The Peer and Non-peer: the potential of risk management for HIV prevention in contexts of prostitution

Quality of life from women's perspective in the exercise of sex work: a study of social representations

OBJECTIVES

to analyze the social representations elaborated by sex workers from Alto Sertão Produtivo Baiano about quality of life.

METHODS

a qualitative study, based on the Social Representation Theory, carried out in the region of Alto Sertão Produtivo Baiano, with 30 sex workers. Individual in-depth interview was carried out, with speeches organized in a corpus and treated in IRAMUTEQ, enabling lexical analysis for Descending Hierarchical Classification.

RESULTS

four thematic classes emerged, in which social representations of quality of life pervade: money earned to supply needs; association with healthy living and obtaining health (physical and mental); balance of emotions (although there are some negative sensations such as fear and anxiety); and faith in a deity.

FINAL CONSIDERATIONS

the social representations elaborated by sex workers about quality of life are anchored in concepts, subjective and practical, punctuated by the World Health Organization.

A retreat from human rights? A reflection on sex work's place in contemporary HIV prevention

In 2012, the World Health Organization guidelines for HIV prevention recommended the decriminalisation of sex work as their number one good practice. Although human rights language played a key role in the international scientific and activist endorsement of the WHO policies, since then there have been few initiatives in terms of advancing the kinds of structural and political changes endorsed. In this Commentary, we reflect on sex work's place in the broader field of the biomedicalization of responses to HIV. The analysis is based on literature reviews and our research trajectories, including preliminary results from a qualitative study on the implementation of PrEP in Rio de Janeiro, Brazil. We argue that sex workers occupy an ambiguous and less visible role in current AIDS policies, and that such policies are increasingly characterised by their prioritisation of biomedical approaches over structural factors. These shifts should be understood as part of a broader, global hegemony of clinical responses to HIV prevention and the continuation of a neoliberal discourse around human rights, without adequate investment in the material conditions necessary to guarantee these rights.

Sentidos Atribuídos à Satisfação Sexual por Trabalhadoras do Sexo

Objetivou-se compreender os sentidos atribuídos à satisfação sexual por mulheres que vivenciam o trabalho sexual. Trata-se de um estudo qualitativo, fundamentado nas abordagens fenomenológicas de Sartre e Heidegger. Foi realizado com 30 trabalhadoras sexuais da região do Alto Sertão Produtivo Baiano. Evidenciou-se que as mulheres têm os sentidos sobre satisfação sexual estruturados na dimensão financeira em interface à autoestima e ao ato sexual, explicadas a partir das experiências aprendidas, enquanto são/estão inseridas no serviço sexual. Esses sentidos revelam que o prazer em conexão ao dinheiro é a sobrevivência e subsistência. Já o orgasmo propriamente dito remete à autoestima e às emoções sentidas por quem nutre afeto. Essas nuances mostram que o serviço sexual é, além de ofício, o contexto que permite a elas ser/estar em um espaço com possibilidades de vivências multifacetadas, como a liberdade sexual, em uma temporalidade que é reflexo de subjetividades que extrapolam o determinismo natural.

Sex Work, Essential Work: A Historical and (Necro)Political Analysis of Sex Work in Times of COVID-19 in Brazil

Brazil has made international headlines for the government’s inept and irresponsible response to the COVID-19 pandemic. In this context, sex worker activists have once again taken on an essential role in responding to the pandemic amidst State absences and abuses. Drawing on the theoretical framework of necropolitics, we trace the gendered, sexualized, and racialized dimensions of how prostitution and work have been (un)governed in Brazil and how this has framed sex worker activists’ responses to COVID-19. As a group of scholars and sex worker activists based in Rio de Janeiro and São Paulo, we specifically explore the idea of sex workers as “essential workers”, but also of sex work as, essentially, work, demonstrating complicities, differences, and congruencies in how sex workers see what they do and who their allies in the context of the 21st century’s greatest health crisis to date.

Factors associated to inconsistent condom use among sex workers

OBJECTIVE

to analyze the factors associated to the inconsistent condom use among sex workers.

METHOD

a transversal study, carried out in prostitution area, using the Respondent Drive Sampling. The sample was calculated based on the information by the Sex Workers Association: 600 female sex workers. The study selected seven women with different characteristics regarding color, age, and place of work, who were called seeds. After the participation, they received three coupons to recruit other participants in order to obtain a representative sample. The definition of inconsistent condom use was determined as occasional use or never using it. Univariate analyses and a multivariate logistic regression were performed.

RESULTS

416 female sex workers participated in the study. The associated factors were having studied for less than eight years (Odds Ratio = 27.28), not having a permanent partner (Odds Ratio = 2.79), high alcohol use (Odds Ratio = 5.07), and being black (Odds Ratio = 2.21).

CONCLUSION

the factors associated to inconsistent condom use were: lower education levels, not having a permanent partner, high alcohol use, and being black.

Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up

Access to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation.Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs).Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIV-infected partners. LTFU rate was 72.8% and predictors included being Black (aPR = 1.15, 95% confidence interval [CI]: 1.03-1.30), using drugs/alcohol (aPR = 1.15, 95% CI: 1.01-1.32) and having received nPEP at an HIV outpatient clinic (aPR = 1.35, 95% CI: 1.20-1.51) or at an infectious diseases hospital (aPR = 1.37, 95% CI: 1.11-1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41-59 years = 0.80, 95% CI: 0.68-0.96).Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT.

Rites of Resistance: Sex Workers' Fight to Maintain Rights and Pleasure in the Centre of the Response to HIV in Brazil

Drawing on ethnographic research conducted from 2011 to 2015 and the authors' long-term engagement in diverse aspects of HIV and human rights advocacy in Brazil, this paper explores key elements of the Brazilian sex workers' movement response to HIV and the broader political factors that profoundly influenced its trajectory. We argue that the movement has constantly challenged representations of prostitution by affirming sex workers' roles as political actors, not just peer educators, in fighting the HIV epidemic and highlight their development of a sex positive and pleasure centred response that fought stigma on multiple fronts. Moments of tension such as the censorship of an HIV prevention campaign and implementation of 'test and treat' projects are analysed, as are the complex questions that Brazil's 2016 political and economic crisis evokes in terms of how to develop and sustain responses to HIV driven by communities but with material commitment from the State. We conclude with what we see to be the unique, central components of Brazilian sex workers' approach to HIV prevention and what lessons can be learned from it for broader collective health movements in Latin America and beyond.