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Lancet Hiv ; 9(7):E506-E516, 2022.
Article in English | Web of Science | ID: covidwho-2081748


The Middle East and north Africa is one of only two world regions where HIV incidence is on the rise, with most infections occurring among key populations: people who inject drugs, men who have sex with men, and female sex workers. In this Review, we show a trend of increasing HIV prevalence among the three key populations in the Middle East and north Africa. Although the epidemic continues at a low level in some countries or localities within a country, there is evidence for concentrated epidemics, with sustained transmission at considerable HIV prevalence among people who inject drugs and men who have sex with men in over half of countries in the region with data, and among female sex workers in several countries. Most epidemics emerged around 2003 or thereafter. The status of the epidemic among key populations remains unknown in several countries due to persistent data gaps. The HIV response in Middle East and north Africa remains far below global targets for prevention, testing, and treatment. It is hindered by underfunding, poor surveillance, and stigma, all of which are compounded by widespread conflict and humanitarian crises, and most recently, the advent of COVID-19. Investment is needed to put the region on track towards the target of eliminating HIV/AIDS as a global health threat by 2030. Reaching this target will not be possible without tailoring the response to the needs of key populations, while addressing, to the extent possible, the complex structural and operational barriers to success.

EClinicalMedicine ; 52: 101612, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2015139


Background: HIV disproportionately affects people who inject drugs, transgender people, sex workers, men who have sex with men, and incarcerated people. Recognized as key populations (KP), these groups face increased impact of HIV infection and reduced access to health assistance. In 1990, the Center for Disease Control and Prevention organized technical guidance on HIV Voluntary Counseling and Testing (VCT-HIV), with subsequent trials comparing intervention methodologies, no longer recommending this strategy. However, KP needs have not been explicitly considered. Methods: We assessed VCT-HIV effectiveness for sexual risk-reduction among KP (PROSPERO 2020 CRD42020088816). We searched Pubmed, EMBASE, Global Health, Scopus, PsycINFO, and Web of Science for peer-reviewed, controlled trials from February, 2020, to April, 2022. We screened the references list and contacted the main authors, extracted data through Covidence, applied the Cochrane Risk-of-Bias tool, and performed the meta-analysis using Review Manager. Findings: We identified 17 eligible trials, including 10,916 participants and evaluated HIV risk behaviors. When compared to baseline, VCT-HIV reduced unsafe sex frequency (Z=5.40; p<0.00001, I²=0%). Interpretation: While our meta-analysis identified VCT-HIV as protective for sexual risk behaviors for among KP, the results are limited to MSM and PWID, demonstrating the paucity of data on the other KP. Also, it highlights the importance of applying a clear VCT-HIV guideline as well as properly training the counselors. Funding: Research funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ/MS-DIAHV N° 24/2019), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

Texto & contexto enferm ; 30: e20200560, 2021. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1987241


ABSTRACT Objective: to analyze the scientific evidence on COVID-19 coping and prevention strategies implemented to female sex workers in the context of several countries. Methods: this is an integrative literature review, with data collected in the PubMed, Scopus, Virtual Health Library and Google Scholar databases using the Boolean descriptors "COVID-19" and "sex workers" and "Delivery of Health Care", with a time frame from 2019 to 2020. A priori, 215 publications were found. After selection, anchored in the inclusion criteria and in the answer to the guiding question, 19 articles were used, whose information was organized in a synoptic table, and the texts were analyzed using semantic content. Results: after content analysis of actions implemented or recommended in different countries, so that female sex workers can prevent contamination by Sars-CoV-2, four categories were highlighted: programmatic/governmental actions and responses from society; combating the stigmas involved in sex work; health education through technological/digital and media resources; adjustment of health services. Conclusion: gender, race and class inequalities, as well as social stigmas, have been maintained by states governed by patriarchy and, therefore, are the main barriers for female sex workers to adopt strategies to combat COVID-19. Even so, intersectoral actions have been implemented/recommended in several countries such as the adjustment of sexual health services, financial incentives to improve the services of signal operators and digital technologies to implement effective actions to promote health education and enable the distribution of inputs for individual protection and prevention.

RESUMEN Objetivo: analizar la evidencia científica sobre las estrategias de afrontamiento y prevención del COVID-19 implementadas a las trabajadoras sexuales, en el contexto de varios países. Métodos: revisión integradora de la literatura, con datos recopilados en las bases de datos PubMed, Scopus, Virtual Health Library y Google Scholar utilizando los descriptores booleanos "COVID-19" and "sex workers" and "Delivery of Health Care", con un marco temporal de 2019 a 2020. A priori, se encontraron 215 publicaciones. Tras la selección, anclada en los criterios de inclusión y en la respuesta a la pregunta orientadora, se utilizaron 19 artículos, cuya información se organizó en la tabla sinóptica y los textos se analizaron a través del contenido semántico. Resultados: luego del análisis de contenido de las acciones implementadas o recomendadas en diferentes países, para que las trabajadoras sexuales puedan prevenir la contaminación por Sars-CoV-2, se destacaron cuatro categorías: acciones programáticas/gubernamentales y respuestas de la sociedad; combatir los estigmas relacionados con el trabajo sexual; educación para la salud a través de recursos tecnológicos/digitales y mediáticos; reajuste de los servicios de salud. Conclusión: las inequidades de género, raza y clase, así como los estigmas sociales, han sido mantenidos por estados gobernados por el patriarcado y, por lo tanto, son las principales barreras para que las trabajadoras sexuales adopten estrategias para enfrentar el COVID-19. Aun así, se han implementado/recomendado acciones intersectoriales en varios países como el reajuste de los servicios de salud sexual, incentivos financieros para mejorar los servicios de los operadores de señales y tecnologías digitales para implementar acciones efectivas que promuevan la educación en salud y permitan la distribución de insumos para la protección y prevención individual.

RESUMO Objetivo: analisar as evidências científicas sobre as estratégias de enfrentamento e prevenção à COVID-19 implementadas às trabalhadoras sexuais, no contexto de diversos países. Métodos: revisão integrativa de literatura, com dados coletados nas bases PubMed, Scopus, Biblioteca Virtual em Saúde e Google Scholar usando os descritores booleanos "COVID-19" and "sex workers" and "Delivery of Health Care", com recorte temporal de 2019 a 2020. Encontrou-se, a priori, 215 publicações. Após a seleção, ancorada nos critérios de inclusão e na resposta à pergunta norteadora, aproveitaram-se 19 artigos, cujas informações foram organizadas no quadro sinóptico e os textos analisados mediante o conteúdo semântico. Resultados: após análise de conteúdo das ações implementadas ou recomendadas nos diversos países, para que as profissionais do sexo possam se prevenir da contaminação pelo SARS-Cov-2, foram evidenciadas quatro categorias: ações programáticas/governamentais e respostas da sociedade; combate aos estigmas envoltos do trabalho sexual; educação em saúde através de recursos tecnológicos/digitais e midiáticos; readequação dos serviços de saúde. Conclusão: as iniquidades de gênero, raça e classe, bem como os estigmas sociais têm sido mantidas por Estados regidos pelo patriarcado e, por isso, são as principais barreiras para adoção de estratégias de enfrentamento à COVID-19 por parte das trabalhadoras sexuais. Ainda assim, ações intersetoriais foram implementadas/recomendadas em diversos países como a readequação dos serviços de saúde sexual, incentivos financeiros para melhoria dos serviços das operadoras de sinal e tecnologias digitais para implementação de ações efetivas à promoção da educação em saúde e possibilitar a distribuição de insumos para proteção e prevenção individual.

Humans , Female , Women's Health , Coronavirus Infections , Pandemics , Sex Workers , Gender Identity
Liberabit ; 28(1): e551, Jan.-June 2022. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1979900


Abstract Background: The number of elderly people in the world is growing significantly, so there is an urgent need to ensure that this population can live a full life, especially taking into account the current COVID-19 pandemic scenario. Objective: To analyze the social representations of LGBT old age for male and female sex workers through the pandemic. Method: A qualitative, descriptive, and exploratory research conducted with 10 male and 10 female sex workers aged between 18 and 48. Sociodemographic questionnaires and semi-structured interviews were administered using Google Forms and then analyzed by descending hierarchical classification through the IRaMuTeQ software. Results: The analysis showed three classes: (1) «Social understanding of the topic LGBT old age,¼ (2) «Stigma of genders and sexual orientations,¼ and (3) «Physical transformations and their accompanying obstacles¼. Conclusions: The representations are associated with the difficulties that elderly people have with aging in society, as well as debating LGBT old age. There are also greater obstacles regarding aging of female sex workers. In this way, the study seeks to contribute to broaden the knowledge of the psychosocial aspects of LGBT aging and old age, especially those of sex workers.

Resumen Antecedentes: el número de personas mayores en el mundo está creciendo significativamente, por lo que urge la necesidad de asegurar que esta población pueda vivir una vida plena, especialmente, teniendo en cuenta el actual escenario pandémico de COVID-19. Objetivo: analizar las representaciones sociales de la vejez LGBT para los trabajadores del sexo masculino y femenino frente a la pandemia. Método: se trata de una investigación cualitativa, descriptiva y exploratoria. Participaron 10 hombres y 10 mujeres, de entre 18 y 48 años, todos profesionales del sexo. Se utilizaron cuestionarios sociodemográficos y entrevistas semiestructuradas, realizadas mediante Google Forms y posteriormente analizadas mediante el método de Clasificación Jerárquica Descendente, en el software IRaMuTeQ. Resultados: los análisis presentaron tres clases: (1) la comprensión social del tema de la vejez LGBT, (2) los estigmas sobre los géneros y las orientaciones sexuales y (3) los cambios físicos y los obstáculos que vienen con ellos. Conclusiones: las representaciones están asociadas a las dificultades que tienen las personas mayores para envejecer en sociedad, así como para debatir sobre la vejez LGBT. También existen obstáculos aún mayores para el envejecimiento de las mujeres profesionales del sexo. Así, el estudio anhela contribuir a la ampliación del conocimiento de los aspectos psicosociales de la vejez LGBT, en especial de los profesionales del sexo.

Afr J AIDS Res ; 21(2): 183-193, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1963328


This study focuses on female sex workers as a key population group that suffers a degree of vulnerability according to the World Health Organisation (WHO). Key populations refer to people at heightened risk of contracting the human immunodeficiency virus (HIV) due to specific behaviours and social and legal environments which increase their vulnerability to the virus. Key populations are disproportionately affected by HIV, yet they have less access to HIV services compared to the general population. The coronavirus (COVID-19) lockdown and its restrictive measures have further widened the inequalities and gaps in accessing HIV services for this group. A descriptive phenomenological study was undertaken to explore female sex workers' experiences of utilisation of HIV services during COVID-19. The study setting was the Bulawayo Metropolitan Province, Zimbabwe. Data were collected through in-depth individual interviews with 10 female sex workers. Purposive sampling coupled with snowballing was utilised for recruiting participants. Data were analysed guided by the seven-step Colaizzi technique. Rigour was ensured through adhering to Lincoln and Guba's trustworthiness criteria. The study found that the COVID-19 pandemic adversely affected the livelihoods of sex workers and their utilisation of HIV services. There was limited access to HIV services due to an initial lack of travel authorisation letters and financial challenges experienced by study participants. In addition, the quality of care in health care facilities was further compromised by poor screening processes and reduced provider-client interactions. Maintaining access to HIV services for female sex workers during pandemics is critical for the country to attain HIV epidemic control.

Shared trauma, shared resilience during a pandemic: Social work in the time of COVID-19 ; : 303-311, 2021.
Article in English | APA PsycInfo | ID: covidwho-1930237


This chapter describes the emotional impact of shared cultural trauma experiences in the psychotherapeutic interaction between Dana, a Black cisgender female sex worker, and her current therapist, also a Black cisgender female. Both appreciate that Dana's narrative of her psychological challenges is unusual and that exposure is risky because of the clandestine nature of the sex industry and safety concerns. This is a primary reason that the voices of Black cisgender female sex workers are generally not reflected in academic research and literature. Current shifts in the sociopolitical climate are creating space for sex workers of color to enter unfamiliar and uncomfortable fora to procure appropriate representation, protection, access to resources, and emotional support. For these reasons, Dana has chosen to make her voice count. Her therapist also shares her own personal and professional reflections on the convergence of the pandemics. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

African Journal of Reproductive Health ; 26(3):10, 2022.
Article in English | Web of Science | ID: covidwho-1897312


The restrictive measures taken to curb and mitigate the spread of the corona virus (COVID-19) had negative implications on the vulnerable populations. Of the latter, the most severely affected were sex workers, whose work venues and customers were locked down. This descriptive phenomenological study explored effects of COVID-19 on female sex workers in Bulawayo, Zimbabwe. Snowballing sampling was used to recruit participants. Data were collected through in-depth face-to-face individual interviews with ten female sex workers. The sample size was determined by data saturation. Colaizzi's seven-step content analysis approach was followed to guide data analysis. Rigour was ensured by adhering to Guba and Lincoln's trustworthiness criteria. The study found that the measures impacted negatively on sex workers' income, making it difficult for them to get money for food and rentals. In response, some sex workers adopted innovative entrepreneurship. Others engaged in risky sexual behaviours, further aggravating their situation emotionally and psychologically. It is recommended that the government and policy makers provide psychosocial and economic support to protect the rights of female sex workers in order to maintain the gains made in HIV response.

Mankind Quarterly ; 62(1):32-55, 2021.
Article in English | Scopus | ID: covidwho-1876626


Pandemic diseases have always disrupted the livelihoods of people. “Key populations” such as commercial sex workers (CSWs), who are not legally recognized in Zimbabwe, have been affected during pandemics and disasters through loss of their livelihoods. The study sought to determine the extent to which the COVID-19 pandemic has affected the livelihoods of sex workers in the city of Masvingo, Zimbabwe. A mixed methods approach was adopted for this study where both quantitative and qualitative methods were used. Quantitative data were collected through 200 questionnaires out of an estimated population of 600. The study used expert and purposive sampling and employed unstructured interviews to capture the experiences of the target populations during the COVID-19 pandemic. Quantitative data is presented in the form of tables and figures, and inferential statistics models are used to analyze quantitative data. A thematic approach was used to present and analyze qualitative data. Results of the study indicate that the COVID-19 pandemic aggravated the socio-economic situation of commercial sex work (CSW) through loss of income. Findings further indicate that as companies reduced the number of workers reporting for duty daily, contract workers who include sex workers were the first to be placed on forced leave, resulting in loss of their only source of alternative formal income. Many sex workers were restricted from accessing sexual and reproductive health and from collecting their medical supplies and contraceptives as security forces mounted checkpoints that denied people entry into town. It is recommended that Zimbabwean legal and labor instruments must recognize individuals engaged in commercial sex work so as to reduce their vulnerability during pandemics and other disasters. © 2021 Ulster Institute for Social Research. All rights reserved.

Qualitative Sociology Review ; 18(1):74-95, 2022.
Article in English | Scopus | ID: covidwho-1743079


Micro-enterprises and self-employed individuals have been hit particularly hard by the economic effects of the COVID-19 pandemic, but few studies have tackled the issue. This paper is based on four in-depth case studies of self-employed people from different sectors who have been greatly affected by measures taken to control the pandemic. By capturing shifts in the perception of institutional and economic pressures, as well as precarity after the outbreak of COVID-19, we gained profound insight into crisis management among entrepreneurs working in niche or marginalized fields of business. We found parallels in their biographies and attitudes, but their perceptions of the COVID-19 pandemic differ. We observed paradoxes and hybrid logic, as well as different ways of coping with the crisis. Having a “plan B” helped in some cases, while all of them benefitted from the solidarity of networks and communities. © 2022 QSR V.

IJID Reg ; 3: 114-116, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1739807


The 2025 UNAIDS targets prioritize reaching all subpopulations living with HIV and those at risk for HIV as the only pathway to achieving control of the HIV epidemic. This has brought to the fore the importance of addressing the needs of key marginalized groups and placing such communities at the center of HIV response strategies. However, the COVID-19 pandemic has resulted in a setback in terms of confronting HIV. With this in mind, it is important not only to protect services within HIV responses among key populations, but also to expand such services to meet the UNAIDS 2025 targets. Without this, gains in controlling COVID-19 may be achieved at the expense of losses in controlling the spread of HIV, which had been achieved after sustained and resource-intensive actions.

Jaids-Journal of Acquired Immune Deficiency Syndromes ; 87(3):899-911, 2021.
Article in English | Web of Science | ID: covidwho-1688202


Background: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall. Setting: Yaounde (Cameroon) and Cotonou (Benin). Methods: We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/ epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partner-ships, compared with a scenario without COVID-19. Results: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaounde, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. Conclusions: Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.

Human Organization ; 80(4):292-301, 2021.
Article in English | Scopus | ID: covidwho-1687618


The COVID-19 pandemic primarily affects people in precarious conditions, and sex workers are in a vulnerable position because their occupation is usually considered “dirty work.” Examining the cases in Taiwan, we find that contrary to general imagination, sex workers managed to make their living not only by diversifying their economic activities but also by reorganizing their core services—sex. Moreover, they were able to adapt their relations with peers and clients and gained social capital that empowered them to alleviate negative impacts brought by the pandemic. Copyright © 2021 by the Society for Applied Anthropology

Int J Environ Res Public Health ; 19(3)2022 01 26.
Article in English | MEDLINE | ID: covidwho-1648423


The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

COVID-19 , HIV Infections , Sex Workers , Condoms , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Humans , Indonesia/epidemiology , Pandemics , SARS-CoV-2 , Safe Sex
Studies in Political Economy ; 102(3):354-375, 2021.
Article in English | ProQuest Central | ID: covidwho-1642117


In the United Kingdom, United Sex Workers is organizing as the sex workers' branch of the trade union United Voices of the World (UVW). Sex workers have located dancer unionization and labour rights within a political framework and set of demands relating to socially reproductive labour and decriminalization of all forms of sex work. Their efforts have led to an Employment Tribunal decision that dancers fall within the definition of “worker” found in various UK labour laws. At the same time, the broad perspective and demands of the sex-worker rights movement expose the limits of worker status, and the gains made through unionization have, at least at this time, been eclipsed by COVID-19.

Arch Sex Behav ; 51(1): 331-342, 2022 01.
Article in English | MEDLINE | ID: covidwho-1527477


Primary or first-hand stigma, associated with sex work, sometimes disparagingly referred to as "prostitution" or "whore" stigma, was a fundamental cause of social inequities for sex workers before the COVID-19 pandemic. In addition, courtesy stigma, or stigma by association linked with involvement with a stigmatized group, has long limited the ability of sex worker organizations to secure adequate funds to meet the needs of sex workers in their communities. In reaction to the pandemic, sex worker organizations quickly responded and in a variety of ways have been helping to ease the impact of the pandemic on sex workers in their communities. In November 2020, we interviewed 10 members of sex worker organizations from seven different communities across Canada about how they have been dealing with the immediate and longer-term impacts of the COVID-19 pandemic in their communities. Three strategic actions stood out in the interviews: (1) challenging stigma to help sex workers access government emergency funding; (2) reorganizing and adapting services to provide outreach to sex workers in their communities; and (3) advocating for continuous organizational funding. The findings show that primary stigma and courtesy stigma have further marginalized sex worker organizations and their clients during the pandemic. We conclude with participants' recommendations to address avoidable harms of COVID-19 among sex workers and to better support sex worker organizations in Canada.

COVID-19 , Sex Workers , Humans , Pandemics , SARS-CoV-2 , Social Stigma
J Int AIDS Soc ; 24 Suppl 6: e25813, 2021 10.
Article in English | MEDLINE | ID: covidwho-1487490


INTRODUCTION: Sisters with a Voice (Sisters), a programme providing community-led differentiated HIV prevention and treatment services, including condoms, HIV testing, pre-exposure prophylaxis (PrEP) and antiretroviral therapy linkage for sex workers, reached over 26,000 female sex workers (FSW) across Zimbabwe in 2020. Zimbabwe's initial Covid "lockdown" in March 2020 and associated movement restrictions interrupted clinical service provision for 6 weeks, particularly in mobile clinics, triggering the adaptation of services for the Covid-19 context and a scale up of differentiated service delivery (DSD) models. PrEP service delivery decentralized with shifts from clinical settings towards community/home-based, peer-led PrEP services to expand and maintain access. We hypothesize that peer-led community-based provision of PrEP services influenced both demand and supply-side determinants of PrEP uptake. We observed the effect of these adaptations on PrEP uptake among FSW accessing services in Sisters in 2020. METHODS: New FSW PrEP initiations throughout 2020 were tracked by analysing routine Sisters programme data and comparing it with national PrEP initiation data for 2020. We mapped PrEP uptake among all negative FSW attending services in Sisters alongside Covid-19 adaptations and shifts in the operating environment throughout 2020: prior to lockdown (January-March 2020), during severe restrictions (April-June 2020), subsequent easing (July-September 2020) and during drug stockouts that followed (October-December 2020). RESULTS AND DISCUSSION: PrEP uptake in 2020 occurred at rates <25% (315 initiations or fewer) per month prior to the emergence of Covid-19. In response to Covid-19 restrictions, DSD models were scaled up in April 2020, including peer demand creation, community-based delivery, multi-month dispensing and the use of virtual platforms for appointment scheduling and post-PrEP initiation support. Beginning May 2020, PrEP uptake increased monthly, peaking at an initiation rate of 51% (n = 1360) in September 2020. Unexpected rise in demand coincided with national commodity shortages between October and December 2020, resulting in restriction of new initiations with sites prioritizing refills. CONCLUSIONS: Despite the impact of Covid-19 on the Sisters Programme and FSW mobility, DSD adaptations led to a large increase in PrEP initiations compared to pre-Covid levels demonstrating that a peer-led, community-based PrEP service delivery model is effective and can be adopted for long-term use.

Anti-HIV Agents , COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , Sex Workers , Anti-HIV Agents/therapeutic use , Communicable Disease Control , Female , HIV Infections/drug therapy , HIV Infections/prevention & control , Humans , SARS-CoV-2
Int J Equity Health ; 20(1): 237, 2021 10 30.
Article in English | MEDLINE | ID: covidwho-1486579


We argue commercial sex workers have rights to healthcare and psychosocial support. While decriminalization is not legally enacted in most countries, we would suggest these workers rights include freedom from harassment and opportunities to lead healthy lives. The need for healthcare access for all is heightened in the COVID-19 pandemic where some people flout rules on lockdown by engaging with commercial sex workers and may unwittingly spread SARS-CoV-2 in so doing. Unrestricted healthcare access without stigma for commercial sex workers protects them, and has a beneficial societal effect on those who engage with them and on their contacts.

COVID-19 , Sex Workers , Communicable Disease Control , Health Personnel , Health Services Accessibility , Humans , Pandemics , SARS-CoV-2
Interface (Botucatu, Online) ; 25(supl.1): e200712, 2021.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1389008


A pandemia de Covid-19 traz desafios aos governos e às sociedades. Os efeitos da pandemia nas regiões marcadas por extrema desigualdade social e nas populações com maior vulnerabilidade e precariedade das condições de vida são deletérios, o que demanda referenciais teórico-metodológicos para compreender seus impactos e construir estratégias para enfrentá-la. Nesse ensaio crítico, aborda-se a interconexão de marcadores sociais da diferença na produção das desigualdades que atingem os grupos sociais já marginalizados - como usuários de drogas em situação de rua, trabalhadoras sexuais, trabalhadoras domésticas e jovens LGBTQIA+ - e analisam-se as potencialidades da perspectiva interseccional nas análises e na construção política do enfrentamento do problema. (AU)

The Covid-19 pandemic poses a number of challenges to governments and society. The pandemic has detrimental effects on regions characterized by deep social inequality and the most vulnerable populations, leading to the need for theoretical and methodological frameworks to help understand its impacts and build strategies to address them. This critical essay addresses the interconnection between social markers of the difference in the production of the inequalities that affect marginalized social groups, such as homeless drug users, sex workers, domestic workers and the young LGBTQIA+ community, and analyzes the strengths of the intersectional perspective for the analysis of problems and construction of policies to tackle them. (AU)

La pandemia de Covid-19 presenta desafíos a los gobiernos y a las sociedades. Los efectos de la pandemia en regiones señaladas por extrema desigualdad social y en las poblaciones con mayor vulnerabilidad y precariedad de las condiciones de vida son perniciosos, lo que demanda factores referenciales teórico-metodológicos para comprender sus impactos y construir estrategias para enfrentarla. En este ensayo crítico se abordan la interconexión de marcadores sociales de la diferencia en la producción de las desigualdades que afectan a los grupos sociales ya marginalizados, como usuarios de drogas en situación de vivir en la calle, trabajadoras sexuales, trabajadoras domésticas y jóvenes LGBTQIA+, y se analizan las potencialidades de la perspectiva interseccional en los análisis y en la construcción política del enfrentamiento del problema. (AU)

Homeless Persons , Vulnerable Populations , Intersectional Framework , COVID-19/epidemiology , Sex Work , Brazil , Sexual and Gender Minorities
Rev. baiana enferm ; 35: e37327, 2021.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1328347


Objetivo refletir sobre as situações de vulnerabilidades em saúde vivenciadas por trabalhadoras sexuais durante a pandemia decorrente da infecção pelo SARS-CoV-2. Método trata-se de estudo reflexivo, fundamentado no referencial teórico conceitual da vulnerabilidade em quatro dimensões: ontológica, epidemiológica, simbólica e político-programática. Resultado a saúde das profissionais do sexo, na experiência cotidiana do trabalho sexual, tem sido um desafio para os governos entre todos os grupos associados a estigmas e populações vulneráveis, justamente por serem marginalizados socialmente. Isso se configura como importante para a compreensão desse fenômeno em meio à crise financeira, econômica e de saúde que pessoas de diferentes nações sofrem diante do progresso da SARS-CoV-2. Conclusão as situações de vulnerabilidade em saúde decorrente da infecção pelo SARS-CoV-2 que expõem as profissionais do sexo são consolidadas, principalmente, pela ausência do Estado na proteção sócio legal e na garantia dos direitos humanos, para que essas mulheres adquiram condições de enfrentamento e prevenção.

Objetivo reflexionar sobre las situaciones de vulnerabilidades en salud experimentadas por las trabajadoras sexuales durante la pandemia resultante de la infección por SARS-CoV-2. Método se trata de un estudio reflexivo, basado en el marco teórico conceptual de vulnerabilidad en cuatro dimensiones: ontológica, epidemiológica, simbólica y política-programática. Resultado la salud de las trabajadoras sexuales, en la experiencia diaria del trabajo sexual, ha sido un desafío para los gobiernos entre todos los grupos asociados con estigmas y poblaciones vulnerables, precisamente porque están socialmente marginadas. Esto es importante para entender este fenómeno en medio de la crisis financiera, económica y de salud que sufren personas de diferentes naciones ante el progreso del SARS-CoV-2. Conclusión las situaciones de vulnerabilidad a la salud resultantes de la infección por SARS-CoV-2 a que exponen las trabajadoras sexuales se consolidan, principalmente, por la ausencia del Estado en la protección social-jurídica y en la garantía de los derechos humanos, para que estas mujeres adquieran condiciones de enfrentamiento y prevención.

Objective to reflect on the situations of health vulnerabilities experienced by sex workers during the pandemic resulting from SARS-CoV-2 infection. Method this is a reflective study, based on the conceptual theoretical framework of vulnerability in four dimensions: ontological, epidemiological, symbolic and political-programmatic. Result the health of sex workers, in the daily experience of sexual work, has been a challenge for governments among all groups associated with stigmas and vulnerable populations, precisely because they are socially marginalized. This is important for understanding this phenomenon in the midst of the financial, economic and health crisis that people from different nations suffer before the progress of SARS-CoV-2. Conclusion the situations of health vulnerability resulting from the SARS-CoV-2 infection that expose sex workers are consolidated, mainly, by the absence of the State in the social-legal protection and in the guarantee of human rights, so that these women acquire conditions of coping and prevention.

Humans , Coronavirus Infections , Health Vulnerability , Sex Workers , Pandemics
Arch Sex Behav ; 50(5): 2017-2029, 2021 07.
Article in English | MEDLINE | ID: covidwho-1287445


We evaluated the impact of the coronavirus disease (COVID-19) on the sex work industry and assessed how it has impacted the health and social conditions of sex workers in Singapore. We conducted a sequential exploratory mixed methods study amidst the COVID-19 pandemic from April to October 2020, including in-depth interviews with 24 stakeholders from the sex work industry and surveyor-administered structured surveys with 171 sex workers. COVID-19 had a substantial impact on sex workers' income. The illegality of sex work, stigma, and the lack of work documentation were cited as exclusionary factors for access to alternative jobs or government relief. Sex workers had experienced an increase in food insecurity (57.3%), housing insecurity (32.8%), and sexual compromise (8.2%), as well as a decrease in access to medical services (16.4%). Being transgender female was positively associated with increased food insecurity (aPR = 1.23, 95% CI [1.08, 1.41]), housing insecurity (aPR = 1.28, 95% CI [1.03, 1.60]), and decreased access to medical services (aPR = 1.74, 95% CI [1.23, 2.46]); being a venue-based sex worker was positively associated with increased food insecurity (aPR = 1.46, 95% CI [1.00, 2.13]), and being a non-Singaporean citizen or permanent resident was positively associated with increased housing insecurity (aPR = 2.59, 95% CI [1.73, 3.85]). Our findings suggest that COVID-19 has led to a loss of income for sex workers, greater food and housing insecurity, increased sexual compromise, and reduced access to medical services for sex workers. A lack of access to government relief among sex workers exacerbated such conditions. Efforts to address such population health inequities should be implemented.

COVID-19/psychology , Pandemics , Sex Workers/psychology , COVID-19/epidemiology , Female , Humans , Male , SARS-CoV-2 , Singapore/epidemiology