HIV Vulnerability Among Survival Sex Workers Through Sexual Violence and Drug Taking in a Qualitative Study From Victoria, Canada, With Additional Implications for Pre-exposure Prophylaxis for Sex Workers.

Bryan Eric Benner

doi:10.3389/fsoc.2021.714208

Abstract

Objective: This qualitative study investigates how social and structural forces mediate vulnerability to HIV infection and transmission among survival sex workers, their clients, and their non-commercial, intimate partners—with especial focus on sexual violence and drug taking. Method: I employed an adapted grounded theory approach to conducting and analyzing (n = 9) open-ended, in-depth interviews with a convenience sample of currently working (and recently exited) survival sex workers from a community setting in Victoria, Canada. Findings: Participants revealed important contexts and conditions under which they were vulnerable to HIV infection. At the behavioural level, participants were aware of how HIV could be transmitted (condomless sex and sharing drug equipment), yet participants voiced strongly how structural and systemic features (for instance, client violence, the need for drugs, and “bad date” referrals) could squeeze and constrain their agency to take up safer practices, mediating their optimal HIV health and safety. Some participants reported strained relationships with police because of previous drug involvement. Conclusion: Survival sex workers constitute a health population vulnerable to HIV infection, and ensuring there could be a supportive (outreach) community replete with HIV resources is paramount. The availability of safer sex and drug equipment play important roles in HIV behavioural prevention efforts. However, uptake of pre-exposure prophylaxis (PrEP) at no cost in the Canadian province of British Columbia could be an important and beneficial structural intervention for non-injection drug taking cis-female sex workers in this study who are presently ineligible for no cost PrEP.

Highlights

Background and StudySurvival sex workers have been recognised across the literature as an intensely stigmatised health population whose members live and work amid myriad contexts and conditions that drive sexual violence and raise their risk of HIV infection (Shannon et al, 2008; Chettiar et al, 2010; Landsberg et al, 2017; Argento et al, 2020)
Very little is known about how survival sex workers living without HIV in the Victoria community conceptualise and characterise their vulnerability to HIV infection and transmission
The following three research questions guided this study: Firstly, how are social contexts and conditions understood to mediate HIV vulnerabilities among survival sex workers living without HIV when offering commercial services to clients? Secondly, what are the social contexts and conditions under which survival sex workers perceive greater HIV vulnerabilities with their non-commercial, intimate partners? And lastly, what are the strategies employed by sex workers to maintain and support their sexual health, and how are these strategies understood?

Summary

Introduction

Background and StudySurvival sex workers have been recognised across the literature as an intensely stigmatised health population whose members live and work amid myriad contexts and conditions that drive sexual violence and raise their risk of HIV infection (Shannon et al, 2008; Chettiar et al, 2010; Landsberg et al, 2017; Argento et al, 2020). The following three research questions guided this study: Firstly, how are social contexts and conditions understood to mediate HIV vulnerabilities among survival sex workers living without HIV when offering commercial services to clients? In answering these questions, I examine a rich qualitative dataset generated from participant interviews (n 9) with cismale and cis-female (currently working and recently exited) survival sex workers living without HIV from a community setting in Victoria, Canada. The knowledge from this study could provide a backdrop for discussions on social policy and programming [for instance, the no cost eligibility for pre-exposure prophylaxis (PrEP)] aimed at ameliorating the health, safety, and well-being of this vulnerable health population

Methods

Results

Conclusion