Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives

Abstract

BackgroundSex workers (SWs) experience a disproportionately high burden of HIV, with evidence indicating that complex and dynamic factors within work environments play a critical role in mitigating or producing HIV risks in sex work. In light of sweeping policy efforts to further criminalize sex work globally, coupled with emerging calls for structural responses situated in labour and human-rights frameworks, this meta-synthesis of the qualitative and ethnographic literature sought to examine SWs’ narratives to elucidate the ways in which physical, social and policy features of diverse work environments influence SWs’ agency to engage in HIV prevention.MethodsWe conducted a meta-synthesis of qualitative and ethnographic studies published from 2008 to 2014 to elucidate SWs’ narratives and lived experiences of the complex and nuanced ways in which physical, social, and policy features of indoor and outdoor work environments shape HIV prevention in the sex industry.ResultsTwenty-four qualitative and/or ethnographic studies were included in this meta-synthesis. SWs’ narratives revealed the nuanced ways that physical, social, and policy features of work environments shaped HIV risk and interacted with macrostructural constraints (e.g., criminalization, stigma) and community determinants (e.g., sex worker empowerment initiatives) to shape SWs’ agency in negotiating condom use. SWs’ narratives revealed the ways in which the existence of occupational health and safety standards in indoor establishments, as well as protective practices of third parties (e.g., condom promotion) and other SWs/peers were critical ways of enhancing safety and sexual risk negotiation within indoor work environments. Additionally, working in settings where negative interactions with law enforcement were minimized (e.g., working in decriminalized contexts or environments in which peers/managers successfully deterred unjust policing practices) was critical for supporting SWs’ agency to negotiate HIV prevention.ConclusionsPolicy reforms to remove punitive approaches to sex work, ensure supportive workplace standards and policies, and foster SWs’ ability to work collectively are recommended to foster the realization of SWs’ health and human rights across diverse settings. Future qualitative and mixed-methods research is recommended to ensure that HIV policies and programmes are grounded in SWs’ voices and realities, particularly in more under-represented regions such as Eastern Europe and Sub-Saharan Africa.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2491-x) contains supplementary material, which is available to authorized users.

Recent im/migration to Canada linked to unmet health needs among sex workers in Vancouver, Canada: Findings of a longitudinal study

“…Specifically, institutional barriers that may affect obtainment of health services for im/migrant SWs include fear of disclosing sex work to health providers, foregoing care in order to continue earning income, denial or delay of public health insurance, high cost of private health insurance, and ineligibility for social assistance and subsidized housing (Anderson et al, 2015; Goldenberg, Duff, & Krusi, 2015; Oxman-Martinez et al, 2005). Not having a provincial health insurance card was strongly correlated with reporting institutional-level barriers to health care among SWs, as determined by a researcher in Vancouver (Socías et al, 2016).…”

The Role of Sex Work Pay in Moderating the Effect of Mobile Phone Solicitation on Condom Practices: An Analysis of Female Sex Workers in India

“…The fluidity of this finding, where only a sub-set of low paid FSWs were most at risk for inconsistent condom use, stands in contrast to traditional frameworks of sex work environments, where economic status and type of solicitation strategy inform relatively fixed socio-environmental influences on FSW condom practices [17,19–22]. Our findings underscore a need to devise more compatible frameworks to assess risks within sex work environments, which account for the varied effects of mobile phones on FSW condom practices.…”

“…Research to date has demonstrated that the economic status of a FSW (e.g., low or high paid FSW) is closely linked to how effectively a FSW safely navigates within sex work environments and in turn, the level of formal or informal support to enable safe sexual practices with clients [17–23]. This is consistent with findings that economic debt and more generally, economic vulnerability, contributes to HIV risk for sex workers [1,24].…”

“…Venues that do not maintain or enforce policies to regulate client behavior with sex workers (e.g., street based sex work) may provide more risks for violence against sex workers by clients, greater alcohol consumption by clients, less access to condoms as well as less support for sex workers to negotiate condom use with clients [17,18,20–23]. The extent to which these findings apply in the context of widespread mobile phone use as a solicitation method is vastly understudied.…”

Physical and Sexual Violence Affecting Female Sex Workers in Abidjan, Côte d'Ivoire: Prevalence, and the Relationship with the Work Environment, HIV, and Access to Health Services

“…20,21 The objectives of this study are to estimate the prevalence of physical and sexual violence among FSW in Abidjan, Côte d’Ivoire and identify associated structural determinants in the work environment, HIV related outcomes, and experience in accessing health services.…”