Abstract
We evaluated the impact of the coronavirus disease (COVID-19) on the sex work industry and assessed how it has impacted the health and social conditions of sex workers in Singapore. We conducted a sequential exploratory mixed methods study amidst the COVID-19 pandemic from April to October 2020, including in-depth interviews with 24 stakeholders from the sex work industry and surveyor-administered structured surveys with 171 sex workers. COVID-19 had a substantial impact on sex workers' income. The illegality of sex work, stigma, and the lack of work documentation were cited as exclusionary factors for access to alternative jobs or government relief. Sex workers had experienced an increase in food insecurity (57.3%), housing insecurity (32.8%), and sexual compromise (8.2%), as well as a decrease in access to medical services (16.4%). Being transgender female was positively associated with increased food insecurity (aPR = 1.23, 95% CI [1.08, 1.41]), housing insecurity (aPR = 1.28, 95% CI [1.03, 1.60]), and decreased access to medical services (aPR = 1.74, 95% CI [1.23, 2.46]); being a venue-based sex worker was positively associated with increased food insecurity (aPR = 1.46, 95% CI [1.00, 2.13]), and being a non-Singaporean citizen or permanent resident was positively associated with increased housing insecurity (aPR = 2.59, 95% CI [1.73, 3.85]). Our findings suggest that COVID-19 has led to a loss of income for sex workers, greater food and housing insecurity, increased sexual compromise, and reduced access to medical services for sex workers. A lack of access to government relief among sex workers exacerbated such conditions. Efforts to address such population health inequities should be implemented.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic was declared by the World Health Organization as a public health emergency of international concern on January 30, 2020, Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10508-021-01951-8.Data were rapidly emerging that the COVID-19 pandemic was exacerbating the hardships that sex workers face around the world (UNAIDS, 2020b)
Stakeholders interviewed in the qualitative component of the study identified how the COVID-19 pandemic and its concomitant movement control measures had led to a loss of jobs due to the closure of venues where sex work had typically taken place: After the licensed brothels and entertainment establishments were told to shut down, a week later, the unlicensed brothels were told to shut down
One manager at a commercial entity explained how sex workers, who were living in densely populated conditions, were worried about contracting COVID-19 and potentially infecting others living in the same house
Summary
Data were rapidly emerging that the COVID-19 pandemic was exacerbating the hardships that sex workers face around the world (UNAIDS, 2020b). As a key population already vulnerable to the acquisition of HIV and other STIs, disruptions in accessing care and medications for STI prevention and treatment due to COVID-19 control measures have exacerbated their vulnerabilities (Global Network of Sex Work Projects, 2020b). This is further compounded for sex workers who operate in settings where punitive measures linked to sex work, HIV, and COVID-19-related laws prevail. While some countries have offered street-based sex workers relief, sex workers have noted that these payouts have not been enough for them due to a lack of food and shelter security (Global Network of Sex Work Projects, 2020a)
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