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.
Background In a recent PID treatment trial, MG was recovered significantly less from women treated with a regimen that included metronidazole. Our objective was to determine if cervical MG at randomization and following treatment correlated with vaginal dysbiosis. Methods This is a secondary analysis of the ACE Trial, a randomized trial comparing single dose ceftriaxone and two weeks of doxycycline, with either metronidazole 500 mg PO BID or placebo for 2 weeks. At enrollment and at 30 days following treatment, vaginal samples were evaluated for BV by Nugent criteria, and quantitative PCR was performed for anaerobic organisms. Endocervical swabs were tested for MG by NAAT. Results At randomization, MG infection was detected in 41/ 233 (18%) women, but detection at follow-up differed for those who received metronidazole [4/94 (4%)] vs placebo [14/ 99 (14%), p<0.05]. Women having MG at baseline had higher concentrations of four microbes (Gardnerella vaginalis, Atopobium vaginae, Megasphaera lornae, Prevotella timonensis) compared to women without cervical MG (P<0.05 for each), and each of these microorganisms was associated with cervical MG after treatment (P<0.05 for each). Although BV by Nugent criteria was not significantly associated with MG at randomization, women without BV following PID treatment were less likely to have MG infection than women with BV (4% vs 18%, p<0.01). Conclusion MG infection following PID is uncommon among women treated with metronidazole along with ceftriaxone and doxycycline, despite limited activity of this regimen against MG. MG infection was associated with vaginal dysbiosis, as defined by higher densities of BV-associated bacteria. These results suggest that a PID regimen with oral metronidazole and eradication of BV pathogens might be key to eliminating MG in women. Whether women diagnosed with PID should be tested for MG and treated with targeted therapy if positive remains uncertain.
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