Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi, Kenya

Gichuna, Susan; Hassan, Rahma; Sanders, Teela; Campbell, Rosie; Mutonyi, Mercy; Mwangi, Peninah

doi:10.1080/17441692.2020.1810298

Cited by 76 publications

(157 citation statements)

References 12 publications

(13 reference statements)

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“…Specifically, existing socioeconomic inequities, including reduced access to health insurance and unstable housing, have been associated with HIV service interruptions. [14, 27] In addition, key populations—including MSM, female sex workers, people who use drugs, and transgender populations—that depend on services from community-based organizations because of stigma within the health sector may be particularly vulnerable to disruptions in outreach services caused by shelter-in-place mandates [28-30].…”

Section: Resultsmentioning

confidence: 99%

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

Baral

Rao

Rwema

et al. 2021

Preprint

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BackgroundCOVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. We conducted a scoping review to characterize the impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.MethodsA scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection and mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English.ResultsA total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 12.1% (16/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.DiscussionCOVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. Data reviewed here suggest that effective strengthening of health systems should include investment in public health with adequate funding to ensure continuity of care for emergent and existing public health threats.

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Section: Resultsmentioning

confidence: 99%

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

Baral

Rao

Rwema

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…With loss of income accompanied by a lack of access to government relief, and deteriorating health and social conditions, it is unsurprising that sex workers have continued to work amidst the pandemic, exposing them to further risks of sexual compromise, sexually transmitted infections, and COVID-19. Many scholars and policymakers had made calls to action earlier on in the pandemic to highlight these exacerbating inequities (Adebisi et al, 2020 ; Lam, 2020a , b , c ; Platt et al, 2020 ), and more recent studies across the world have validated these concerns—that sex workers are facing poor access to health services, and need to continue working to survive (Callander et al, 2020 ; Gichuna et al, 2020 ; Singer, Crooks, Johnson, Lutnick, & Matthews, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Coronavirus Disease (COVID-19) on the Health and Social Needs of Sex Workers in Singapore

Tan

Ho²,

Sherqueshaa³

et al. 2021

Arch Sex Behav

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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.

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“…This had multiple impacts on FSW who suddenly found their access to essential services such as food banks, shelters, health care (including sexual and reproductive health), addiction support or psychotherapy significantly reduced, when not eliminated altogether. 29 , 30 For many women engaged in sex work, unresolved past trauma, mental health, and addiction are a constant concern in their lives. 31 COVID-19 was a stressful event for many 12 , 32 and this, combined with concerns regarding access to basic necessities, might have contributed to a worsening of mental health issues.…”

Section: Recommendationsmentioning

confidence: 99%

Double Jeopardy: Maintaining Livelihoods or Preserving Health? The Tough Choices Sex Workers Faced during the COVID-19 Pandemic

Shareck

Hassan

Buhariwala

et al. 2021

J Prim Care Community Health

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The COVID-19 pandemic and associated public health preventive measures such as lockdown and home confinement have posed unique challenges to female sex workers (FSW) globally, including in Canada where the sex trade is not formally recognized. In this commentary, we discuss the unintended consequences the pandemic has had on various social determinants of health among FSW. We draw on a review of scholarly and grey literature, complemented by our experience with the Exit Doors Here program, a sex work exiting program implemented in Toronto, Canada. Due to COVID-19, many FSW suddenly lost their main source of income, work conditions became riskier, and sheltering-in-place presented challenges for women with no safe housing. The slowdown of social and health care services also meant FSW were not receiving the required attention. We make recommendations for intersectoral mitigation strategies to limit the short- and long-term impacts of COVID-19 on FSW health and livelihoods. Recommendations focus on addressing women’s marginalizing circumstances and speak to a gender transformative approach to the COVID-19 recovery. Our recommendations are relevant to FSW and other marginalized groups, in the current context and in the context of future health, social, and economic crises.

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Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi, Kenya

Cited by 76 publications

References 12 publications

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

The Impact of the Coronavirus Disease (COVID-19) on the Health and Social Needs of Sex Workers in Singapore

Double Jeopardy: Maintaining Livelihoods or Preserving Health? The Tough Choices Sex Workers Faced during the COVID-19 Pandemic

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