Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.
Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
BMC Infect Dis. 2019 Mar 5;19(1):212. doi: 10.1186/s12879-019-3694-z.
BACKGROUND: Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries. METHODS: We searched for publications over the last decade (January 2005-March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited. RESULTS: Research demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted. CONCLUSIONS: The high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.
背景:在全球不同地区,性工作者仍然面临着不成比例的艾滋病毒和其他性传播及血源感染(STBBI)负担。有证据表明,行为和生物医学干预措施在降低人群层面的 STBBI 方面仅取得了中等程度的成功,这导致人们呼吁增加结构性和社区主导的干预措施。鉴于在高收入环境中,除艾滋病毒以外,减轻性工作者 STBBI 风险的结构性方法仍知之甚少,因此,这项关键性综述旨在全面综合全球研究和文献,以确定决定 HIV 和其他 STBBI 的因素,以及为高收入国家的所有性别性工作者提供有前途的干预实践。
方法:我们检索了过去十年(2005 年 1 月至 2016 年 3 月)的文献,其中包括性工作者(顺性别女性、顺性别男性和跨性别者)。从定量同行评议研究中获得的数据与公开提供的报告和定性/人种学研究进行了三角测量,在定量证据有限的情况下,这些研究可以提供补充。
结果:研究表明,结构性因素(例如暴力、耻辱感、刑事定罪、恶劣的工作条件)对增加性工作者 STBBI 风险具有直接和间接影响,这进一步加剧了个人和人际因素(例如心理健康、药物使用、无保护性行为)的影响。获得卫生和 STBBI 预防服务的机会仍然令人关注。充分的性工作非刑事化已被证明具有最大的潜力,可以通过减少工作场所暴力和增加获得更安全工作场所的机会,来避免性工作中的新感染。突出强调了应该扩大和评估以预防 STBBIs 的有前途的实践和战略。
结论:高收入环境中性工作者 STBBI 负担沉重,令人严重关切。本综述独特地增进了我们对增强和减轻所有性别性工作者 STBBI 风险的多层次因素的理解。研究表明,多管齐下的结构性和社区主导的方法对于解决 STBBI 负担至关重要,也是实现性工作者健康和人权的必要条件。鉴于性工作者群体的异质性,以及顺性别男性和跨性别性工作者面临的独特脆弱性,应利用混合方法进一步开展研究,以描绘风险的交叉点,并缓解关键的健康不平等。
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