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Traumatic Associations amongst Men and Women Selling Sex in the Philippines. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The present study explores trauma-related factors (human trafficking or physical or sexual violence during transactional sex) associated with interest in future community mobilization around health and human rights. Community mobilization among persons selling sex aims to help participants overcome trauma and increase self-reliance through peer advocacy and collective action for improved human conditions. However, how violence and human trafficking impact community mobilization participation among men and women selling sex is less known. Methods: The current study uses data (n = 96) from the baseline survey of participants in the pilot Kapihan community mobilization intervention, which recruited 37 men and 59 women from Metro Manila, Philippines. Multiple logistic regression was used to analyze factors (violence, human trafficking) independently associated with the desire to participate in community mobilization, adjusting for socio-demographic variables. Results: An increased interest in participating in community mobilization around health and human rights was significantly associated with having experienced physical or sexual abuse in the sex trade (AOR = 10.86; CI 1.48–79.69) and less history of trafficking (AOR = 0.14; 95% CI 0.02–0.97), adjusting for age, gender, income, number of children, and whether they considered group goals or had previously participated in community mobilization. Conclusion: Understanding the impact of experiences with physical and sexual violence and human trafficking on health and human rights mobilization participation can inform the design and recruitment for future community-based interventions. Further investigation needs to explore why experiences with human trafficking, having more children, or being a woman lessened the desire to mobilize in this Philippines context. Findings imply that trauma may be more complex. More work is needed to better identify interventions for those with a history of being trafficked or victimized by physical or sexual violence during transactional sex exchanges.
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Sahay S, Verma A, Shewale S, Bangar S, Bijeshkumar A, Angolkar M, Subramanian T, Chandhiok N. Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India. BMC Infect Dis 2021; 21:930. [PMID: 34496781 PMCID: PMC8424160 DOI: 10.1186/s12879-021-06612-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empowering female sex workers (FSWs) through women controlled HIV prevention option has been in focus globally. FSWs are important target for oral pre exposure prophylaxis (PrEP). A multi-centric qualitative study was conducted to explore the FSWs' willingness to use oral PrEP in India. METHODS Seventy three interviews and 02 focus group discussions were conducted at 3 high HIV prevalent states in India during 2013-14. Study explored issues around willingness to use oral PrEP. The study was approved by the respective institutional ethics committee of the study sites. Thematic analysis using grounded theory approach was used to analyze the data in N-VIVO version 8.0. RESULTS Thematic analysis showed events of forced condom-less sex. FSWs believed that oral PrEP could provide independence, financial gains, and privacy and therefore hoped to use it as an alternative to male condom. However, any impact on physical/ aesthetic attributes and reproductive system were not acceptable and could become a barrier. Provider initiated oral PrEP was not preferred. Providers voiced safety monitoring concerns. Adherence emerged as a challenge because of: (1) alcohol use; (2) taking PrEP tablet each day being boring; (3) Stigma because Oral PrEP is ARV based. Alcohol use and dread of repetitive dose brings forth the need for long acting oral PrEP. CONCLUSION Oral PrEP is acceptable among FSWs; it should be rolled out alongside strong messages on STI protection and PrEP as compliment to condoms. PrEP roll out requires educating communities about HIV treatment versus prevention. Long-acting oral PrEP could address both 'boredom' and alcoholism and sustain adherence.
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Affiliation(s)
- Seema Sahay
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India.
| | - Archana Verma
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - Suhas Shewale
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - Sampada Bangar
- Division of Epidemiology and Biostatistics, ICMR-National AIDS Research Institute, 73, G-Block, MIDC, Bhosari, Pune, Maharashtra, 411026, India
| | - Athokpam Bijeshkumar
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - Mubashir Angolkar
- Department of Public Health, Jawaharlal Nehru Medical College, KLE University, Belagavi, Karnataka, India
| | - Thilakavathi Subramanian
- Division of Social and Behavioral Research, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Nomita Chandhiok
- Division of Reproductive and Child Health, Indian Council of Medical Research, New Delhi, Delhi, India
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Gonzalez C, Brouwer KC, Reed E, Nicholls MJ, Kim J, Gonzalez-Zuniga PE, Gaeta-Rivera A, Urada LA. Women Trading Sex in a U.S.-Mexico Border City: A Qualitative Study of the Barriers and Facilitators to Finding Community and Voice. SEXES 2020; 1:1-18. [PMID: 34386640 PMCID: PMC8357315 DOI: 10.3390/sexes1010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Poverty and income inequality can increase a woman's decision to engage in risky transactional sex, and may lead to unimaginable harms, such as violence, substance use, and human trafficking. This study examines the facilitators and barriers to finding community and voice among women trading sex in Tijuana, Mexico, and what factors, such as socio-structural support, violence, and substance use, may impact their potential to engage with others, including human service providers. Sixty qualitative in-depth interviews were conducted with women trading sex in Tijuana, Mexico. Researchers met with participants for in-depth-face-to-face structured interviews. Data were coded using ATLAS.ti. Participants were aged 19-73 (mean: 37), 98% were of Mexican nationality, 90% reported trading sex independent of the control of others, with 58% identified as independent and street-based. Thirty percent of women trading sex reported substance use (excluding marijuana) and 20% reported injection drug use within 30 days. The majority reported no involvement in mobilization activities, but 85% expressed interest. However, barriers included stigma, cultural gender norms, partner violence, and privacy in regards to disclosure of sex trade involvement, moral conflict (revealing one's involvement in sex trade), involvement in substance use, human trafficking, and feeling powerless. Facilitators were having a safe space to meet, peer support, self-esteem, feeling heard, knowledge of rights, economic need to support families, and staying healthy. Findings imply the potential to go beyond mobilizing limited groups of women in the sex trade and instead involve whole community mobilization; that is, to reach and include the more vulnerable women (substance use, trafficked) in supportive services (social services, exit strategies, better healthcare opportunities, and/or education for healthcare providers to help break societal stigmas regarding women in the sex trade) and to change the status of women in society in general.
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Affiliation(s)
- Claudia Gonzalez
- College of Health and Human Services, San Diego State University School of Social Work, San Diego, CA 92182, USA
| | - Kimberly C. Brouwer
- Department of Family Medicine and Public Health, University of California, La Jolla, CA 92093, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, La Jolla, CA 92093, USA
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA 92182, USA
- Center on Gender Equity and Health, University of California, La Jolla, CA 92093, USA
| | - Melanie J. Nicholls
- College of Health and Human Services, San Diego State University School of Social Work, San Diego, CA 92182, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, La Jolla, CA 92093, USA
| | - Jessica Kim
- Center for Justice and Reconciliation, Point Loma Nazarene University, San Diego, CA 92106, USA
| | | | - Andrés Gaeta-Rivera
- Instituto Chihuahuense de Salud Mental, 31000 Chihuahua, Mexico
- School of Medicine and Psychology, Universidad Autónoma de Baja California, 21289 Tijuana, Baja California, Mexico
| | - Lianne A. Urada
- College of Health and Human Services, San Diego State University School of Social Work, San Diego, CA 92182, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, La Jolla, CA 92093, USA
- Center on Gender Equity and Health, University of California, La Jolla, CA 92093, USA
- Correspondence:
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Mahapatra B, Walia M, Patel SK, Battala M, Mukherjee S, Patel P, Subramanium B, Atmavilas Y, Saggurti N. Sustaining consistent condom use among female sex workers by addressing their vulnerabilities and strengthening community-led organizations in India. PLoS One 2020; 15:e0235094. [PMID: 32609731 PMCID: PMC7329078 DOI: 10.1371/journal.pone.0235094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Between 2014 and 2017, a program aimed at reducing HIV risk and promoting safe sex through consistent use of condoms sought to work through addressing social and economic vulnerabilities and strengthening community-led organizations (COs) of female sex workers (FSWs). This study examines if the program was effective by studying relationship between strengthening of COs, vulnerability reduction, and sustaining of consistent condom use behavior among FSWs. Methods We used a longitudinal study design to assess the change in outcomes. A three-stage sampling design was used to select FSWs for the study. Panel data of 2085 FSWs selected from 38 COs across five states of India was used to examine the change in various outcomes from 2015 (Survey Round 1) to 2017 (Survey Round 2). The CO level program pillar measuring institutional development assessed performance of COs in six domains critical for any organization’s functionality and sustainability: governance, project management, financial management, program monitoring, advocacy and networking, and resource mobilization. Overall, 32 indicators from all these domains were used to compute the CO strength score. A score was computed by taking mean of average dimension scores. The overall score was divided into two groups based on the median cutoff; COs which scored below the median were considered to have low CO strength, while COs which scored above or equal to median were considered to have high CO strength. Multivariable regression modeling techniques were used to examine the effect of program pillars on outcome measures. Results Analyses showed a significant improvement in the strength of the COs over time; percentage of COs having high strength improved from 50% in 2015 to 87% in Round 2. The improvement in CO’s strength increased financial security (Adjusted Odds Ratio [AOR]: 2.18, p<0.01), social welfare security (AOR: 1.71, p<0.01), and socio-legal security (AOR: 2.20, p<0.01) among FSWs. Further, improvement in financial security led to significant increase in consistent condom use with client among FSWs (AOR: 1.69, p<0.01) who were members of COs having high strength. Sustained consistent condom use was positively associated with young age (<30 years), ability to negotiate with clients for condom use, membership in self-help groups, high self-efficacy, self-confidence, and client solicitation in streets and brothels. Conclusions Improving financial security and strengthening FSW led CO can improve sustained and consistent condom use. In addition, the program should focus on enhancing ability of FSWs to negotiate with clients for condom use, promote membership in self-help groups and target FSWs who are 30 years or older, and soliciting from homes to sustain consistent condom use across all FSWs.
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Affiliation(s)
| | | | | | | | | | - Prachi Patel
- Catalyst Management Services, Bengaluru, Karnataka, India
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Choi EH, Jung HS. Models for Developing Community Organizations to Reinforce Health Management in Small Businesses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072444. [PMID: 32260225 PMCID: PMC7177578 DOI: 10.3390/ijerph17072444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/16/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022]
Abstract
The incidence of occupational diseases in small businesses is higher than in big ones, and this fact puts the former in need of a healthcare management model they can administer. This study established a model based on community organizational development theory to reinforce worker empowerment for healthcare in small businesses, focusing on health centers for workers (HCFW). The researchers surveyed 408 workers at 39 small businesses in the B region of South Korea, according to the characteristics of business sites, general characteristics of workers, and elements of community organizational development theory, and analyzed their results with a structural equation. The research period was September, 2015. Five concepts were examined: empowerment in healthcare, community capacity, participation and relevance, critical consciousness, and issue selection. The results revealed that greater community capacity led to greater participation and relevance (γ = 0.39) and empowerment in healthcare (γ = 0.25), while greater participation and relevance led to greater empowerment in healthcare (γ = 0.76). In addition, greater critical consciousness led to greater participation and relevance (γ = 0.12). Finally, greater community capacity led to greater issues selection (γ = 0.56), which in turn led to greater participation and relevance (γ = 0.25). The study makes proposals for directions of health centers for workers and community networks. Confirmation of this model for worker empowerment suggests several directions to HCFW in relation to workers and community networks.
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Affiliation(s)
- Eun-Hi Choi
- Department of Nursing, Eulji University, Daejeon 34824, Korea;
| | - Hye-Sun Jung
- Department of Preventive Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence:
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Gram L, Fitchett A, Ashraf A, Daruwalla N, Osrin D. Promoting women's and children's health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers. BMJ Glob Health 2019; 4:e001972. [PMID: 31908874 PMCID: PMC6936553 DOI: 10.1136/bmjgh-2019-001972] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/23/2019] [Accepted: 11/10/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Community mobilisation through group activities has been used to improve women's and children's health in a range of low-income and middle-income contexts, but the mechanisms through which it works deserve greater consideration. We did a mixed-methods systematic review of mechanisms, enablers and barriers to the promotion of women's and children's health in community mobilisation interventions. METHODS We searched for theoretical and empirical peer-reviewed articles between January 2000 and November 2018. First, we extracted and collated proposed mechanisms, enablers and barriers into categories. Second, we extracted and synthesised evidence for them using narrative synthesis. We assessed risk of bias with adapted Downs and Black and Critical Appraisal Skills Programme checklists. We assigned confidence grades to each proposed mechanism, enabler and barrier. RESULTS 78 articles met the inclusion criteria, of which 39 described interventions based on a participatory group education model, 19 described community-led structural interventions to promote sexual health in marginalised populations and 20 concerned other types of intervention or multiple interventions at once. We did not have high confidence in any mechanism, enabler or barrier. Two out of 15 proposed mechanisms and 10 out of 12 proposed enablers and barriers reached medium confidence. A few studies provided direct evidence relating proposed mechanisms, enablers or barriers to health behaviours or health outcomes. Only two studies presented mediation or interaction analysis for a proposed mechanism, enabler or barrier. CONCLUSION We uncovered multiple proposed mechanisms, enablers and barriers to health promotion through community groups, but much work remains to provide a robust evidence base for proposed mechanisms, enablers and barriers. PROSPERO REGISTRATION NUMBER CRD42018093695.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Adam Fitchett
- Faculty of Life Sciences, University College London, London, UK
| | - Asma Ashraf
- Institute for Global Health, University College London, London, UK
| | - Nayreen Daruwalla
- Society for Nutrition, Education & Health Action (SNEHA), Mumbai, Maharashtra, India
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Hay K, McDougal L, Percival V, Henry S, Klugman J, Wurie H, Raven J, Shabalala F, Fielding-Miller R, Dey A, Dehingia N, Morgan R, Atmavilas Y, Saggurti N, Yore J, Blokhina E, Huque R, Barasa E, Bhan N, Kharel C, Silverman JG, Raj A. Disrupting gender norms in health systems: making the case for change. Lancet 2019; 393:2535-2549. [PMID: 31155270 PMCID: PMC7233290 DOI: 10.1016/s0140-6736(19)30648-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that health systems reinforce patients' traditional gender roles and neglect gender inequalities in health, health system models and clinic-based programmes are rarely gender responsive, and women have less authority as health workers than men and are often devalued and abused. With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found that institutional support and respect of nurses improves quality of care, and that women's empowerment collectives can increase health-care access and provider responsiveness. We see promise from social movements in supporting women's reproductive rights and policies. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.
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Affiliation(s)
| | - Lotus McDougal
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Valerie Percival
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON Canada
| | - Sarah Henry
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Jeni Klugman
- Georgetown Institute for Women, Peace and Security, Georgetown University, Washington, DC, USA; Women and Public Policy Program, Harvard Kennedy School, Cambridge, MA, USA
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Rebecca Fielding-Miller
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Arnab Dey
- Sambodhi Research & Communications, Noida, Uttar Pradesh, India
| | | | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | | | | | - Jennifer Yore
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Elena Blokhina
- Vladman Institute of Pharmacology, Department of Psychiatry, First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russia
| | | | - Edwine Barasa
- Kemri-Wellcome Trust, Kenya Research Programme, Nairobi, Kenya
| | - Nandita Bhan
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Jay G Silverman
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA.
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