Sex Workers and Syndemics: A Population Vulnerable to HIV and COVID-19

Abstract

COVID-19 has disproportionately affected vulnerable populations across the U.S. Street-based sex workers are one vulnerable population whose health and impact of COVID-19 have been understudied to date. The goal of this study was to evaluate findings from a community needs assessment with street-based sex workers on impact of COVID-19 on health behaviors and social circumstances. A brief survey was developed at a community-based harm reduction and recovery services organization. Surveys were administered by peer specialists to street-based sex workers during street outreach in April and May 2020. A total of 46 surveys were analyzed. Many individuals reported continuing to do sex work and use substances during the COVID pandemic. Slightly more than a quarter of individuals ( n = 13; 28.3%) indicated using personal protective equipment while doing sex work and described challenges to using precautions when working with clients. Individuals had used marijuana ( n = 32, 71.1%), cocaine ( n = 17, 39.5%), prescription stimulants ( n = 9, 21.4%), methamphetamines ( n = 5, 11.9%), prescription opioids ( n = 12, 27.3%), street opioids ( n = 12, 27.3%), sedatives ( n = 11, 25.0%), hallucinogens ( n = 3, 6.8%), inhalants ( n = 3, 7.0%), or some other substance ( n = 4, 8.7%) in the past 30 days. About half (48.8%) reported that COVID-19 had a major impact on their lives. This study is among the first to characterize the impact of COVID-19 on street-based sex workers. From a public health standpoint, this group also represents a high-priority population given their vulnerability and close contact with others, which increases the potential for community spread.

Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic

“…Our data show that the shift to online sex work does not guarantee an income adequate to support FSWs' needs; i.e., taking up online sex work was not a determinant of the likelihood of suffering a major income reduction (Tables 4 and S2). This result is also noted in other qualitative studies [4,23]. Meanwhile, only around 40% of FSWs were found to adequately adhere to COVID-19 prevention measures during sex work, highlighting their risk of exposure to COVID-19 infection for a significant number of FSWs during the pandemic.…”

“…FSWs reported various reasons for their reduced condom usage during the pandemic, with the reduced access to supply being one of them [31]. Another potential reason is the more difficult negotiation of condom use with clients [4]. Our data appear not to support this latter factor, however, since client frequency was not associated with condom use frequency.…”

“…For example, in a bid to attract more clients and thus more income, many FSWs have been forgoing the use of condoms [3]. A similar logic could also apply during the COVID-19 pandemic, whereby to keep their head above water, FSWs may forgo COVID-19-preventive behaviors during their transactional sex activities, exposing them to the heightened risk of COVID-19 transmission [4].…”

“…Notwithstanding these recommendations, recent qualitative data showed that the pandemic has affected FSW communities around the world. Even with the adoption of these behavioral changes, i.e., online sex work and strict adherence to COVID-19 preventive measures during in-person sex work, many still reported severe socioeconomic impacts resulting from difficulties in accessing preventive aids and other resources [4,22,23]. FSWs have also faced higher barriers to accessing healthcare [24], including trouble accessing condoms and HIV tests [9].…”

Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities

“…Globally, there were calls at the start of the pandemic that the needs of sex workers must be considered in the response, highlighting issues of changing sex work patterns and how the most marginalized may feel the impact most acutely, further perpetuating their marginalization [83]. Numerous reports have highlighted how COVID-19 and its accompanying responses have impacted sex workers in places ranging from the USA to Singapore to Thailand and beyond [84][85][86][87]. In Uganda, a revival of the link between truck drivers and sex workers in potentially spreading COVID-19, familiar to the early history of the HIV response, has been reported [88].…”