Health vulnerabilities in female sex workers in Brazil, 2016

Abstract

Female sex workers (FSW) suffer stigma and discrimination that negatively impact their physical and mental health and affect access to health care services. This paper aims to describe selected health indicators among FSW in 12 Brazilian cities in 2016. Brazilian cross-sectional Biological Behavioral Surveillance Survey was conducted in 2016 among 4328 FSW recruited by respondent-driven sampling. The sample weighing was inversely proportional to participant's network sizes and the seeds were excluded from the analysis. Health indicators were estimated with 95% confidence interval and included indicators of health status, symptoms of depression, antenatal care, pap smear coverage, signs and symptoms of sexually transmitted infection, contraception and regular condom use, number of births and children alive per women, human immunodeficiency virus and syphilis testing, usual source of care, and perception of discrimination. Most participants self-rated their health as very good/good (65.8%) and 27.7% were positively screened for major depressive disorder episode on Patient Health Questionnaire-2. Antenatal coverage was 85.8% and 62.3% of FSW had access to pap smear exam in the past 3 years. A total of 67.0% of FSW were using some contraceptive method at the time of the study. Male condom was the most common method (37.1%), followed by oral pill (28.9%). A total of 22.5% FSW had never been tested for HIV and the main reasons were "not feeling at risk" (40.4%) and "being afraid or ashamed" (34.0%). The vast majority of FSW used Brazilian National Health System as their usual source of health care (90.2%). Approximately one-fifth of the participants felt discriminated against or were treated worse for being FSW (21.4%) and only 24.3% disclose their sex work status in health services. The vulnerability of FSW is expressed in all health indicators. Indicators of health status, antenatal care, pap smear coverage, and contraception were worse than in the Brazilian population, and point out to the importance of increase FSW's access to health care services. Also, stigma and discrimination emerged as an important barrier to FSW's health care in all dimensions and need to be struggled.

Determinant Factors of Antenatal Clinic on Female Sex Workers Attendance within Nairobi County, Kenya

“…The finding of conceiving after entering sex work is consistent with studies done among the same population of FSWs where it was reported they conceived during sex work (Beckham et al, 2015;Du Plessis et al, 2020;Moore et al, 2023;Shewale & Sahay, 2022). The findings were also consistent with a study in Brazil, which documented that most FSWs started prenatal care in the first trimester of their pregnancy, with antenatal coverage at 85.8% (Braga et al, 2022).…”

Maternal health and maternal health service utilization among female sex workers: A scoping review

“…During full-text reviews, seven publications were determined to have used the same datasets produced from three studies to report on similar outcomes. [37][38][39][40][41][42][43] These records were merged to represent the three studies and results from one publication per study were extracted for this review. In total, 18 peer-reviewed publications were included in this review.…”

“…This qualitative study based in Mumbai, India, reported that few FSWs discussed receiving breastfeeding counseling from medical providers during in-depth interviews. 43 In addition, among FSWs that did report counseling experience, they described the guidance they received as primarily focused on discouraging breastfeeding. This was due to providers’ concerns about mother-to-child transmission of HIV and women’s ability to maintain an adequate milk supply.…”

Leveraging Responsible, Explainable, and Local Artificial Intelligence Solutions for Clinical Public Health in the Global South

“…As a consequence, the global community has failed to sufficiently and proactively identify, and respond to secondary impacts that intensify as "globally networked hyperrisks" [40] generated by "strongly connected, global networks" and complex, interacting, "highly interdependent systems", cascading across various sectors and scales-local, regional, national and international, individual, community/population, public, and global [39][40][41]. In addition, existing risk management and governance infrastructure for disease and disease outbreak policies often lack adequate mechanisms for considering the diverse needs of vulnerable or at-risk populations, including those living in informal settlements and geographically isolated settings [42], socio-economically deprived or underserved populations [43,44], those who are homeless [45], racialized visible minorities [46,47], women [48], the elderly [49], persons with disabilities [50], Indigenous communities [51], informal workers [52], migrants and refugees [53], those without citizenship rights [54,55], sex workers [56][57][58], and the two-spirit, lesbian, gay, bisexual, transgender/transsexual, queer, intersex, asexual, polysexual/pansexual (2SLGBTQIAP+) community [59], among others.…”