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Nattabi J, Bahar OS, Nabayinda J, Nabunya P, Kiyingi J, Kizito S, Namuwonge F, Nsubuga E, Witte SS, Ssewamala FM. Crossroads of Choice: A qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda. RESEARCH SQUARE 2024:rs.3.rs-4468785. [PMID: 38883774 PMCID: PMC11177997 DOI: 10.21203/rs.3.rs-4468785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Women Engaged in commercial Sex Work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk to HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs. Methods Semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within a larger study-Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 HIV hotspots in the Southern region of Uganda. Participants were selected based on their intervention attendance (high/medium/low attendance). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to from transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?". All interviews were audio-recorded, transcribed verbatim and translated into English. Thematic analysis in Dedoose software was used to analyze the data. Results Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and continuing sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to leave sex work. Individual level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the structural level, factors which include interpersonal stigma and discrimination (from immediate family and community members), physical and sexual violence and income related factors were identified as facilitators and barriers to leaving sex work. Conclusion Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.
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Jewkes R, Milovanovic M, Otwombe K, Hlongwane K, Hill N, Mbowane V, Gray G, Coetzee J. Understanding drivers of female sex workers' experiences of external/enacted and internalised stigma: findings from a cross-sectional community-centric national study in South Africa. CULTURE, HEALTH & SEXUALITY 2023; 25:1433-1448. [PMID: 36592099 DOI: 10.1080/13691058.2022.2160014] [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: 08/05/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
To deepen our understanding of sex work stigma, and to its drivers and their interrelation, we conducted an analysis using structural equation modelling of the South African National Sex Worker Survey. We enrolled 3005 women in sex work using multi-stage sampling across all South Africa's provinces. Experience of external/enacted and internalised stigma was widespread. Non-partner rape, intimate partner violence and partner controlling behaviour (often expressions of external/enacted stigma) compounded internalised stigma. These experiences of violence, other manifestations of external/enacted stigma and food insecurity, were key drivers of internalised stigma, and often had an impact on mental health. We found that considerable protection against stigma emanated from viewing sex work positively. This resistance to stigma provided opportunities to shift the narrative. Reducing sex workers' exposure to external/enacted stigmatising behaviour, including by enabling more to work indoors, and providing greater protection from partner violence and rape, are critical for better health and well-being. Ending the criminalisation of sex work is foundational for safer working conditions and better health outcomes for sex workers, similarly providing adequately funded mental and physical health and social care through sex work specific programmes.
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Affiliation(s)
- Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Naomi Hill
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Hillbrow, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
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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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Hallett N, Christie C, Docherty-Smith J, Welborn H, Wright H, Molloy E, Chandan JS, Croxford S, Taylor J, Bradbury-Jones C. Healthcare interventions for sex workers: protocol for a scoping review. BMJ Open 2023; 13:e074983. [PMID: 37558442 PMCID: PMC10432664 DOI: 10.1136/bmjopen-2023-074983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Sex workers, who provide sexual or erotic acts in exchange for payment, often experience multiple disadvantages, including mental ill health and substance misuse. Mainstream healthcare services are generally not configured to facilitate engagement with sex workers and therefore, services are needed that are accessible to this population. The aim of this scoping review is to understand the evidence base for approaches, services and interventions that are aimed at addressing sex workers' health needs. METHODS AND ANALYSIS Nine databases, CINAHL, Embase, EThOS, Google Scholar, Health Management Information Consortium, MEDLINE, ProQuest Dissertations and Theses, PsycINFO and Web of Science (Core Collection), will be searched, with results limited to English language publications and those published from 2003 onwards. De-duplication, study selection and data extraction will be conducted using Covidence software. Included studies will describe or evaluate approaches, services or interventions that address the health needs of sex workers who offer services that involve physical contact with a client. ETHICS AND DISSEMINATION No ethical review is needed. The final report will be shared with Birmingham City Council as part of ongoing work and will be disseminated by peer-reviewed publication. STUDY REGISTRATION Open Science Framework (doi: 10.17605/OSF.IO/N7WSX).
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Affiliation(s)
- Nutmeg Hallett
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Jack Docherty-Smith
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Heather Welborn
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hannah Wright
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleanor Molloy
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sara Croxford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - Julie Taylor
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Caroline Bradbury-Jones
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Pearce LA, Borschmann R, Young JT, Kinner SA. Advancing cross-sectoral data linkage to understand and address the health impacts of social exclusion: Challenges and potential solutions. Int J Popul Data Sci 2023; 8:2116. [PMID: 37670956 PMCID: PMC10476462 DOI: 10.23889/ijpds.v8i1.2116] [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: 09/07/2023] Open
Abstract
The use of administrative health data for research, monitoring, and quality improvement has proliferated in recent decades, leading to improvements in health across many disease areas and across the life course. However, not all populations are equally visible in administrative health data, and those that are less visible may be excluded from the benefits of associated research. Socially excluded populations - including the homeless, people with substance dependence, people involved in sex work, migrants or asylum seekers, and people with a history of incarceration - are typically characterised by health inequity. Yet people who experience social exclusion are often invisible within routinely collected administrative health data because information on their markers of social exclusion are not routinely recorded by healthcare providers. These circumstances make it difficult to understand the often complex health needs of socially excluded populations, evaluate and improve the quality of health services that they interact with, provide more accessible and appropriate health services, and develop effective and integrated responses to reduce health inequity. In this commentary we discuss how linking data from multiple sectors with administrative health data, often called cross-sectoral data linkage, is a key method for systematically identifying socially excluded populations in administrative health data and addressing other issues related to data quality and representativeness. We discuss how cross-sectoral data linkage can improve the representation of socially excluded populations in research, monitoring, and quality improvement initiatives, which can in turn inform coordinated responses across multiple sectors of service delivery. Finally, we articulate key challenges and potential solutions for advancing the use of cross-sectoral data linkage to improve the health of socially excluded populations, using international examples.
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Affiliation(s)
- Lindsay A. Pearce
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Rohan Borschmann
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry; University of Oxford, Oxford, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse T. Young
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Stuart A. Kinner
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
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Csete J, Elliott R, Bernard EJ. So many harms, so little benefit: a global review of the history and harms of HIV criminalisation. Lancet HIV 2023; 10:e52-e61. [PMID: 36202138 DOI: 10.1016/s2352-3018(22)00248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
Since the early years of HIV, many jurisdictions have criminalised HIV non-disclosure, potential or perceived exposure, and transmission. Many of these laws and prosecutions are without a scientific basis and reflect an inaccurate understanding of HIV-related risk and harm. Numerous studies of HIV criminal prosecutions show that women, sex workers, racial minorities, gay and bisexual men, transgender people, immigrants, and Indigenous people are disproportionately charged and convicted, often resulting in long custodial sentences. Data from molecular HIV surveillance, used to track HIV outbreaks in marginalised populations, are prone to be misused in HIV criminal cases. Scientific consensus statements and international standards have helped to guide advocacy to repeal or reform a number of these laws, resulting in fewer prosecutions in some jurisdictions. Many successful reform efforts have been led by people living with HIV and are notable at a moment of reckoning on racism and inequality in global health.
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Affiliation(s)
- Joanne Csete
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
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Ikuteyijo OO, Akinyemi AI, Merten S. Exposure to job-related violence among young female sex workers in urban slums of Southwest Nigeria. BMC Public Health 2022; 22:1021. [PMID: 35597935 PMCID: PMC9123769 DOI: 10.1186/s12889-022-13440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background In Nigeria, many young girls are engaged in commercial sex work as a means of livelihood and support of dependent relatives. Although studies have documented some of the violence related issues among commercial sex workers, the plight of adolescent and young sex workers particularly in urban slums may be different in context and depth. Objective This study explored the lived experiences of violence and health related harm among vulnerable young female sex workers in urban slums in Ibadan and Lagos, Southwest Nigeria. It also analyzed their coping strategies and survival mechanisms. Design The study is cross-sectional and applied an interpretive phenomenological approach to this qualitative study through in-depth interviews. Participants Young female sex workers ages (15–24 years) who reported having experienced violence were recruited for the study. Twelve participants completed the interviews out the 20 initially contacted. Data collection and analysis Primary data were collected using in-depth interviews (IDIs). Data were transcribed using a phenomenological framework analysis. Participants’ reports based on life experiences were identified: lived experience “daily brothel life experience”; sources of violence such as law enforcement agents’ intermittent raids; violence experience with clients who often demanded sexual acts beyond the agreed scope; and coping strategies employed to mitigate the challenges. Settings The study was conducted in brothels of two selected slum areas in Ibadan and Lagos, Southwest Nigeria. Results The results showed that the major motivation for engaging in commercial sex work was for economic reasons. However, there are inherent risks involved particularly for the vulnerable young people. Stigmatization from the community, clients’ uncontrolled-aggressive behavior and harassment from law enforcement agents are some of the frequent violence experiences reported. Self-help coping strategies are usually employed to prevent or mitigate the challenges. Conclusion The plight of this young people required policy and program attention towards alternative economic empowerment to rehabilitate those willing to leave the profession. Also the need to develop arm reduction interventions towards protection of young sex workers against violence. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-13440-1.
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Affiliation(s)
- Olutoyin Opeyemi Ikuteyijo
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Akanni Ibukun Akinyemi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.,University of Basel, Basel, Switzerland
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