarmingly high number of barriers when they seek to healthcare services. This has resulted in unmet healthcare needs and substantially poorer health outcomes than the general Canadian population. The objective of this study was to use a systems thinking approach to gain an in-depth understanding of the barriers sex workers face and how access could be improved. METHODS The analysis was conducted using a systems thinking methodology, which incorporates systems tools and inquiry processes. The methodology comprised 2 domains of inquiry: (1) Problem Landscape, (2) Solutions Landscape. Systems tools and methods, such as causal loop diagrams, iceberg diagram, and systems mapping, investigated the problem landscape for understanding the interconnected nature of the issue, alongside review of both published and gray literature. An environmental scan explored the current solutions landscape. These methods connected through systemic inquiry processes, including ongoing review and application of diverse perspectives, boundary judgments, interrelationships; enabled gaps and levers of change to be determined. RESULTS The main barriers sex workers face are stigma, criminalization, accessibility, and cost of healthcare. The stigma of sex work stems from otherization, paternalism, and moralistic, faith-based beliefs. The barriers unique to sex work are stigma and criminalization; both of which surface as avoidance, dislike, and/or fear of medical professionals. Five gaps each with a lever of change to improve access were identified: (1) Stigma - Collectivization and external collaboration, (2) Criminal status of sex work - Decriminalization, (3) Lack of adequate education - Improved healthcare professional training and anti-discriminatory health policies, (4) Lack of support - Increased community-based healthcare services, (5) Cost of healthcare - Universal coverage of "secondary" healthcare components. CONCLUSION Through reducing the stigma surrounding sex work, making changes that improve the healthcare services that sex workers receive, and collaboration between involved parties, sex workers can be prevented from falling through the cracks of the Canadian healthcare system; lessening the health inequities sex workers face and improving their health outcomes.
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Emanuel E, Slater L, Croxford S, Edmundson C, Ibitoye A, Njoroge J, Ijaz S, Hope V, Platt L, Phipps E, Desai M. Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey. Public Health 2023; 225:79-86. [PMID: 37922590 DOI: 10.1016/j.puhe.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. STUDY DESIGN The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. METHODS Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. RESULTS Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043). CONCLUSIONS Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.
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Affiliation(s)
- E Emanuel
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - L Slater
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom.
| | - S Croxford
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - A Ibitoye
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - J Njoroge
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Ijaz
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V Hope
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; Liverpool John Moores University, Liverpool, United Kingdom
| | - L Platt
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E Phipps
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Desai
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
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Potter L, McDonagh L, Horwood J, Farr M, Feder G, Wong G. Improving access to general practice for people with severe and multiple disadvantage: a realist review protocol (The Connection Study). Wellcome Open Res 2023; 8:331. [PMID: 38074196 PMCID: PMC10704067 DOI: 10.12688/wellcomeopenres.19460.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction: Despite having high unmet health need, people with severe and multiple disadvantage (SMD, including combinations of homelessness, substance misuse, poor mental health and domestic violence and abuse) have poor access to general practice. This realist review will examine the existing evidence on interventions or aspects of routine care in general practice that are likely to increase or decrease access to general practice for people with SMD. Methods and analysis: he aim of this review is to identify how these interventions or aspects of routine care increase or decrease access to general practice for people with SMD, in which contexts and for which patients. This review will involve a process comprising five sequential phases: (1) identifying established theories, (2) conducting an extensive search for proof, (3) selecting appropriate articles, (4) gathering and organising relevant data, and (5) utilising a realist analytical approach to synthesise evidence and make conclusions. Local implementation documents, in addition to published research studies, will be incorporated to enrich the analysis. We will collaborate with a stakeholder group consisting of people with lived experience of SMD and those who support them to advise us throughout. Ethics and dissemination: Ethical approval is not required. Our findings will be disseminated through peer-reviewed publications, conference presentations and lay summaries and will be used to develop a complex intervention for improving access to general practice for and with people with severe and multiple disadvantage. PROSPERO registration number: CRD42023390495.
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Affiliation(s)
- Lucy Potter
- Centre for Academic Primary Care, University of Bristol, Bristol, England, BS8 2PN, UK
| | - Lorraine McDonagh
- Research Department of Primary Care and Population Health, University College London, London, England, NW3 2PF, UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, University of Bristol, Bristol, England, BS8 2PN, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS1 2NT, UK
| | - Michelle Farr
- Centre for Academic Primary Care, University of Bristol, Bristol, England, BS8 2PN, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS1 2NT, UK
| | - Gene Feder
- Centre for Academic Primary Care, University of Bristol, Bristol, England, BS8 2PN, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, OX2 6GG, UK
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Gittins R, Teck JTW, Knowles R, Clarke N, Baldacchino A. Implementing buprenorphine prolonged-release injection using a health at the margins approach for transactional sex-workers. Front Psychiatry 2023; 14:1224376. [PMID: 37547196 PMCID: PMC10400437 DOI: 10.3389/fpsyt.2023.1224376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background Access to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers frequently cycled in and out of treatment for OUD such that they never reached a level of engagement that permitted opportunities to meet their healthcare or housing needs. Barriers to accessing care provision include an itinerant lifestyle, difficulties with travel at unpredictable hours, impacting upon adherence to medication regimens including daily supervised consumption. Objectives To use a co-produced, "health at the margins" approach, to reach the sex-working population in Leeds, and support informed choices about the potential to receive buprenorphine prolonged-release injection (BPRI) as a treatment option for OUD. Methods BPRI was introduced using a theory of change model and improvements in sex-worker care delivery was reviewed. Strategies included buprenorphine micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based and trauma-informed approach. Results Benefits of BPRI included removal of the need for daily pharmacy visits, reducing the risk of diversion, improved medication adherence, stability and engagement with treatment and supportive services. Conclusion BPRI may offer an additional option for pharmacological interventions for people with OUD where there may be increased barriers to accessing treatment for example due to sex-working. Strategies for effective BPRI include micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based approach.
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Affiliation(s)
| | - Joseph Tay Wee Teck
- Forward Leeds and Humankind Charity, Durham, United Kingdom
- Population and Behavioural Science Research Division, School of Medicine, St Andrews University, St Andrews, United Kingdom
| | | | - Nicole Clarke
- Forward Leeds and Humankind Charity, Durham, United Kingdom
| | - Alexander Baldacchino
- Population and Behavioural Science Research Division, School of Medicine, St Andrews University, St Andrews, United Kingdom
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Brooks SK, Patel SS, Greenberg N. Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1969-2010. [PMID: 37311934 PMCID: PMC10263380 DOI: 10.1007/s10508-023-02633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Samantha K Brooks
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, SE5 9RJ, UK.
| | - Sonny S Patel
- Transcultural Conflict and Violence Initiative, Georgia State University, Atlanta, GA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, SE5 9RJ, UK
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Johnson L, Potter LC, Beeching H, Bradbury M, Matos B, Sumner G, Wills L, Worthing K, Aldridge RW, Feder G, Hayward AC, Pathak N, Platt L, Story A, Sultan B, Luchenski SA. Interventions to improve health and the determinants of health among sex workers in high-income countries: a systematic review. Lancet Public Health 2023; 8:e141-e154. [PMID: 36334613 PMCID: PMC10564624 DOI: 10.1016/s2468-2667(22)00252-3] [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: 02/20/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
Many sex worker populations face high morbidity and mortality, but data are scarce on interventions to improve their health. We did a systematic review of health and social interventions to improve the health and wider determinants of health among adult sex workers in high-income countries. We searched MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science, EthOS, OpenGrey, and Social Care Online, as well as the Global Network of Sex Work Projects and the Sex Work Research Hub for studies published between Jan 1, 2005 and Dec 16, 2021 (PROSPERO CRD42019158674). Quantitative studies reporting disaggregated data for sex workers were included and no comparators were specified. We assessed rigour using the Quality Assessment Tool for Quantitative Studies. We summarised studies using vote counting and a narrative synthesis. 20 studies were included. Most reported findings exclusively for female sex workers (n=17) and street-based sex workers (n=11). Intervention components were divided into education and empowerment (n=14), drug treatment (n=4), sexual and reproductive health care (n=7), other health care (n=5), and welfare (n=5). Interventions affected a range of mental health, physical health, and health behaviour outcomes. Multicomponent interventions and interventions that were focused on education and empowerment were of benefit. Interventions that used peer design and peer delivery were effective. An outreach or drop-in component might be beneficial in some contexts. Sex workers who were new to working in an area faced greater challenges accessing services. Data were scarce for male, transgender, and indoor-based sex workers. Co-designed and co-delivered interventions that are either multicomponent or focus on education and empowerment are likely to be effective. Policy makers and health-care providers should improve access to services for all genders of sex workers and those new to an area. Future research should develop interventions for a greater diversity of sex worker populations and for wider health and social needs.
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Affiliation(s)
- Luke Johnson
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK; Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Lucy C Potter
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Molly Bradbury
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Bella Matos
- Department of Psychology, The American University of Paris, Paris, France
| | - Grace Sumner
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Lorna Wills
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Kitty Worthing
- Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Gene Feder
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew C Hayward
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Neha Pathak
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Al Story
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK; Find & Treat, University College London Hospital, London, UK
| | - Binta Sultan
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK; Find & Treat, University College London Hospital, London, UK
| | - Serena A Luchenski
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
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Rashid A. Yonder: Anticipatory medications, food insecurity, childhood vaccination, and street sex workers. Br J Gen Pract 2022; 72:232. [PMID: 35483955 PMCID: PMC11189048 DOI: 10.3399/bjgp22x719381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- GP and Clinical Associate Professor, UCL Medical School, UCL, London. @Dr_A_Rashid
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