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Lazarus L, Herpai N, Pavlova D, Murney MA, Balakireva O, Tarasova T, McClarty L, Pickles M, Mishra S, Forget E, Becker M, Lorway R. Exploring the impact of military conflict on sex work in Ukraine: Women's experiences of economic burden. Glob Public Health 2023; 18:2092187. [PMID: 35760779 DOI: 10.1080/17441692.2022.2092187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
Little is known about the impact of military conflict on sex work from the perspective of sex workers. We attempt to explore the meaning of conflict on sex work by asking women about the changes that they have experienced in their lives and work since the beginning of the 2014 military conflict in eastern Ukraine. The findings in this article are based on qualitative interviews with 43 cisgender women living and practicing sex work in Dnipro, eastern Ukraine. Our analysis highlights the meanings that sex workers have linked to the conflict, with financial concerns emerging as a dominant theme. The conflict therefore functions as a way of understanding changing economic circumstances with both individual and broader impacts. By better understanding the meaning of conflict as expressed by sex workers, we can begin to adapt our response to address emerging, and unmet, needs of the community.
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Affiliation(s)
- Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Herpai
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Daria Pavlova
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, Kyiv, Ukraine
| | - Maureen A Murney
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Olga Balakireva
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, Kyiv, Ukraine
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine
| | - Tatiana Tarasova
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, Kyiv, Ukraine
| | - Leigh McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael Pickles
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - 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
| | - Evelyn Forget
- Department of Community Health Sciences, 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
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Nicolau IA, Shokoohi M, McBane JE, Pogany L, Popovic N, Nicholson V, Hillier S, Aran N, Brophy J, Burt K, Cox J, de Pokomandy A, Kakkar F, Kelly D, Kerkerian G, Kogilwaimath S, Kroch A, Dias Lima V, Linthwaite B, Mbuagbaw L, McClarty L, Turvey S, Owino M, Martin C, Hogg RS, Loutfy M. A two-day workshop reviewing Canadian provincial and national HIV care cascade indicators, reporting, challenges, and recommendations. J Assoc Med Microbiol Infect Dis Can 2022; 7:247-268. [PMID: 36337608 PMCID: PMC9629730 DOI: 10.3138/jammi-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The HIV care cascade is an indicators-framework used to assess achievement of HIV clinical targets including HIV diagnosis, HIV care initiation and retention, initiation of antiretroviral therapy, and attainment of viral suppression for people living with HIV. METHODS The HIV Care Cascade Research Development Team at the CIHR Canadian HIV Trials Network Clinical Care and Management Core hosted a two-day virtual workshop to present HIV care cascade data collected nationally from local and provincial clinical settings and national cohort studies. The article summarizes the workshop presentations including the indicators used and available findings and presents the discussed challenges and recommendations. RESULTS Identified challenges included (1) inconsistent HIV care cascade indicator definitions, (2) variability between the use of nested UNAIDS's targets and HIV care cascade indicators, (3) variable analytic approaches based on differing data sources, (4) reporting difficulties in some regions due to a lack of integration across data platforms, (5) lack of robust data on the first stage of the care cascade at the sub-national level, and (6) inability to integrate key socio-demographic data to estimate population-specific care cascade shortfalls. CONCLUSION There were four recommendations: standardization of HIV care cascade indicators and analyses, additional funding for HIV care cascade data collection, database maintenance and analyses at all levels, qualitative interviews and case studies characterizing the stories behind the care cascade findings, and employing targeted positive-action programs to increase engagement of key populations in each HIV care cascade stage.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Joanne E McBane
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Pogany
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Nashira Popovic
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Valerie Nicholson
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Sean Hillier
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Niloufar Aran
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Jason Brophy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberley Burt
- HIV Program, Eastern Health, St. John’s, Newfoundland, Canada
| | - Joseph Cox
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Fatima Kakkar
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Deborah Kelly
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Geneviève Kerkerian
- Infectious Diseases Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Siddharth Kogilwaimath
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abigail Kroch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Viviane Dias Lima
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Lawrence Mbuagbaw
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Maureen Owino
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Committee for Accessible AIDS Treatment, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
| | - Carrie Martin
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- Concordia, Montreal, Quebec, Canada
| | - Robert S Hogg
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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McClarty L, Lazarus L, Pavlova D, Reza-Paul S, Balakireva O, Kimani J, Tarasova T, Lorway R, Becker ML, McKinnon LR. Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities. Curr HIV/AIDS Rep 2021; 19:76-85. [PMID: 34822064 PMCID: PMC8614077 DOI: 10.1007/s11904-021-00591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. Recent Findings Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya, Ukraine, and India and place these in the broader global context of sex worker communities, drawing on common themes that span geographies. Summary COVID-19-associated lockdowns have significantly disrupted sex work, leading to economic and health challenges for sex workers, ranging from HIV-related services to mental health and exposure to violence. Several adaptations have been undertaken by sex workers and frontline workers, including migration, a move to mobile services, and struggling to find economic supports. Strengthening community-based responses for future pandemics and other shocks is critical to safeguard the health of marginalized populations.
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Affiliation(s)
- Leigh McClarty
- 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
| | - Daria Pavlova
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
| | - Sushena Reza-Paul
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Ashodaya Samithi, Mysuru, India
| | - Olga Balakireva
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine
| | - Joshua Kimani
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 504-745 Bannatyne Ave, Winnipeg, MB, R3E 0J9, Canada
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, University of Nairobi, Nairobi, Kenya
| | - Tetiana Tarasova
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 504-745 Bannatyne Ave, Winnipeg, MB, R3E 0J9, Canada
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 504-745 Bannatyne Ave, Winnipeg, MB, R3E 0J9, Canada.
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, University of Nairobi, Nairobi, Kenya.
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Maritim C, McClarty L, Leung S, Bruce S, Restall G, Migliardi P, Becker M. HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada. J Assoc Med Microbiol Infect Dis Can 2021; 6:119-128. [PMID: 36341034 PMCID: PMC9608691 DOI: 10.3138/jammi-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/04/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. METHODS Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. RESULTS By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants (p < 0.05). CONCLUSIONS The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.
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Affiliation(s)
- Charity Maritim
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leigh McClarty
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stella Leung
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Restall
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paula Migliardi
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Marissa Becker
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
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Yudistira H, McClarty L, Bloodworth RAM, Hammond SA, Butcher H, Mark BL, Cardona ST. Phenylalanine induces Burkholderia cenocepacia phenylacetic acid catabolism through degradation to phenylacetyl-CoA in synthetic cystic fibrosis sputum medium. Microb Pathog 2011; 51:186-93. [PMID: 21511027 DOI: 10.1016/j.micpath.2011.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 03/23/2011] [Accepted: 04/05/2011] [Indexed: 11/15/2022]
Abstract
Synthetic cystic fibrosis sputum medium (SCFM) is rich in amino acids and supports robust growth of Burkholderia cenocepacia, a member of the Burkholderia cepacia complex (Bcc). Previous work demonstrated that B. cenocepacia phenylacetic acid (PA) catabolic genes are up-regulated during growth in SCFM and are required for full virulence in a Caenorhabditis elegans host model. In this work, we investigated the role of phenylalanine, one of the aromatic amino acids present in SCFM, as an inducer of the PA catabolic pathway. Phenylalanine degradation intermediates were used as sole carbon sources for growth and gene reporter experiments. In addition to phenylalanine and PA, phenylethylamine, phenylpyruvate, and 2-phenylacetamide were usable as sole carbon sources by wild type B. cenocepacia K56-2, but not by a PA catabolism-defective mutant. EMSA analysis showed that the binding of PaaR, the negative regulator protein of B. cenocepacia PA catabolism, to PA regulatory DNA could only be relieved by phenylacetyl-Coenzyme A (PA-CoA), but not by any of the putative phenylalanine degradation intermediates. Taken together, our results show that in B. cenocepacia, phenylalanine is catabolized to PA and induces PA catabolism through PA activation to PA-CoA. Thus, PaaR shares the same inducer with PaaX, the regulator of PA catabolism in Escherichia coli, despite belonging to a different protein family.
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Affiliation(s)
- Harry Yudistira
- Department of Microbiology, University of Manitoba, Winnipeg, Canada
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