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Perdomo Sandoval LA, Goberna-Tricas J. Sexual health beliefs and prevention of sexually transmitted infections among cisgender women sex workers in Colombia. PLoS One 2024; 19:e0305293. [PMID: 38865312 PMCID: PMC11168633 DOI: 10.1371/journal.pone.0305293] [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: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION The stigma and social discrimination against cisgender women sex workers lead many of them to live in conditions characterized by social inequality, marginalization, persecution, and limited opportunities for sexual health literacy. Consequently, they are often compelled to establish a framework of preventive beliefs with little scientific validity, which they use to identify, mitigate, or avoid sexual health risks arising from their interactions with clients. This study investigates the sexual health beliefs that influence self-care practices aimed at preventing sexually transmitted infections among cisgender women sex workers in Colombia. METHODS We conducted a qualitative study framed in Hermeneutic Phenomenology. In-depth interviews and discussion groups were conducted with 34 cisgender women sex workers over 18 years of age in the center of the cities of Bogotá and Barranquilla in Colombia. RESULTS Seven themes emerged from the reflective and inductive thematic analysis of the narratives: (1) popular habits for the prevention of contagion, (2) ocular assessment of genitals, (3) condom lubrication, (4) suspicion of a hidden infection in the client, (5) saliva and oral contact as a source of contagion, (6) avoidance of semen contact, (7) and trust in God as protection. CONCLUSIONS The findings reflect the need for health and social professionals to promote participatory and inclusive cooperation with sex workers to update the framework of preventive beliefs that help them guide sexual health self-care with autonomy and self-efficacy, strengthening favorable beliefs and negotiating unfavorable ones. It is also essential to have a sex worker-informed sexual health policy that guides the promotion of sexual health that is sensitive to the needs and consistent with the risks of sex work and ensures friendly and non-oppressive preventive care environments for sex workers.
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Affiliation(s)
- Luis Albeiro Perdomo Sandoval
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing. Doctoral Program in Nursing and Health, University of Barcelona, Barcelona, Spain
| | - Josefina Goberna-Tricas
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing. ADHUC. Research Center for Theory, Gender, Sexuality. University of Barcelona, Barcelona, Spain
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Pearson J, Machat S, McDermid J, Goldenberg SM, Krüsi A. An Evaluation of Indoor Sex Workers' Sexual Health Access in Metro Vancouver: Applying an Occupational Health & Safety Lens in the Context of Criminalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1857. [PMID: 36767222 PMCID: PMC9914303 DOI: 10.3390/ijerph20031857] [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: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The criminalization of sex work has been consistently shown to undermine workers' Occupational Health and Safety (OHS), including sexual health. Drawing on the 'Guide to OHS in the New Zealand Sex Industry' (the Guide), we assessed barriers to sexual health best practices among indoor sex workers in Metro Vancouver, Canada, in the context of ongoing criminalization. Part of a longstanding community-based study, this analysis drew on 47 qualitative interviews (2017-2018) with indoor sex workers and third parties. Participants' narratives were analyzed drawing on a social determinants of health framework and on the Guide with specific focus on sexual health. Our findings suggest that sex workers and third parties utilize many sexual health strategies, including use of Personal Protective Equipment (PPE) and peer-driven sexual health education. However, participant narratives demonstrate how structural factors such as criminalization, immigration, and stigma limit the accessibility of additional OHS best practices outlined in the Guide and beyond, including access to non-stigmatizing sexual health assessments, and distribution of diverse PPE by third parties. Our current study supports the need for full decriminalization of sex work, including im/migrant sex work, to allow for the uptake of OHS guidelines that support the wellbeing and autonomy of all sex workers.
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Affiliation(s)
- Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Sylvia Machat
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Moore BE, Govaerts L, Kapadia F. Maternal health and maternal health service utilization among female sex workers: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231206303. [PMID: 37899632 PMCID: PMC10617279 DOI: 10.1177/17455057231206303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND High proportions of female sex workers (FSWs) become pregnant and have children. Many FSWs are at increased risk of maternal health complications due to factors such as poverty, violence, and healthcare barriers. Despite this, FSWs' maternal health and use of maternal health services (MHS) receive limited attention. OBJECTIVES The objectives of this scoping review are to (1) synthesize existing data on FSWs' maternal health and MHS utilization and (2) assess the state of peer-reviewed literature on FSWs' maternal health in regard to methodological approaches and reported outcomes. ELIGIBILITY CRITERIA Included articles were peer-reviewed, published in English, and reported empirical data on FSWs for outcomes related to antenatal care, pregnancy, and labor complications, postnatal and delivery care, and/or barriers to MHS. SOURCES OF EVIDENCE Article searches were conducted in PubMed, Web of Science, Global Health, Sociological Abstracts, Sociological Index, PsychInfo, and CINAHL. CHARTING METHODS Information extracted from eligible articles included publication year, study design, location, sample size, outcome measures, and findings. The "Three Delays" model was used to synthesize findings on barriers to MHS as relevant to phase I, II, or III delays. RESULTS Eighteen publications met the eligibility criteria. Studies were conducted in 11 countries and primarily reported quantitative data from cross-sectional surveys. The most frequently reported outcome was antenatal care utilization (n = 14), whereas few studies reported findings related to postnatal care and breastfeeding counseling (n = 2). Across publications, there was a substantial range in the proportion of FSWs who reported accessing different types of MHS. CONCLUSION Literature on FSWs' maternal health is limited and heterogenous. More research is needed that specifically focuses on measuring outcomes related to FSWs' maternal health and examines associated factors. Such work can inform future research directions and public health interventions for FSWs-a population of marginalized women whose maternal health has been overlooked in existing efforts.
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Affiliation(s)
- Brandi E Moore
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Lauren Govaerts
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Farzana Kapadia
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
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Grenfell P, Stuart R, Eastham J, Gallagher A, Elmes J, Platt L, O’Neill M. Policing and public health interventions into sex workers’ lives: necropolitical assemblages and alternative visions of social justice. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2096428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Pippa Grenfell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Stuart
- School of Social Sciences, Brunel University, London, UK
| | | | | | - Jocelyn Elmes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Platt
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Maggie O’Neill
- Department of Sociology, University College Cork, Cork, Ireland
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5
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Bungay V, Guta A, Slemon A, Varcoe C, Comber S. The Ethics of Financial Incentivization for Health Research Participation Among Sex Workers in a Canadian Context. QUALITATIVE HEALTH RESEARCH 2022; 32:942-955. [PMID: 35349393 DOI: 10.1177/10497323221089877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research incentivization with sex workers is common, yet limited guidance exists for ethical incentives practice. We undertook a critical qualitative inquiry into how researchers (n = 17), community services staff (n = 17), and sex workers participating in research (n = 53) perceive incentives in a Canadian context. We employed an interpretive thematic approach informed by critical perspectives of relational autonomy for analysis. Four themes illustrate how (un)ethical use of incentives is situated in transactional micro-economies among groups experiencing severe marginalization: i) transactional research economy, ii) incentive type: assumptions and effects, iii) incentive amount: too much too little?, and iv) resistance, trauma, and research-related harm. Paternalistic assumptions about capacities of sex workers to act in their own best interests conflicted with participants' rights and abilities for self-determination; with researchers maintaining ultimate decision-making authority. Power differentials create conditions of harm. Safe, equitable approaches concerning research incentive use must redress relations of power that perpetuate oppression.
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Affiliation(s)
- Vicky Bungay
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Adrian Guta
- School of Social Work, 8637University of Windsor, Windsor, ON, Canada
| | - Allie Slemon
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Colleen Varcoe
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Scott Comber
- Rowe School of Business, 3688Dalhousie University, Halifax, NS, Canada
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McBride B, Shannon K, Pearson J, Krüsi A, Braschel M, Goldenberg SM. Seeing pre-screened, regular clients associated with lower odds of workplace sexual violence and condom refusal amidst sex work criminalization: findings of a community-based cohort of sex workers in Metro Vancouver, Canada (2010-2019). BMC Public Health 2022; 22:519. [PMID: 35296270 PMCID: PMC8928629 DOI: 10.1186/s12889-022-12903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Research that accurately represents how characteristics of sex work clients relate to sex workers’ labour conditions is crucial for informing evidence-based legislation which upholds sex workers’ human rights. As little quantitative research has examined how seeing regulars (repeat clients) impacts sex workers’ occupational safety, particularly under ‘end-demand’ criminalization in Canada, our study aimed to explore how seeing mostly regulars shapes workplace sexual violence and client condom refusal. Methods We drew on longitudinal data from a community-based open cohort of 900+ sex workers in Vancouver, recruited via time-location sampling during day and late-night outreach to indoor, outdoor, and online solicitation spaces. We used logistic regression analyses and multivariable GEE confounder models to 1) describe correlates of seeing mostly pre-screened, regular clients, 2) identify associations between seeing mostly regulars and odds of experiencing occupational outcomes of workplace sexual violence and client condom refusal, and 3) examine the interaction between seeing mostly regulars and work environment on workplace sexual violence and client condom refusal. Results Participants’ median age was 35, and 55.6% had completed high school. Over the 9-year study (n=925), 20.9% (193) experienced 282 events of workplace sexual violence and 40.2% (372) faced 702 events of client condom refusal. In multivariable GEE confounder models, seeing mostly regulars was associated with reduced odds of sexual violence (AOR 0.73, 95%CI 0.53-1.02, p=0.067) and client condom refusal (AOR 0.70, 95%CI 0.57-0.86). In multivariable GEE confounder models examining the additive interaction between seeing mostly regulars and work environment, participants who saw mostly regulars and primarily worked in outdoor or informal indoor venues faced significantly lower odds of experiencing workplace sexual violence (AOR 0.69, 95%CI 0.49-0.95) and client condom refusal (AOR 0.64, 95%CI 0.52 -0.80) relative to those who worked in the same venues and did not see mostly regulars. Conclusion Our findings highlight protective effects of seeing pre-screened regulars within a criminalized setting. Removal of ‘end-demand’ client criminalization is needed to enable sex workers to effectively screen clients, support HIV/STI prevention, and advance sex workers’ human rights.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T1Z3, Canada
| | - Jennie Pearson
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T1Z3, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada
| | - Shira M Goldenberg
- Centre for Gender & Sexual Health Equity, c/o St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada. .,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, Hardy Tower - Room 119, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.
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McBride B, Shannon K, Murphy A, Wu S, Erickson M, Goldenberg SM, Krüsi A. Harms of third party criminalisation under end-demand legislation: undermining sex workers' safety and rights. CULTURE, HEALTH & SEXUALITY 2021; 23:1165-1181. [PMID: 32744171 PMCID: PMC7855821 DOI: 10.1080/13691058.2020.1767305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
After Canada's laws criminalising sex work were struck down by the Supreme Court for violating sex workers' rights and new end-demand legislation was passed in 2014. These new laws however continue to criminalise sex work third parties (i.e. venue owners/managers) who gain material benefits, despite evidence that managed in-call venues can provide important protections for sex workers. As part of a longstanding community-based study in Vancouver, this analysis drew on 25 in-depth interviews with third parties who provide services for indoor sex workers. We explored how end-demand third party criminalisation shapes indoor sex workers' working conditions, health and safety. We found that most third parties were women and current/former sex workers, problematising assumptions of third parties as exploitative male "pimps". Third parties provided client screening, security and sexual health resources for sex workers, yet end-demand laws restricted condom availability and access to police protections in case of violence, thereby undermining sex workers' health and safety. Our findings highlight that third party criminalisation under end-demand legislation reproduces the unsafe working conditions under the previous laws deemed unconstitutional by Canada's highest court. Legislative reforms to decriminalise all aspects of the sex industry, including sex workers' right to work with third parties, are urgently needed.
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Affiliation(s)
- Bronwyn McBride
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Alka Murphy
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Sherry Wu
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Margaret Erickson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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Herpai N, Lazarus L, Forget E, Balakireva O, Pavlova D, McClarty L, Lorway R, Pickles M, Isac S, Sandstrom P, Aral S, Mishra S, Ma H, Blanchard J, Becker M, On Behalf Of The Dynamics Study Team. Exploring the dynamics of workplace typologies for sex workers in Eastern Ukraine. Glob Public Health 2021; 17:2034-2053. [PMID: 34403303 DOI: 10.1080/17441692.2021.1965180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examine the typologies of workplaces for sex workers in Dnipro, Ukraine as part of the larger Dynamics Study, which explores the influence of conflict on sex work. We conducted a cross-sectional survey with 560 women from September 2017 to October 2018. The results of our study demonstrate a diverse sex work environment with heterogeneity across workplace typologies in terms of remuneration, workload, and safety. Women working in higher prestige typologies earned a higher hourly wage, however client volume also varied which resulted in comparable monthly earnings from sex work across almost all workplace types. While sex workers in Dnipro earn a higher monthly wage than the city mean, they also report experiencing high rates of violence and a lack of personal safety at work. Sex workers in all workplaces, with the exception of those working in art clubs, experienced physical and sexual violence perpetrated by law enforcement officers and sex partners. By understanding more about sex work workplaces, programmes may be better tailored to meet the needs of sex workers and respond to changing work environments due to ongoing conflict and COVID-19 pandemic.
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Affiliation(s)
- Nicole Herpai
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Evelyn Forget
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Olga Balakireva
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine.,Ukrainian Institute for Social Research after Olexander Yaremenko, Kyiv, Ukraine
| | - Daria Pavlova
- Ukrainian Institute for Social Research after Olexander Yaremenko, Kyiv, Ukraine
| | - Leigh McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael Pickles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Canada
| | - Sevgi Aral
- Division of Sexually Transmitted Disease Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - James Blanchard
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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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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10
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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.
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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
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11
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Laprise C, Bolster-Foucault C. Understanding barriers and facilitators to HIV testing in Canada from 2009-2019: A systematic mixed studies review. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2021; 47:105-125. [PMID: 33746619 PMCID: PMC7968477 DOI: 10.14745/ccdr.v47i02a03] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND HIV testing is a core pillar of Canada's approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed. OBJECTIVE To examine current barriers and facilitators of HIV testing across key populations and jurisdictions in Canada. METHODS A systematic mixed studies review of peer-reviewed and grey literature was conducted identifying quantitative and qualitative studies of barriers and facilitators to HIV testing in Canada published from 2009 to 2019. Studies were screened for inclusion and identified barriers and facilitators were extracted. The quality of included studies was assessed and results were summarized. RESULTS Forty-three relevant studies were identified. Common barriers emerge across key populations and jurisdictions, including difficulties accessing testing services, fear and stigma surrounding HIV, low risk perception, insufficient patient confidentiality and lack of resources for testing. Innovative practices that could facilitate HIV testing were identified, such as new testing settings (dental care, pharmacies, mobile units, emergency departments), new modalities (oral testing, peer counselling) and personalized sex/gender and age-based interventions and approaches. Key populations also face unique sociocultural, structural and legislative barriers to HIV testing. Many studies identified the need to offer a broad range of testing options and integrate testing within routine healthcare practices. CONCLUSION Efforts to improve access to HIV testing should consider barriers and facilitators at the level of the individual, healthcare provider and policy and should focus on the accessibility, inclusivity, convenience and confidentiality of testing services. In addition, testing services must be adapted to the unique needs and contexts of key populations.
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Affiliation(s)
- Claudie Laprise
- Public Health Agency of Canada, Health Security and Infrastructure Branch, Public Health Capacity and Knowledge Management Unit, Québec Regional Office; Montréal, QC
| | - Clara Bolster-Foucault
- Public Health Agency of Canada, Health Security and Infrastructure Branch, Public Health Capacity and Knowledge Management Unit, Québec Regional Office; Montréal, QC
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12
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McBride B, Shannon K, Bingham B, Braschel M, Strathdee S, Goldenberg SM. Underreporting of Violence to Police among Women Sex Workers in Canada: Amplified Inequities for Im/migrant and In-Call Workers Prior to and Following End-Demand Legislation. Health Hum Rights 2020; 22:257-270. [PMID: 33390711 PMCID: PMC7762889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sex workers globally face high levels of violence. In Canada, im/migrant sex workers who work in indoor venues may be uniquely targeted by police due to immigration policies, racialized policing, and the conflation of trafficking and sex work. In 2014, Canada passed end-demand legislation that purportedly encourages sex workers to report violence to police; however, little research has evaluated its impact. Using interrupted time series and multivariable logistic regression, we examined proportions of reporting violent incidents to police among sex workers who had experienced workplace violence (2010-2017), including potential changes prior to and following end-demand legislation. We then modeled the independent effects of im/migrant status and place of work on reporting violence. Among sex workers who experienced recent violence during the 7.5-year study (n=367), 38.2% of all participants and 12.7% of im/migrants reported violence to police, and there was no significant change in violence reporting after end-demand legislation. Our results suggest that end-demand laws do not remove barriers to justice faced by sex workers and instead actually perpetuate harms, particularly for racialized im/migrant and indoor workers. Policy reforms to decriminalize sex work, address discriminatory policing, and promote access to safety and justice are urgently needed.
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Affiliation(s)
- Bronwyn McBride
- Postdoctoral Fellow at Simon Fraser University and at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Kate Shannon
- Professor at the University of British Columbia and Executive Director at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Brittany Bingham
- Director of Indigenous Research at the Centre for Gender and Sexual Health Equity and Vancouver Coastal Health Aboriginal Health, Vancouver, Canada
| | - Melissa Braschel
- Statistician and Data Manager at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Steffanie Strathdee
- Associate Dean at the University of California San Diego School of Medicine, San Diego, USA
| | - Shira M. Goldenberg
- Assistant Professor at Simon Fraser University and Director of Research Education at the Centre for Gender and Sexual Health Equity, Vancouver, Canada
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Dzinamarira T, Mulindabigwi A, Mashamba-Thompson TP. Co-creation of a health education program for improving the uptake of HIV self-testing among men in Rwanda: nominal group technique. Heliyon 2020; 6:e05378. [PMID: 33163663 PMCID: PMC7610321 DOI: 10.1016/j.heliyon.2020.e05378] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study sought to collaborate with key stakeholders to reach a consensus regarding the predominant barriers preventing the uptake of HIV testing services (HTS) by men and co-create an acceptable educational program to improve the knowledge of HIV self-testing (HIVST) among men in Rwanda. Methods We employed the nominal group technique to identify a consensus regarding the predominant barriers currently impeding the male uptake of HTS. The health education program content was guided by the ranked barriers. We applied Mezirow's Transformational Learning Theory for curriculum development. Results Eleven key barriers currently impeding the male uptake of HTS were identified in the nominal group process. The stakeholders co-created an interactive, structured curriculum containing information on the health locus of control; HIV etiology, transmission, diagnosis, status disclosure benefits, care and treatment services; and an overview of the HIVST background and test procedure to address multiple barriers. Conclusion Key stakeholders co-created a comprehensive health education program tailored to men, which integrates education about health beliefs, HIV/AIDS and HIVST. Further studies to assess the effectiveness of the program are needed. It is anticipated that the intervention will improve the uptake of HIVST among men in Kigali, Rwanda.
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Affiliation(s)
- Tafadzwa Dzinamarira
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | | | - Tivani Phosa Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Department of Public Health, University of Limpopo, Polokwane, Limpopo Province, South Africa
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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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Harms of Workplace Inspections for Im/Migrant Sex Workers in In-Call Establishments: Enhanced Barriers to Health Access in a Canadian Setting. J Immigr Minor Health 2020; 21:1290-1299. [PMID: 30652237 DOI: 10.1007/s10903-019-00859-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Given shifting sex work criminalization and enforcement in Canada, this study examined worrying about workplace inspections by authorities amongst indoor sex workers in Vancouver (2014-2017). Data were drawn from a community-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate factors associated with worry about inspections. 23.9% of participants experienced workplace inspections; 51.6% worried about inspections. In multivariable analyses, worrying about inspections was associated with recent im/migration [adjusted odds ratio (AOR) 3.13; 95% confidence interval (CI) 1.77-5.53], police harassment (AOR 3.49; 95% CI 1.92-6.34), and workplace violence (AOR 1.66, 95% CI 1.09-2.51). In a multivariable confounder model, worry was independently associated with barriers to health access (AOR 1.45, 95% CI 1.06-1.98). Im/migrant indoor workers are disproportionately impacted by concerns about workplace inspections, which was independently linked to enhanced barriers to health access. Current criminalization measures may exacerbate health inequities among im/migrant sex workers.
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Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci9010001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
System-involvement resulting from anti-trafficking interventions and the criminalization of sex work and migration results in negative health impacts on sex workers, migrants, and people with trafficking experiences. Due to their stigmatized status, sex workers and people with trafficking experiences often struggle to access affordable, unbiased, and supportive health care. This paper will use thematic analysis of qualitative data from in-depth interviews and ethnographic fieldwork with 50 migrant sex workers and trafficked persons, as well as 20 key informants from legal and social services, in New York and Los Angeles. It will highlight the work of trans-specific and sex worker–led initiatives that are internally addressing gaps in health care and the negative health consequences that result from sexual humanitarian anti-trafficking interventions that include policing, arrest, court-involvement, court-mandated social services, incarceration, and immigration detention. Our analysis focuses on the impact of criminalization on sex workers and their experiences with sexual humanitarian efforts intended to protect and control them. We argue that these grassroots community-based efforts are a survival-oriented reaction to the harms of criminalization and a response to vulnerabilities left unattended by mainstream sexual humanitarian approaches to protection and service provision that frame sex work itself as the problem. Peer-to-peer interventions such as these create solidarity and resiliency within marginalized communities, which act as protective buffers against institutionalized systemic violence and the resulting negative health outcomes. Our results suggest that broader public health support and funding for community-led health initiatives are needed to reduce barriers to health care resulting from stigma, criminalization, and ineffective anti-trafficking and humanitarian efforts. We conclude that the decriminalization of sex work and the reform of institutional practices in the US are urgently needed to reduce the overall negative health outcomes of system-involvement.
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Magalhães RDLB, Sousa LRM, Gir E, Galvão MTG, Oliveira VMCD, Reis RK. Factors associated to inconsistent condom use among sex workers. Rev Lat Am Enfermagem 2019; 27:e3226. [PMID: 31826167 PMCID: PMC6896796 DOI: 10.1590/1518-8345.2951.3226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/07/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE to analyze the factors associated to the inconsistent condom use among sex workers. METHOD a transversal study, carried out in prostitution area, using the Respondent Drive Sampling. The sample was calculated based on the information by the Sex Workers Association: 600 female sex workers. The study selected seven women with different characteristics regarding color, age, and place of work, who were called seeds. After the participation, they received three coupons to recruit other participants in order to obtain a representative sample. The definition of inconsistent condom use was determined as occasional use or never using it. Univariate analyses and a multivariate logistic regression were performed. RESULTS 416 female sex workers participated in the study. The associated factors were having studied for less than eight years (Odds Ratio = 27.28), not having a permanent partner (Odds Ratio = 2.79), high alcohol use (Odds Ratio = 5.07), and being black (Odds Ratio = 2.21). CONCLUSION the factors associated to inconsistent condom use were: lower education levels, not having a permanent partner, high alcohol use, and being black.
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Affiliation(s)
| | - Laelson Rochelle Milanês Sousa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Vanessa Moura Carvalho de Oliveira
- Universidade Federal do Piauí, Departamento de Enfermagem, Teresina, PI, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Renata Karina Reis
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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What Works? Prevention and Control of Sexually Transmitted Infections and Blood-Borne Viruses in Migrants from Sub-Saharan Africa, Northeast Asia and Southeast Asia Living in High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071287. [PMID: 30974851 PMCID: PMC6480002 DOI: 10.3390/ijerph16071287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/05/2023]
Abstract
Migration is a significant risk factor for the acquisition of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STIs). An increasing proportion of these infections in high-income countries, such as Australia, are among migrants moving from low and middle-income countries with a high prevalence of HIV, HBV and other STIs. This systematic review explored the prevention and control of HIV, HBV and other STIs in migrants (>18 years) from Southeast Asia, Northeast Asia and sub-Saharan Africa living in high-income countries with universal health care. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Six academic databases were searched for articles published between 2002 and 2018. Sixteen peer-reviewed articles met the inclusion criteria, consisting of fourteen quantitative and two qualitative studies conducted in Australia, the Netherlands, Canada, Spain, Italy, and Germany. Three levels of interventions were identified: individual, community and structural interventions. Most studies addressed factors at an individual level; interventions were most commonly outreach testing for HIV, HBV and other STIs. Few studies addressed structural factors or demonstrated comprehensive evaluation of interventions. Limited population-specific findings could be determined. To prevent further transmission of HIV, HBV and other STIs, comprehensive public health approaches must consider the complex interactions between migration, health care system determinants, and broader socioeconomic and sociocultural factors.
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McBride B, Goldenberg SM, Murphy A, Wu S, Braschel M, Krüsi A, Shannon K. Third Parties (Venue Owners, Managers, Security, etc.) and Access to Occupational Health and Safety Among Sex Workers in a Canadian Setting: 2010-2016. Am J Public Health 2019; 109:792-798. [PMID: 30897001 DOI: 10.2105/ajph.2019.304994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the impact of engagement with third parties (i.e., managers, receptionists, or owners of in-call venues; advertisers; security; spotters; and others) on sex workers' occupational health access. METHODS We drew longitudinal data from An Evaluation of Sex Workers' Health Access, a community-based cohort of more than 900 women sex workers. We used multivariable logistic regression and generalized estimating equations to (1) examine factors correlated with accessing third-party administrative or security services and (2) evaluate the impact of third-party services on access to mobile condom distribution and sex worker and community-led services (2010-2016). Finally, we evaluated changes in accessing third-party services pre-post end-demand criminalization (2010-2017). RESULTS Im/migrant sex workers (persons with any type of legal status who were born in another country; adjusted odds ratio [AOR] = 2.32; 95% confidence interval [CI] = 1.35, 3.98) had higher odds of accessing third-party services. In confounder models, third-party services were independently correlated with increased access to mobile condom distribution (AOR = 1.84; 95% CI = 1.47, 2.31) and sex worker and community-led services (AOR = 1.61; 95% CI = 1.15, 2.24). End-demand criminalization was linked to a decrease in access to third-party services (AOR = 0.79; 95% CI = 0.63, 0.99). CONCLUSIONS This research suggests that access to administrative and security services from third parties increases sex workers' occupational health and safety. Policy reforms to ensure sex workers' labor rights, including access to hiring third parties, are recommended.
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Affiliation(s)
- Bronwyn McBride
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Shira M Goldenberg
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Alka Murphy
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Sherry Wu
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Melissa Braschel
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Andrea Krüsi
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
| | - Kate Shannon
- All of the authors are with the Centre for Gender and Sexual Health Equity, Vancouver, BC. Bronwyn McBride is also with the Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver. Shira M. Goldenberg is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Kate Shannon is also with the Faculty of Medicine, University of British Columbia, Vancouver
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20
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Pantelic M, Sprague L, Stangl AL. It's not "all in your head": critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations. BMC Infect Dis 2019; 19:210. [PMID: 30832613 PMCID: PMC6399894 DOI: 10.1186/s12879-019-3704-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
Background Internalized HIV stigma is a public health concern as it can compromise HIV prevention, care and treatment. This paper has two aims. First, it highlights the urgent need for research evidence on internalized HIV stigma based on critical knowledge gaps. Here, critical knowledge gaps were identified based on most up-to-date systematic review-level evidence on internalized stigma related to HIV and mental health difficulties. Secondly, the paper calls for a shift in focus of internalized HIV stigma research, one that moves beyond psychological frameworks to integrate social, structural and intersectional conceptualizations of stigma. This part of the paper reviews the evolution of stigma theory since Goffman’s 1963 seminal work - which defined stigma - to present. Main text Despite studies consistently suggesting that internalized HIV stigma is more prevalent than enacted stigma, there is little evidence of well-established programs to address it. In addition to this, considerable gaps in basic knowledge about the drivers of internalized HIV stigma hamper the development of an evidence-based response to the problem. The limited intervention and epidemiological research on the topic treats internalized HIV stigma as a purely psychological phenomenon. The second part of the paper provides arguments for studying internalized HIV stigma as a function of social and structural forces: (1) Individual-level interventions for internalized HIV stigma are rooted in out-dated theoretical assumptions; (2) From an ethics point of view, it could be argued that individual-level interventions rely on a victim-centric approach to a public health problem; (3) Social and structural approaches to internalized HIV stigma must be explored due to the high opportunity cost associated with small-scale individual-level interventions. Conclusions Critical gaps in intervention and epidemiological research in internalized HIV stigma remain. There has been an absence of a shared, sound theoretical understanding of internalized HIV stigma as a manifestation of social and structural factors. This commentary sought to stimulate a dialogue to remedy this absence. Future research should take into account ethical considerations, the evolution of stigma theory over the past five decades, intersectionality and opportunity cost when framing hypotheses, developing theories of change and designing interventions.
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Affiliation(s)
- Marija Pantelic
- Frontline AIDS, Secretariat, Preece House, 91-101 Davigdor Rd, Brighton, Hove, BN3 1RE, UK. .,Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford, OX1 2ER, UK.
| | - Laurel Sprague
- Global Network of People Living with HIV (GNP+), Eerste Helmersstraat 17 B3 I, 1054 CX, Amsterdam, The Netherlands
| | - Anne L Stangl
- Department of Global Health, Youth and Development, The International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
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Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med 2018; 15:e1002680. [PMID: 30532209 PMCID: PMC6289426 DOI: 10.1371/journal.pmed.1002680] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur. METHODS AND FINDINGS We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. CONCLUSIONS Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.
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Schwartz SR, Kavanagh MM, Sugarman J, Solomon SS, Njindam IM, Rebe K, Quinn TC, Toure-Kane C, Beyrer C, Baral S. HIV viral load monitoring among key populations in low- and middle-income countries: challenges and opportunities. J Int AIDS Soc 2018; 20 Suppl 7. [PMID: 29171178 PMCID: PMC5978693 DOI: 10.1002/jia2.25003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/08/2022] Open
Abstract
Introduction Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population‐level, community viral load is a metric of HIV programme effectiveness and can identify “hotspots” of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.
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Affiliation(s)
- Sheree R Schwartz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Matthew M Kavanagh
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.,O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Illiassou M Njindam
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kevin Rebe
- Anova Health Institute, Cape Town, South Africa
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Division of Intramural Research, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Coumba Toure-Kane
- Department of Bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Structural determinants of inconsistent condom use with clients among migrant sex workers: findings of longitudinal research in an urban canadian setting. Sex Transm Dis 2016; 42:312-6. [PMID: 25970307 DOI: 10.1097/olq.0000000000000276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migrant women in sex work experience unique risks and protective factors related to their sexual health. Given the dearth of knowledge in high-income countries, we explored factors associated with inconsistent condom use by clients among migrant female sex workers over time in Vancouver, BC. METHODS Questionnaire and HIV/sexually transmitted infection testing data from a longitudinal cohort, An Evaluation of Sex Workers Health Access, were collected from 2010 to 2013. Logistic regression using generalized estimating equations was used to model correlates of inconsistent condom use by clients among international migrant sex workers over a 3-year study period. RESULTS Of 685 participants, analyses were restricted to 182 (27%) international migrants who primarily originated from China. In multivariate generalized estimating equations analyses, difficulty accessing condoms (adjusted odds ratio [AOR], 3.76; 95% confidence interval [CI], 1.13-12.47) independently correlated with increased odds of inconsistent condom use by clients. Servicing clients in indoor sex work establishments (e.g., massage parlors) (AOR, 0.34; 95% CI, 0.15-0.77), and high school attainment (AOR, 0.22; 95% CI, 0.09-0.50) had independent protective effects on the odds of inconsistent condom use by clients. CONCLUSIONS Findings of this longitudinal study highlight the persistent challenges faced by migrant sex workers in terms of accessing and using condoms. Migrant sex workers who experienced difficulty in accessing condoms were more than 3 times as likely to report inconsistent condom use by clients. Laws, policies, and programs promoting access to safer, decriminalized indoor work environments remain urgently needed to promote health, safety, and human rights for migrant workers in the sex industry.
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Anderson S, Jia JX, Liu V, Chattier J, Krüsi A, Allan S, Maher L, Shannon K. Violence prevention and municipal licensing of indoor sex work venues in the Greater Vancouver Area: narratives of migrant sex workers, managers and business owners. CULTURE, HEALTH & SEXUALITY 2015; 17:825-841. [PMID: 25686777 PMCID: PMC4470838 DOI: 10.1080/13691058.2015.1008046] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Using a socio-ecological, structural determinants framework, this study assesses the impact of municipal licensing policies and related policing practices across the Greater Vancouver Area (Canada) on the risk of violence within indoor sex work venues. Qualitative interviews were conducted with 46 migrant/immigrant sex workers, managers and owners of licensed indoor sex work establishments and micro-brothels. Findings indicate that policing practices and licensing requirements increase sex workers' risk of violence and conflict with clients and result in heightened stress, an inability to rely on police support, lost income and the displacement of sex workers to more hidden informal work venues. Prohibitive licensing and policing practices prevent sex workers, managers and owners from adopting safer workplace measures and exacerbate health and safety risks for sex workers. This study provides critical evidence of the negative public health implications of prohibitive municipal licensing in the context of a criminalised and enforcement-based approach to sex work. Workplace safety recommendations include the decriminalisation of sex work and the elimination of disproportionately high fees for licences, criminal record restrictions, door lock restrictions, employee registration requirements and the use of police as licensing inspectors.
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Affiliation(s)
- Solanna Anderson
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Jessica Xi Jia
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Vivian Liu
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Jill Chattier
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Sarah Allan
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Lisa Maher
- Kirby Institute, UNSW Australia, Australia
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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