Trans Women Sex Workers Research Articles

Assessing the Fulfillment of Transwomen Sex Workers’ Social, Cultural, and Economic Rights in Yogyakarta: A Capabilities Approach-Based Study

Transwomen community in the Special Region of Yogyakarta (Yogyakarta) faces distress in obtaining their social, cultural, and economic rights as part of the society. The stigma attached to them as non-conforming in the midst of Indonesian people with a majority of binary genders causes discrimination. It becomes difficult for them to access healthcare services, deal with civil registration matters, and getting proper job opportunities that often leads many of them to end up as sex workers. Although those rights should be guaranteed by the state. This research aims to analyze the implementation of equality principles based on Nussbaum’s capabilities approach theory by examining the fulfillment of the transwomen sex workers’ social, cultural, and economic rights in Yogyakarta. In-depth interview method is used for collecting empirical data. While data analysis is done through a case study approach. It is concluded that the social, cultural, and economic rights of transwomen sex workers in Yogyakarta have not been fulfilled thoroughly since only the capabilities of life, bodily health, senses, imagination, and thought, emotions, practical reason, affiliation, and other species are fulfilled. However, control over one’s environment in political context, bodily integrity, and play capabilities were not.

Trans Women Sex Workers in Northern Malaysia: A Qualitative Study

Objective: This study aims to understand in-depth the factors that motivate sex work among trans women, how they source their clients, and to explore their knowledge, attitude, and practices on safe sex. Method: In this qualitative study, a case study approach was selected to explore the motivating factors related to sex work, the factors that encourage sex work, and the safe sex practices among trans women in Northern Malaysia. The snowball sampling method was used and thirteen in-depth interviews were conducted using a semi-structured interview guide. Result: Financial reason was the main motivating factor for sex work. Most of them used online applications or websites to source clients and some used pimps who play an important role in sex education and protection. These trans women were well aware and equipped with knowledge on safe sex, and the use of condoms and attended regular check-ups and counselling when needed. Conclusion: Trans women should not be discriminated against and denied proper employment which can lead them to sex work.

Factors associated with PrEP knowledge and intention to use PrEP among HIV-negative men and trans women sex workers in Spain

ABSTRACT Lack of data regarding knowledge and intention to use pre-exposure prophylaxis (PrEP) among sex workers exists in Spain. We conducted a cross-sectional analysis based on data from SexCohort study, which included male (MSW) and trans women sex workers (TWSW), aged ≥18 and recruited in two community-based centres in Barcelona, Spain. Of 116 TWSW and 79 MSW, 49.1% and 58.2% had factual knowledge of PrEP, and 40.3% and 70.1% had the intention to use PrEP, respectively. In the multivariable analyses, we found that education and condomless anal sex with stable partners were associated with PrEP knowledge. Regarding intention to use PrEP, TWSW were less likely than MSW to report an intention to use it (aOR = 0.35, 95% CI: 0.16–0.74). Furthermore, intention to use PrEP was associated with being foreign-born, practicing chemsex, and visiting a medical service in the last 12 months. The results of this study inform future trans-specific guidance for PrEP to be effectively implemented in Spain.

Trans Women’s Body Self-Image and Health: Meanings and Impacts of Sex Work

This paper aims to present and discuss the results of a qualitative study conducted in the city of Porto, Portugal, aiming to understand the self-determination process and the meanings and impacts of sex work on trans women’s body self-image and health. Between January and July 2019, six individual interviews were performed with participants aged between 23 and 57 and then analyzed using thematic analysis. The results suggest that the participants were subjected to several experiences of discrimination and violence since childhood, negatively impacting their health and social integration. In their narratives, a conflict between the idea of an idealized body, congruent with gender identity, and the idea of a profitable body, compatible with the requirements of sex work clients, emerged. As a consequence, several tensions are experienced, both in personal and professional domains. Additionally, the difficulties felt in accessing the National Health System, to receive specialized support and treatment, increase the risk of being exposed to clandestine procedures, which exacerbates their vulnerability. The findings point to the importance of comprehending trans women sex workers’ needs and reanalyzing how their health conditions might be improved.

Syndemic Conditions and Their Association with HIV/STI Sexual Risk Behaviors Among Transgender Women and Cisgender Men Sex Workers in Catalonia: The SexCohort Project.

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). 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). 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. 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.

BARRIERS TO GOVERNMENTAL INCOME SUPPORTS FOR SEX WORKERS DURING COVID-19: RESULTS OF A COMMUNITY-BASED COHORT IN METRO VANCOUVER.

The COVID-19 pandemic has brought into stark focus the economic inequities faced by precarious, criminalized and racialized workers. Sex workers have been historically excluded from structural supports due to criminalization and occupational stigma. Given emerging concerns regarding sex workers' inequitable access to COVID-19 income supports in Canada and elsewhere, our objective was to identify prevalence and correlates of accessing emergency income supports among women sex workers in Vancouver, Canada. Data were drawn from a longstanding community-based open cohort (AESHA) of cis and trans women sex workers in Metro Vancouver from April 2020-April 2021 (n = 208). We used logistic regression to model correlates of access to COVID-19 income supports. Among 208 participants, 52.9% were Indigenous, 6.3% Women of Colour (Asian, Southeast Asian, or Black), and 40.9% white. Overall, 48.6% reported accessing income supports during the pandemic. In adjusted multivariable analysis, non-injection drug use was associated with higher odds of accessing COVID-19 income supports (aOR: 2.58, 95% CI: 1.31-5.07), whereas Indigenous women faced reduced odds (aOR 0.55, 95% CI 0.30-1.01). In comparison with other service workers, access to income supports among sex workers was low overall, particularly for Indigenous sex workers, demonstrating the compounding impacts of colonization and disproportionate criminalization of Indigenous sex workers. Results highlight the need for structural supports that are low-barrier and culturally-safe to support sex workers' health, safety and dignity.

Prevalence And Particularities Associated With Positive Serology For HIV In Trans Women And Travestis Sex Professionals

Objective: This study aims to analyze the prevalence of HIV positive serology in trans women sex workers, and the main problems associated. Methods: Scientific articles were found searching data platforms (PubMed, Virtual Health Library, Web of Science and Google Scholar) as much as much as epidemiological bulletins and statistical data from the Ministério da Saúde do Brasil (Ministry of Health) and UNAIDS were included. Results: Gender violence and gender inequality can contribute to the increased vulnerability of the transgender population to HIV. Globally, trans women are 50 times more likely to be infected with HIV, with seroprevalence in Brazil ranging from 16.9% to 65.3%. Studies point to prostitution as one of the main causes of seroconversion in trans women, especially between the ages of 18 and 24 years. Due to the immense marginalization, transsexual women have an evident difficulty in entering the labor market and accessing basic rights, such as health. These factors contribute to a greater vulnerability to HIV infection. Conclusion: The Ministry of Health needs to improve more incisively the prevention and assessment strategies of the risk levels of HIV transmission, without perpetuating gender violence, including by making it invisible, which contributes to maintaining the vulnerability of the professional transsexual population of sex.

Stigma, Social Cohesion, and Mental Health Among Transgender Women Sex Workers Living with HIV in the Dominican Republic.

Globally, transgender (trans) women experience pervasive stigma, which contributes to health inequities across multiple mental health outcomes. While trans stigma has been associated with increased mental health challenges, less is known about how stigma related to sex work and HIV affect mental health. Social cohesion may ameliorate the negative health consequences of stigma, but little is known about how social cohesion is associated with mental health among trans women. Using cross-sectional survey data collected in 2019 among 100 trans women sex workers living with HIV in Santo Domingo, Dominican Republic, we examined associations between stigma (related to HIV, sex work, and trans identity), social cohesion, and depression and anxiety symptoms. In unadjusted models, enacted and internalized sex work stigma were associated with greater odds of depression and anxiety symptoms and social cohesion was associated with less depression and anxiety. Resisted sex work stigma, which captured acceptance of self and work, was associated with lower odds of depression and trans stigma was associated with increased anxiety. In adjusted models, internalized sex work stigma was associated with increased depression (aOR=1.19, p=0.018) and anxiety symptoms (aOR=1.12, p=0.021), while social cohesion was associated with reduced depression (OR=0.81, p=0.002) and anxiety symptoms (aOR=0.086, p=0.023). Findings indicate the need for interventions to focus on reducing internalized sex work stigma and promoting social cohesion to improve mental health among trans women. Additional research is needed to determine how to best measure the intersections between HIV, sex work, and trans stigma and their impact on mental health.

Towards action research with trans women sex workers: Policy, space and social challenges.

Trans women face multiple social, economic and health inequalities and the impact of gender oppression and violence is even more profoundly experienced by trans women sex workers, although in culturally specific ways. This paper presents a pilot study conducted to explore and engage with the context of trans women sex workers in Lido Tre Archi, Italy. In line with the community psychology values of social justice, social change and participation, we outline our engagement process and key challenges observed when attempting action research with such a highly marginalised group. Data were collected in the form of ethnographic notes from informal consultations with different stakeholders and participant observations, and of documents (newspaper articles, picture captions) and were analysed using thematic analysis. Findings are organised in three themes relating to the social, policy and physical context in Lido Tre Archi demonstrating evidence of the contextual challenges and how they intertwine to generate a spiral of marginalisation and social exclusion for the participants. We take a collaborative and reflexive stance in our work and conclude with recommended steps and potential limitations to initiate an action research project.

Provocation as Agentic Practice: Gender Performativity in Online Strategies of Transgender Sex Workers

Abstract Fluid performances of gender online by gender-diverse individuals facing discrimination and fetishization raises questions about whether these acts are a source of empowerment or reinforce prevailing prejudice. We combine virtual ethnography and interviews with transwomen sex workers in Singapore (n = 14) to explore the dynamic between sociostructural oppression and agentic resistance. First, heterosexual power relations manifest online via digital practices of access, surveillance, and intervention to discriminate against and objectify respondents’ identities and bodies. Second, the online response can be categorized into specific digital practices of avoidance involving privacy and anonymity, accommodation via subtle practices of submission, and collaboration via community mobilization. Finally, gender performativity on sites for sex solicitation manifests in the presentation of both essentialist (submissive femininity) and provocative (hyper-sexual) embodiments, defying simplistic characterization into the structure-agency dynamic. We discuss the co-constructive nature of socially situated gender performances and the potential for challenging normative regimes of gender.

Disparities in HIV-related risk and socio-economic outcomes among trans women in the sex trade and effects of a targeted, anti-sex-trafficking policy.

Marginalization of sex work presents numerous risks for trans women (TW) engaged in the sex trade, including criminalization, traumatization, and contracting HIV. We identified socio-economic and HIV risk disparities among trans women sex workers and others who do sex work (TWSW/OWSW), and evaluated these disparities for TWSW/OWSW compared to TW not engaged in sex work from pre- and post-implementation of the US 2018 "Allow States and Victims to Fight Online Sex Trafficking Act" and "Stop Enabling Sex Traffickers Act" (FOSTA-SESTA). We analyzed 429 trans women (TW) from the Trans*National cohort study (2016-2019). Generalized estimating equations (GEE) characterized differences in socio-economic and HIV risk outcomes for TWSW/OWSW compared to TW not engaged in sex work over the study period. Adjusted, pre-to-post law changes in these outcomes for TWSW/OWSW versus TW not engaged in sex work were compared using difference-in-differences GEE regression analyses. Over 18 months, TWSW/OWSW had higher adjusted odds of being unstably housed, having income from criminalized sources, experiencing transphobic hate crimes, experiencing discrimination from police/courts, being incarcerated, meeting sex partners in the street/public settings, meeting sex partners on Craigslist or other online forums (except dating apps), or engaging in condomless anal intercourse, (p<0.01 for all comparisons); TWSW/OWSW also had a higher mean number of income sources (p=0.03). One difference-in-differences analysis showed additive interaction: the adjusted mean number of income sources reported by TWSW/OWSW compared to those not engaged in sex work decreased from pre-to post-FOSTA-SESTA (from 1.79 to 1.48 for TWSW/OWSW and from 1.52 to 1.47 for TW not engaged in sex work; p=0.01). Disparities in socio-economic and HIV-related risk outcomes exist for TWSW/OWSW in San Francisco. There is an urgent need for comprehensive, long-term follow-up data of TW to accurately analyze policy effects, especially given the recent enactment of a number of other policies targeting TW.

Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda

BackgroundTrans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms.MethodsThis exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches.ResultsIndividual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity.ConclusionsIndividual, community and healthcare system barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.

"I've Learned to Value Myself More": Piloting an Adapted Multilevel Intervention for Transgender Women Sex Workers Living with HIV in the Dominican Republic.

Purpose: Transgender (trans) women living with HIV experience suboptimal care and treatment outcomes. We adapted a multilevel intervention to improve HIV outcomes and overall well-being among trans women sex workers living with HIV. The intervention, called Abriendo Puertas (AP; Opening Doors), included: individual counseling, peer navigation, and community mobilization "open houses." The purpose of this article is to describe acceptability and initial outcomes of the adapted AP pilot and explore intervention experiences to inform recommendations for improvement. Methods: After an iterative adaptation process, we recruited 30 trans women sex workers living with HIV to participate in the pilot. We conducted baseline and endline (12-months) surveys to compare HIV care and treatment outcomes and qualitative interviews to assess intervention experiences with a subsample (n=20). Results: Intervention retention was high, with 86.7% of participants (n=26/30) completing both baseline and endline surveys. At endline, there was a significant increase in current anti-retroviral therapy (ART) use (70.0% to 84.6%, p<0.03) and positive, but not significant, trends in missed care appointments in the past 6 months (34.5% to 20.0%, p<0.39) and not having missed any ART doses in the past 4 days (85.7% to 95.5%, p<0.50). Intervention acceptability was high across all components: individual counseling (96.1%), peer navigation (80.8%), and open houses (84.6%). Participants emphasized that trust and being treated with respect allowed them to relax and improve their self-esteem. Limited trust and cohesion among trans women, however, limited more extensive engagement with peer navigation and community mobilization components. Conclusion: Future efforts to strengthen the AP intervention with trans women sex workers should continue to address emotional, instrumental, and informational support needs related to living with HIV through individual counseling, peer navigation, and open houses while also enhancing group-level activities to build trust and generate a collective commitment to promote the well-being of the community.

The impact of end-demand legislation on sex workers' access to health and sex worker-led services: A community-based prospective cohort study in Canada.

Following a global wave of end-demand criminalization of sex work, the Protection of Communities and Exploited Persons Act (PCEPA) was implemented in Canada, which has implications for the health and safety of sex workers. This study aimed to evaluate the impact of the PCEPA on sex workers' access to health, violence, and sex worker-led services. Longitudinal data were drawn from a community-based cohort of ~900 cis and trans women sex workers in Vancouver, Canada. Multivariable logistic regression examined the independent effect of the post-PCEPA period (2015-2017) versus the pre-PCEPA period (2010-2013) on time-updated measures of sex workers' access to health, violence supports, and sex worker/community-led services. The PCEPA was independently correlated with reduced odds of having access to health services when needed (AOR 0.59; 95%CI: 0.45-0.78) and community-led services (AOR 0.77; 95%CI: 0.62-0.95). Among sex workers who experienced physical violence/sexual violence or trauma, there was no significant difference in access to counseling supports post-PCEPA (AOR 1.24; 95%CI: 0.93-1.64). Sex workers experienced significantly reduced access to critical health and sex worker/community-led services following implementation of the new laws. Findings suggest end-demand laws may exacerbate and reproduce harms of previous criminalized approaches to sex work in Canada. This study is one of the first globally to evaluate the impact of end-demand approaches to sex work. There is a critical evidence-based need to move away from criminalization of sex work worldwide to ensure full labor and human rights for sex workers. Findings warn against adopting end-demand approaches in other cities or jurisdictions.

¿Te Recurseas? Mapping, Enumerating, and Describing Male and Transwomen Sex Workers in Venue-Based and Virtual Spaces in Lima, Peru.

HIV disproportionately affects men who have sex with men and transwomen in Latin America. Globally, efforts to map, enumerate, and describe male and transwomen sex workers (MTSWs) are limited. We mapped and described venue- and non-venue-based MTSWs and enumerated venuebased MTSWs in Lima, Peru's capital. With venue-based MTSWs, we identified and described the venues, SWs, and clients and enumerated the SWs. With non-venue-based MTSWs, we described SW offerings and SWs. Male SWs (MSWs) are concentrated downtown, with many moving online. Transwomen SWs (TSWs) are spread across metropolitan Lima, with fewer online. At venues, there are more TSWs than MSWs, TSWs reported more HIV and sexual risk behaviors, and MSWs had more female partners. Non-venue-based MSWs used condoms less than venue-based MSWs. Results support systematic efforts to describe hard-to-reach MTSWs and their different types of partners, all of whom have unique, differing needs for HIV/ STI education, prevention, testing, and care services.

Correlates of Suicidality Among A Community-Based Cohort of Women Sex Workers: The Protective Effect of Social Cohesion.

Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.

The Effect of Violence and Intersecting Structural Inequities on High Rates of Food Insecurity among Marginalized Sex Workers in a Canadian Setting.

Food security is both a basic human right and a public health necessity. Despite known gendered contexts of food insecurity, there is a dearth of research on prevalence and factors driving increased food insecurity for sex workers in a criminalized setting. The current study longitudinally examines the prevalence and structural and individual factors associated with increased odds of food insecurity among street and off-street sex workers in a Canadian urban setting. Prospective analyses drew on data from a community-based longitudinal cohort of cis and trans women in street and off-street sex work in An Evaluation of Sex Workers Health Access (2010-2014). The primary outcome was a time-updated measure of food insecurity, using the Radimer-Cornell scale. We used bivariable and multivariable logistic regression using generalized estimating equations to prospectively model correlates of food insecurity over a five-year period. Of 761 cis and trans women sex workers, 72.4% (n = 551) were food insecure over the study period. Over a third (35.2%, n = 268) identified as Indigenous and a quarter, 25.6% (n = 195) were of a gender/sexual minority. Within the 11.0% (n = 84) of women living with HIV, 96.4% (n = 81) were food insecure over the follow-up period. In multivariable analysis, Indigenous ancestry (AOR = 1.58 [95% CI 1.18, 2.10]), unstable housing (AOR = 1.27 [95% CI 1.03, 1.57]), stimulant use (AOR = 1.97 [95% CI 1.57, 2.45]), heroin use (AOR = 1.72 [95% CI 1.36, 2.19]), mental health diagnosis (AOR = 2.38 [95% CI 1.85, 3.05]), recent violence (AOR = 1.54 [95% CI 1.24, 1.91]), means of food access: reliant on food services only vs. self-sufficient (AOR = 1.78 [95% CI 1.38, 2.29]), and means of food access: both vs. self-sufficient (AOR = 2.29 [95% CI 1.84, 2.86]) were associated with food insecurity. In separate multivariable models, both recent and lifetime physical and/or sexual violence remained independently associated with food insecurity (AOR 1.54 [95% CI 1.24, 1.91]; AOR 4.62 [95% CI 2.99, 7.14], respectively). Almost all study participants living with HIV reported being food insecure. These intersecting risks demonstrate the negative impacts associated with living with HIV, experiencing food insecurity and/or physical or sexual violence. This study also highlights the potential for interventions that address structural inequities (e.g., decriminalizing sex work) to have crosscutting impacts to reduce barriers to accessing necessities (including food) or health and social services (e.g., methadone; primary care).

Sexual Risk, Behavior, and HIV Testing and Status Among Male and Transgender Women Sex Workers and Their Clients in Lima, Peru

ABSTRACTObjectives: To determine the socio-demographics, sexual practices, and HIV prevalence of male sex workers (MSWs), transwomen sex workers (TSWs), and their male clients in Lima, Peru. Methods: Following ethnographic mapping of sex work venues, the authors revisited randomly selected venues to survey MSWs, TSWs and their clients. Results: MSWs and TSW clients are more educated than MSW clients and TSWs. Only 50% of TSW clients have received HIV testing. Self-reported HIV positivity is highest among MSW clients and TSWs. Conclusion: Notable differences exist between MSWs and TSWs and their clients that can affect the health of these groups and warrant intervention.

Community‐based screening of hepatitis C with a one‐step RNA detection algorithm from dried‐blood spots: Analysis of key populations in Barcelona, Spain

Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N=580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.

Bodies and desires on the internet: An approach to trans women sex workers’ websites

Most literature on prostitution centres exclusively on street and female sex workers. Considering the lack of inclusion of trans sex workers within research agendas and public policies, in this article I analyse websites where trans women offer their services in Portugal and the UK. I examine the way trans women escorts present themselves to potential clients through detailed descriptions of their bodies’ sizes, physical attributes, personal characteristics and lovemaking skills, and how they negotiate gender, nationality, race, ethnicity and sexuality in relation to the cultural and socio-economic demands of the market. An intersectional framework provides the critical perspective from which to consider how certain trans narratives are displayed through these online advertisements while decentring hegemonic notions (mainly, white and middle class) of representing trans experiences. This exploratory research aims to better understand the online trans sex industry as a place of empowerment where ‘beautiful’ trans escorts can strategically position themselves in order to succeed in a competitive market and, simultaneously, lay claim for a certain degree of (finite) recognition.