Kielhold Kirstin, Shannon Kate, Krüsi Andrea, Valencia Esteban, Pearson Jennie, Goldenberg Shira M
School of Public Health, San Diego State University, San Diego, California, USA.
Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.
J Epidemiol Community Health. 2024 Dec 10;79(1):36-41. doi: 10.1136/jech-2024-221989.
Women sex workers face substantial health inequities due to structural barriers including criminalisation and stigma. Stigma has been associated with HIV-related inequities among marginalised populations, however, we know less about the impacts of sex work-specific occupational stigma on HIV/sexually transmitted infection (STI) risk among women sex workers. Given these research gaps and the disproportionate burden of stigma faced by sex workers, we evaluated the association between sex work occupational stigma and recent inconsistent condom use with clients, over an 8-year period (2014-2022).
Baseline and semiannual questionnaire data from a prospective, community-based cohort of sex workers in Vancouver, Canada from September 2014 to February 2022 were used. We employed complete-case bivariate and multivariate logistic regression analysis using generalised estimating equations to analyse the relationship between sex work occupational stigma and inconsistent condom use for vaginal/anal sex with clients in the past 6 months.
Among 574 participants, the cumulative prevalence of inconsistent condom use by clients and sex work occupational stigma in the last 6 months was 32.1% (n=184) and 59.9% (n=344), respectively, over the 8-year period. In adjusted multivariable analysis, exposure to sex work occupational stigma was associated with almost twofold increased odds of recent inconsistent condom use with clients (adjusted OR 1.93, 95% CI 1.23 to 3.03) over the 8-year period.
Multilevel interventions addressing the role of occupational stigma are needed for HIV and STI prevention efforts, including scale-up of sex worker-led/delivered sexual health services and structural changes to decriminalise and destigmatise sex work.
由于包括刑事定罪和污名化在内的结构性障碍，女性性工作者面临着严重的健康不平等。污名化与边缘化人群中与艾滋病毒相关的不平等现象有关，然而，我们对性工作特定职业污名对女性性工作者艾滋病毒/性传播感染（STI）风险的影响了解较少。鉴于这些研究空白以及性工作者面临的不成比例的污名负担，我们评估了2014年至2022年这8年期间性工作职业污名与最近与客户不一致使用避孕套之间的关联。
使用了来自加拿大温哥华一个基于社区的性工作者前瞻性队列在2014年9月至2022年2月期间的基线和半年期问卷调查数据。我们采用完全病例双变量和多变量逻辑回归分析，并使用广义估计方程来分析性工作职业污名与过去6个月与客户进行阴道/肛交时不一致使用避孕套之间的关系。
在574名参与者中，在这8年期间，过去6个月客户不一致使用避孕套和性工作职业污名的累积患病率分别为32.1%（n = 184）和59.9%（n = 344）。在调整后的多变量分析中，在这8年期间，遭受性工作职业污名与最近与客户不一致使用避孕套的几率增加近两倍相关（调整后的比值比为1.93，95%置信区间为1.23至3.03）。
艾滋病毒和性传播感染预防工作需要采取多层次干预措施来解决职业污名的作用，包括扩大由性工作者主导/提供的性健康服务，以及进行结构性变革以使性工作非刑罪化和消除污名化。
