Comparing Stigma and HIV Outcomes Between Transgender and Cisgender Women Sex Workers Living with HIV in the Dominican Republic.

Purpose: Using an intersectionality framework, we compared stigma and HIV care and treatment outcomes across transgender and cisgender women sex workers living with HIV in the Dominican Republic (DR). Methods: In 2018-2019, data were collected in Santo Domingo, DR, using interviewer-administered surveys among 211 cisgender women and 100 transgender women. We used t-tests and chi-square tests to examine differences in sex work stigma, HIV stigma, and HIV care and treatment. Results: Transgender participants reported more anticipated HIV stigma (mean=13.61, standard deviation [SD]=2.39) than cisgender participants (mean=12.96, SD=2.21; p=0.018), but there were no statistically significant differences for internalized or enacted HIV stigma. Cisgender participants reported more anticipated sex work stigma (cisgender: mean=50.00, SD=9.22; transgender: mean=44.02, SD=9.54; p<0.001), but transgender women reported more enacted (cisgender: mean=49.99, SD=9.11; transgender: mean=59.93, SD=4.89; p<0.001) and internalized sex work stigma (cisgender: mean=50.00, SD=8.80; transgender: mean=57.84, SD=8.34; p<0.001), with no significant differences in resistance to sex work stigma. Cisgender women were significantly more likely to have received HIV care (cisgender: 99.53%, transgender: 91.00%, p<0.001), be currently taking antiretroviral therapy (cisgender: 96.21%, transgender: 84.00%, p<0.001), and be virally suppressed (cisgender: 76.19%, transgender: 64.00%, p=0.025). Conclusions: Transgender participants consistently had poorer HIV care and treatment outcomes compared with cisgender participants. Differences in stigma experiences between transgender and cisgender participants depended on the type of stigma. Findings reflect the intersectional nature of distinct types and forms of stigma among sex workers. Understanding the shared and unique experiences of transgender and cisgender women will improve HIV care engagement and viral suppression.

Individual and Collective Forms of Stigma Resistance: Pathways Between HIV and Sex Work Stigma and Viral Suppression Among Female Sex Workers in the Dominican Republic.

Intersecting forms of stigma including both HIV and sex work stigma have been known to impede HIV prevention and optimal treatment outcomes among FSW. Recent research has indicated that intersectional stigma can be resisted at the community and individual level. We assessed pathways between HIV stigma, sex work stigma, social cohesion and viral suppression among a cohort of 210 FSW living with HIV in the Dominican Republic. Through Poisson regression we explored the relationship between HIV outcomes and internalized, anticipated and enacted HIV and sex work stigma, and resisted sex work stigma. We employed structural equation modeling to explore the direct effect of various forms of stigma on HIV outcomes, and the mediating effects of multi-level stigma resistance including social cohesion at the community level and occupational dignity at the individual level. 76.2% of FSW were virally suppressed and 28.1% had stopped ART at least once in the last 6 months. ART interruption had a significant negative direct effect on viral suppression (OR = 0.26, p < 0.001, 95% CI: 0.13-0.51). Social cohesion had a significant positive direct effect on viral suppression (OR = 2.07, p = 0.046, 95% CI: 1.01-4.25). Anticipated HIV stigma had a significant negative effect on viral suppression (OR = 0.34, p = 0.055, 95% CI: 0.11-1.02). This effect was mediated by the interaction between cohesion and dignity which rendered the impact of HIV stigma on viral suppression not significant. Findings demonstrate that while HIV stigma has a negative impact on viral suppression among FSW, it can be resisted through individual and collective means. Results reinforce the importance of community-driven, multi-level interventions.

Violence suffered by Venezuelan immigrant female sex workers: an intersectional view / Violencia sufrida por trabajadoras sexuales inmigrantes venezolanas: una mirada interseccional / Violências sofridas por mulheres imigrantes venezuelanas profissionais do sexo: um olhar interseccional

ABSTRACT Objective: To characterize and analyze violence committed against Venezuelan immigrant female sex workers, from the perspective of an intersectional look at social class, gender and race-ethnicity. Method: Exploratory study with a qualitative approach. Data sources: interviews with 15 Venezuelan immigrant women sex workers and 37 Brazilian online media reports that addressed the topic. Data were submitted to thematic content analysis, with the support of Qualitative Data Analysis (WebQDA) software. Results: Thematic analysis of data from reports and interviews allowed the emergence of three empirical categories: Structural violence and reasons that led to prostitution: a question of social class; Among the forms of violence, the most feared: physical violence; Violence based on gender and race-ethnicity. Conclusion: The study made it possible to recognize that Venezuelan immigrant women who are sex workers in Brazil are subject to different types of violence and exploitation. This scenario is due to a reality of life and work that is based on the exploitation of female workers who experience the consequences of the interweaving of subalternities characteristic of their social insertion of class, gender and race-ethnicity.

RESUMEN Objetivo: Caracterizar y analizar la violencia ejercida contra trabajadoras sexuales inmigrantes venezolanas, desde una mirada interseccional de clase social, género y raza-etnia. Método: Estudio exploratorio con enfoque cualitativo. Fuentes de datos: entrevistas con 15 trabajadoras sexuales inmigrantes venezolanas y 37 informes de medios en línea brasileños que abordaron el tema. Los datos fueron sometidos al análisis de contenido temático, con el apoyo del software Qualitative Data Analysis (WebQDA). Resultados: El análisis temático de los datos de los informes y entrevistas permitió la emergencia de tres categorías empíricas: Violencia estructural y motivos que llevaron a la prostitución: una cuestión de clase social; Entre las formas de violencia, las más temidas: la violencia física; Violencia basada en el género y la raza-etnia. Conclusión: El estudio permitió reconocer que las mujeres inmigrantes venezolanas que ejercen el trabajo sexual en Brasil están sujetas a diferentes tipos de violencia y explotación. Este escenario obedece a una realidad de vida y de trabajo que se fundamenta en la explotación de los trabajadores que experimentan las consecuencias del entrecruzamiento de subalternidades propias de su inserción social de clase, género y raza-etnia.

RESUMO Objetivo: Caracterizar e analisar violências praticadas contra mulheres imigrantes venezuelanas profissionais do sexo, na perspectiva de um olhar interseccional de classe social, gênero e raça-etnia. Método: Estudo exploratório de abordagem qualitativa. Fontes dos dados: entrevistas com 15 mulheres imigrantes venezuelanas trabalhadoras do sexo e 37 reportagens da mídia online brasileira que abordavam o tema. Os dados foram submetidos à análise de conteúdo temática, com o apoio do software Qualitative Data Analysis (WebQDA). Resultados: A análise temática dos dados das reportagens e das entrevistas permitiu a emergência de três categorias empíricas: Violência estrutural e motivos que levaram à prostituição: uma questão de classe social; Entre as violências, a mais temida: a violência física; Violências baseadas no gênero e na raça-etnia. Conclusão: O estudo permitiu reconhecer que mulheres imigrantes venezuelanas profissionais do sexo no Brasil estão sujeitas a diferentes tipos de violência e exploração. Este cenário deve-se a uma realidade de vida e trabalho que se fundamenta na exploração de trabalhadoras que vivenciam as consequências do entrelaçamento das subalternizações características da sua inserção social de classe, gênero e raça-etnia.

Uso de sustancias psicoactivas (SPA) en el ejercicio del trabajo sexual de hombres y mujeres cisgénero y mujeres transgénero inmigrantes venezolanos en Colombia / Use of psychoactive substances (PAS) in the sex work of cisgender men and women and transgender women Venezuelan immigrants in Colombia

RESUMEN Objetivo: Identificar las estrategias de consumo de sustancias psicoactivas (SPA) en hombres y mujeres cisgénero y mujeres transgénero inmigrantes venezolanos dedicados al trabajo sexual en Colombia. Métodos: Se realizó un estudio cualitativo con un enfoque hermenêutico interpretativo, utilizando como técnica de investigación la entrevista semiestructurada, las cuales fueron aplicadas en el Área Metropolitana del Valle de Aburrá, Bogotá, D.C. y el Eje Cafetero colombiano, a través de un sistema de muestreo por conveniencia. Resultados: Se realizaron 55 entrevistas en dichas regiones. El 60 % de los entrevistados eran hombres cisgénero, 31 % mujeres cisgénero y 9 % mujeres transgénero. La edad promedio de los participantes fue de 27 años. Se observó que el uso de sustancias psicoactivas en las y los trabajadores sexuales depende de elementos de tipo personal y contextual. Los primeros se relacionan con estrategias de afrontamiento frente al estrés y la ansiedad durante el ejercicio del trabajo sexual, así como al uso lúdico y recreativo de estas sustancias, mientras que las estrategias contextuales están vinculadas con el uso compartido SPA con los clientes y el aumento del rendimiento sexual durante el ejercicio del sexo transaccional. Conclusiones: El consumo de sustancias psicoactivas durante el ejercicio del trabajo sexual es multicausal, y, por lo tanto, es fundamental abordar este asunto de forma integral, considerando la interrelación entre el sujeto, la sustancia que se consume y los contextos sociales y sexuales donde se emplea, permitiendo definir las acciones más pertinentes y apropiadas para disminuir los impactos sobre la salud de los implicados.

ABSTRACT Objective: To identify the strategies of consumption of psychoactive substances (PAS) in cisgender men and women and transgender Venezuelan immigrant women engaged in sex work in Colombia. Methods: A qualitative study was carried out with an interpretive hermeneutic approach, using the semi-structured interview as a research technique, which were applied in the Metropolitan Area of Valle de Aburrá, Bogotá, D.C. and the Colombian Coffee Region, through a convenience sampling system. Results: 55 interviews were conducted in these regions. 60 % of the interviewees were cisgender men, 31 % cisgender women and 9 % transgender women. The average age of the participants was 27 years. It was observed that the use of psychoactive substances in sex workers depends on personal and contextual factors. The former is related to coping strategies against stress and anxiety during the exercise of sex work, as well as the recreational and recreational use of these substances, while the contextual strategies are linked to the shared use of SPA with clients and the increase of sexual performance during the exercise of transactional sex. Conclusions: The consumption of psychoactive substances during the exercise of sex work is multicausal, and, therefore, it is essential to address this issue in a comprehensive manner, considering the interrelation between the subject, the substance that is consumed and the social and sexual contexts where it is used, allowing defining the most pertinent and appropriate actions to reduce the impacts on the health of those involved.

[Factors associated with condom use among sex workers of venezuelan origin in ColombiaFatores associados ao uso de preservativo em profissionais do sexo de origem venezuelana na Colômbia]. / Factores asociados con el uso del condón en trabajadoras y trabajadores sexuales de origen venezolano en Colombia.

Objective: To describe the factors that determine condom use in Venezuelan immigrant sex workers in Colombia. Methods: A qualitative study was conducted with an interpretive hermeneutic approach, using semi-structured interviews developed in the Metropolitan Area of Aburrá Valley, Bogotá, and the Colombian coffee-growing region. Results: Fifty-five interviews were conducted. Of the total number of people interviewed, 60% were cisgender men, 31% were cisgender women, and 9% were transgender women. The average age of the participants was 27 years. Sixty-nine percent were irregular migrants in Colombia. Only 11% were affiliated with the health system. It was observed that condom use is inconsistent among sex workers, depending on personal and social factors. Conclusions: The factors that influence condom use in sex workers of Venezuelan origin in Colombia are determined by various factors, both personal and social. Personal factors relate to knowledge, support networks, and risk perception, while social factors are associated with substance use, stigma and discrimination, and the places where sex work is done. Social factors are the ones that most influence inconsistent condom use in cisgender men and transgender women.

Objetivo: Descrever os fatores que determinam o uso de preservativo em profissionais do sexo venezuelanos imigrantes na Colômbia. Métodos: Foi realizado um estudo qualitativo com abordagem hermenêutica interpretativa, que utilizou como técnica de pesquisa a entrevista semiestruturada, desenvolvido na Região Metropolitana de Valle de Aburrá, Bogotá, D.C., e na região cafeeira colombiana. Resultados: Foram realizadas 55 entrevistas. Do total de pessoas entrevistadas, 60% eram homens cisgêneros, 31% mulheres cisgêneros e 9% mulheres transgêneros. A idade média dos participantes foi de 27 anos. Sessenta e nove por cento estão na Colômbia de forma irregular. Em relação à filiação ao sistema de saúde, apenas 11% são filiados. Observou-se que o uso de preservativo em profissionais do sexo é inconsistente, já que depende de fatores pessoais e sociais. Conclusões: Os fatores que influenciam o uso de preservativo por profissionais do sexo de origem venezuelana na Colômbia são determinados por vários aspectos pessoais e sociais. Os aspectos pessoais se referem ao conhecimento, redes de apoio e percepção de risco, enquanto os sociais estão associados ao uso de substâncias psicoativas, ao estigma e à discriminação, e aos locais onde o trabalho sexual é realizado. Esses últimos são os que mais influenciam o uso inconsistente de preservativo por homens cisgêneros e mulheres transgêneros.

Stigma and HIV Treatment Outcomes Among Transgender Women Sex Workers in the Dominican Republic.

Trans women experience multiple forms of intersecting stigma due to trans identity, HIV, and sex work, which can negatively affect their health. There is limited understanding of the relationships between stigma and HIV care and treatment outcomes. We assessed associations between multiple forms and types of stigma and HIV treatment outcomes among trans women who conduct sex work in Santo Domingo, Dominican Republic using cross-sectional survey data. Most participants had received HIV care (91%) and were currently taking anti-retroviral therapy (ART) (84%). Only 64% were virally suppressed. Nearly one-third (32%) had interrupted ART at some point; those who had never interrupted ART were more likely to be suppressed. Drug use was associated with ART interruption. Higher enacted HIV stigma was associated with current ART use. Higher enacted HIV stigma and higher anticipated sex work stigma were associated with ART adherence. Higher trans stigma was associated with being virally suppressed. Findings highlight the importance of addressing multiple forms of stigma at the individual and clinic levels to improve and sustain viral suppression. Future research is needed to assess if unexpected associations between stigma and HIV outcomes reflect processes of resilience. Future research is also needed to assess the pathways between drug use, ART interruption, and viral suppression among trans women.

Substance Use and Depression Impede ART Adherence Among Female Sex Workers Living with HIV in the Dominican Republic.

Female sex workers (FSW) have worse HIV outcomes in part due to lower anti-retroviral therapy (ART) adherence. Substance use and depression are important barriers to ART adherence, yet few studies have assessed these relationships among FSW in longitudinal studies. Cross-Lagged Panel Models and autoregressive mediation analyses assessed substance use (illicit drug use and alcohol use disorders) in relation to ART non-adherence and the mediation role of depressive symptoms among 240 FSW living with HIV in the Dominican Republic. In annual visits (T1, T2, T3), the majority (70%, 66%, and 53%) reported at-risk drinking and 15%, 13% and 9% used illicit drug during the past 6 months. Most FSW (70%, 62% and 46%) had mild-to-severe depression. Illicit drug use predicted later ART non-adherence. This relationship was not mediated via depressive symptoms. Integrated substance use and HIV care interventions are needed to promote ART adherence and viral suppression among FSW.

RESUMEN: Las trabajadoras sexuales (TRSX) tienen peores resultados de VIH debido en parte a la menor adherencia a la terapia antirretroviral (TAR). El uso de sustancias y la depresión son barreras importantes para la adherencia; sin embargo, pocos estudios longitudinales han evaluado estas relaciones entre las TRSX. Utilizamos modelos de panel y análisis de mediación para evaluar el uso de sustancias en relación a la falta de adherencia al TAR y el papel de mediación de los síntomas depresivos entre 240 TRSX con VIH en la República Dominicana. En visitas anuales (T1, T2, T3), la mayoría (70%, 66%, and 53%) reportó consumo riesgoso de alcohol y 15%, 13% y 9% consumieron alguna droga ilícita durante los últimos 6 meses. La mayoría (70%, 62% y 46%) tenían depresión leve a grave. El uso de drogas ilícitas predijo la falta de adherencia al TAR. Esta relación no fue mediada por síntomas depresivos. Se necesitan intervenciones integradas de atención del VIH y el uso de sustancias para promover la adherencia al TAR y la supresión viral entre TRSX.

The Intimate Relationship Experiences of Women Engaged in Transactional Sex Work in Barbados.

This phenomenological study, consisting of individual interviews with a sample of 30 women engaged in sex work, examines the intimate relationships of women engaged in sex work in Barbados. Participants often entered relationships with men they met while engaged in sex work. Most experienced relationships that became transactional, abusive, and exploitative. Intimate partner violence (IPV) challenged their ability to negotiate condom use with intimate partners placing them at risk for HIV. A cycle emerged of entering relationships to exit the violent conditions of sex work and then re-entering sex work to escape IPV. Implications for mental health, HIV prevention, IPV, and empowerment services are described.

Sex Work Venue Disorder and HIV/STI Risk Among Female Sex Workers in Two México-US Border Cities: A Latent Class Analysis.

Research increasingly recognizes the importance of social and built environments in shaping health, including risks for and outcomes related to HIV and sexually transmitted infections (STI), but research on sex work venues is limited. We use latent class analysis to identify patterns of sex work venue characteristics and factors associated with class membership in two México-US border cities. Among 603 female sex workers (FSW), three classes of sex work venues were identified: low, medium, and high disorder venues, characterized by level of violence, policing and drug activity. In multivariable analysis, risk exposures and outcomes varied by class, suggesting the need for place-based interventions that are tailored to specific venue profiles and that promote FSW health and safety in the workplace.

Factores asociados con el uso del condón en trabajadoras y trabajadores sexuales de origen venezolano en Colombia / Factors associated with condom use among sex workers of venezuelan origin in Colombia / Fatores associados ao uso de preservativo em profissionais do sexo de origem venezuelana na Colômbia

RESUMEN Objetivo. Describir los factores que determinan el uso del condón en trabajadores y trabajadoras sexuales inmigrantes venezolanos en Colombia. Métodos. Se realizó un estudio cualitativo con un enfoque hermenéutico interpretativo, en el cual se utilizó como técnica de investigación la entrevista semiestructurada, desarrolladas en el Área Metropolitana del Valle de Aburrá, Bogotá D.C. y el eje cafetero colombiano. Resultados. Se realizaron 55 entrevistas. Del total de personas entrevistadas, 60% eran hombres cisgénero, 31% mujeres cisgénero y 9% mujeres transgénero. La edad promedio de los participantes fue de 27 años. Sesenta y nueve por ciento se encuentra de manera irregular en Colombia. En cuanto a la afiliación al sistema de salud, solo 11% están afiliados. Se observó que el uso del condón en los trabajadores sexuales es inconsistente, ya que este depende de factores de tipo personal y social. Conclusiones. Los factores que influyen en el uso del condón en trabajadores y trabajadoras sexuales de origen venezolano en Colombia están determinados por diversos aspectos tanto personales como sociales. Los primeros se refieren a los conocimientos, las redes de apoyo y la percepción del riesgo, mientras que los sociales se asocian con el consumo de sustancias psicoactivas, el estigma y la discriminación, y los lugares para el ejercicio del trabajo sexual. Estos últimos son los que más influyen en el uso inconsistente del condón en hombres cisgénero y en mujeres transgénero.

ABSTRACT Objective. To describe the factors that determine condom use in Venezuelan immigrant sex workers in Colombia. Methods. A qualitative study was conducted with an interpretive hermeneutic approach, using semi-structured interviews developed in the Metropolitan Area of Aburrá Valley, Bogotá, and the Colombian coffee-growing region. Results. Fifty-five interviews were conducted. Of the total number of people interviewed, 60% were cisgender men, 31% were cisgender women, and 9% were transgender women. The average age of the participants was 27 years. Sixty-nine percent were irregular migrants in Colombia. Only 11% were affiliated with the health system. It was observed that condom use is inconsistent among sex workers, depending on personal and social factors. Conclusions. The factors that influence condom use in sex workers of Venezuelan origin in Colombia are determined by various factors, both personal and social. Personal factors relate to knowledge, support networks, and risk perception, while social factors are associated with substance use, stigma and discrimination, and the places where sex work is done. Social factors are the ones that most influence inconsistent condom use in cisgender men and transgender women.

RESUMO Objetivo. Descrever os fatores que determinam o uso de preservativo em profissionais do sexo venezuelanos imigrantes na Colômbia. Métodos. Foi realizado um estudo qualitativo com abordagem hermenêutica interpretativa, que utilizou como técnica de pesquisa a entrevista semiestruturada, desenvolvido na Região Metropolitana de Valle de Aburrá, Bogotá, D.C., e na região cafeeira colombiana. Resultados. Foram realizadas 55 entrevistas. Do total de pessoas entrevistadas, 60% eram homens cisgêneros, 31% mulheres cisgêneros e 9% mulheres transgêneros. A idade média dos participantes foi de 27 anos. Sessenta e nove por cento estão na Colômbia de forma irregular. Em relação à filiação ao sistema de saúde, apenas 11% são filiados. Observou-se que o uso de preservativo em profissionais do sexo é inconsistente, já que depende de fatores pessoais e sociais. Conclusões. Os fatores que influenciam o uso de preservativo por profissionais do sexo de origem venezuelana na Colômbia são determinados por vários aspectos pessoais e sociais. Os aspectos pessoais se referem ao conhecimento, redes de apoio e percepção de risco, enquanto os sociais estão associados ao uso de substâncias psicoativas, ao estigma e à discriminação, e aos locais onde o trabalho sexual é realizado. Esses últimos são os que mais influenciam o uso inconsistente de preservativo por homens cisgêneros e mulheres transgêneros.

"Me echaron de mi casa, empecé a trabajar en la calle": interseccionalidad y apartheid ocupacional en el trabajo sexual. Un estudio de caso / "Eles me expulsaram da minha casa, comecei a trabalhar na rua": interseccionalidade e apartheid ocupacional no trabalho sexual. Um estudo de caso / "They kicked me out of my house, I started working on the street": intersectionality and occupational apartheid in sex work. A case study

Resumen Introducción Las mujeres que se han dedicado al trabajo sexual han sido una comunidad estigmatizada, marginada y alienada socialmente. Particularmente, en el caso de las mujeres trans la situación ha sido peor, enfrentando mayores porcentajes de violencia. Objetivo Analizar la historia de vida de una mujer trans que se desempeña en el trabajo sexual, a partir de un análisis interseccional y ocupacional. Método Empleamos un estudio cualitativo basado en la técnica de investigación Historia de Vida, considerando elementos de la entrevista narrativa ocupacional. Resultados Desde su historia, podemos ver que hay elementos que han interseccionado a lo largo de su vida, tales como los dominios: estructural, disciplinar, hegemónico e interpersonal. Sus elecciones ocupacionales han estado fuertemente influenciadas por su contexto dentro de un apartheid ocupacional, buscando la generación de espacios de resistencia y agencia frente a las diferentes adversidades. Conclusiones Estas situaciones precarizan sus condiciones de vida y ponen en alerta las influencias de los sistemas económicos, políticos, heteronormados, entre otros, en la determinación de la vida de las personas.

Resumo Introdução As mulheres que se envolvem em trabalho sexual têm sido uma comunidade estigmatizada, marginalizada e socialmente alienada. Particularmente no caso das mulheres trans, há o enfrentamento de maiores porcentagens de violência. Objetivo Analisar a história de vida de uma mulher trans que atua no trabalho sexual, a partir de uma análise interseccional e ocupacional. Método Utilizou-se um estudo qualitativo baseado na técnica de pesquisa História de Vida, considerando elementos da entrevista narrativa ocupacional. Resultados A partir de sua história, podemos perceber que há elementos que se cruzaram ao longo de sua vida, como os domínios: estrutural, disciplinar, hegemônico e interpessoal. E que suas escolhas ocupacionais foram fortemente influenciadas por seu contexto dentro de um apartheid ocupacional, buscando gerar espaços de resistência e agenciamento diante de diferentes adversidades. Conclusões Essas situações tornam suas condições de vida precárias e alertam para as influências de sistemas econômicos, políticos, heteronormativos, entre outros, na determinação da vida das pessoas.

Abstract Introduction Women who have engaged in sex work have been a stigmatized, marginalized, and socially alienated community. Particularly, in the case of trans women, there is a bigger percentage of violence. Objective To analyze the life story of a trans woman who works in sex work, based on an intersectional and occupational analysis. Method We used a qualitative study based on the Life History research technique, considering elements of the occupational narrative interview. Results From her history, we can see that there are elements that have intersected throughout her life, such as the domains: structural, disciplinary, hegemonic, and interpersonal. And that her occupational choices have been strongly influenced by her context within occupational apartheid, seeking to generate spaces of resistance and agency in the face of different adversities. Conclusions These situations make her living conditions precarious and alert the influences of economic, political, and heteronormative systems, among others, in determining people's lives.

Quality of life from women's perspective in the exercise of sex work: a study of social representations / Calidad de vida de las mujeres en el trabajo sexual: estudio de las representaciones sociales / Qualidade vida na perspectiva de mulheres no exercício do trabalho sexual: estudo de representações sociais

ABSTRACT 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.

RESUMEN Objetivos: analizar las representaciones sociales elaboradas por trabajadoras sexuales del Alto Sertão Produtivo Baiano sobre la calidad de vida. Métodos: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado en la región de Alto Sertão Produtivo Baiano, con 30 trabajadoras sexuales. Entrevista individual en profundidad, con discursos organizados en un corpus y tratados en IRAMUTEQ, posibilitando el análisis léxico para Clasificación Jerárquica Descendente. Resultados: surgieron cuatro clases temáticas, en las que impregnan las representaciones sociales de la calidad de vida: el dinero ganado para suplir las necesidades; para la asociación con la vida sana y la obtención de la salud (física y mental); el equilibrio de las emociones (aunque hay algunas sensaciones negativas como el miedo y la ansiedad); y la fe en una deidad. Consideraciones Finales: las representaciones sociales elaboradas por las trabajadoras sexuales sobre la calidad de vida están ancladas en conceptos, subjetivos y prácticos, puntuados por la Organización Mundial de la Salud.

RESUMO Objetivos: analisar as representações sociais elaboradas por trabalhadoras sexuais procedentes do Alto Sertão Produtivo Baiano sobre qualidade de vida. Métodos: estudo qualitativo, baseado na Teoria das Representações Sociais, realizado na Região do Alto Sertão Produtivo Baiano, com 30 trabalhadoras sexuais. Realizou-se entrevista em profundidade individual, com discursos organizados em um corpus e tratados no software IRAMUTEQ, possibilitando a análise lexical para a Classificação Hierárquica Descendente. Resultados: revelaram-se quatro classes temáticas, nas quais as representações sociais da qualidade de vida perpassam: pelo dinheiro conquistado para suprimento das necessidades; pela associação à vida saudável e obtenção da saúde (física e mental); pelo equilíbrio das emoções (ainda que haja algumas sensações negativas como o medo e ansiedade); e pela fé em uma divindade. Considerações Finais: as representações sociais elaboradas pelas trabalhadoras sexuais acerca da qualidade de vida estão ancoradas em conceitos, subjetivos e práticos, pontuados pela Organização Mundial da Saúde.

Trabalho sexual no Brasil: uma abordagem do protagonismo das prostitutas na luta pelo reconhecimento do direito ao exercício da profissão / Sexual work in Brazil: An approach to the protagonism of prostitutes in their struggle for recognition of the right to exercise the profession

RESUMO O presente ensaio teve como objeto de estudo a luta das prostitutas brasileiras pelo reconhecimento do trabalho sexual como profissão. Utilizando revisão bibliográfica, apresenta a formação do Movimento das Prostitutas no Brasil e suas reivindicações, busca definir o que é trabalho sexual e, ao final, discorre sobre o percurso dessas reivindicações no Poder Legislativo. Conclui-se que os entraves ao reconhecimento da profissão pelo Estado brasileiro estão relacionados com o estigma que marca as trabalhadoras do sexo.

ABSTRACT This essay aimed to study the struggle of Brazilian prostitutes for the recognition of sexual work as a profession. Through a bibliographic review, it presents the establishment of the Brazilian Prostitutes Movement and its claims, seeks to define sex work, and, finally, shows the trajectory of their claims in the Legislative Branch. It concluded that the obstacles to the recognition of the profession by the Brazilian State are related to the stigma that marks sex workers.

[On the margins of care: sex workers' experiences of health and social (non-)protection in Oporto, Portugal]. / Al margen de los cuidados: experiencias de (des)protección sociosanitaria de trabajadoras del sexo en Oporto, Portugal.

This article analyzes the social and health challenges linked to sex work and the interventions carried out within this arena, taking into consideration the ways in which prostitution is socially marginalized. Basing our analysis on the experiences and understandings of sex workers practicing in the city of Oporto (Portugal), we attempt to understand the main forms of vulnerability faced by this group, along with the ways in which they experience the relationship with State services and social and health interventions that target them. Qualitative field research was conducted involving a case study of an intervention project. Data collection was carried out from March to June 2019, and included documentary research, participant observation, and semi-structured interviews with project staff and six sex workers. Among the results of our study, we found that sex workers are subject to severe constraints, limiting their use of informal support networks and their access to State social protection and healthcare services. Moreover, although the intervention project based on harm reduction intended to support these women and was indeed valued, it had a strong epidemiological prevention bias favoring an individualistic and assistentialist approach, while failing to address other social vulnerabilities identified by the women themselves.

Teniendo en cuenta las marginaciones que recaen sobre la prostitución, analizamos los retos sociales y sanitarios que subyacen al ejercicio del trabajo sexual y la intervención realizada en este ámbito. Partimos de las experiencias y entendimientos de trabajadoras sexuales que ejercen su actividad en la ciudad de Oporto (Portugal), en un intento de comprender cuáles son las principales vulnerabilidades a las que se enfrentan y cómo viven la relación con los servicios del Estado y con la intervención sociosanitaria dirigida a ellas. La investigación de campo siguió un enfoque cualitativo basado en un estudio de caso de un proyecto de intervención. La recolección de datos se llevó a cabo, entre los meses de marzo y junio de 2019, mediante investigación documental, ejercicios de observación participante y entrevistas semiestructuradas al personal técnico y a seis trabajadoras sexuales. Como resultado de esta investigación, se ha constatado que las trabajadoras del sexo están sometidas a graves restricciones que limitan su recurso a las redes de apoyo informales y su acceso a los dispositivos de protección del Estado en términos de apoyo social y atención sanitaria. Es más, el proyecto de intervención de reducción de riesgos que apoya a estas mujeres, aunque valorado, asume un fuerte sesgo de prevención epidemiológica y favorece un enfoque individualista y asistencialista, dejando al descubierto otras vulnerabilidades sociales identificadas por ellas mismas.

COVID-19 vaccine uptake among people who inject drugs in Tijuana Mexico.

Background: SARS-CoV-2 prevalence is elevated among people who inject drugs (PWID). In Tijuana, Mexico, COVID-19 vaccines became available to the general population in June 2021, but uptake among PWID was <10%. We studied COVID-19 vaccine uptake among PWID in Tijuana following implementation of a pop-up vaccination clinic. Methods: Beginning in October, 2020, PWID in Tijuana aged ≥18 years were enrolled into a longitudinal cohort study. At baseline and semi-annually, participants underwent interviewer-administered interviews on health behaviors and COVID-19 exposures through April 5, 2022. From June 21-September 20, 2021, staff referred PWID to a temporary COVID-19 vaccine pop-up clinic that was coincidentally established near the study office. Participants attending the clinic completed a short interview on barriers to vaccination and were offered facilitated access to free Janssen® COVID-19 vaccine. All participants were reimbursed $5 for this interview, regardless of whether or not they chose to be vaccinated. Poisson regression was used to evaluate the effect of the pop-up clinic on COVID-19 vaccination uptake, controlling forpotential confounders. Results: Of 344 participants, 136 (39.5%) reported having received at least one COVID-19 vaccine dose during the 10 months follow-up period, of whom 113 (83.1%) received vaccine at the pop-up clinic and 23 (16.9%) elsewhere. One third of those receiving COVID-19 vaccine during the pop-up clinic were previously vaccine hesitant. Attending the pop-up clinic was independently associated with higher rates of COVID-19 vaccination Adjusted Rate Ratio (AdjRR: 9.15; 95% CI: 5.68-14.74). Conclusions: We observed a significant increase in COVID-19 vaccine uptake associated with attending a temporary pop-up vaccine clinic in Tijuana suggesting that efforts to improve vaccination in this vulnerable population should include convenient locations and staff who have experience working with substance using populations. Since COVID-19 vaccination rates remain sub-optimal, sustained interventions to increase uptake are needed.

Love and anger: Putafeminismos/whore feminisms in Brazil.

In this article, I discuss how love and anger have affected the political struggles of putafeministas/whore-feminists in Brazil. Love, considered to be at the centre of diverse social justice and, particularly, feminist projects, is a relevant assertion of decolonial feminism, a line of thought that has vastly disseminated during the last years in the country. In an ominous political context, marked by growing conservatism and the destablisation of rights that had been previously guaranteed, feminisms' expansion has led to the incorporation of an array of heterogeneous ideas. Putafeministas political struggles have taken place in a milieu in which the multiplicity of histories, needs and strategies of different categories of women seemed to be recognised and celebrated. Yet, far from being acknowledged by lines of decolonial thinking, putafeministas have faced a growing spiral of violence and anger from other Brazilian feminists. I explore this process, basing myself on ethnographic studies conducted since 2010 about relations between feminisms and prostitution in Brazil. My main point is that these confrontations are related to the incorporation of transnational flows of feminist ideas regarding 'rape culture' that associating sex work with paid rape encompass decolonial possibilities.

Pleasure and protagonism: An interview with Maria de Jesus Almeida Costa, a Black sex worker activist from Brazil's Northeast region.

Pleasure and protagonism are two words that define Maria de Jesus Almeida Costa, or Dijé, as friends call her. She was just an adolescent when she first arrived in the São Luiz red light district and began to fight against the violence and injustice she witnessed. Today, she is 62 years old and the leader of the sex worker movement in the Brazilian state of Maranhão, in the Northeast region of the country. She is widely recognised for her tireless fight for the preservation of the historical centre of São Luiz where the red light district remains to this day, and where Jesus also raised her children and lives to this day. In this interview, Jesus talks about the pleasures and dangers of prostitution, her fight against racism and sex work stigma, her relationship with the academy and researchers, the alliances and partnerships she mobilised during the Covid-19 pandemic and the challenges that she is facing in Brazil's current conservative, far-right government.

HTLV-1 Is Also a Sexually Transmitted Infection.

HTLV-1 is a retrovirus which causes diverse diseases in 10% of its infected population, significantly worsening their quality of life and mortality rate. Even though it is globally distributed and is endemic in many countries (including Peru), it is still highly neglected. It spreads through vertical, sexual and parenteral transmission. As no effective treatment against this virus exist, prevention is required to contain it. The World Health Organization published a technical report on the matter in 2021, with the collaboration of international HTLV-1 experts. However, neither the impact of sexual transmission (cause of the majority of adult cases and infection in non-endemic areas) nor its prevention were considered. Evidence is presented, which shows the magnitude of sexual transmission, its risk factors and preventive measures; hoping it will encourage health workers to help eradicate this infection.

Negociações Cotidianas de Travestis e Mulheres Trans Trabalhadoras Sexuais / Transvestites and Trans Women Sex Workers' Daily Negotiations / Negociaciones diarias de travestis y trabajadoras sexuales trans

Este artigo busca compreender as negociações cotidianas sobre "sexo seguro" e acesso aos serviços de saúde de travestis e mulheres transexuais trabalhadoras sexuais. Foi conduzida uma análise com suporte do método fenomenológico de pesquisa, sendo entrevistadas três travestis e duas mulheres trans profissionais do sexo. A análise compreensiva apresentou duas categorias: "Sexo seguro nas ruas: negociações de finanças, risco e desejo", que apresenta os elementos negociados nas vivências de rua, e "Outsiders e Estabelecidos: a visibilidade seletiva em instituições e seus efeitos no cuidado da saúde trans", que desvela os sentidos nas vivências negociadas no cotidiano das instituições de saúde.

This article seeks to understand transvestites and transsexual women sex workers' daily negotiations on "safe sex" and access to health services. An analysis was conducted with the support of the phenomenological research method, with three transvestites and two trans women sex workers being interviewed. The comprehensive analysis presented two categories: "Safe sex on the streets: negotiations of finances, risk and desire", which presents the elements negotiated in street experiences, and "Outsiders and Established: the selective visibility in institutions and their effects on trans health care", which unveils the senses in the experiences negotiated in the daily lives of health institutions.

Este artículo busca comprender las negociaciones diarias sobre "sexo seguro" y acceso a servicios de salud de travestis y trabajadoras sexuales transexuales. Se realizó un análisis con el apoyo del método de investigación fenomenológico, siendo entrevistados tres travestis y dos trabajadoras sexuales trans. El análisis integral presentó dos categorías: "Sexo seguro en la calle: negociaciones de finanzas, riesgo y deseo" - que presenta los elementos que son acordados en las experiencias de la calle - y "Forasteros y Establecidos: la visibilidad selectiva en las instituciones y sus efectos en el cuidado de la salud trans", que desvela los sentidos en las experiencias negociadas en el día a día de las instituciones de salud.

Assessing the Relationship Between HIV Quality of Care and Treatment Literacy on ART Adherence and Viral Suppression Among Female Sex Workers Living in the Dominican Republic.

This study assessed the relationship between the quality of HIV care and treatment literacy on antiretroviral therapy (ART) adherence and viral suppression among female sex workers (FSWs) living with HIV (n = 211) in Santo Domingo, Dominican Republic. Multivariable logistic regression results indicate better patient-provider communication (AOR 1.04; 95% CI 1.01-1.07) and respectful treatment (AOR 2.17; 95% CI 1.09-4.32) increase the odds of viral suppression, while higher costs reduce both the odds of ART adherence (AOR 0.57, 95% CI 0.34- 0.95) and being virally suppressed (AOR 0.59, 95% CI 0.41-0.85). Greater treatment literacy was associated with an increased odds of ART adherence (AOR 4.15 for understanding of viral load; 95% CI 1.50-11.52) and viral suppression (AOR 2.75 for understanding of CD4 count; 95% CI 1.31-5.80). Findings support investments in treatment education, effective and respectful patient-provider communication, dignified care, and cost-support for associated HIV care costs to facilitate FSWs' pathway towards viral suppression.

RESUMEN: Este estudio evaluó la relación entre la calidad de la atención para el VIH y la alfabetización relacionada al tratamiento sobre la adherencia a la terapia antirretroviral (TAR) y la supresión viral entre las trabajadoras sexuales (TRSX) que viven con el VIH (n = 211) en Santo Domingo, República Dominicana. Los resultados de la regresión logística multivariable indican una mejor comunicación entre el paciente y el proveedor (RMa: 1.04; IC del 95%: 1.01­1.07) y un tratamiento respetuoso (RMa: 2.17; IC del 95%: 1.09­4.32) aumenta la probabilidad de supresión viral, mientras que los costos elevados reducen tanto las probabilidades de adherencia al TAR (RMa: 0.57; IC del 95%: 0.34­0.95) como la supresión viral (RMa: 0.59, IC del 95%: 0.41­0.85). Una mayor alfabetización relacionada al tratamiento se asoció con una mayor probabilidad de adherencia al TAR (RMa: 4.15 para la comprensión de la carga viral; IC del 95%: 1.50­11.52) y la supresión viral (RMa: 2.75 para la comprensión del conteo de CD4; IC del 95%: 1.31­5.80). Los hallazgos respaldan inversiones en educación sobre el tratamiento, la comunicación efectiva y respetuosa entre el paciente y el proveedor, la atención digna y el apoyo económico para los costos asociados con la atención del VIH para facilitar el camino de las TRSX hacia la supresión viral.