Abstract
BackgroundAcross diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries.MethodsWe searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited.ResultsResearch demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted.ConclusionsThe high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.
Highlights
Across diverse regions globally, sex workers continue to face a disproportionate burden of Human immunodeficiency virus (HIV) and other sexually transmitted and blood borne infections (STBBIs)
The high burden of STBBIs among sex workers across high-income settings is of major concern
Individual and interpersonal determinants were examined in 12 studies focusing on female sex workers (Table 1), 3 studies focusing on cis male sex workers (Table 2), and 3 studies focusing on trans sex workers (Table 3)
Summary
Sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). In many high-income countries and regions, such as Canada, the United States, Australia, and New Zealand, sex workers are amongst key populations most heavily affected by the HIV epidemic and continue to face a disproportionate burden and elevated risk for HIV and other sexually transmitted and blood borne infections (STBBIs) [1, 2]. Structural and community-level factors continue to both increase STBBI vulnerabilities (e.g., violence, stigma) and mitigate acquisition (e.g., safer working conditions, sex worker-led programming) among sex workers [1, 2]. Such factors account for the significant heterogeneity in burden of STBBIs among sex workers within and across settings
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
