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Gonzalez-Arribas O, Panadero S, Recalde-Esnoz I, Vazquez JJ. Stressful Life Events Among Women Suffering Homelessness and Prostitution in Spain. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3311-3317. [PMID: 39107532 DOI: 10.1007/s10508-024-02969-4] [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: 01/13/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 09/13/2024]
Abstract
The aim of the study was to analyze the differences in suffering stressful life events (SLE) among women experiencing homelessness who had or had not been in prostitution. Data were collected from a sample of 135 women experiencing homelessness in Madrid. A total of 81% of the women interviewed had never been in prostitution, while 19% had been in prostitution at some point in their lives. Participants were recruited from shelters, drop-in centers, and public spaces. The information was collected using a structured interview. The results showed that women experiencing homelessness who had been in prostitution suffered a greater number of SLE, both in childhood and adolescence and throughout life. The interviewed who had been in prostitution were between two and nine times more likely to have experienced during their childhood and adolescence violence in their family, as well as to have run away from home, experienced abuse, attempted suicide, and used drugs excessively. Furthermore, during their lifetime, the interviewed who had been in prostitution were between two and four times more likely to suffer from serious physical and mental health issues, excessive alcohol consumption, intimate partner violence, physical violence from others, suicide attempts, police reporting, and unwanted pregnancies. Additionally, they were four to six times more likely to have been sexually assaulted or convicted/imprisoned for a crime, seven times more likely to have been arrested, and a striking 32 times more likely to have used drugs excessively.
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Affiliation(s)
| | - Sonia Panadero
- Department of Clinical Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Irantzu Recalde-Esnoz
- Department of Educational Sciences, Universidad de Alcala, Aulario María de Guzmán. C/ San Cirilo, s/n., 28801, Alcala de Henares, Madrid, Spain
| | - Jose Juan Vazquez
- Department of Social Psychology, Universidad de Alcala, Alcala de Henares, Spain.
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Powers RA, Burckley J, Centelles V. The Legality of Labor and Perceptions of Deservingness of Rights and Services for Sex Workers. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3609-3624. [PMID: 39138694 DOI: 10.1007/s10508-024-02951-0] [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: 02/19/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 08/15/2024]
Abstract
Access to social services like healthcare, education, housing, and welfare are integral to creating an equitable society. While many populations inherently benefit from these services, sex workers are often denied these rights and services because of the nature of their work. The purpose of this study was to examine perceptions of deservingness of sex workers for a wide range of rights and services. This study distinguished those attitudes across legal and illegal forms of sex work, identified attitudinal and demographic correlates associated with those perceptions, and examined potential interactions between respondents' gender and age. Participants included a nationwide sample of adults from the USA (n = 549). Results indicated that participants perceived legal sex work as more deserving of rights and services compared to illegal sex work. Perceptions of deservingness were associated with attitudes toward abortion, LGBTQ+ rights, and perceptions of government legitimacy. Overall, older individuals were less willing to extend rights and services to sex workers and women were more likely to perceive sex workers as deserving of rights and services. There was an interaction between gender and age. For illegal sex work, gender differences in perceptions converged as participants aged, whereas for legal sex work, gender differences were exacerbated with age, with men reporting particularly restrictive perceptions of deservingness.
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Affiliation(s)
- Ráchael A Powers
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | | | - Vanessa Centelles
- Department of Sociology, Colorado State University, Fort Collins, CO, USA
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Gunst A, Uusitalo M, Pölönen P, Petrík Š, Antfolk J. Sex workers' professional agency, quality of life, and problematic substance use in Finland. Scand J Psychol 2024. [PMID: 39277810 DOI: 10.1111/sjop.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION Sex workers suffer considerable marginalization that limits their choices and exposes them to various types of harm. Hence, it is important to examine sex workers' professional agency and its association with quality of life. In the current study, we investigated professional agency, quality of life, and problematic substance use among sex workers in Finland. METHODS Using an online survey, we collected data from 136 sex workers contacted through Finnish sex work organizations and social media platforms. We conducted correlational analyses between the study variables and linear regression analyses with professional agency as the independent variable and quality of life and problematic alcohol and drug use as dependent variables. RESULTS As expected, in the regression analyses, professional agency was strongly positively associated with quality of life (β = 0.86, p < 0.001) and negatively associated with problematic alcohol (β = -0.38, p = 0.002) and drug (β = -0.69, p < 0.001) use. Professional agency explained as much as 73% of the variance in quality of life. Most sex workers rated their quality of life as either good or very good. CONCLUSION Our results underscore the importance of professional agency to sex workers' well-being, explaining a substantial proportion of the variance in quality of life. Promoting agency should therefore be at the heart of sex work policymaking. However, as most of the respondents were Finnish-born cis women, our results might not generalize to foreign-born, male, and gender diverse sex workers. Future studies should prioritize reaching these populations to ensure broader representativeness.
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Affiliation(s)
- Annika Gunst
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Mimmi Uusitalo
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Petra Pölönen
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Štefan Petrík
- National Institute of Education and Youth, Banská Bystrica, Slovakia
| | - Jan Antfolk
- Department of Psychology, Åbo Akademi University, Turku, Finland
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Tao X, Huang Y, Zheng P, Wang G, Xu Y, Chen Y, Deng B, Chen X, Qin T, Liao Y, Shi M, Lu B, Wu Y, Li J, Ye L, Liang H, Wei F, Jiang J. Application of 'CDC- Public Security Bureau-NGO' Joint Prevention and Control Mechanism Allied AIDS prevention and control in Guigang, Guangxi. BMC Public Health 2024; 24:2416. [PMID: 39237891 PMCID: PMC11375977 DOI: 10.1186/s12889-024-19873-0] [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] [Received: 03/15/2023] [Accepted: 08/23/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND HIV/AIDS has emerged as a nationwide epidemic and has taken the forefront position as the primary infectious killer of adults in China. The control and prevention of the disease have been hampered by a weak link in the form of heterosexual transmission. However, conventional intervention measures have demonstrated suboptimal efficacy in reducing the incidence of new HIV infections. In light of the current epidemiological characteristics, we have developed and executed an innovative intervention model known as the Joint Prevention and Control Mechanism of the 'CDC-Public Security Bureau-NGO'. The purpose of this research is to assess the impact of this model on the AIDS awareness, HIV infection rates, sexual behavior, and associated factors among female sex workers and elderly clients. Through the provision of robust evidence of the efficacy of this innovative model, we seek to advocate for its implementation in future interventions. METHODS The research design of this study incorporates both a serial cross-sectional study and time-series analysis from 2014 to 2021, including a 4-year traditional intervention (2014-2017) and the 4-year 'CDC-Public Security Bureau-NGO' innovative intervention (2018-2021), was conducted to evaluate the effects of the new intervention. The GM(1, 1) model was performed to predict the proportion of HIV infection without implementing the innovative intervention in 2018-2021; P and C values were used to evaluate the performance of the model. Mann-Kendall test and descriptive methods were used to analyzed the trend of traditional and innovative interventions models on HIV positive detection rate in FSWs and elderly clients. RESULTS The condom usage rates during the last commercial sexual encounter for FSWs and elderly clients improved from 74.9% and 9.1%, respectively, to 96.9% and 28.1%. (P < 0.05), newly reported cases of HIV have decreased by 15.56% yearly and the HIV positive detection rate among middle-aged and elderly people has dropped by 14.47%. The innovative intervention model has significantly reduced the HIV infection rates. CONCLUSIONS The 'CDC-Public Security Bureau-NGO' innovative intervention has achieved beneficial effects on HIV/AIDS prevention and control and provides a good reference for Guangxi, China.
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Affiliation(s)
- Xing Tao
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Yunxuan Huang
- Guigang Center for Disease Control and Prevention, Guigang, Guangxi, China
| | - Pingzuo Zheng
- Guigang Center for Disease Control and Prevention, Guigang, Guangxi, China
| | - Gang Wang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Yuexiang Xu
- Guigang Center for Disease Control and Prevention, Guigang, Guangxi, China
| | - Yongfeng Chen
- Guigang Center for Disease Control and Prevention, Guigang, Guangxi, China
| | - Benben Deng
- Guigang Center for Disease Control and Prevention, Guigang, Guangxi, China
| | - Xiu Chen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Tongxue Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Yinlu Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Minjuan Shi
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Beibei Lu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Yuting Wu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinmiao Li
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China.
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China.
| | - Fashuang Wei
- Guigang Center for Disease Control and Prevention, Guigang, Guangxi, China.
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
- China (Guangxi) - ASEAN Joint Laboratory of Emerging Infectious Diseases, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China.
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Cochran T, Smith L, Ayers K, van Stone M. Beyond Stigma: The Case Against the Criminalization of Sex Work for HIV Prevention and Health Equity. Am J Public Health 2024:e1-e4. [PMID: 39236281 DOI: 10.2105/ajph.2024.307782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Affiliation(s)
- Tyler Cochran
- Tyler Cochran is with the Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore. Leah Smith is with Cincinnati Children's Hospital Medical Center, Ohio. Kara Ayer is with Cincinnati Children's Hospital Medical Center, and University of Cincinnati, College of Medicine, Ohio. Maureen van Stone is with Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, and The Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Leah Smith
- Tyler Cochran is with the Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore. Leah Smith is with Cincinnati Children's Hospital Medical Center, Ohio. Kara Ayer is with Cincinnati Children's Hospital Medical Center, and University of Cincinnati, College of Medicine, Ohio. Maureen van Stone is with Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, and The Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Kara Ayers
- Tyler Cochran is with the Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore. Leah Smith is with Cincinnati Children's Hospital Medical Center, Ohio. Kara Ayer is with Cincinnati Children's Hospital Medical Center, and University of Cincinnati, College of Medicine, Ohio. Maureen van Stone is with Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, and The Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Maureen van Stone
- Tyler Cochran is with the Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore. Leah Smith is with Cincinnati Children's Hospital Medical Center, Ohio. Kara Ayer is with Cincinnati Children's Hospital Medical Center, and University of Cincinnati, College of Medicine, Ohio. Maureen van Stone is with Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, and The Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
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Zuniga JM, Prachniak C, Policek N, Magula N, Gandhi A, Anderson J, Diallo DD, Lima VD, Ravishankar S, Acharya S, Achrekar A, Adeleke M, Aïna É, Baptiste S, Barrow G, Begovac J, Bukusi E, Castel A, Castellanos E, Cestou J, Chirambo G, Crowley J, Dedes N, Ditiu L, Doherty M, Duncombe C, Durán A, Futterman D, Hader S, Kounkeu C, Lawless F, Lazarus JV, Lex S, Lobos C, Mayer K, Mejia M, Moheno HR, d'Arminio Monforte A, Morán-Arribas M, Nagel D, Ndugwa R, Ngunu C, Poonkasetwattana M, Prins M, Quesada A, Rudnieva O, Ruth S, Saavedra J, Toma L, Wanjiku Njenga L, Williams B. IAPAC-Lancet HIV Commission on the future of urban HIV responses. Lancet HIV 2024; 11:e607-e648. [PMID: 39043198 DOI: 10.1016/s2352-3018(24)00124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Affiliation(s)
- José M Zuniga
- International Association of Providers of AIDS Care, Washington, DC, USA; Fast-Track Cities Institute, Washington, DC, USA.
| | | | | | | | - Anisha Gandhi
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | | | - Elizabeth Bukusi
- Kenya Medical Research Institute, Nairobi, Kenya; University of Nairobi, Nairobi, Kenya
| | | | | | - Jorge Cestou
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | | | | | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chris Duncombe
- International Association of Providers of AIDS Care, Washington, DC, USA
| | - Adriana Durán
- Ministry of Health, City of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Chyrol Kounkeu
- Cameroonian Association for the Development and Empowerment of Vulnerable People, Yaoundé, Cameroon
| | - Fran Lawless
- Mayor's Office of Health Policy, New Orleans, LA, USA
| | - Jeffrey V Lazarus
- University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | | | | | - Kenneth Mayer
- Fenway Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Carol Ngunu
- Nairobi City County Department of Health, Nairobi, Kenya
| | | | - Maria Prins
- Academic Medical Center, Amsterdam, Netherlands
| | - Amara Quesada
- Action for Health Initiatives, Quezon City, Philippines
| | | | - Simon Ruth
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
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7
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Lahav-Raz Y, Prior A, Peled E. The Question of Moral Worth in a Controversial Market: Moral Justification Regimes and Boundary Work Among Israeli Men Who Pay for Sex Abroad. JOURNAL OF SEX RESEARCH 2024; 61:1073-1084. [PMID: 36794294 DOI: 10.1080/00224499.2023.2175346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study examined the internal moral debate that takes place among Israeli men who pay for sex (MWPS) while traveling abroad. We explored how they construct their sense of moral worth and present themselves as moral subjects in light of the intensified stigmatization of their actions. Using the theoretical frameworks of pragmatic morality and boundary work, we conceptualize four main moral justification regimes that MWPS use to construct themselves as moral subjects: Cultural normalization; Conditional freedom of choice; The altruistic act of charity; and Unpacking the Stigma Discourse. The findings highlight how these justification regimes are anchored in three intersecting fields - cultural, spatial, and power relations - which produce various matrices of conflict, compromise, or collaboration in different situations. Thus, the flexible switching between various justification regimes reveals how MWPS define themselves and their activities and negotiate various moral dispositions - akin to various cultural logics - in the context of moral taint and stigma.
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Affiliation(s)
- Yeela Lahav-Raz
- The Sociology & Anthropology Department, Ben Gurion University of the Negev
| | - Ayelet Prior
- The Bob Shapell School of Social Work, Tel Aviv University
| | - Einat Peled
- The Bob Shapell School of Social Work, Tel Aviv University
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8
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Kielhold K, Shannon K, Krüsi A, Valencia E, Pearson J, Goldenberg SM. Association between sex work occupational stigma and inconsistent condom use: findings from a community-based cohort of women sex workers in Vancouver, Canada (2014-2022). J Epidemiol Community Health 2024:jech-2024-221989. [PMID: 39179380 DOI: 10.1136/jech-2024-221989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Women sex workers face substantial health inequities due to structural barriers including criminalisation and stigma. Stigma has been associated with HIV-related inequities among marginalised populations, however, we know less about the impacts of sex work-specific occupational stigma on HIV/sexually transmitted infection (STI) risk among women sex workers. Given these research gaps and the disproportionate burden of stigma faced by sex workers, we evaluated the association between sex work occupational stigma and recent inconsistent condom use with clients, over an 8-year period (2014-2022). METHODS Baseline and semiannual questionnaire data from a prospective, community-based cohort of sex workers in Vancouver, Canada from September 2014 to February 2022 were used. We employed complete-case bivariate and multivariate logistic regression analysis using generalised estimating equations to analyse the relationship between sex work occupational stigma and inconsistent condom use for vaginal/anal sex with clients in the past 6 months. RESULTS Among 574 participants, the cumulative prevalence of inconsistent condom use by clients and sex work occupational stigma in the last 6 months was 32.1% (n=184) and 59.9% (n=344), respectively, over the 8-year period. In adjusted multivariable analysis, exposure to sex work occupational stigma was associated with almost twofold increased odds of recent inconsistent condom use with clients (adjusted OR 1.93, 95% CI 1.23 to 3.03) over the 8-year period. CONCLUSION Multilevel interventions addressing the role of occupational stigma are needed for HIV and STI prevention efforts, including scale-up of sex worker-led/delivered sexual health services and structural changes to decriminalise and destigmatise sex work.
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Affiliation(s)
- Kirstin Kielhold
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Division of Social Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Division of Social Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Esteban Valencia
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Division of Social Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Division of Social Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shira M Goldenberg
- School of Public Health, San Diego State University, San Diego, California, USA
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9
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Lépine A, Procureur F, Szawlowski S, Treibich C, Mbaye EH, Gueye K, Ndour CT. Optimising the public health benefits of sex work regulation in Senegal: Results from qualitative interviews with policy stakeholders. PLoS One 2024; 19:e0306803. [PMID: 39146371 PMCID: PMC11326597 DOI: 10.1371/journal.pone.0306803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/24/2024] [Indexed: 08/17/2024] Open
Abstract
CONTEXT There is compelling evidence that eliminating sexually transmitted infections (STIs) among female sex workers (FSWs) is a cost-effective approach to reducing the spread of HIV/AIDS. Although many countries recognise sex work as a public health issue, few have implemented public health policies specifically aimed at controlling the transmission of HIV/AIDS among FSWs. In particular, Senegal stands out as the only African country to regulate sex work through a specific public health policy that requires FSWs to register with a health centre. Despite the potential health and legal benefits associated with registration, a staggering 80% of FSWs in Senegal remain unregistered. This low registration rate hinders the realisation of the policy's full potential for public health benefits. The reluctance of FSWs to register is due to inherent flaws in the policy design, where the disadvantages of registration outweigh the benefits for FSWs. OBJECTIVE To identify which modifications to the current registration policy have the potential to increase uptake of registration by FSWs and to assess their feasibility in the context of Senegal. METHOD We conducted a qualitative policy research study using semi-structured in-depth interviews with 22 national stakeholders in this policy, including representatives from the police, government and non-governmental organisations (NGOs) in Dakar, Senegal, as well as FSWs' leaders. The interview data were thematically coded using the interview topic guide and other recurring themes and analysed using thematic analysis on Nvivo 12. RESULTS A total of 20 relevant themes were selected, focusing primarily on assessing the feasibility of potential interventions and identifying potential barriers and associated risks. We found that, without changing current legislation, improving relationships between FSWs and police officers, providing accurate and accessible information about the rules and benefits of the policy, and offering psychosocial support have the potential to improve both the registration rate of FSWs and their wellbeing. Policy features designed to increase registration by improving FSWs' confidentiality, and thus their confidence in the services offered, were also discussed. CONCLUSIONS The study highlighted that several national public health policies could be changed to increase the registration rate of FSWs and improve their wellbeing without overturning constitutional law.
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Affiliation(s)
- Aurélia Lépine
- Institute for Global Health, University College London, London, United Kingdom
| | - Fanny Procureur
- Institute for Global Health, University College London, London, United Kingdom
| | - Sandie Szawlowski
- Institute for Global Health, University College London, London, United Kingdom
| | - Carole Treibich
- CNRS, INRAE, Grenoble INP, GAEL, Univ. Grenoble Alpes, Grenoble, France
| | - El Hadj Mbaye
- AIDS Division, Ministry of Health and Social Action, Dakar, Senegal
| | - Khady Gueye
- AIDS Division, Ministry of Health and Social Action, Dakar, Senegal
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10
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Logie CH, Kinitz DJ, Gittings L, Lalor P, MacKenzie F, Newman PA, Baral SD, Mbuagbaw L, Shuper P, Levermore K. Intersecting Stigma and the HIV Care Cascade: Qualitative Insights from Sex Workers, Men who have Sex with Men, and Transgender Women Living with HIV in Jamaica. AIDS Behav 2024:10.1007/s10461-024-04460-6. [PMID: 39098884 DOI: 10.1007/s10461-024-04460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
In Jamaica, stigma experiences of sex workers (SW), gay men and other men who have sex with men (MSM), and transgender women living with HIV remain understudied. To address this gap, we explored experiences of stigma and linkages with the HIV care cascade among key populations living with HIV in Jamaica, including cisgender women SW, MSM, and transgender women. This qualitative study involved n = 9 focus groups (FG), n = 1 FG per population living with HIV (SW, MSM, transgender women) in each of three sites (Kingston, St. Ann, Montego Bay). We also conducted key informant (KI) interviews. We applied thematic analysis informed by the Health Stigma and Discrimination (HSD) Framework. FG participants (n = 67) included SW (n = 18), MSM (n = 28), and trans women (n = 21); we interviewed n = 10 KI (n = 5 cisgender women, n = 5 cisgender men). Participant discussions revealed that stigma drivers included low HIV treatment literacy, notably misinformation about antiretroviral therapy (ART) benefits and HIV acquisition risks, and a lack of legal protection from discrimination. Stigma targets health (HIV) and intersecting social identities (sex work, LGBTQ identities, gender non-conformity, low socio-economic status). Stigma manifestations included enacted stigma in communities and families, and internalized stigma-including lateral violence. HIV care cascade impacts included reduced and/or delayed HIV care engagement and ART adherence challenges/disruptions. Participants discussed strategies to live positively with HIV, including ART adherence as stigma resistance; social support and solidarity; and accessing affirming institutional support. In addition to addressing intersecting stigma, future research and programing should bolster multi-level stigma-resistance strategies to live positively with HIV.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Richmond Hill, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | - David J Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lesley Gittings
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Patrick Lalor
- Jamaica AIDS Support for Life (JASL), Kingston, Jamaica
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Paul Shuper
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada
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11
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Jones HS, Anderson RL, Cust H, McClelland RS, Richardson BA, Thirumurthy H, Malama K, Hensen B, Platt L, Rice B, Cowan FM, Imai-Eaton JW, Hargreaves JR, Stevens O. HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e1244-e1260. [PMID: 39030057 DOI: 10.1016/s2214-109x(24)00227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/08/2024] [Accepted: 05/24/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Women who engage in sex work in sub-Saharan Africa have a high risk of acquiring HIV infection. HIV incidence has declined among all women in sub-Saharan Africa, but trends among women who engage in sex work are poorly characterised. We synthesised data on HIV incidence among women who engage in sex work in sub-Saharan Africa and compared these with the total female population to understand relative incidence and trends over time. METHODS We searched MEDLINE, Embase, Global Health, and Google Scholar from Jan 1, 1990, to Feb 28, 2024, and grey literature for studies that reported empirical estimates of HIV incidence among women who engage in sex work in any sub-Saharan Africa country. We calculated incidence rate ratios (IRRs) compared with total female population incidence estimates matched for age, district, and year, did a meta-analysis of IRRs, and used a continuous mixed-effects model to estimate changes in IRR over time. FINDINGS From 32 studies done between 1985 and 2020, 2194 new HIV infections were observed among women who engage in sex work over 51 490 person-years. Median HIV incidence was 4·3 per 100 person years (IQR 2·8-7·0 per 100 person-years). Incidence among women who engage in sex work was eight times higher than matched total population women (IRR 7·8 [95% CI 5·1-11·8]), with larger relative difference in western and central Africa (19·9 [9·6-41·0]) than in eastern and southern Africa (4·9 [3·4-7·1]). There was no evidence that IRRs changed over time (IRR per 5 years: 0·9 [0·7-1·2]). INTERPRETATION Across sub-Saharan Africa, HIV incidence among women who engage in sex work remains disproportionately high compared with the total female population. However, constant relative incidence over time indicates HIV incidence among women who engage in sex work has declined at a similar rate. Location-specific data for women who engage in sex work incidence are sparse, but improved surveillance and standardisation of incidence measurement approaches could fill these gaps. Sustained and enhanced HIV prevention for women who engage in sex work is crucial to address continuing inequalities and ensure declines in new HIV infections. FUNDING Bill & Melinda Gates Foundation, UK Research and Innovation, National Institutes of Health. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Harriet S Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Rebecca L Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Henry Cust
- Institute of Global Health, University College London, London, UK
| | - R Scott McClelland
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Kalonde Malama
- Ingram School of Nursing, McGill University, Montréal, Quebec, QC, Canada
| | - Bernadette Hensen
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, UK
| | - Frances M Cowan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Jeffrey W Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - James R Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
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12
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Galárraga O, Wilson-Barthes M, Chivardi C, Gras-Allain N, Alarid-Escudero F, Gandhi M, Mayer KH, Operario D. Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01705-y. [PMID: 39002005 DOI: 10.1007/s10198-024-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence (p = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers (p < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.
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Affiliation(s)
- Omar Galárraga
- Department of Health Services Policy and Practice, Brown University School of Public Health, 121 South Main St. Box G-S121-2, Providence, RI, 02903, USA.
- International Health Institute, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
| | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA
| | - Carlos Chivardi
- National Institute of Public Health (INSP), University No. 655 Colonia Santa María Ahuacatitlán, Cuernavaca, Mexico
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Nathalie Gras-Allain
- Center for HIV/AIDS Prevention and Care, Clínica Especializada Condesa, Gral. Benjamín Hill 24, Hipódromo Condesa Cuauhtémoc, México City, 06170, Mexico
| | - Fernando Alarid-Escudero
- Center for Economics Teaching and Research (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, Aguascalientes, CP, 20313, Mexico
- Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305, USA
| | - Monica Gandhi
- University of California, 1001 Potrero Ave, #423D, San Francisco, CA, 94110, USA
| | - Kenneth H Mayer
- The Fenway Institute, 7 Haviland St, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Don Operario
- Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
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13
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Carr C, King LM, Maizel J, Scaglione NM, Stetten NE, Varnes JR, Tomko C. Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model. TRAUMA, VIOLENCE & ABUSE 2024; 25:2436-2451. [PMID: 38054440 DOI: 10.1177/15248380231214786] [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: 12/07/2023]
Abstract
Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.
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Affiliation(s)
- Cary Carr
- University of Florida, Gainesville, USA
| | | | - Jennifer Maizel
- University of Florida, Gainesville, USA
- Nova Southeastern University, Fort Lauderdale, FL, USA
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14
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Dutta MJ, Mahtani R, Ho V, Sherqueshaa S, Thomas S, Jalleh-Hosey AA, Pitaloka D, Zapata D, Elers P. Culturally Centering the Voices of Transgender Sex Workers in Singapore: Health, Materiality and Violence. HEALTH COMMUNICATION 2024:1-9. [PMID: 38918887 DOI: 10.1080/10410236.2024.2365487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
The transgender sex worker experience of health in Singapore is multidimensional, working at the intersections of culture, social class, and gendered marginalization. Drawing on in-depth interviews with transgender sex workers in the context of Singapore's extreme neoliberalism and located within a larger culture-centered intervention that emerged through an academic-activist-community partnership, this study foregrounds the everyday meanings of health among transgender sex workers who are marginalized. We offer a discursive register for theorizing violence as disruption of health. Participants narrate health as the negotiation of stigmas coded into their everyday lives, the forms of material violence they experience, and the struggles with accessing secure housing. The theorizing of violence as threat to health by transgender sex workers shapes the health advocacy and health activism that takes the form of a 360 degrees campaign. This essay pushes the literature on the culture-centered approach (CCA) by centering voice as the basis for structurally transformative articulations amidst neoliberal authoritarianism.
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Affiliation(s)
- Mohan J Dutta
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
| | | | | | | | | | | | - Dyah Pitaloka
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
| | - Dazzelyn Zapata
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
| | - Phoebe Elers
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
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15
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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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16
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Frost E, Shannon K, Braschel M, Kestler M, Pearson J, Perry C, Goldenberg SM. Pandemic-related challenges accessing food and primary healthcare among sex workers during the COVID-19 pandemic: findings from a community-based cohort in Vancouver, Canada. BMC Public Health 2024; 24:1544. [PMID: 38849769 PMCID: PMC11162031 DOI: 10.1186/s12889-024-18959-z] [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] [Received: 01/25/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Globally, the COVID-19 pandemic upended healthcare services and created economic vulnerability for many. Criminalization of sex work meant sex workers were largely ineligible for Canada's government-based financial pandemic relief, the Canadian Emergency Response Benefit. Sex workers' loss of income and inability to access financial support services during the pandemic resulted in many unable to pay rent or mortgage, and in need of assistance with basic needs items including food. Little is known about the unique experiences of sex workers who faced challenges in accessing food during the pandemic and its impact on healthcare access. Thus, we aimed to identify the association between pandemic-related challenges accessing food and primary healthcare among sex workers. METHODS Prospective data were drawn from a cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access, AESHA; 2010-present). Data were collected via questionnaires administered bi-annually from October 2020-August 2021. We used univariate and multivariable logistic regression with generalized estimating equations to assess the association between pandemic-related challenges accessing food and challenges accessing primary healthcare over the study period. RESULTS Of 170 participants, 41% experienced pandemic-related challenges in accessing food and 26% reported challenges accessing healthcare. Median age was 45 years (IQR:36-53), 56% were of Indigenous ancestry, 86% experienced intimate partner violence in the last six months, and 62% reported non-injection substance use in the last six months. Experiencing pandemic-related challenges accessing food was positively associated with challenges accessing primary healthcare (Adjusted Odds Ratio: 1.99, 95% Confidence Interval: 1.02-3.88) after adjustment for confounders. CONCLUSIONS Findings provide insight about the potential role community-based healthcare delivery settings (e.g., community clinics) can play in ameliorating access to basic needs such as food among those who are highly marginalized. Future pandemic response efforts should also take the most marginalized populations' needs into consideration by establishing strategies to ensure continuity of essential services providing food and other basic needs. Lastly, policies are needed establishing basic income support and improve access to food resources for marginalized women in times of crisis.
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Affiliation(s)
- Elizabeth Frost
- Joint Doctoral Program in Public Health, San Diego State University and UC San Diego, San Diego, USA
| | - Kate Shannon
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
- Division of Social Medicine, University of British Columbia, Vancouver, Canada
| | - Melissa Braschel
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Jennie Pearson
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Chelsey Perry
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Shira M Goldenberg
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA.
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17
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Machat S, McBride B, Murphy A, Mo M, Goldenberg S, Krüsi A. AN EVALUATION OF INDOOR SEX WORKERS' PSYCHOSOCIAL OCCUPATIONAL HEALTH AND SAFETY IN METRO VANCOUVER, CANADA. OCCUPATIONAL HEALTH SCIENCE 2024; 8:383-406. [PMID: 39148898 PMCID: PMC11323036 DOI: 10.1007/s41542-023-00169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2023] [Accepted: 11/01/2023] [Indexed: 08/17/2024]
Abstract
Criminalization of sex work is linked to increased risk of violence and lack of workplace protections for sex workers. Most jurisdictions globally prohibit some or all aspects of sex work with New Zealand constituting a notable exception, where sex work has been decriminalized and regulated via OHS guidelines. We used the Guide to Occupational Health and Safety in the New Zealand Sex Industry (NZ Guide) as an analytical framework to examine the lived-experiences of psychosocial OHS conditions of indoor sex workers in Metro Vancouver under end-demand criminalization. We drew on 47 semi-structured interviews, conducted in English, Mandarin, and Cantonese in 2017-2018, with indoor sex workers and third parties providing services for them. Participants' narratives were analyzed using a coding framework based on the NZ Guide's psychosocial factors section, including safety and security from violence and complaints processes, which highlighted specific OHS shortcomings in the context of end-demand sex work legislation in indoor sex work environments. Participants identified a significant lack of OHS support, including a lack of safety training, right to refuse services, and access to justice in the context of labour rights violations or fraud, robbery or violence. Our findings emphasize the benefits of full decriminalization of sex work to facilitate sex workers' access to OHS through development and implementation of OHS guidelines designed by and for the indoor sex industry. OHS guidelines should focus on labour rights and protections, including development of sex workers' right to refuse services and access to justice.
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Affiliation(s)
- Sylvia Machat
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Bronwyn McBride
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Alka Murphy
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Minshu Mo
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
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18
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Onur Şimşek K, Özgülnar N. Evaluation of health status of transgender sex workers in Turkey: A qualitative study. Aten Primaria 2024; 56:102875. [PMID: 38350365 PMCID: PMC10874743 DOI: 10.1016/j.aprim.2024.102875] [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: 08/09/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Sex workers can be disadvantaged in terms of overall health due to challenging living and working conditions. This research aimed to evaluate the health status and experiences related to sexually transmitted infections (STDs) of unregistered transgender sex workers in Turkey. DESIGN It employed a phenomenological qualitative research design. SITE: Data were collected in Istanbul between March 2021 and November 2021. PARTICIPANTS Data were collected through in-depth interviews involving 24 people (19 sex workers and 5 physicians). METHODS Key statements were listed during data analysis, and clusters of meanings were formed based on these statements. The participants' statements were used for contextual and structural descriptions. RESULTS Sex workers suffer from chronic illnesses such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, allergic diseases, and neurological disorders. Among the health issues affecting them, the most notable ones are STDs, psychological problems, and the risk of suicide. Sex workers also face a dilemma between choosing public hospitals and private hospitals. Majority of sex workers undergo regular testing for STDs, with the frequency varying from person to person. Reasons for not undergoing regular testing include lack of social security coverage, financial constraints, lack of information, and feeling undervalued. Some individuals are being subjected to mandatory testing. CONCLUSIONS It is recommended that sex workers who seek and request healthcare services should be provided with detailed information and education, particularly regarding psychological problems and STDs.
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Affiliation(s)
| | - Nuray Özgülnar
- Istanbul University, Istanbul Faculty of Medicine, Department of Public Health, Fatih 34390, Istanbul, Turkey
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19
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Birger L, Peled E, Benyamini Y. Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization - A scoping review. J Adv Nurs 2024; 80:2273-2289. [PMID: 38069507 DOI: 10.1111/jan.16010] [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] [Received: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIM To systematically map the extent, range and nature of qualitative studies that explored female sex workers' own perspectives on barriers to accessing reproductive healthcare services. DESIGN A scoping review of the literature utilizing Arksey and O'Malley's method. DATA SOURCES/REVIEW METHODS A search of the electronic databases MEDLINE/ PubMed, PsycNET, Sociological Abstracts, ProQuest, ScienceDirect, HeinOnline, Scopus, Web of Science and Google Scholar was conducted for items published in English between 2001 and 2021. RESULTS Twenty-one studies were included in the review, the majority of which were conducted in lower-middle-income countries. RHC themes studied were diverse, with a few more studies focusing on STI/HIV, contraceptive use and pregnancy than those focusing on childbirth and postnatal care. The findings indicate barriers in four main domains: socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. Stigma was a major multifaceted barrier. CONCLUSION Female sex workers experience exclusion in utilizing reproductive healthcare services globally. As such, healthcare services are advised to adopt a nonjudgemental approach, to enhance physical accessibility and to train nurses and other healthcare professionals on reproductive health needs of female sex workers. Finally, knowledge production processes on the RHC of FSW should adopt a holistic view of FSW, by exploring their needs and barriers related to childbirth and maternity care and by including the perspectives of FSW in high-income countries. IMPACT The review offered an in-depth understanding of female sex workers' own perspectives regarding needs and barriers in utilizing reproductive healthcare services. Findings indicated socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. The review could inform the training of nurses and other healthcare professionals in reproductive healthcare services globally. Researchers should adopt a holistic view of female sex workers, by exploring their family planning needs, including barriers related to childbirth, maternity and postpartum care. REPORTING METHOD We adhered to the EQUATOR guidelines PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.
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Affiliation(s)
- Lior Birger
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Peled
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Benyamini
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
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20
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Avallone F, Hickson F. Sexual Health Needs Among Men Who Engage in Transactional Sex with Men in the UK. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2397-2404. [PMID: 38467959 DOI: 10.1007/s10508-024-02838-0] [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: 12/20/2022] [Revised: 12/30/2023] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
Men who engage in transactional sex with men (MTSM) are a high-risk population for HIV and other sexually transmitted infections. Epidemiological data have so far included them in the broad category of men who have sex with men (MSM), while research on transactional sex typically focused on female sex workers. The internet has substantially changed sex work practices and earlier findings concerning the sexual health needs of MTSM may no longer be applicable. We analyzed quantitative data from MSM based in the UK (n = 11629) taking part in the European MSM Internet Survey (EMIS-2017). Compared to non-MTSM, MTSM (n = 230; 2%) were younger, more likely to self-identify as an ethnic minority, be single, have lower education levels, struggle financially, and-controlling for age-more likely to be living with diagnosed HIV. Commonly unmet needs among all MSM were a lack of confidence in accessing HIV post-exposure prophylaxis, uncertainty about HIV status, and ignorance of where to access hepatitis vaccinations. Compared with other MSM, MTSM were notably less satisfied with the safety of their sexual practices, less confident in their ability to maintain sexual boundaries, and more likely to engage in risk because of absent precautionary resources. Given their greater opportunity for sexual risk, as well as fewer resources for negotiating safety, our findings suggest that services should prioritize MTSM in HIV prevention and sexual health promotion, including assertiveness and social skills training, in addition to knowledge-based education.
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Affiliation(s)
- Francesco Avallone
- Department of Family Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada.
- Center for Outcomes Research and Evaluation Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| | - Ford Hickson
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Adedoja D, Kuhns LM, Radix A, Garofalo R, Brin M, Schnall R. MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation. JMIR Form Res 2024; 8:e56561. [PMID: 38814701 PMCID: PMC11176877 DOI: 10.2196/56561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community-informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term-at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. OBJECTIVE The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. METHODS The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. RESULTS MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). CONCLUSIONS Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth.
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Affiliation(s)
- Dorcas Adedoja
- Columbia University School of Nursing, New York City, NY, United States
| | - Lisa M Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Robert Garofalo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maeve Brin
- Columbia University School of Nursing, New York City, NY, United States
| | - Rebecca Schnall
- Columbia University School of Nursing, New York City, NY, United States
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22
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Sudirham. Insights into chlamydia and gonorrhea dynamics in Southern China: a perspective for application in Indonesia. J Public Health (Oxf) 2024; 46:e364-e365. [PMID: 38282039 DOI: 10.1093/pubmed/fdad282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Sudirham
- Department of Public Health, Faculty of Sport Science and Public Health, Manado State University, Tondano, North Sulawesi 95618, Indonesia
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23
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Phillips TR, Fairley CK, Maddaford K, McNulty A, Donovan B, Guy R, McIver R, Wigan R, Varma R, Ong JJ, Callander D, Skelsey G, Pony M, O'Hara D, Bilardi JE, Chow EP. Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study. JMIR Public Health Surveill 2024; 10:e46845. [PMID: 38767954 PMCID: PMC11148521 DOI: 10.2196/46845] [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: 02/27/2023] [Revised: 01/07/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. OBJECTIVE This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. METHODS This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. RESULTS In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. CONCLUSIONS Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.
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Affiliation(s)
- Tiffany R Phillips
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Christopher K Fairley
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Kate Maddaford
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | | | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Rebecca Wigan
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Rick Varma
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason J Ong
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Operational Centre Geneva, Medecins Sans Frontiers, Mombasa, Kenya
- SexTech Lab, The New School, New York, NY, United States
| | | | - Mish Pony
- Scarlet Alliance, Australian Sex Workers Association, Sydney, Australia
| | - Dylan O'Hara
- Vixen, Victoria's Peer Sex Worker Organisation, Melbourne, Australia
| | - Jade E Bilardi
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Eric Pf Chow
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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24
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Yimam JA, Luslseged S, Tura JB, Bedassa BB, Wariso FB, Rameto MA, Abdella S. Determinants of depressive and alcohol use disorders among female sex workers in Ethiopia: evidence from a national bio-behavioral survey, 2020. BMC Psychiatry 2024; 24:344. [PMID: 38714984 PMCID: PMC11075289 DOI: 10.1186/s12888-024-05799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Female sex workers (FSWs) face an elevated risk of developing mental health disorders and alcohol use disorders (AUD), which in turn increase their vulnerability to HIV and other sexually transmitted infections (STIs) and other negative outcomes. To effectively address both of these health issues, it is crucial to understand the shared key determinants underlying these illnesses, which is a substantial knowledge gap in Ethiopia and elsewhere in the world. Therefore, this study aimed to identify the common key determinants of depression and AUD among FSWs in Ethiopia using a bivariate multivariable ordinal logistic model. METHODS We analyzed cross-sectional biobehavioral data collected in 2020 from 16 cities and major towns in Ethiopia using the respondent-driven sampling (RDS) technique, which involved a total of 6,085 FSWs. FSWs who had lived at the study sites for at least a month before the study period were deemed eligible for recruitment. Major depressive disorder (DD) and AUD were screened using the Patient Health Questionnaire (PHQ9) and alcohol use disorder identification test (AUDIT), respectively. We used descriptive statistics to summarize study population characteristics and bivariate multivariable ordinal logistic regression (BMOLR) to identify common determinants of DD and AUD combined and their nonnormal correlation. RESULTS Among 6085 FSWs screened for DD and AUD, 13.5% and 4.0% have met the criteria for moderate and severe depressive disorder, respectively, and 20.3% and 34.7% have met the AUDIT criteria for harmful or hazardous behavior and alcohol dependence, respectively. FSW with experience of inconsistent condom use, condom failure, violence, mobility, use of any drugs, non-paying partners, abortion, and selling sex for more than five years were associated with an increase in the severity of both disorders. A high average income from selling sex and the number of paying partners reduced the severity of depression and increased the level of alcohol dependence. Being HIV positive and ever having anal sex were associated only with an increase in depression. CONCLUSION Major DD and AUD are prevalent among FSWs in Ethiopia. The findings revealed that common key determinants, which exacerbated the severity of both disorders, were also risk factors for HIV and other STIs. Consequently, integrated STI strategies are essential in the screening, referral, and treatment of depression and AUD. Intervention packages should encompass determinants of depression and AUD, including condom utilization, drug use, mobility between towns, abortion, violence, and counseling services. Additionally, strategies to ensure economic security should be incorporated.
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Affiliation(s)
- Jemal Ayalew Yimam
- Department of statistics, College of Natural Science, Wollo University, Kombolcha, Ethiopia.
| | - Sileshi Luslseged
- College of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jaleta Bulti Tura
- TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Feyiso Bati Wariso
- TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Saro Abdella
- TB/HIV Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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25
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Gnaim-Mwassi N, Winterstein TB, Avieli H. I'm a 45-year-old woman in the body of an 80-year-old: The multiple losses of living and aging in the shadow of prostitution. J Nurs Scholarsh 2024; 56:405-416. [PMID: 38263887 DOI: 10.1111/jnu.12958] [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: 08/16/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Research on aging women who are involved in prostitution is currently limited, both in terms of the number of studies conducted and their scope. Nevertheless, the available research suggests that women who are aging while involved in prostitution may confront some unique challenges. Thus, the study aims to explore the experiences of aging as narrated by Arab women in prostitution, using Intersectionality as a theoretical framework. METHOD Interpretive phenomenological analysis was used, and semistructured interviews were performed with 12 participants. FINDINGS Four themes emerged: "I'm a 45-year-old woman in the body of an 80-year-old:" Loss of physical and mental health; "There is no retirement plan in prostitution: Economic and social losses; As they were taken, my soul went with them too: The loss of the parenting experience and motherhood"; and "I'm going to get older with the disgust clinging to me:" The loss of authentic identity and dignity. CONCLUSION The findings demonstrate how aging serves to exacerbate overlapping forms of discrimination and marginalization. CLINICAL RELEVANCE Healthcare professionals, including nurses caring for older women in prostitution, should be aware of their unique circumstances, considering the social, economic, and healthcare obstacles they face. By being cognizant of these factors, healthcare practitioners can provide meaningful assistance in their pursuit of improved quality of life.
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Affiliation(s)
- Nora Gnaim-Mwassi
- The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- The Department of Gerontology, University of Haifa, Haifa, Israel
| | - Tova Band Winterstein
- The Minerva Center on Intersectionality in Aging (MCIA), University of Haifa, Haifa, Israel
- The Department of Gerontology, University of Haifa, Haifa, Israel
| | - Hila Avieli
- The Department of Criminology, Ariel University, Ariel, Israel
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26
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Walker JG, Elmes J, Grenfell P, Eastham J, Hill K, Stuart R, Boily MC, Platt L, Vickerman P. The impact of policing and homelessness on violence experienced by women who sell sex in London: a modelling study. Sci Rep 2024; 14:8191. [PMID: 38589373 PMCID: PMC11002010 DOI: 10.1038/s41598-023-44663-w] [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] [Received: 08/09/2022] [Accepted: 10/11/2023] [Indexed: 04/10/2024] Open
Abstract
Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88-4.43) or displaced (4.79, 1.99-12.11), or of experiencing displacement if homeless (3.60, 1.59-8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53-81%). The effects are non-linear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5-10.3%) or 6.7% (3.7-10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1-11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4-6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9-19.6%) in combination. Violence reduces by 26.5% (22.6-28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.
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Affiliation(s)
- Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kathleen Hill
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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27
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Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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28
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Brennan RP, Fitzgerald L, Dean JA, Selvey L. 'Change creates change' - older female sex workers' experiences through the early COVID-19 pandemic. CULTURE, HEALTH & SEXUALITY 2024; 26:466-482. [PMID: 37355340 DOI: 10.1080/13691058.2023.2224869] [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: 09/08/2022] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
COVID-19 and associated policy responses created unique social, economic and health risks for sex workers. Through semi-structured interviews we explored pre- and early COVID-19 experiences and work practices of ten cisgender female sex workers 50 years of age and older in Queensland, Australia, analysing the findings using a risk environment framework. Throughout early 2020, participants navigated a complex risk environment, managing economic needs, health and safety, occupational stigma and policing. Australia's policy responses altered the risks and opportunities available to participants. Half the participants continued sex work and half stopped sex work with some accessing economic support and withdrawing superannuation savings. Those who continued sex work drew on life and work experience to reassess changing health, stigma, and policing risks, and adapted their work strategies by increasing client screening and modifying services. Participants relied on information from peer networks and organisations to guide work practices but remained wary of contact tracing, police and the media. Decriminalisation of sex work and the strengthening of sex worker organisation and government partnerships are important in embedding equity in responses to ongoing and new public health threats.
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Affiliation(s)
- Rachael P Brennan
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Lisa Fitzgerald
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Judith A Dean
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Linda Selvey
- School of Public Health, The University of Queensland, Herston, QLD, Australia
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29
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Siegel K, Cabán M, Brown-Bradley CJ, Schrimshaw EW. Experiences of interpersonal violence among a diverse sample of male sex workers. CULTURE, HEALTH & SEXUALITY 2024; 26:531-545. [PMID: 37480576 PMCID: PMC10800640 DOI: 10.1080/13691058.2023.2231049] [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: 01/11/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
A notable portion of men who have sex with men engage in exchange sex-i.e. the trading of sex for money, drugs, shelter or other material goods. Despite the risks for physical and sexual violence, threatening behaviour and robbery that male sex workers confront, very little is known about their experiences of such actions by clients. To gain more insight into male sex workers' experiences of interpersonal violence, we analysed qualitative interview data from 180 men who have sex with men from 8 US cities who engaged in sex work with clients they had met primarily through dating/hookup websites and apps. Participants discussed their experiences of a range of untoward behaviours by clients including physical violence, sexual violence, threats and robbery. Healthcare and social services providers can play a significant role in violence prevention among male sex workers. The decriminalisation of sex work could also potentially reduce the risks many sex workers face by facilitating their reporting of harms suffered.
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Affiliation(s)
- Karolynn Siegel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New york, NY, USA
| | - María Cabán
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New york, NY, USA
| | - Courtney J. Brown-Bradley
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New york, NY, USA
| | - Eric W. Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central FL, Orlando, FL, USA
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30
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Vergara CI, Solymosi R. Correlates of Client-Perpetrated Violence Against Female Sex Workers in Bogotá. Violence Against Women 2024; 30:743-767. [PMID: 36482734 PMCID: PMC10854203 DOI: 10.1177/10778012221142919] [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] [Indexed: 12/22/2023]
Abstract
This paper aims to estimate the prevalence of client-perpetrated violence against female sex workers (FSWs) in Bogotá and to understand what structural and environmental factors are associated with such victimization. The project used secondary data from interviews with 2,684 FSWs. Multivariable binary logistic regression was used to test for associations with client-perpetrated violence. Findings reveal that factors such as experiencing police harassment and social stigma were positively associated with client-perpetrated violence. Situational factors such as providing services in motels, hotels, on the street, and in cars were also associated with increased odds of becoming a victim of violence.
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Affiliation(s)
| | - Reka Solymosi
- Department of Criminology, University of Manchester, Manchester, UK
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31
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Narasimhan M, Hargreaves JR, Logie CH, Abdool-Karim Q, Aujla M, Hopkins J, Cover J, Sentumbwe-Mugisa O, Maleche A, Gilmore K. Self-care interventions for women's health and well-being. Nat Med 2024; 30:660-669. [PMID: 38454127 DOI: 10.1038/s41591-024-02844-8] [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: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - James R Hargreaves
- Center for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Jane Cover
- Sexual and Reproductive Health Program, PATH, Seattle, WA, USA
| | | | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Kate Gilmore
- Department of International Development, London School of Economics and Political Science, London, UK
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32
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Stenersen MR, Thomas K, McKee S. Police Harassment and Violence Against Transgender & Gender Diverse Sex Workers in the United States. JOURNAL OF HOMOSEXUALITY 2024; 71:828-840. [PMID: 36228168 DOI: 10.1080/00918369.2022.2132578] [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: 06/16/2023]
Abstract
Sex workers continue to experience high rates of abuse and violence around the world. However, information regarding police-perpetrated harassment and violence against transgender and gender diverse (TGD) sex workers in the United States remains extremely limited. The current study is the first known examination of police interaction, harassment, and violence among TGD sex workers in the United States using a large nationwide dataset. Data from 23,372 TGD people were used. Results revealed that sex workers were more likely to experience police interaction, harassment, and violence compared to non-sex workers. Among sex workers with police interaction while doing sex work, 89.2% reported experiencing at least one type of harassment and/or violence. Regression analyses revealed that individuals with no reported income and trans women were more likely to experience multiple types of police harassment/violence. Taken together, TGD sex workers continue to experience alarming rates of interaction, harassment, and violence from police in the United States. Urgent, and effective intervention is needed to eliminate police harassment and violence toward TGD sex workers and provide support for TGD sex workers who survive this violence.
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Affiliation(s)
- Madeline R Stenersen
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn Thomas
- Justice Collaboratory, Yale Law School & SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sherry McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Ramos SD, Woodward H, Kannout L, Du Bois S. Dimensional Reduction in Barriers and Facilitators to Pre-exposure Prophylaxis (PrEP) Uptake Willingness for Full-Service Sex Workers. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:799-810. [PMID: 37962828 DOI: 10.1007/s10508-023-02742-z] [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: 03/01/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Full-Service Sex Workers (FSSWs) face heightened risk of acquiring HIV, yet exhibit relatively low adoption of pre-exposure prophylaxis (PrEP)-an antiviral that substantially reduces HIV acquisition risk. Little work examines barriers and facilitators to PrEP uptake willingness among FSSWs. This study aimed to identify the distinct components of barriers and facilitators to PrEP uptake willingness for FSSWs. Here, we subjected 19 PrEP barriers and facilitators identified in the literature to a principal component analysis (PCA) among a sample of 83 FSSWs. Preliminary statistics supported factorability of data. PCA revealed three distinct components of barriers and facilitators that explained 62.80% of the total variance in survey responses. We labeled these components Behavioral and Social Concerns (α = 0.93), Access and Affordability (α = 0.67), and Biologically Based Health Concerns (α = 0.79). This study shows promise for future clinical and research utility of these factors and provides a basis for future psychometric studies of barriers and facilitators to PrEP uptake willingness among FSSWs.
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Affiliation(s)
- Stephen D Ramos
- Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
- SDSU Research Foundation, San Diego State University, San Diego, CA, USA.
| | - Honor Woodward
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Lynn Kannout
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Steff Du Bois
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Morris E, Teplinskaya A, Olansky E, Rinderle JK, Chapin-Bardales J. Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:9-20. [PMID: 38261546 PMCID: PMC10826686 DOI: 10.15585/mmwr.su7301a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
CDC recommends pre-exposure prophylaxis (PrEP) for transgender women who have sex with men and who report sexual behaviors that place them at substantial ongoing risk for HIV exposure, including those who engage in nonsterile syringe sharing. Providing transgender women with access to PrEP is a critical strategy for reducing HIV acquisition and ending the HIV epidemic. Survey results from the National HIV Behavioral Surveillance Among Transgender Women were used to assess characteristics associated with past-year discussions of PrEP with a health care provider and PrEP use. Bivariate analyses were conducted to assess the association between covariates (sociodemographic, HIV-associated characteristics, and gender-affirming care) and each outcome, accounting for sampling design. All covariates that were statistically significant at p<0.05 in the bivariate analyses were included in multivariate models, and manual backward elimination was used to obtain final models that retained statistically significant covariates. Among 902 transgender women from seven urban areas in the United States without HIV infection in the analyses, 57% had recently discussed PrEP with a health care provider, and 32% recently had used PrEP. In the final multivariate model, the following subgroups of transgender women were more likely to report recent PrEP use: those who identified as Black or African American or Hispanic or Latina, had two or more sex partners in the past 12 months, had condomless sex in the past 12 months, reported their last sex partner was infected with HIV, had condomless sex with their last sex partner whose HIV status was positive or unknown, ever had transgender-specific health care, and currently had transgender-specific health insurance coverage. Participants who were less likely to have recently used PrEP were those who wanted to but were not currently taking hormones and those aged <40 years. Providing increased access to gender-affirming care and training health care providers who serve transgender women to incorporate PrEP into existing services might increase PrEP use among transgender women.
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Affiliation(s)
| | | | | | | | | | - National HIV Behavioral Surveillance Among Transgender Women Study Group
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Social & Scientific Systems, Inc., Silver Spring, Maryland; Prevention Communication Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
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Singer RB, Barrow J, Johnson AK, Zemlak J, Crooks N, Abboud S, Bruce D, Green N, Stamps J, Neely J, Sherman SG, Patil CL, Matthews AK. Centering PrEP: utilizing ADAPT-ITT to inform group PrEP care for sex workers in Chicago. BMC Public Health 2024; 24:56. [PMID: 38166881 PMCID: PMC10762989 DOI: 10.1186/s12889-023-17508-4] [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] [Received: 07/02/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Sex workers, those who trade sex for monetary or nonmonetary items, experience high rates of HIV transmission but have not been adequately included in HIV prevention and Pre-Exposure Prophylaxis (PrEP) adherence program development research. Community-empowered (C.E.) approaches have been the most successful at reducing HIV transmission among sex workers. Centering Healthcare (Centering) is a C.E. model proven to improve health outcomes and reduce health disparities in other populations, such as pregnant women, people with diabetes, and sickle cell disease. However, no research exists to determine if Centering can be adapted to meet the unique HIV prevention needs of sex workers. OBJECTIVE We aim to explain the process by which we collaboratively and iteratively adapted Centering to meet the HIV prevention and PrEP retention needs of sex workers. METHODS We utilized the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, Testing (ADAPT-ITT) framework, a model for adapting evidence-based interventions. We applied phases one through six of the ADAPT-ITT framework (Assessment, Decision, Adaptation, Production, Topical Experts, Integration) to the design to address the distinct HIV prevention needs of sex workers in Chicago. Study outcomes corresponded to each phase of the ADAPT-ITT framework. Data used for adaptation emerged from collaborative stakeholder meetings, individual interviews (n = 36) and focus groups (n = 8) with current and former sex workers, and individual interviews with care providers (n = 8). In collaboration with our community advisory board, we used a collaborative and iterative analytical process to co-produce a culturally adapted 3-session facilitator's guide for the Centering Pre-exposure Prophylaxis (C-PrEP +) group healthcare model. RESULTS The ADAPT-ITT framework offered structure and facilitated this community-empowered innovative adaptation of Centering Healthcare. This process culminated with a facilitator's guide and associated materials ready for pilot testing. CONCLUSIONS In direct alignment with community empowerment, we followed the ADAPT-ITT framework, phases 1-6, to iteratively adapt Centering Healthcare to suit the stated HIV Prevention and PrEP care needs of sex workers in Chicago. The study represents the first time the first time Centering has been adapted to suit the HIV prevention and PrEP care needs of sex workers. Addressing a gap in HIV prevention care for sex workers, Centering PrEP harnesses the power of community as it is an iteratively adapted model that can be piloted and replicated regionally, nationally, and internationally.
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Affiliation(s)
- Randi Beth Singer
- College of Nursing, University of Illinois Chicago (UIC), Chicago, IL, USA.
| | - Janelli Barrow
- College of Nursing, University of Illinois Chicago (UIC), Chicago, IL, USA
| | | | - Jessica Zemlak
- College of Nursing, Marquette University, Milwaukee, WI, USA
| | - Natasha Crooks
- College of Nursing, University of Illinois Chicago (UIC), Chicago, IL, USA
| | - Sarah Abboud
- College of Nursing, University of Illinois Chicago (UIC), Chicago, IL, USA
| | - Douglas Bruce
- College of Science and Health, DePaul University, Chicago, IL, USA
| | - Noel Green
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | | | - Susan G Sherman
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago (UIC), Chicago, IL, USA
- School of Nursing, University of Michigan, Ann Arbor, USA
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Goddard-Eckrich D, Gatanaga OS, Thomas BV, Liu Y, Downey DL, Dsouza N, Medley B, Hunt T, Wu E, Johnson K, Black C, Brown M, Hall J, El-Bassel N, Gilbert L. Characteristics of drug-involved black women under community supervision; implications for retention in HIV clinical trials and healthcare. SOCIAL WORK IN HEALTH CARE 2024; 63:35-52. [PMID: 37965711 PMCID: PMC10842763 DOI: 10.1080/00981389.2023.2278781] [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: 04/29/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023]
Abstract
This study examined retention and its relationship to mental health, substance use, and social determinants of health in a randomized clinical trial of a behavioral HIV/sexually transmitted infection prevention intervention with drug-involved Black women (N = 348) under community supervision programs in New York City. Using secondary analysis, we used logistic models to test the association between factors related to mental health, substance use, and social determinants of health and follow-up assessment completion (three, six, and 12 months). Participants who were diagnosed with schizophrenia had lower odds of retention. Participants who misused prescription opiates during their lifetime or food insecure in the past 90 days had higher odds of retention throughout the intervention.
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Affiliation(s)
| | | | | | - Yang Liu
- The Social Intervention Group, Columbia University, New York, New York
| | - Dget Lynn Downey
- The Social Intervention Group, Columbia University, New York, New York
| | - Nishita Dsouza
- The Social Intervention Group, Columbia University, New York, New York
| | - Bethany Medley
- The Social Intervention Group, Columbia University, New York, New York
| | - Timothy Hunt
- The Social Intervention Group, Columbia University, New York, New York
| | - Elwin Wu
- The Social Intervention Group, Columbia University, New York, New York
| | - Karen Johnson
- University of Alabama School of Social Work, Tuscaloosa, AL
| | - Chermaine Black
- The Social Intervention Group, Columbia University, New York, New York
| | - Mary Brown
- The Social Intervention Group, Columbia University, New York, New York
| | - Jennifer Hall
- The Social Intervention Group, Columbia University, New York, New York
| | - Nabila El-Bassel
- The Social Intervention Group, Columbia University, New York, New York
| | - Louisa Gilbert
- The Social Intervention Group, Columbia University, New York, New York
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Kline NS, Webb NJ, Griner SB. Transgender Incarceration and Law Enforcement as a Source of Harm: Upstream and Primordial Prevention Perspectives. VIOLENCE AND VICTIMS 2023; 38:897-909. [PMID: 37989527 DOI: 10.1891/vv-2022-0106] [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: 11/23/2023]
Abstract
In the United States (US), transgender individuals are more likely to experience violence and sexual assault in jails and prisons compared with cisgender peers. Harms of incarceration on transgender individuals include limited access to medical care and hormone therapy, as well as being housed in facilities based on biological sex instead of gender identity. However, there has been insufficient research on addressing factors that lead to transgender individuals being incarcerated in the first place. In this article, we argue the need to focus on law enforcement interactions with transgender individuals in the US to reduce incarceration-related harms. Using the perspectives of primordial prevention and focusing on upstream factors that create health-related harms, we assert that focusing on law enforcement is a necessary component in addressing how the criminal justice system harms transgender individuals.
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Affiliation(s)
- Nolan S Kline
- University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Nathaniel J Webb
- University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
| | - Stacey B Griner
- University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
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Smith-Sreen J, Bosire R, Farquhar C, Katz DA, Kimani J, Masyuko S, Mello MJ, Aluisio AR. Leveraging emergency care to reach key populations for 'the last mile' in HIV programming: a waiting opportunity. AIDS 2023; 37:2421-2424. [PMID: 37965739 PMCID: PMC10655840 DOI: 10.1097/qad.0000000000003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Joshua Smith-Sreen
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Carey Farquhar
- Department of Global Health
- Department of Epidemiology
- Medicine, University of Washington, Seattle, Washington, USA
| | | | - Joshua Kimani
- University of Nairobi College of Health Sciences, Institute of Tropical and Infectious Diseases, Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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39
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Decriminalisation and the end of AIDS: keep the promise, follow the science, and fulfill human rights. Sex Reprod Health Matters 2023; 31:2194188. [PMID: 37351922 PMCID: PMC10291907 DOI: 10.1080/26410397.2023.2194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
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40
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Zhang CX, Lewer D, Aldridge RW, Hayward AC, Cornaglia C, Trussell P, Lillford-Wildman C, Castle J, Gommon J, Campos-Matos I. Small numbers, big impact: making a utilitarian case for the contribution of inclusion health to population health in England. J Epidemiol Community Health 2023; 77:816-820. [PMID: 37734936 DOI: 10.1136/jech-2023-220849] [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: 05/12/2023] [Accepted: 07/28/2023] [Indexed: 09/23/2023]
Abstract
Inclusion health groups make up a small proportion of the general population, so despite the extreme social exclusion and poor health outcomes that these groups experience, they are often overlooked in public health investment and policy development. In this paper, we demonstrate that a utilitarian argument can be made for investment in better support for inclusion health groups despite their small size. That is, by preventing social exclusion, there is the potential for large aggregate health benefits to the whole population. We illustrate this by reframing existing published mortality estimates into population attributable fractions to show that 12% of all-cause premature deaths (95% CI 10.03% to 14.29%) are attributable to the circumstances of people who experience homelessness, use drugs and/or have been in prison. We also show that a large proportion of cause-specific premature deaths in the general population can be attributed to specific inclusion health groups, such as 43% of deaths due to viral hepatitis (95% CI 30.35% to 56.61%) and nearly 4000 deaths due to cancer (3844, 95% CI 3438 to 4285) between 2013 and 2021 attributed to individuals who use illicit opioids. Considering the complexity of the inclusion health policy context and the sparseness of evidence, we discuss how a shift in policy framing from 'inclusion health vs the rest of the population' to 'the impact of social exclusion on broader population health' makes a better case for increased policy attention and investment in inclusion health. We discuss the strengths and limitations of this approach and how it can be applied to public health policy, resource prioritisation and future research.
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Affiliation(s)
- Claire X Zhang
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Dan Lewer
- Institute of Epidemiology & Health Care, University College London, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Andrew C Hayward
- Institute of Epidemiology & Health Care, University College London, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Carlotta Cornaglia
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Peta Trussell
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Charlotte Lillford-Wildman
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Joanna Castle
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Jake Gommon
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Ines Campos-Matos
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
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Scoular J, Sanders T, Balderston S, Abel G, Brents B, Ellison G, Marriott N. Understanding sexual violence in sex working populations-Law, legal consciousness and legal practice in four countries (2021-2023): Study Protocol v2.5. PLoS One 2023; 18:e0283067. [PMID: 37943857 PMCID: PMC10635539 DOI: 10.1371/journal.pone.0283067] [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: 09/26/2022] [Accepted: 03/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Globally, the most important human rights and public health issue that sex workers face is their experience of high levels of violence (Kinnell, 2006, Kinnell, 2008, Alexander, 1999). Deering's systematic review estimated levels of sexual violence in sex working populations as being between 14% and 54% (Deering et al, 2014). AIMS This international, robust mixed methods study will explore the frequency of sexual violence against sex workers, barriers in criminal justice and the legal consciousness of sex workers regarding their rights and consent. The hypothesis to be tested is that the safety of sex workers from sexual violence is mediated by the differing legal contexts of sex work environments. We will compare experiences across research sites in the context of legalisation (Nevada USA), client criminalisation (Northern Ireland), decriminalisation (New Zealand) and partial criminalisation (England, Scotland and Wales) [henceforth ESW]. METHODS An international survey (n = 1,000) will be translated into several languages, to disaggregate experiences by demographic categories (gender, ethnicity, sexual orientation) and sex work sector (including online, street-based and brothels). Interviews (n = 100) with sex workers, police, prosecutors and service providers will be thematically analysed to explore legal consciousness, why the patterns occur and contextualise the statistical findings. These data will be supplemented with comparative legislative, policy and case analysis. Research study data will be used to compare the social factors and legal norms shaping sex workers experiences of sexual violence, justice and support interventions. Recommendations for a 'best practice' review of legal improvements and support interventions will be produced following completion of the study. Given the sensitive nature of the research, robust ethical and data protection mechanisms are in place. The research has ethical approval from each research site, an Advisory Board and trained, paid peer researchers to assist with data gathering, analysis and dissemination. The study will report findings in 2023/2024.
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Affiliation(s)
- Jane Scoular
- Law School, University of Strathclyde, Scotland, United Kingdom
| | - Teela Sanders
- School of Criminology, University of Leicester, England, United Kingdom
| | | | - Gillian Abel
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Barbara Brents
- Sociology, University of Nevada, Las Vegas, Nevada, United States of America
| | - Graham Ellison
- School of Law, Queen’s University Belfast, Northern Ireland, United Kingdom
| | - Nigel Marriott
- Marriott Statistical Consulting, Bristol, England, United Kingdom
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Benoit C, Mellor A, Premji Z. Access to Sexual Rights for People Living with Disabilities: Assumptions, Evidence, and Policy Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3201-3255. [PMID: 35881252 DOI: 10.1007/s10508-022-02372-x] [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: 11/24/2021] [Revised: 06/12/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Sexuality scholars have historically understudied the link between disability, sexual exclusion, and social justice, including equal rights for people living with disabilities (PLWD) to enjoy a sexual and intimate life in adulthood. There have been some recent efforts to rectify this situation, with studies emerging concerning strategies for promoting their sexual rights. Our Target Article explores one contentious service option-the possibility of "sexual assistance" for PLWD, which ranges in meaning across countries from sex surrogacy to physical contact with paid sexual assistants. We conducted a knowledge synthesis using a scoping review methodology to identify the breadth of the academic scholarship available and assess its alignment with current ethical and moral debates and recent policies and practices surrounding the sexual scripts of PLWD as they relate to sexual assistance. We categorized the relevant articles in our scoping review into two broad classes: those that support sex-negative perspectives (i.e., framing sexuality as risky, adversarial, etc.) and those that support sex-positive perspectives (i.e., framing sexuality as normative, consensual, etc.). Our results show that sex-negative cultural scripts call for limitations of the sexual rights of PLWD due to their inherent vulnerability as having disabled sexualities and/or due to their heightened risk of exploiting sexual partners, especially cis women who sell sexual services. The sex-positive cultural scripts understand PLWD as having the same rights to sexual citizenship as non-disabled individuals and that to achieve this, equitable access to sexual health services in decriminalized and regulated service environments is needed. We conclude with limitations of our investigation and recommendations for further research on this understudied topic, including the possible integration of positive disabled sexuality and abuse prevention.
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Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
| | - Andrea Mellor
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Zahra Premji
- McPherson Library, University of Victoria, Victoria, BC, Canada
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Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [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] [Received: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
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Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
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Mitjà O, Padovese V, Folch C, Rossoni I, Marks M, Rodríguez i Arias MA, Telenti A, Ciuffi A, Blondeel K, Mårdh O, Casabona J. Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100742. [PMID: 37927427 PMCID: PMC10625005 DOI: 10.1016/j.lanepe.2023.100742] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023]
Abstract
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Cinta Folch
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Isotta Rossoni
- Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Netherland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom
- Division of Infection and Immunology, University College London, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
| | - Miquel Angel Rodríguez i Arias
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
| | | | - Angela Ciuffi
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Otilia Mårdh
- STI, Blood Borne Viruses and TB Section, Disease Programmes Unit, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Lipira LE, Glick JL, German D, Glick SN, Moreno C, Elimam D, Brantley ML, Pichon LC, Barak N, Booth MM, Flynn C, Menza T. Type of Exchange Sex and Associated Behaviors and Outcomes Among Cisgender Men and Women at Increased Risk for HIV via Heterosexual Transmission in Six U.S. Metropolitan Areas. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3313-3327. [PMID: 37612535 DOI: 10.1007/s10508-023-02663-x] [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: 01/06/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023]
Abstract
Exchange sex is associated with sexual risk behaviors and poor outcomes and different types may incur different levels of risk. We assessed risk profiles of different types of exchange sex among non-injecting cisgender men and women who participated in the 2019 National HIV Behavioral Surveillance project at six sites. Six percent of men and 19% of women reported exchange sex in the past year; most engaged in non-commercial exchange sex for drugs/money with smaller percentages reporting formal sex work or non-commercial exchange sex for goods or services other than drugs/money. Exchange sex was associated with sexual risk and prevention behaviors and psychosocial and sexual health outcomes and associations varied by type of exchange sex. Efforts to improve access to STI/HIV testing and PrEP may benefit from tailoring based on type of exchange sex. Findings indicate value in a broader definition of exchange sex with follow-up assessment of exchange sex typology.
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Affiliation(s)
- Lauren E Lipira
- Regional Research Institute, Portland State University, Portland, OR, USA.
- Public Health Division, Oregon Health Authority, 800 NE Oregon St, Portland, OR, 97232, USA.
| | - Jennifer L Glick
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Courtney Moreno
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Dena Elimam
- Epidemiology Section, Georgia Department of Public Health, Division of Health Protection, Atlanta, GA, USA
| | - Meredith L Brantley
- HIV/STI/Viral Hepatitis Section, Tennessee Department of Health, Nashville, TN, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | | | | | - Colin Flynn
- Maryland Department of Health, Baltimore, MD, USA
| | - Timothy Menza
- Public Health Division, Oregon Health Authority, 800 NE Oregon St, Portland, OR, 97232, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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46
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Lazarus L, Herpai N, Pavlova D, Gill A, Cholette F, McClarty LM, Isac S, Lopatenko A, Pickles M, Mishra S, Shaw SY, Lorway R, McKinnon LR, Sandstrom P, Blanchard J, Balakireva O, Becker ML. A cross-sectional survey exploring HIV and HCV prevalence among men who purchase sex in Dnipro, Ukraine. BMC Public Health 2023; 23:2054. [PMID: 37858070 PMCID: PMC10588219 DOI: 10.1186/s12889-023-16903-1] [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: 01/05/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND HIV programming in Ukraine largely targets "key population" groups. Men who purchase sex are not directly reached. The aim of our study was to explore the prevalence of sexually transmitted and blood-borne infections (STBBIs) among men who purchase sex from female sex workers. METHODS Following geographic mapping and population size estimation at each "hotspot", we conducted a cross-sectional bio-behavioural survey with men who purchase sex between September 2017 and March 2018 in Dnipro, Ukraine. Eligibility criteria included purchasing sex services at a "hotspot" and being ≥ 18 years. Participants completed a structured questionnaire, followed by HIV/HCV rapid testing and a dried blood spot (DBS) sample collection for confirmatory serology. RESULTS The study enrolled 370 participants. The median age was 32 (interquartile range [IQR] = 27-38) and the median age of first purchase of sexual services was 22 (IQR = 19-27). Over half (56%) of participants reported ever testing for HIV; four participants (2%, N = 206) reported having tested positive for HIV, with three out of the four reporting being on ART. Forty percent of participants had ever tested for HCV, with three (2%, N = 142) having ever tested positive for HCV. In DBS testing, nine participants (2.4%) tested positive for HIV and 24 (6.5%) tested positive for ever having an HCV infection. CONCLUSION Prevalence of HIV and HCV in this population was high. Given high rates of study enrolment and testing, efforts should be made to reach men who purchase sex with expanded STBBI programming.
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Affiliation(s)
- Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada.
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Nicole Herpai
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Daria Pavlova
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, Kyiv, Ukraine
| | - Amaanat Gill
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - François Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Leigh M McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Delhi, India
| | - Anna Lopatenko
- Dnipropetrovsk Regional Center for Socially Significant Diseases, Dnipro, Ukraine
| | - Michael Pickles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - 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
| | - Souradet Y Shaw
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
| | - Paul Sandstrom
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - James Blanchard
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Olga Balakireva
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, Kyiv, Ukraine
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave., Winnipeg, Manitoba, R2E 0T6, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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47
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Jones HS, Anderson RL, Cust H, McClelland RS, Richardson BA, Thirumurthy H, Malama K, Hensen B, Platt L, Rice B, Cowan FM, Imai-Eaton JW, Hargreaves JR, Stevens O. HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.17.23297108. [PMID: 37905066 PMCID: PMC10615019 DOI: 10.1101/2023.10.17.23297108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction HIV incidence among women in sub-Saharan Africa (SSA) has declined steadily, but it is unknown whether new infections among women who engage in sex work (WESW) have declined at a similar rate. We synthesised estimates of HIV incidence among WESW in SSA and compared these to the wider female population to understand levels and trends in incidence over time. Methods We searched Medline, Embase, Global Health, Popline, Web of Science, and Google Scholar from January 1990 to October 2022, and grey literature for estimates of HIV incidence among WESW in SSA. We included studies reporting empirical estimates in any SSA country. We calculated incidence rate ratios (IRR) compared to age-district-year matched total female population incidence estimates. We conducted a meta-analysis of IRRs and used a continuous mixed-effects model to estimate changes in IRR over time. Results From 32 studies between 1985 and 2020, 2,194 new HIV infections were observed in WESW over 51,000 person-years (py). Median HIV incidence was 4.3/100py (IQR 2.8-7.0/100py), declining from a median of 5.96/100py between 1985 and 1995 to a median of 3.2/100py between 2010 and 2020. Incidence among WESW was nine times higher than in matched total population women (RR 8.6, 95%CI: 5.7-12.9), and greater in Western and Central Africa (RR 22.4, 95%CI: 11.3-44.3) than in Eastern and Southern Africa (RR 5.3, 95%CI: 3.7-7.6). Annual changes in log IRRs were minimal (-0.1% 95%CI: -6.9 to +6.8%). Conclusions Across SSA, HIV incidence among WESW remains disproportionately high compared to the total female population but showed similar rates of decline between 1990 and 2020. Improved surveillance and standardisation of approaches to obtain empirical estimates of sex worker incidence would enable a clearer understanding of whether we are on track to meet global targets for this population and better support data-driven HIV prevention programming.
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Affiliation(s)
- Harriet S Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca L Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Henry Cust
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - R Scott McClelland
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kalonde Malama
- University of Toronto Factor-Inwentash Faculty of Social Work, Toronto Ontario, Canada
| | - Bernadette Hensen
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- Sheffield Centre for Health and Related Research (SCHARR); School of Medicine and Population Health, University of Sheffield, UK
| | - Frances M Cowan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Jeffrey W Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James R Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Mbotwa CH, Kazaura MR, Moen K, Leshabari MT, Metta E, Mmbaga EJ. Retention in an mHealth App Aiming to Promote the Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers in Dar es Salaam, Tanzania: Prospective Cohort Study. JMIR Mhealth Uhealth 2023; 11:e46853. [PMID: 37855221 PMCID: PMC10595516 DOI: 10.2196/46853] [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: 03/21/2023] [Revised: 06/17/2023] [Accepted: 08/04/2023] [Indexed: 10/20/2023] Open
Abstract
Background Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa. Objective This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania. Methods A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app's back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app. Results A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01). Conclusions Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase.
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Affiliation(s)
- Christopher H Mbotwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, United Republic of Tanzania
| | - Method R Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Melkizedeck T Leshabari
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Emmy Metta
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
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49
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Hendrickson ZM, Tomko C, Galai N, Sisson LN, Glick JL, Sherman SG. A Longitudinal Analysis of Residential Mobility and Experience of Client Violence Among Women Who Exchange Sex in Baltimore. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11017-11045. [PMID: 37395208 DOI: 10.1177/08862605231178492] [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] [Indexed: 07/04/2023]
Abstract
Residential mobility remains an underexplored yet critical construct that may influence the risk of violence among women who exchange sex. This study examined the longitudinal relationship between residential mobility and experience of client-perpetrated physical or sexual violence among women who exchange sex in Baltimore, Maryland. Participants were at least at 18 years of age, were cisgender women, reported having engaged in transactional sex three or more times within the last 3 months, and were willing to be contacted for 6-, 12-, and 18-month follow-up visits. Analyses of responses from 370 women who exchange sex participating in at least one study visit were conducted. Unadjusted and adjusted Poisson regression models of the association over time between residential mobility and recent experience of physical or sexual violence were fit. Generalized estimating equations with an exchangeable correlation structure and robust variance estimation were used to account for clustering of participants' responses over time. Findings demonstrated that those who had lived in at least four places in the past 6 months had a 39% increased risk of client-perpetrated physical violence (aRR: 1.39; 95% CI: 1.07-1.80; p < .05) and a 63% increased risk of sexual violence (aRR: 1.63; 95% CI: 1.14-2.32; p < .01) compared to their less-mobile counterparts. These findings provide necessary evidence of correlations over time between residential mobility and experience of client-perpetrated violence among women who exchange sex. Strengthening our understanding of how residential mobility intersects with violence is critical for the development of public health interventions that are relevant to women's lives and needs. Future interventions should explore including residential mobility, a critical pillar of housing instability, with efforts to address client-perpetrated violence.
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Affiliation(s)
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Haifa, Mt Carmel, Haifa, Israel
| | | | - Jennifer L Glick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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50
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Vimpere L, Sami J, Jeannot E. Cervical cancer screening programs for female sex workers: a scoping review. Front Public Health 2023; 11:1226779. [PMID: 37841741 PMCID: PMC10570451 DOI: 10.3389/fpubh.2023.1226779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Cervical cancer (CC) is the fourth most common neoplasia affecting women worldwide. Female sex workers (FSWs) are among those at highest risk of developing and succumbing to CC. Yet, they are often overlooked in CC screening programs and have limited access to CC healthcare globally. The development of CC screening programs for this high-risk target population is necessary to reduce the global burden of this disease and to reach the World Health Organization's objective of accelerating the elimination of CC. Objective This review summarizes findings on CC screening programs for FSWs that have been implemented worldwide, and assesses their effectiveness and sustainability. Methods A scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A literature search was performed on PubMed, Swisscovery, and Google Scholar for studies describing and assessing CC screening programs for FSWs. In addition, targeted searching online Non-Governmental and International Organizations websites identified grey literature. A single reviewer screened titles and abstracts, and extracted data from the research findings. Results The search identified 13 articles published from 1989 to 2021. All implemented programs successfully reached FSWs and provided them with CC screening during the study period. The most effective and sustainable strategies were the Screen and Treat approach, introducing CC screening into existing STI services in drop-in or outreach clinics, HPV-DNA self-sampling, and integrating sex-workers-specific services in public health facilities. Follow-up was deemed the main challenge in providing and enhancing CC healthcare to FSWs with rates of loss to follow-up ranging from 35 to 60%. Conclusion FSWs are often omitted in national CC screening programs. The further development and improvement of CC healthcare, including follow-up systems, for this high-priority target population are imperative.
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Affiliation(s)
- Léa Vimpere
- Global Studies Institute, Université de Genève, Geneva, Switzerland
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jana Sami
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Emilien Jeannot
- Faculty of Medicine, Institute of Global Health, Geneva, Switzerland
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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