COVID-19, Stigma, and the Ongoing Marginalization of Sex Workers and their Support Organizations

Decriminalization and What Else? Alternative Structural Interventions to Promote the Health, Safety, and Rights of Sex Workers

“…Yet by criminalizing sex work, those who perform the job are denied their livelihood; pushed deeper into precarity, poverty, and poor health (Platt et al 2018;Vanwesenbeeck 2017); and subjected to stigma, harassment, and discrimination (Biradavolu et al 2012;Foley 2017;Argento et al 2020;Crago et al 2021;Benoit et al 2016Benoit et al , 2018. Numerous countries have proposed ending this "prostitution problem" (Benoit et al 2019a;Abel 2011;Abel et al 2010;Armstrong 2021) by decriminalizing sex work, and implementing a highlevel, evidence-based strategy to reduce an assortment of unnecessary harms experienced by sex workers (Benoit et al 2019b;Goldenberg et al 2017;Benoit and Unsworth 2021;Abel et al 2010;Abel 2011;Armstrong 2021;Stardust et al 2021;Vanwesenbeeck 2017;West et al 2022;Pitcher 2015).…”

“…Structural interventions refer to public health and other macro-and meso-level strategies that bridge rights and policies and promote health, well-being, and dignity for marginalized groups by altering the structural context within which their health, safety, and well-being are produced and reproduced (Blankenship et al 2000). In addition to negative moral judgment and punitive measures governing their work, many sex workers have a history of complexity in their lives that predisposes them to comparatively high degrees of food insecurity and other forms of economic hardship, low educational achievement, inadequate housing, poor physical and mental health, high levels of long-term disability and unmet health needs, and elevated rates of assault and victimization (McCarthy et al 2014;Benoit and Unsworth 2021;Benoit et al 2021a;Benoit et al 2016;Hardy and Sanders 2015;McMillan and Worth 2017;Vijayakumar et al 2019;Vijayakumar 2018). In our call for empirical papers, we encouraged submissions reporting research findings on the structural factors, such as material hardship, poverty, insecure housing, the multi-generational impacts of colonization, and stigma that play a key role in predisposing sex workers to an elevated risk of experiencing social disadvantages (Hardy and Sanders 2015;Lanau and Matolcsi 2022).…”

Harm reduction and rights-based approaches to reduce monkeypox transmission among sex workers

“… 45 Other promising models that should be extended to monkeypox virus include sex-worker led COVID-19 or hepatitis B vaccination clinics offered in sex work venues in partnership with medical or public health staff, mobile health services in sex work and drug use establishments in partnership with street nurses, and initiatives providing food and income support to sex workers needing to quarantine that were developed during the COVID-19 pandemic. 46 , 47 , 48 Hepatitis B vaccination clinics held in sex worker workplaces recorded far higher vaccine coverage for sex workers than traditional health services. 49 Mobile health services have been identified as key interventions for sexual and reproductive health for sex workers 50 , 51 , 52 in low-income, middle-income, and high-income contexts.…”

“…Both the HIV and COVID-19 pandemics underscore the severely harmful effects of the criminalisation of sex work and stigma and the urgent need to address the unmet occupational needs of sex workers that must be considered in the monkeypox virus response. 47 , 48 , 53 , 54 Harm reduction and rights-based approaches to sex work 31 in the context of monkeypox virus are imperative. These approaches need to include sex workers of all genders—particularly racialised and marginalised sex workers—in public health planning and messaging alongside structural interventions.…”

Guest Editors’ Introduction to the Special Section on the Impact of COVID-19 on Sexual Health and Behaviors

“…Qualitative interviews with PLHIV and their health care providers highlighted the profound disruptions in SRH services during the pandemic including restricted access to clinics, limited availability of antiretroviral therapy, and financial strains due to shortages in staffing, medications, supplies, and employment loss. Benoit and Unsworth ( 2021 ) examined how persistent stigma affected sex workers during the COVID-19 pandemic from the perspective of organizational support staff who provide critical health and social services to sex workers to increase our understanding of what it will take to avoid the economic, social, and health harms of COVID-19 among sex workers in Canada. The next two papers in this set focused on the effects of the pandemic on sexual behaviors, mental health, and preventive sexual health care highlighting the disruptions in sexual behavior (partner reduction), accessing and receiving PrEP and other HIV services, and pandemic-induced increases in anxiety and depression among sexual and gender minorities living in the USA (Grov et al, 2021 ) and the sudden and pronounced increase in depression and anxiety following the onset of the COVID-19 pandemic in an ongoing cohort of Australian gay and bisexual men (Bavinton et al, 2022 ).…”