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Logie CH, MacKenzie F, Malama K, Lorimer N, Lad A, Zhao M, Narasimhan M, Fahme S, Turan B, Kagunda J, Konda K, Hasham A, Perez-Brumer A. Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings. Reprod Health 2024; 21:51. [PMID: 38609975 PMCID: PMC11010352 DOI: 10.1186/s12978-024-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. METHODS Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. FINDINGS The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. CONCLUSIONS This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada.
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada.
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Nicole Lorimer
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Anoushka Lad
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Michelle Zhao
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Sasha Fahme
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bülent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Julia Kagunda
- Elim Trust, Nairobi, Kenya
- Daystar University, Nairobi, Kenya
| | - Kelika Konda
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Mesías-Gazmuri J, Folch C, Ferrer L, Reyes-Urueña J, Egea-Cortés L, Morales A, Villegas L, Casabona J. Syndemic Conditions and Their Association with HIV/STI Sexual Risk Behaviors Among Transgender Women and Cisgender Men Sex Workers in Catalonia: The SexCohort Project. Int J Behav Med 2023; 30:824-835. [PMID: 36333554 DOI: 10.1007/s12529-022-10138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transgender women and cisgender men sex workers are vulnerable to HIV and sexually transmitted infections (STIs). This study aimed to explore in depth the prevalence of syndemic conditions and their association with the sexual risk behaviors for HIV/STI acquisition in cis men and trans women sex workers in Barcelona (Catalonia, Spain). METHOD We conducted a study between 2014 and 2018 to determine whether syndemic conditions (frequent alcohol consumption and polydrug use (> 2) during sex with clients; experience of violence; and lack of healthcare access) are associated with HIV/STI sexual risk behaviors. A "syndemic index" was calculated based on the cumulative number of syndemic conditions (0 to 4). RESULTS In the last year (2018), 78.8% of cisgender men and 68.1% of transgender women reported at least one syndemic condition. The most prevalent syndemic factor in both cisgender men and transgender women was violence (38.8% and 43.6% respectively). In multivariable analysis, an association was found between condomless anal sex and violence (aOR = 1.81), and frequent alcohol consumption and violence with reporting > 10 clients/week (aOR = 2.73 and 1.88, respectively). The higher the number of syndemic factors, the greater probability of having > 10 clients/week and reporting condomless anal sex with clients. CONCLUSION Psychosocial conditions have a syndemic effect on risky sexual behaviors highlighting the need for a more holistic approach to HIV/STI prevention targeting these populations.
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Affiliation(s)
- Jocelyn Mesías-Gazmuri
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
- Doctorat Metodologia de La Recerca Biomèdica I Salut Publica, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cinta Folch
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain.
| | - Laia Ferrer
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Juliana Reyes-Urueña
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Laia Egea-Cortés
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
| | | | | | - Jordi Casabona
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
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Decriminalisation and the end of AIDS: keep the promise, follow the science, and fulfill human rights. Sex Reprod Health Matters 2023; 31:2194188. [PMID: 37351922 PMCID: PMC10291907 DOI: 10.1080/26410397.2023.2194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
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4
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Mitjà O, Padovese V, Folch C, Rossoni I, Marks M, Rodríguez i Arias MA, Telenti A, Ciuffi A, Blondeel K, Mårdh O, Casabona J. Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100742. [PMID: 37927427 PMCID: PMC10625005 DOI: 10.1016/j.lanepe.2023.100742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023]
Abstract
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Cinta Folch
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Isotta Rossoni
- Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Netherland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom
- Division of Infection and Immunology, University College London, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
| | - Miquel Angel Rodríguez i Arias
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
| | | | - Angela Ciuffi
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Otilia Mårdh
- STI, Blood Borne Viruses and TB Section, Disease Programmes Unit, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Lipira LE, Glick JL, German D, Glick SN, Moreno C, Elimam D, Brantley ML, Pichon LC, Barak N, Booth MM, Flynn C, Menza T. Type of Exchange Sex and Associated Behaviors and Outcomes Among Cisgender Men and Women at Increased Risk for HIV via Heterosexual Transmission in Six U.S. Metropolitan Areas. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3313-3327. [PMID: 37612535 DOI: 10.1007/s10508-023-02663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023]
Abstract
Exchange sex is associated with sexual risk behaviors and poor outcomes and different types may incur different levels of risk. We assessed risk profiles of different types of exchange sex among non-injecting cisgender men and women who participated in the 2019 National HIV Behavioral Surveillance project at six sites. Six percent of men and 19% of women reported exchange sex in the past year; most engaged in non-commercial exchange sex for drugs/money with smaller percentages reporting formal sex work or non-commercial exchange sex for goods or services other than drugs/money. Exchange sex was associated with sexual risk and prevention behaviors and psychosocial and sexual health outcomes and associations varied by type of exchange sex. Efforts to improve access to STI/HIV testing and PrEP may benefit from tailoring based on type of exchange sex. Findings indicate value in a broader definition of exchange sex with follow-up assessment of exchange sex typology.
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Affiliation(s)
- Lauren E Lipira
- Regional Research Institute, Portland State University, Portland, OR, USA.
- Public Health Division, Oregon Health Authority, 800 NE Oregon St, Portland, OR, 97232, USA.
| | - Jennifer L Glick
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Courtney Moreno
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Dena Elimam
- Epidemiology Section, Georgia Department of Public Health, Division of Health Protection, Atlanta, GA, USA
| | - Meredith L Brantley
- HIV/STI/Viral Hepatitis Section, Tennessee Department of Health, Nashville, TN, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | | | | | - Colin Flynn
- Maryland Department of Health, Baltimore, MD, USA
| | - Timothy Menza
- Public Health Division, Oregon Health Authority, 800 NE Oregon St, Portland, OR, 97232, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Kelberga Kelberg A, Martinsone B. Motivation of sex workers who provide camming services to engage in sex with their real-life and virtual partners. Front Psychol 2023; 14:1173902. [PMID: 37469897 PMCID: PMC10352917 DOI: 10.3389/fpsyg.2023.1173902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
In this study, the motivations of 80 sex workers who provide camming services (76 females and 4 non-binary/trans/gender fluid individuals; aged from 20 to 49 years, M = 30.68, SD = 6.43; 56.2% married or in a committed relationship, 18.8% in a non-committed relationship and 25% - single) were compared in terms of engaging in sexual activity with their real-life partners versus their virtual partners (predominantly kink-oriented clients). Presented with 16 reasons to engage in sexual activity, the respondents rated the frequency to engage in sex for each of these reasons with their real-life and virtual partners. Results showed that there were five reasons in which there were differences in motivation to engage in sex with real-life versus virtual partners and 11 reasons showed no differences. Specifically, respondents reported engaging in sex more often with their virtual partners to get resources and to experience a specific type of sex (kink), while they reported engaging in sex more often with their real-life partners to experience physical pleasure, motivated by physical desirability of a partner and to express love and commitment. However, for all other reasons that motivate people to engage in sex, including stress reduction, experience seeking, self-esteem boost, social status, revenge, utilitarian reasons, emotional expression, duty or pressure, thrill of the forbidden, mate guarding, and desire to have sex with a person of other gender, respondents engaged in sex equally frequently with their real-life and virtual partners (clients) and there were no statistical differences. This study adds to the existing research on sex work by providing insights into the motivations of sex workers to engage in sex with different partners and demonstrates that apart from common sense differences the reasons to engage in sex with clients and real-life partners are vastly similar.
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Sherman SG, Tomko C, Nestadt DF, Silberzahn BE, Clouse E, Haney K, Allen ST, Galai N. Impact of a Community Empowerment Intervention on Sexually Transmitted Infections Among Female Sex Workers in Baltimore, Maryland. Sex Transm Dis 2023; 50:374-380. [PMID: 36749851 DOI: 10.1097/olq.0000000000001781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Female sex workers ( FSWs) are vulnerable to a number of health issues, but often delay seeking health care due to structural barriers. Multiservice drop-in centers have been shown to increase FSW access to health services globally, but their impact on FSW in the United States is lacking. This study seeks to evaluate the effect of a community-level empowerment intervention (the multiservice drop-in SPARC center) on cumulative sexually transmitted infections (STIs) among FSW in a city in the United States. METHODS Between September 2017 and January 2019, 385 FSWs were recruited in Baltimore. Participants from areas served by SPARC were recruited to the intervention; other areas of Baltimore were the control. Follow-up occurred at 6, 12, and 18 months. The primary outcome is cumulative STI (ie, positive gonorrhea or chlamydia test at any follow-up). We tested effect modification by condomless sex with paying clients reported at baseline. Logistic regressions with propensity score weighting were used to estimate intervention effect, accounting for loss to follow-up, with bootstrap confidence intervals. RESULTS Participants completed 713 follow-up study visits (73%, 70%, 64% retention at 6, 12, and 18 months, respectively). Baseline STI prevalence was 28% and cumulative STI prevalence across follow-ups was 26%; these both did not differ between control and intervention communities in bivariate analyses. After adjusting for covariates, FSW in the intervention had a borderline-significant decrease in odds of cumulative STI compared with control (odds ratio, 0.61, P = 0.09 ) . There was evidence of effect modification by baseline condomless sex, such that FSW in the intervention who reported condomless sex had lower odds of cumulative STI compared with FSW in the control community who also reported baseline condomless sex (odds ratio, 0.29; P = 0.04). CONCLUSIONS Results demonstrate the value of a low-barrier, multiservice model on reducing STIs among the highest-risk FSW.Clinical Trial Number: NCT04413591.
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Affiliation(s)
- Susan G Sherman
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catherine Tomko
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Danielle F Nestadt
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Emily Clouse
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine Haney
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sean T Allen
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Singer R, Abboud S, Johnson AK, Zemlak JL, Crooks N, Lee S, Wilson J, Gorvine D, Stamps J, Bruce D, Sherman SG, Matthews AK, Patil CL. Experiences of Sex Workers in Chicago during COVID-19: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5948. [PMID: 37297552 PMCID: PMC10252736 DOI: 10.3390/ijerph20115948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on mental health; and (5) adaptive strategies for working during COVID-19. Participants reported that their physical and mental health, economic stability, and safety worsened due to COVID-19 and that adaptive strategies did not serve to improve working conditions. Findings highlight the ways in which sex workers are particularly vulnerable during a public health crisis, such as COVID-19. In response to these findings, targeted resources, an increased access to funding, community-empowered interventions and policy changes are needed to protect the health and safety of sex workers in Chicago.
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Affiliation(s)
- Randi Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Amy K. Johnson
- Ann & Robert H. Lurie Children’s, Chicago, IL 60611, USA
| | | | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sangeun Lee
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | | | - Della Gorvine
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL 60653, USA
| | - Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL 60614, USA
| | | | | | - Crystal L. Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
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Goldenberg SM, Pearson J, Moreheart S, Nazaroff H, Krüsi A, Braschel M, Bingham B, Shannon K. Prevalence and structural correlates of HIV and STI testing among a community-based cohort of women sex workers in Vancouver Canada. PLoS One 2023; 18:e0283729. [PMID: 36996154 PMCID: PMC10062647 DOI: 10.1371/journal.pone.0283729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In light of the stark inequities in HIV and sexually transmitted infections (STIs) experienced by women sex workers, empirical evidence is needed to inform accessible and sex worker-friendly models of voluntary, confidential and non-coercive HIV and STI testing. We evaluated the prevalence and structural correlates of HIV/STI testing in the last 6 months in a large, community-based cohort of women sex workers in Vancouver, Canada. METHODS Data were drawn from an open community-based open cohort of women sex workers (January 2010-August 2021) working across diverse street, indoor, and online environments in Vancouver, Canada. Using questionnaire data collected by experiential (sex workers) and community-based staff, we measured prevalence and used bivariate and multivariable logistic regression to model correlates of recent HIV/STI testing at enrollment. RESULTS Of 897 participants, 37.2% (n = 334) identified as Indigenous, 31.4% as Women of Color/Black (n = 282), and 31.3% (n = 281) as White. At enrollment, 45.5% (n = 408) reported HIV testing, 44.9% (n = 403) reported STI testing, 32.6% (n = 292) reported receiving both HIV and STI testing, and 57.9% (n = 519) had received an HIV and/or STI test in the last 6 months. In adjusted multivariable analysis, women accessing sex worker-led/specific services had higher odds of recent HIV/STI testing, (Adjusted Odds Ratio (AOR): 1.91, 95% Confidence Interval (CI): 1.33-2.75), whereas Women of Color and Black women (AOR: 0.52, 95%CI: 0.28-0.98) faced significantly lower odds of recent HIV/STI testing. CONCLUSIONS Scaling-up community-based, sex worker-led and tailored services is recommended to enhance voluntary, confidential, and safe access to integrated HIV/STI testing, particularly for Women of Color and Black Women. Culturally safe, multilingual HIV/STI testing services and broader efforts to address systemic racism within and beyond the health system are needed to reduce inequities and promote safe engagement in services for racialized sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Hannah Nazaroff
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Brittany Bingham
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Indigenous Health, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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10
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Johnson L, Potter LC, Beeching H, Bradbury M, Matos B, Sumner G, Wills L, Worthing K, Aldridge RW, Feder G, Hayward AC, Pathak N, Platt L, Story A, Sultan B, Luchenski SA. Interventions to improve health and the determinants of health among sex workers in high-income countries: a systematic review. Lancet Public Health 2023; 8:e141-e154. [PMID: 36334613 PMCID: PMC10564624 DOI: 10.1016/s2468-2667(22)00252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
Many sex worker populations face high morbidity and mortality, but data are scarce on interventions to improve their health. We did a systematic review of health and social interventions to improve the health and wider determinants of health among adult sex workers in high-income countries. We searched MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science, EthOS, OpenGrey, and Social Care Online, as well as the Global Network of Sex Work Projects and the Sex Work Research Hub for studies published between Jan 1, 2005 and Dec 16, 2021 (PROSPERO CRD42019158674). Quantitative studies reporting disaggregated data for sex workers were included and no comparators were specified. We assessed rigour using the Quality Assessment Tool for Quantitative Studies. We summarised studies using vote counting and a narrative synthesis. 20 studies were included. Most reported findings exclusively for female sex workers (n=17) and street-based sex workers (n=11). Intervention components were divided into education and empowerment (n=14), drug treatment (n=4), sexual and reproductive health care (n=7), other health care (n=5), and welfare (n=5). Interventions affected a range of mental health, physical health, and health behaviour outcomes. Multicomponent interventions and interventions that were focused on education and empowerment were of benefit. Interventions that used peer design and peer delivery were effective. An outreach or drop-in component might be beneficial in some contexts. Sex workers who were new to working in an area faced greater challenges accessing services. Data were scarce for male, transgender, and indoor-based sex workers. Co-designed and co-delivered interventions that are either multicomponent or focus on education and empowerment are likely to be effective. Policy makers and health-care providers should improve access to services for all genders of sex workers and those new to an area. Future research should develop interventions for a greater diversity of sex worker populations and for wider health and social needs.
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Affiliation(s)
- Luke Johnson
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK; Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Lucy C Potter
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Molly Bradbury
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Bella Matos
- Department of Psychology, The American University of Paris, Paris, France
| | - Grace Sumner
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Lorna Wills
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Kitty Worthing
- Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Gene Feder
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew C Hayward
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Neha Pathak
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Al Story
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK; Find & Treat, University College London Hospital, London, UK
| | - Binta Sultan
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK; Find & Treat, University College London Hospital, London, UK
| | - Serena A Luchenski
- Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, London, UK
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11
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Knudtzen FC, Mørk L, Nielsen VN, Astrup BS. Accessing vulnerable undocumented migrants through a healthcare clinic including a community outreach programme: a 12-year retrospective cohort study in Denmark. J Travel Med 2022; 29:6353013. [PMID: 34401917 DOI: 10.1093/jtm/taab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Little is known about the healthcare needs of the increasing number of undocumented migrants in Europe. We aimed to gain knowledge about undocumented migrants use of a free healthcare clinic including an outreach programme in Denmark. METHODS We conducted a retrospective cohort study of all patients registered in the database at the AmiAmi healthcare clinic in Fredericia, Denmark, 1 January 2006-30 July 2019. RESULTS In all, 579 patients from 47 different countries were included, of which 525 (90.7%) were cis-women (= assigned female sex at birth and identifies as female). They had a total of 3135 consultations (median 3, interquartile range 2-6), and 19% used the clinic over a period of >2 years. In all, 820 consultations (26%) were done as part of the outreach programme, and the number of outreach contacts increased significantly over the study period (P < 0.001). Of 738 tests for sexually transmitted infections (STIs), 76 (13.1%) patients were found positive for one or several STIs. Transgender women and cross-dressing men had significantly higher risk of STIs (25.8% vs 10.3%, P = 0.007) compared with cis-women. Of 94 patients referred to the public healthcare system, the majority (n = 64) was referred to the department of gynaecology during pregnancy or for induced abortion. A total of 52 patients (9.0%) reported being submitted to abuse or violence while in Denmark, and another 24 (4.1%) were registered as victims of human trafficking. CONCLUSIONS Our results highlight the multifaceted healthcare needs of undocumented migrants, with an increasing use of healthcare services over the study period. It underlines the importance of outreach programmes to reach this patient group at their place of work or stay. Finally, it emphasizes that transgender female and cross-dressing male sex workers are an especially vulnerable group with higher risk of human immunodeficiency virus and other STIs compared with cis-women.
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Affiliation(s)
- Fredrikke C Knudtzen
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark.,Clinical Center for Emerging and Vector-borne Infections, Department of Infectious Diseases, Odense University Hospital, J.B.Winsloews vej 4, entrance 18-20, 5000 Odense C, Denmark
| | - Lone Mørk
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark
| | - Vibeke N Nielsen
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark
| | - Birgitte S Astrup
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark.,Department of Forensic Pathology, Institute of Forensic Medicine, University of Southern Denmark, J.B.Winsloews vej 17, 5000 Odense C, Denmark
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12
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Ferrer L, González V, Martró E, Folch C, Saludes V, Muñoz R, Rodríguez V, Morales A, Meroño M, Morey F, Sanjosé SD, Casabona J. High HIV/STI prevalence among cisgender men and transgender women sex workers attending community-based centres in Barcelona, Spain: The Sweetie Project. Int J STD AIDS 2022; 33:1045-1053. [DOI: 10.1177/09564624221116536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to describe the socio-demographics, and the sexual and health-seeking behaviours of cisgender men and transgender women sex workers (M & TWSW) attending community-based organisations (CBOs) in Barcelona, Spain, as well as to estimate the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Chlamydia Trachomatis (CT) and Neisseria gonorrhoeae (NG) among them at different anatomical sites. Methods The Sweetie Project was a community-based cross-sectional study of 147 M & TWSW recruited in two CBOs in Barcelona between 2017 and 2018. A nurse collected biological samples from rectum, pharynx and urethra from the subjects at each CBO and the participants self-completed an epidemiological questionnaire. Results The highest prevalence observed was for HIV infection (25.3%) followed by bacterial STIs (NG 19.2% and CT 10.3%). The most prevalent anatomical site was pharyngeal (17.7%) followed by rectal (13.8%). More than half of participants who had a pharyngeal infection presented an isolated pharyngeal infection (57.7%) and half of those who had a rectal or urethral infection presented an isolated infection respectively. The seroprevalence of HCV and HBV was 2.4% and 34.2% respectively. There was a poor but statistically significant correlation between HIV and rectal CT infection ( r = 0.31), previous exposure to HCV ( r = 0.27) or self-reported STI ( r = 0.23), as well as between previous exposure to HCV and rectal CT ( r = 0.21) or self-reported STI ( r = 0.20). Discussion The Sweetie Project confirms the high burden of HIV and bacterial STIs among a sample of M&TWSW recruited in CBOs and reinforces the need to routinely screen them at all exposed anatomical sites.
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Affiliation(s)
- Laia Ferrer
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Victoria González
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Elisa Martró
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Cinta Folch
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Verónica Saludes
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Rafael Muñoz
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - Vanesa Rodríguez
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Francisca Morey
- Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - Sílvia de Sanjosé
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola), Spain
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13
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Glick JL, Beckham SW, White RH, Nestadt DF, Logie CH, Galai N, Sherman SG. The Importance of Sexual Orientation in the Association Between Social Cohesion and Client Condom Coercion Among Women Who Exchange Sex in Baltimore, Maryland. AIDS Behav 2022; 26:2632-2642. [PMID: 35124757 PMCID: PMC10029811 DOI: 10.1007/s10461-022-03599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 01/12/2023]
Abstract
Among women who exchange sex (WES), social cohesion is associated with multi-level HIV-risk reduction factors, and client condom coercion (CCC) is associated with increased HIV-risk. Sexual minority WES (SM-WES) face exacerbated HIV-risk, yet relevant research is scant. We examined the role of sexual orientation in the relationship between social cohesion and CCC among cisgender WES (n = 384) in Baltimore, Maryland using stratified logistic regression, controlling for potential confounders. Forty-five percent of WES experienced CCC. SM-WES reported significantly higher social cohesion than heterosexual WES. The relationship between social cohesion and CCC differed by sexual orientation. Among SM-WES, higher social cohesion was independently associated with decreased odds of experiencing CCC, controlling for food insecurity, crack use, police harassment, and method of finding clients. Among heterosexual WES, no significant association was found. Ongoing research and practice with WES should (1) collect sexual orientation data to allow for deeper understanding and tailored interventions, (2) leverage and nurture social cohesion and (3) tailor interventions to populations with attention to sexual orientation.
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Affiliation(s)
- Jennifer L Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - S Wilson Beckham
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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14
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Meyers-Pantele SA, Jain S, Sun X, Marks C, DeBeck K, Hayashi K, Strathdee SA, Werb D. Gender and the first-time provision of injection initiation assistance among people who inject drugs across two distinct North American contexts: Tijuana, Mexico and Vancouver, Canada. Drug Alcohol Rev 2022; 41:686-696. [PMID: 34636100 PMCID: PMC8930605 DOI: 10.1111/dar.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Injection drug use initiation is commonly facilitated by other people who inject drugs (PWID). We investigated how the gender of PWID influences their risk of providing initiation assistance to others across two distinct geo-cultural settings. METHODS Data were drawn from two prospective cohorts in Tijuana, Mexico and Vancouver, Canada which conducted semi-annual interviews within the PReventing Injecting by Modifying Existing Responses (PRIMER) study. Participants consisted of PWID who had reported never providing injection initiation assistance at baseline. We then conducted site-specific discrete-time survival analyses assessing the relationship between gender and other relevant covariates (e.g. age and past 6-month sex work) on the risk of the first reported instance of providing initiation assistance. RESULTS Of 1988 PWID (Tijuana: n = 596; Vancouver: n = 1392), 256 (43%) and 511 (36.7%) participants were women, and 42 (1.7%) and 78 (1.6%) reported recent injection initiation assistance across a median of three and two follow-up visits, respectively. Women had a lower risk of providing injection initiation assistance for the first time in Tijuana (adjusted hazard ratio = 0.52, 95% confidence interval 0.27-0.99), but not in Vancouver. Gendered pathways, like sex work, were associated with providing initiation assistance for the first time in Vancouver (adjusted hazard ratio = 1.97, 95% confidence interval 1.08-3.61). DISCUSSION AND CONCLUSIONS Women in Tijuana, but not Vancouver, were less likely to provide first-time initiation assistance among PWID. These results can inform gender- and site-specific prevention efforts aimed at reducing transitions into drug injecting across geographic contexts.
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Affiliation(s)
- Stephanie A. Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, USA,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Charles Marks
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,School of Public Health, University of Nevada, Reno, USA
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, Canada
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15
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Nicholson PJ. William Hogarth, A Harlot’s Progress Plate IV, 1732. Occup Med (Lond) 2021. [DOI: 10.1093/occmed/kqz136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Herpai N, Lazarus L, Forget E, Balakireva O, Pavlova D, McClarty L, Lorway R, Pickles M, Isac S, Sandstrom P, Aral S, Mishra S, Ma H, Blanchard J, Becker M, On Behalf Of The Dynamics Study Team. Exploring the dynamics of workplace typologies for sex workers in Eastern Ukraine. Glob Public Health 2021; 17:2034-2053. [PMID: 34403303 DOI: 10.1080/17441692.2021.1965180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examine the typologies of workplaces for sex workers in Dnipro, Ukraine as part of the larger Dynamics Study, which explores the influence of conflict on sex work. We conducted a cross-sectional survey with 560 women from September 2017 to October 2018. The results of our study demonstrate a diverse sex work environment with heterogeneity across workplace typologies in terms of remuneration, workload, and safety. Women working in higher prestige typologies earned a higher hourly wage, however client volume also varied which resulted in comparable monthly earnings from sex work across almost all workplace types. While sex workers in Dnipro earn a higher monthly wage than the city mean, they also report experiencing high rates of violence and a lack of personal safety at work. Sex workers in all workplaces, with the exception of those working in art clubs, experienced physical and sexual violence perpetrated by law enforcement officers and sex partners. By understanding more about sex work workplaces, programmes may be better tailored to meet the needs of sex workers and respond to changing work environments due to ongoing conflict and COVID-19 pandemic.
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Affiliation(s)
- Nicole Herpai
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Evelyn Forget
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Olga Balakireva
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine.,Ukrainian Institute for Social Research after Olexander Yaremenko, Kyiv, Ukraine
| | - Daria Pavlova
- Ukrainian Institute for Social Research after Olexander Yaremenko, Kyiv, Ukraine
| | - Leigh McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael Pickles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Canada
| | - Sevgi Aral
- Division of Sexually Transmitted Disease Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - James Blanchard
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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17
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Logie CH. Sexual rights and sexual pleasure: Sustainable Development Goals and the omitted dimensions of the leave no one behind sexual health agenda. Glob Public Health 2021; 18:1953559. [PMID: 34278957 DOI: 10.1080/17441692.2021.1953559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This commentary explores the missing discourse of sexual rights and sexual pleasure in the Sustainable Development Goals (SDG) that purport to leave no one behind. The SDG propose a welcome focus on sexual health and human rights for all, expanding beyond the Millennium Development Goals. While promising in many ways for advancing global sexual and reproductive health, and reproductive rights, the omission of sexual rights is troubling. So too is the erasure of lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and sex workers, from the SDG discussions of social inequities. Illustrative examples are provided to demonstrate how a sexual rights focus could advance SDG 3 focused on healthy lives and well-being for all. First, sexual rights are presented as integral to realizing Target 3.3's focus on ending the HIV pandemic among LGBTQ persons and sex workers (and LGBTQ sex workers). Second, sexual pleasure is introduced as an integral component of sexual health and sexual rights that could facilitate the realization of Target 3.7's aim to provide universal access to sexual and reproductive health information and education. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Centre for Gender & Sexual Health Equity, Vancouver, Canada
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18
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Ogden SN, Harris MT, Childs E, Valente PK, Edeza A, Collins AB, Drainoni ML, Mimiaga MJ, Biello KB, Bazzi AR. "You need money to get high, and that's the easiest and fastest way:" A typology of sex work and health behaviours among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103285. [PMID: 33985886 DOI: 10.1016/j.drugpo.2021.103285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the United States, the criminalization and stigmatization of drug use and sex work contribute to infectious disease transmission and healthcare disengagement. People who inject drugs (PWID) and engage in sex work experience exacerbated HIV risk. In the context of the ongoing HIV and overdose epidemics little research describes why PWID engage in sex work and its relative HIV risk. To inform intervention needs, we aimed to create a typology of sex work among PWID with a focus on HIV risk and healthcare utilization behaviours. METHODS We drew from in-depth interviews conducted across Massachusetts and Rhode Island from 2016-2019. Participants were ≥18 years old and self-reported past-month injection drug use and HIV-negative status. Using data from individuals reporting sex work experience (n=33/78), we utilized the framework method to develop a typology of perspectives on sex work engagement and attributes pertaining to HIV risk and healthcare utilization behaviours. RESULTS We uncovered varying perspectives on sex work and associated HIV risks and prevention needs. A typology included three groups who viewed their sex work engagement as a (1) consistent job, (2) income supplement, or (3) survival method to abate withdrawal symptoms. The first group described more consistent sexual and injection behaviours to mitigate HIV risk than the second group. The third group appeared particularly vulnerable to HIV, describing inconsistent condom use and frequent sharing of injection equipment, low healthcare utilization, and limited disclosure of sex work and injection drug use to healthcare providers. CONCLUSION Findings highlight distinct perspectives on sex work among PWID involved in it and corresponding perceptions of HIV risk and healthcare utilization behaviours. Understanding the nuances in sex work engagement among PWID can inform interventions to prevent infectious disease transmission, including efforts to further connect this marginalized population to harm reduction, health, and low barrier opioid treatment services.
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Affiliation(s)
- Shannon N Ogden
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Miriam Th Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston MA, USA; Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | | | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| | - Matthew J Mimiaga
- UCLA Center for LGBTQ Advocacy, Research, and Health, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
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Hoyos-Mallecot Y, Garcia JN, Sulleiro E, Esperalba J, Salmeron P, Zarzuela F, Blanco A, Arando M, Descalzo V, Lopez L, Vall-Mayans M, Barberá MJ, Serra-Pladevall J, LLinas M, Almirante B, Pumarola T, Espasa M. Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification. Sex Transm Infect 2021; 98:166-172. [PMID: 33846278 DOI: 10.1136/sextrans-2020-054779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed 'Drassanes Exprés', a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention. METHODS The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients' sample collection to notification and treatment are analysed. RESULTS Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26-39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2-3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days. CONCLUSIONS Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.
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Affiliation(s)
- Yannick Hoyos-Mallecot
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain .,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Nestor Garcia
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Juliana Esperalba
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Paula Salmeron
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francesc Zarzuela
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Albert Blanco
- Department of Clinical Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maider Arando
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Vicente Descalzo
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Lopez
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martí Vall-Mayans
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Jesús Barberá
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judit Serra-Pladevall
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain.,Department of microbiology, Consorci Hospitalari de Vic, Vic, Spain
| | - Montserrat LLinas
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Benito Almirante
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain.,Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
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20
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Logie CH, White RH, Galai N, Tomko C, Sherman SG. Brief Report: Longitudinal Associations Between Place of Sex Work and Client Condom Coercion Among Sex Workers in Baltimore, Maryland. J Acquir Immune Defic Syndr 2020; 85:579-583. [PMID: 32925362 DOI: 10.1097/qai.0000000000002494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The sex work environment influences sex workers' control over enforcing condom use. Sex work in outdoor and public spaces, compared with indoor spaces, may inhibit condom negotiation. We examined longitudinal associations between public place of sex work and condom coercion among female sex workers. METHODS This cohort study involved 5 data collection points over 1 year among female sex workers (N = 246) in Baltimore, Maryland, recruited by targeted sampling. We conducted bivariate analyses to examine associations between currently conducting any sex work in a public place (PPSW, eg, car, abandoned house, street, park/forest, and public bathroom) vs. exclusively indoor sex work (eg, house, motel, and dance club) with sociodemographic, substance use (eg, injection drug use, crack use), and past 3-month condom coercion (eg, client condom refusal/removal). We used logistic regressions with generalized estimating equations and exchangeable correlation structure to examine longitudinal associations between PPSW and subsequent condom coercion, adjusting for sociodemographic and substance use variables. FINDINGS Among participants (race/ethnicity: White: 67.5%; Black/African American: 22.8%; Latina/other ethnicity: n = 9.8%; age range: 18-61), most reported daily injection drug use (58.5%), daily crack use (62.2%), and homelessness (62.2%). Most (88.6%) reported any PPSW at baseline. Current PPSW was associated with increased odds of past 3-month condom coercion (adjusted odds ratio [aOR]: 1.85, 95% confidence interval: 1.16 to 2.94, P = 0.01) compared with indoor sex work, as was daily crack use (aOR 1.67, 95% confidence interval: 1.18 to 2.37). CONCLUSIONS Public sex work environments were associated with client condom coercion and confer additional sexual health risks in contexts of illegality. Interventions should address risk disparities in social geographies of sex work.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Rebecca H White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
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21
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Logie CH, Wang Y, Lalor P, Williams D, Levermore K, Sherman SG. Exploring associations between place of sex work and HIV vulnerabilities among sex workers in Jamaica. Int J STD AIDS 2020; 31:1186-1194. [PMID: 32928052 DOI: 10.1177/0956462420948408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sex workers' work environment shapes HIV transmission dynamics. We applied the Structural HIV Determinants Framework to examine associations between the work environment of public spaces and HIV infection risks among sex workers in Jamaica, considering macro-structural (police harassment) and intrapersonal (depression) pathways. We implemented a cross-sectional survey with sex workers in Kingston, Ocho Rios, Montego Bay, and nearby towns in Jamaica. We conducted structural equation modeling to examine direct and indirect associations between place of sex work on HIV serostatus via mediators of police harassment and depression. Results indicate that public place of sex work had a significant indirect effect on self-reported HIV-positive serostatus; depression and police harassment mediated this relationship. Findings suggest that in contexts of criminalization, the sex work environment can elevate exposure to police violence and depression, in turn increasing HIV vulnerabilities.
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Affiliation(s)
- Carmen H Logie
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Ying Wang
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | | | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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22
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Pickett ML, Lee J, Brousseau DC, Satterwhite C, Ramaswamy M. Correlates of sexually transmitted infection testing following women's release from jail. Women Health 2020; 60:1109-1117. [PMID: 32757716 DOI: 10.1080/03630242.2020.1802397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Given incarcerated women's frequent transitions between jail and community, it is important to seize opportunities to provide comprehensive health care. A potential time to provide care might be when getting tested for sexually transmitted infections (STIs). Our objective was to determine the proportion of women receiving STI testing and correlates, following jail release. This secondary analysis was of one-year follow-up data from women who participated in a jail-based cervical health literacy intervention in three Kansas City jails from 2014 to 2016. Most (82%) completed the survey in the community. The analysis included 133 women. Mean age 35 years (19-58 years). Sixty-two percent obtained STI testing within one-year post-intervention. Using logistic regression this was associated with younger age (odds ratio [OR] = 0.87; 95% confidence interval [CI] 0.80, 0.95), receiving high school education (OR = 4.33; 95% CI 1.00, 18.74), having insurance (OR = 4.32; 95% CI 1.25, 14.89), no illicit drug use (OR = 0.09; 95% CI 0.01, 0.81), and no drinking problem (OR = 0.04; 95% CI 0.00, 0.45). In this study, many women sought STI testing following jail release. Clinicians/public health practitioners may find it useful to engage these high-risk women in broader women's health services seeking STI testing.
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Affiliation(s)
- Michelle L Pickett
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin , Milwaukee, WI, USA
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University , Lubbock, TX, USA
| | - David C Brousseau
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin , Milwaukee, WI, USA
| | - Catherine Satterwhite
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center , Kansas City, KS, USA
| | - Megha Ramaswamy
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center , Kansas City, KS, USA
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23
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Leblanc NM, Alexander K, Carter S, Crean H, Ingram L, Kobie J, McMahon J. The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center. ACTA ACUST UNITED AC 2020; 1:132-142. [PMID: 32617533 PMCID: PMC7325490 DOI: 10.1089/whr.2019.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | - Kamila Alexander
- Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Hugh Crean
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | | | - James Kobie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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24
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Goldenberg SM, Amram O, Braschel M, Moreheart S, Shannon K. Urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort. Health Place 2020; 62:102288. [PMID: 32479365 PMCID: PMC7574814 DOI: 10.1016/j.healthplace.2020.102288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 01/07/2023]
Abstract
Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers' work/living environments in relation to gentrification exposure in Metro Vancouver (2010-2014), and modeled independent effects of gentrification exposure on reduced utilization of HIV/STI testing, sexual health, and sex worker support services. These decreases occurred despite efforts to scale-up HIV services for marginalized populations. Planning of healthcare, housing, and other support services should be responsive to shifting urban landscapes for marginalized women.
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Affiliation(s)
- Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888, University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
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25
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Severe Food Insecurity, Gender-Based Violence, Homelessness, and HIV Risk among Street-based Female Sex Workers in Baltimore, Maryland. AIDS Behav 2019; 23:3058-3063. [PMID: 31429031 DOI: 10.1007/s10461-019-02643-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite established links between food insecurity and HIV outcomes, no studies have examined the role of food insecurity among female sex workers (FSW) in the United States (US). The aim of this exploratory study was to identify correlates (structural vulnerability and health factors) of severe food insecurity among street-based FSW in Baltimore, Maryland using multivariable logistic regression. In adjusted models, FSW with severe food insecurity were at greater odds of recent homelessness, physical intimate partner violence, client condom refusal, and HIV infection. Multi-sectoral approaches must take into consideration the co-occurrence of structural and health vulnerabilities to food insecurity among FSW in the US, including those that address violence, housing, and HIV.
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26
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Tucker JD, Meier BM, Devoto C, Szunyogova E, Baral S. Sexual health and human rights: protecting rights to promote health. BMC Infect Dis 2019; 19:226. [PMID: 30836936 PMCID: PMC6402151 DOI: 10.1186/s12879-019-3860-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Joseph D Tucker
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building, Chapel Hill, NC, USA. .,Social Entrepreneurship to Spur Health (SESH), Guangzhou, China. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Benjamin M Meier
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,O'Neill Institute for National and Global Health Law, Georgetown Law Center, Washington, DC, USA
| | | | - Eva Szunyogova
- BMC International Health and Human Rights, BMC, London, UK
| | - Stefan Baral
- Departments of Epidemiology, International Health, and Health Policy and Management, Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
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