Centre for Gender & Sexual Health Equity, c/o St Paul's Hospital.
Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, Canada.
AIDS. 2021 Jul 15;35(9):1461-1477. doi: 10.1097/QAD.0000000000002910.
Given stark health inequities among precarious and criminalized workers, we aimed to apply a structural determinants framework to systematically review evidence on HIV/sexually transmitted infection (STI) prevalence, access to HIV/STI/SRH services, and condom use among im/migrant sex workers (ISWs) globally.
Systematic search of peer-reviewed studies published in English (2009-2019). Eligible studies reported HIV/STI, access to HIV/STI/SRH services, and/or condom use outcomes and/or lived experiences among ISWs. Quantitative and qualitative data were synthesized using a structural determinants framework.
Of 425 studies screened, 29 studies from 15 countries were included. HIV prevalence ranged from 0.3 to 13.6% and varied across settings, with highest prevalence among undocumented ISWs in a high-income country (Portugal). Precarious immigration status was a structural factor associated with poorer HIV/STI outcomes, whereas qualitative narratives showed ISWs' lived experiences as strongly shaped by policing and stigma. Despite disparities, in some settings, HIV and STI prevalence were lower and odds of condom use with clients were higher among ISWs relative to non-im/migrant sex workers. This review identified a paucity of research on SRH and male and gender-diverse ISWs. Across legislative settings, criminalization of SW and im/migrant status, policing, and migration-related marginalization were prominent structural barriers to ISWs' HIV/STI/SRH access.
This review identified important inequities and variation in HIV/STI prevalence among ISWs globally. Our findings highlight impacts of the intersections of migration and criminalization, and suggest a need to reform criminalized sex work laws; address punitive policing and immigration enforcement; enable safer indoor work environments; and expand community-based interventions towards promoting HIV/STI/SRH access and health equity among ISWs.
鉴于不稳定和被定罪的工人之间存在明显的健康不平等，我们旨在应用结构决定因素框架，系统地审查全球移民和非移民性工作者（ISW）中艾滋病毒/性传播感染（STI）流行率、获得艾滋病毒/STI/性健康服务以及 condom 使用的证据。
系统搜索 2009 年至 2019 年期间以英文发表的同行评议研究。合格的研究报告了 ISW 中的艾滋病毒/STI、获得艾滋病毒/STI/性健康服务和/或 condom 使用结果以及生活经历。使用结构决定因素框架综合了定量和定性数据。
在筛选出的 425 篇研究中，有 29 篇来自 15 个国家的研究被纳入。艾滋病毒流行率从 0.3%到 13.6%不等，在不同的环境中有所不同，在高收入国家（葡萄牙）未登记的 ISW 中流行率最高。不稳定的移民身份是与较差的艾滋病毒/STI 结果相关的结构因素，而定性叙述表明，ISW 的生活经历受到警察和耻辱感的强烈影响。尽管存在差异，但在某些情况下，ISW 中的艾滋病毒和 STI 流行率较低，与非移民性工作者相比，与客户使用 condom 的几率更高。本综述确定了关于性健康和男性以及性别多样化的 ISW 的研究不足。在所有立法环境中，SW 和移民身份的刑事定罪、警察和与移徙有关的边缘化都是 ISW 获得艾滋病毒/STI/性健康服务的主要结构性障碍。
本综述确定了全球 ISW 中艾滋病毒/STI 流行率的重要不平等和差异。我们的研究结果强调了移徙和刑事定罪的交叉影响，并表明需要改革刑事定罪的性工作法；解决惩罚性警察和移民执法；使室内工作环境更安全；并扩大以社区为基础的干预措施，以促进 ISW 中艾滋病毒/STI/性健康服务和健康公平。
