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Tan RKJ, Ho V, Sherqueshaa S, Dee W, Lim JM, Lo JJM, Teo AKJ, O'Hara CA, Ong C, Ching AH, West BS, Wong ML. COVID-19 and the shifting organisation of sex work markets in Singapore. CULTURE, HEALTH & SEXUALITY 2022; 24:1744-1759. [PMID: 34913401 DOI: 10.1080/13691058.2021.2014975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
While past studies have sought to capture how the COVID-19 pandemic has impacted on the health and sexual lives of sex workers internationally, less attention has been paid to the reorganisation of sex markets as a result of COVID-19. We conducted a sequential exploratory mixed methods study using in-depth interviews, cyber ethnography and surveyor-administered structured surveys among sex workers. We report two key findings on how the pandemic has impacted sex markets in Singapore. First, the organisation of sex markets shifted as a result of lockdown and associated movement control measures. This shift was characterised by the out-migration of sex workers, the reduction in supply and demand for in-person sex work, and a shift towards online spaces. Second, we found that sex workers experienced greater economic hardship as a result of such changes. Given the potential shifts in sex markets as a result of the pandemic, we adopt a World Health Organisation Health Workplace Framework and Model to identify interventions to improve the occupational safety and health of sex workers in a post-COVID-19 era.
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Affiliation(s)
- Rayner Kay Jin Tan
- University of North Carolina Project-China, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | | | | | - Jane Mingjie Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jamie Jay-May Lo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ann Hui Ching
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Brooke S West
- School of Social Work, Columbia University, New York, NY, USA
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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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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Tan RKJ, Ho V, Sherqueshaa S, Dee W, Lim JM, Lo JJM, Teo AKJ, O'Hara CA, Ong C, Ching AH, Wong ML. The Impact of the Coronavirus Disease (COVID-19) on the Health and Social Needs of Sex Workers in Singapore. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2017-2029. [PMID: 34191194 PMCID: PMC8244454 DOI: 10.1007/s10508-021-01951-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 05/07/2023]
Abstract
We evaluated the impact of the coronavirus disease (COVID-19) on the sex work industry and assessed how it has impacted the health and social conditions of sex workers in Singapore. We conducted a sequential exploratory mixed methods study amidst the COVID-19 pandemic from April to October 2020, including in-depth interviews with 24 stakeholders from the sex work industry and surveyor-administered structured surveys with 171 sex workers. COVID-19 had a substantial impact on sex workers' income. The illegality of sex work, stigma, and the lack of work documentation were cited as exclusionary factors for access to alternative jobs or government relief. Sex workers had experienced an increase in food insecurity (57.3%), housing insecurity (32.8%), and sexual compromise (8.2%), as well as a decrease in access to medical services (16.4%). Being transgender female was positively associated with increased food insecurity (aPR = 1.23, 95% CI [1.08, 1.41]), housing insecurity (aPR = 1.28, 95% CI [1.03, 1.60]), and decreased access to medical services (aPR = 1.74, 95% CI [1.23, 2.46]); being a venue-based sex worker was positively associated with increased food insecurity (aPR = 1.46, 95% CI [1.00, 2.13]), and being a non-Singaporean citizen or permanent resident was positively associated with increased housing insecurity (aPR = 2.59, 95% CI [1.73, 3.85]). Our findings suggest that COVID-19 has led to a loss of income for sex workers, greater food and housing insecurity, increased sexual compromise, and reduced access to medical services for sex workers. A lack of access to government relief among sex workers exacerbated such conditions. Efforts to address such population health inequities should be implemented.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| | | | | | | | - Jane Mingjie Lim
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Jamie Jay-May Lo
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | | | - Clarence Ong
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Ann Hui Ching
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
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Blumer N, Pfadenhauer LM, Burns J. Access to HIV-prevention in female sex workers in Ukraine between 2009 and 2017: Coverage, barriers and facilitators. PLoS One 2021; 16:e0250024. [PMID: 33861784 PMCID: PMC8051789 DOI: 10.1371/journal.pone.0250024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
The provision of comprehensive prevention services is vital for reducing the high burden of HIV amongst Ukrainian female sex workers (FSWs). To identify barriers and facilitators that influence access to HIV prevention amongst this population between 2009 and 2017, we developed a literature-informed conceptual framework and conducted a document analysis to identify the components of the Ukrainian prevention package (PP). Using the Integrated Bio Behavioural Surveillance Surveys, we then conducted descriptive analyses to explore PP coverage from 2009 to 2017 and the influence of factors, identified by our conceptual framework. After increasing over four years, a drop in PP coverage was observed from 2013 onwards. Being a client of a non-governmental organisation, street and highway solicitation, non-condom use, and knowledge of HIV may influence access to HIV prevention in the Ukrainian context. Future interventions should consider barriers and facilitators to HIV prevention and the multiple structural levels on which they operate.
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Affiliation(s)
- Natasha Blumer
- Institute for Medical Information Processing, Biometry and Epidemiology – IBE, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
- * E-mail:
| | - Lisa M. Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology – IBE, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology – IBE, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
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Lim RBT, Tham DKT, Cheung ON, Adaikan PG, Wong ML. A Public Health Communication Intervention Using Edutainment and Communication Technology to Promote Safer Sex among Heterosexual Men Patronizing Entertainment Establishments. JOURNAL OF HEALTH COMMUNICATION 2019; 24:47-64. [PMID: 30698082 DOI: 10.1080/10810730.2019.1572839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It is a challenge to reach out, develop and implement a communication intervention for heterosexual men (HSM) patronizing entertainment establishments (EEs) to promote safer sex. We described the theoretical basis and process from assessment to implementation where edutainment (talk shows) and communication technology (interactive web portal) was implemented. A female comedian hosted the talk shows. The portal contained an HIV risk profile calculator with individually tailored strategies to lower risk; two videos on real-life stories of unsafe sex and exit strategies to avoid casual or paid sex; as well as online support. We integrated edutainment, social cognitive theory (SCT) and the elaboration likelihood model (ELM). Edutainment techniques like humor through jokes, fun through games, and narrative persuasion through real-life accounts were applied. The SCT focused on modifying attitudes and social norm on sexual well-being, increasing self-perceived HIV/STI risk as well as building self-efficacy and skills in condom use. We applied the ELM to guide communication strategies and message development. For peripheral processing, we used cues like comedian delivery and charisma. For central processing, we focused on argument framing, issue involvement, argument quality, and modeling. The intervention was effective in promoting condom use with casual partners among the target group in Singapore.
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Affiliation(s)
- Raymond Boon Tar Lim
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Dede Kam Tyng Tham
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Olive Ny Cheung
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - P Ganesan Adaikan
- b Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore city , Singapore
| | - Mee Lian Wong
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
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