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Tag Archives: Health and HIV/AIDS

Lazarus L, Deering KN, Nabess R, Gibson K, Tyndall MW, Shannon K. Occupational Stigma as a Primary Barrier To Health Care For Street-Based Sex Workers in Canada. Culture, health & sexuality. 2012;14(2):139-150. doi:10.1080/13691058.2011.628411.

Abstract:

Individuals working in the sex industry continue to experience many negative health outcomes. As such, disentangling the factors shaping poor health access remains a critical public health priority. Within a quasi-criminalised prostitution environment, this study aimed to evaluate the prevalence of occupational stigma associated with sex work and its relationship to barriers to accessing health services. Analyses draw on baseline questionnaire data from a community-based cohort of women in street-based sex work in Vancouver, Canada (2006–8). Of a total of 252 women, 141 (58.5%) reported occupational sex work stigma (defined as hiding occupational sex work status from family, friends and/or home community), while 125 (49.6%) reported barriers to accessing health services in the previous six months. In multivariable analysis, adjusting for socio-demographic, interpersonal and work environment risks, occupational sex work stigma remained independently associated with an elevated likelihood of experiencing barriers to health access. Study findings indicate the critical need for policy and societal shifts in views of sex work as a legitimate occupation, combined with improved access to innovative, accessible and non-judgmental health care delivery models for street-based sex workers that include the direct involvement of sex workers in development and implementation.

Full text available here.

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Adriaenssens, Stef, and Jef Hendrickx. “Sex, Price and Preferences: Accounting for Unsafe Sexual Practices in Prostitution Markets.” Sociology of Health & Illness 34, no. 5 (June 1, 2012): 665–80. doi:10.1111/j.1467-9566.2011.01400.x.
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Abstract
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Unsafe sexual practices are persistent in prostitution interactions: one in four contacts can be called unsafe. The determinants of this are still matter for debate. We account for the roles played by clients’ preferences and the hypothetical price premium of unsafe sexual practices with the help of a large dataset of clients’ self-reported commercial sexual transactions in Belgium and The Netherlands. Almost 25,000 reports were collected, representing the whole gamut of prostitution market segments. The first set of explanations consists of an analysis of the price-fixing elements of paid sex. With the help of the so-called hedonic pricing method we test for the existence of a price incentive for unsafe sex. In accordance with the results from studies in some prostitution markets in the developing world, the study replicates a significant wage penalty for condom use of an estimated 7.2 per cent, confirmed in both multilevel and fixed-effects regressions. The second part of the analysis reconstructs the demand side basis of this wage penalty: the consistent preference of clients of prostitution for unsafe sex. This study is the first to document empirically clients’ preference for intercourse without a condom, with the help of a multilevel ordinal regression.

Lisa Maher, Thomas Crewe Dixon, Pisith Phlong, Julie Mooney-Somers, Ellen S. Stein, Kimberly Page: “Conflicting Rights: How the Prohibition of Human Trafficking and Sexual Exploitation Infringes the Right to Health of Female Sex Workers in Phnom Penh, Cambodia.” Health and Human Rights Journal. Accessed June 12, 2015.

Abstract

While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced anti-trafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers’ human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia’s AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.

Full article available here.

Jeal, N. and Salisbury, C. (2007), Health needs and service use of parlour-based prostitutes compared with street-based prostitutes: a cross-sectional survey. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 875–881. doi: 10.1111/j.1471-0528.2007.01379.x

Abstract:

Objectives To compare the health needs of prostitutes (sex workers) working in massage parlours with that of those working on the streets.

Design  Cross-sectional survey.

Setting  Inner city, UK.

Population  Women aged 16 years and older selling sex in massage parlours.

Methods  Interviewer-administered questionnaires were undertaken with 71 parlour workers, and results were compared with our previous findings for street sex workers.

Main outcome measures  Self-reported experiences of health and service use.

Results  In comparison with street sex workers, parlour sex workers were less likely to report chronic (43/71 versus 71/71; P < 0.001) and acute (10/71 versus 35/71; P < 0.001) illnesses but more likely to be registered with a GP (67/71 versus 59/71; P= 0.06). They were more likely than street sex workers to have been screened for sexually transmitted infections in the previous year (49/71 versus 33/71; P= 0.011) and more likely to use contraception in addition to condoms (34/71 versus 8/71; P < 0.001). They were less likely to be overdue for cervical screening (5/46 versus 19/48; P= 0.001), and more of those booked for antenatal care in the first trimester attended all follow-up appointments (28/37 versus 14/47; P < 0.001). Fewer parlour sex workers used heroin (4/71 versus 60/71; P < 0.001), crack cocaine (5/71 versus 62/71; P < 0.001) or injected drugs (2/71 versus 41/71 versus; P < 0.001) They reported fewer episodes of intercourse per week (mean 14 versus 22; P < 0.001) with fewer different men (mean 11 versus 19; P < 0.001), less of whom were new (mean 8 versus 13; P < 0.001).

Conclusions  The two groups had very different health experiences, risk-taking behaviour and use of services. To be effective in improving health, different types of service delivered in different settings for different groups are required.

Full text available here.

WHO; UNFPA; UNAIDS; NSWP; World Bank (2013): Implementing Comprehensive HIV/STI Programmes with Sex Workers. 

Overview

This tool offers practical advice on implementing HIV and STI programmes for and with sex workers. It is based on the recommendations in the guidance document on Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries published in 2012 by the World Health Organization, the United Nations Population Fund, the Joint United Nations Programme on HIV/AIDS and the Global Network of Sex Work Projects.

Topics covered in the tool include approaches and principles to building programmes that are led by the sex worker community such as community empowerment, addressing violence against sex workers, and community-led services; they include how to implement the recommended condom and lubricant programming, and other crucial health-care interventions for HIV prevention, treatment and care; and they include suggestions on how to manage programmes and build the capacity of sex worker organizations. The tool contains examples of good practice from around the world that may support efforts in planning programmes and services.

The tool is designed for use by public-health officials and managers of HIV and STI programmes; NGOs, including community and civil-society organizations; and health workers. It may also be of interest to international funding agencies, health policy-makers and advocates.

Full report and policy brief available here. 

Escamilla Loredo, M. I. (2014). Developing safer sex negotiation skills among Latin American female sex workers working in Germany. Bielefeld: Bielefeld University.

Executive Summary.

Sexually transmitted infections (STIs), including HIV, are among the most important
causes of infertility, long-term disability and death in the world (WHO 2012).
Because of the particularities of their job, sex workers (SW) are at great risk of
acquiring HIV/STIs. It is estimated that around 400,000 sex workers are engaged in
Germany and approximately 1 million men look daily for sex workers’ services in the
country (TAMPEP 2010). In Germany, sex work is a commercial activity
predominantly conducted by migrants and by women (TAMPEP 2010, 2007a, 2007b,
2007d). The largest populations of migrant SW in the country are the groups from
Central and Eastern Europe, Asia and Latin America (TAMPEP 2010). Evidence
suggests that sex workers in Germany may not consistently practice protected sex
(RKI 2012; Bremer 2007, 2006; TAMPEP 2010, 2007b, 2007d). Among other
interventions to increase condom use among SW, it is recommended to improve sex
workers’ safer sex negotiation abilities. In this sense, the current study was
conducted to achieve two principal goals: 1) to identify negotiation strategies that
Latin American female sex workers working in Germany (LAFSWs) employ by
attempting to persuade clients resistant to using a condom; and 2) to identify skills
building approaches to teach sex workers condom use negotiation strategies.

Full document available here. 

 

Kimberly Page, Ellen Stein, Neth Sansothy, Jennifer Evans, Marie-Claude Couture, Keo Sichan, Melissa Cockroft, Julie Mooney-Somers, Pisith Phlong, John Kaldor, Lisa Maher, and on behalf of the Young Women’s Health Study Collaborative, John Kaldor, Serey Phal Kien, Kimberly Page, Joel M Palefsky, Vonthanak Saphonn, and Mean Chhi Vun. “Sex work and HIV in Cambodia: trajectories of risk and disease in two cohorts of high-risk young women in Phnom Penh, Cambodia” BMJ Open. 2013; 3(9): e003095

Abstract:

Objectives
HIV prevalence among Cambodian female sex workers (FSW) is among the highest in Southeast Asia. We describe HIV prevalence and associated risk exposures in FSW sampled serially in Phnom Penh, Cambodia (Young Women’s Health Study (YWHS)), before and after the implementation of a new law designed to combat human trafficking and sexual exploitation.

Design
Cross-sectional analysis of baseline data from two prospective cohorts.

Setting
Community-based study in Phnom Penh, Cambodia.

Participants
Women aged 15–29 years, reporting ≥2 sexual partners in the last month and/or engaged in transactional sex in the last 3 months, were enrolled in the studies in 2007 (N=161; YWHS-1), and 2009 (N=220; YWHS-2) following information sessions where 285 and 345 women attended.

Primary outcomes
HIV prevalence, sexual risk behaviour, amphetamine-type stimulant (ATS) and alcohol use, and work-related factors were compared in the two groups, enrolled before and after implementation of the new law.

Results
Participants in the two cohorts were similar in age (median 25 years), but YWHS-2 women reported fewer sex partners, more alcohol use and less ATS use. A higher proportion of YWHS-2 compared with YWHS-1 women worked in entertainment-based venues (68% vs 31%, respectively). HIV prevalence was significantly lower in the more recently sampled women: 9.2% (95% CI 4.5% to 13.8%) vs 23% (95% CI 16.5% to 29.7%).

Conclusions
Sex work context and risk have shifted among young FSW in Phnom Penh, following implementation of anti-prostitution and anti-trafficking laws. While both cohorts were recruited using the same eligibility criteria, more recently sampled women had lower prevalence of sexual risk and HIV infection. Women engaging more directly in transactional sex have become harder to sample and access. Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission.

Full text available here.