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

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I never imagined anything completely shutting down the industry I work in.

Eryc Taylor. Prostitutes Annaka Handel. Kelli Grand. Rusty Joiner. When data were aggregated, within the past Prostitutes Annaka days, individuals reported total anal or vaginal sex partners and 30 of these partnerships did not use condoms. The median of sexual partners Prostitutes Annaka two range 0—30and the median number of condomless sex partners was zero range 0—3.

The use of condoms did vary by type of sex. However, the numbers are too small to draw any meaningful conclusions.

We found that of the eight individuals who wore PPE while doing sex work, three For many, there had been no reported changes to their sex work behavior. I don't want to harm elderly Prostitutes Annaka. Several individuals stated that they had completely stopped Prostitutes Annaka sex work during COVID due to their fears of becoming sick.

Of note, it is possible that for some individuals this was already part of their goals. For those who chose to continue doing sex work, some attempted to implement precaution measures including the use of personal protective equipment or other strategies. If I go back out Prostitutes Annaka to do sex Prostitutes Annaka during this, I will probably die.

Worry about the girls still out there.

Impact on Other Areas of Life Respondents identified significant challenges at Prostitutes Annaka, social, and individual levels when asked about how COVID had impacted other areas of their lives. Many rely on churches or local community organizations providing food on set schedules, but with the pandemic these services were reduced or stopped completely. Finally, not surprisingly, many individuals noted that in addition to reduced access to services and social connection, they were experiencing worsened mental health and increased substance use.

Individuals noted increases in mental health symptoms including depressive, anxious, and psychotic symptoms like delusions and paranoia. Many Prostitutes Annaka that their existing mental health and substance use issues were exacerbated by Prostitutes Annaka of getting COVID For this population, it is extremely difficulty to avoid potential exposures given marginalized housing, sex work, and existing Prostitutes Annaka conditions including HIV.

Already have a compromised immune system. I never imagined anything completely shutting down the industry I work in. In the open-ended questions, many respondents expressed concerns about the possibility of transmission and the challenges posed by wearing personal protective equipment or practicing social distancing Prostitutes Annaka while trying to support themselves financially.

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The number of total sex acts also indicates there were many episodes of close, interpersonal contact, which is a known risk factor for COVID transmission. In addition Prostitutes Annaka potential risk of COVID transmission, there was also potential for HIV transmission, Prostitutes Annaka only half of the sample endorsed using condoms during sex. To our knowledge, we are the first to report on the use of PPE or Prostitutes Annaka precaution measures e.

Syndemics theory posits that co-occurring social epidemics create Prostitutes Annaka synergy that places individuals at risk of disease Singer et al. Our data are interpreted through this lens, recognizing that behaviors such as condomless sex and poor adherence to social distancing are influenced by larger structural and social systems that affect individual behavior.

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The syndemics framework clarifies how multiple factors are Prostitutes Annaka associated with increased risk of COVID Street-based sex workers often operate at the margins of society Prostitutes Annaka experience multiple, syndemic conditions including homelessness, hunger, poverty, substance use, and mental health issues Bauermeister et al.

Paradoxically, despite challenges Prostitutes Annaka by this group, they are often forgotten in the identification of vulnerable communities and not considered in relief Prostitutes Annaka Platt et al. We also recognize that in addition to experiencing multiple co-occurring syndemic conditions, identity as a sex worker likely also intersects with other unique identities Prostitutes Annaka race, gender, and sexual orientation, all of which impact the ability to navigate through society with relatively more ease or difficulty.

We recognize that each of these identities likely intersects with empowerment and perceived control or ability to engage in behaviors to protect their health.

Many individuals in our sample expressed they did not feel they had the power to assert themselves to wear PPE with clients or practice Prostitutes Annaka precautions. Individuals who did not use condoms may have also been affected by similar concerns.

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Our findings that street-based sex workers have been greatly affected by COVID are consistent with work conducted by Callendar et al. They reported that COVID impacted the sex industry and reduced the number of individuals entering sex work, obtaining sex work, and engaging in online services instead of in-person as much as possible.

However, the study also identified that sex workers with fewer options for other work downplayed Prostitutes Annaka significance of the risks posed by COVID Callander et al. Cognitive dissonance theory Festinger, suggests that when individuals notice a discrepancy between their attitudes and behaviors, they are motivated to change one or the other to reduce dissonance or internal conflict.

Applied to this situation, Prostitutes Annaka individuals are forced to continue to work in unsafe Prostitutes Annaka and potentially expose themselves to COVID, Prostitutes Annaka may alter attitudes to perceive this as safer than it is to protect their self-image and reduce dissonance Fischer et al. For street-based sex workers experiencing homelessness, COVID Prostitutes Annaka represented an additional challenge.

People who are experiencing homelessness are at a significant disadvantage when it comes to preventing infection as they often lack access to regular hygiene and sanitation Centers for Disease Control and Prevention, d. Many shelters or housing facilities that would normally take new residents declined to do so because of COVID, Prostitutes Annaka those that Prostitutes Annaka take in residents often saw outbreaks of COVID due to poor hygiene and close living quarters Amaral, Access to PPE at the time of data collection globally and locally was limited, and this impacted not only risk of COVID acquisition and transmission during sexual encounters, but also barriers to accessing general services.

For example, one participant mentioned that the public bus system was requiring masks, which means that for those Prostitutes Annaka without masks who rely on the bus system, they were not allowed Prostitutes Annaka enter.

Since data collection, PPE has become much more available and the CBO has Prostitutes Annaka made efforts to distribute PPE to their clients and the larger community of street-based sex workers to ensure Prostitutes Annaka individuals are able to wear masks when accessing public services like transportation. Several changes have been made to try to address some of the issues identified in this survey to better improve the lives of clients through statewide initiatives, non-profit support, and actions taken at the CBO.

These efforts have been useful in addressing the needs of Prostitutes Annaka and helping improve their quality of life. However, we recognize that systemic challenges that affect street-based sex workers generally, and even more so during COVID, will not be ameliorated with small efforts. As such, we hope that dissemination of these findings can be used to raise awareness and increase change at a larger level to address some of these systemic disadvantages that continue to place street-based sex workers at risk of COVID related morbidity and mortality.

Prostitutes Annaka study was limited by the use of data collection methods employed. Namely, peer specialists administered brief surveys during community outreach. Thus, there were missing data, and a few surveys were lost during the data collection process. However, the use of trusted outreach workers and peer specialists with lived experience through a CBO that works with the population likely also conferred specific benefits including truthful responses and willingness to participate from a population that is often excluded from traditional research on the impact of COVID Our study was also limited by the Prostitutes Annaka factor as Prostitutes Annaka cross-sectional data collection—we are unable to comment on the temporality of associations observed.

Syndemics and public health: Reconceptualizing disease in bio-social context.

Finally, we were limited by a small sample size in that we were not able Prostitutes Annaka undergo inferential statistics to understand more complex relationships between Prostitutes Annaka variables studied. In conclusion, our study documents the impact of COVID on sex work, substance use, and other areas of life among a group of street-based sex workers utilizing survey data with open-ended qualitative sections.

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Importantly, we identify street-based sex workers as a population at risk of COVID due to their marginalization from society, as well Prostitutes Annaka life circumstances including relying on shelter housing and close interpersonal interaction with multiple partners to survive.

The use of a syndemics framework provides a lens to understand the multiple social circumstances that affect the health of this high-needs population and potentially place them at high risk of COVID We hope these findings serve as a call to action Prostitutes Annaka institutions and communities Prostitutes Annaka national- and state-level funding agencies to identify sex workers as a population of public health importance given the risks implied by the nature of their work and limitations to services, housing, and food which, in turn, places them—and thus the larger community—at greater risk of COVID The first draft of the article was written by BGR, and all other authors reviewed, edited, and provided feedback on versions of the article.

All authors read and approved the final article. The study was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. The study was a secondary analysis of needs assessment data conducted with partners from a community-based organization that provides harm reduction services to at-risk individuals. Springer Nature Prostitutes Annaka neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The online version contains supplementary material available Prostitutes Annaka National Center for Biotechnology InformationU. Arch Sex Behav. Published online Mar Brooke G. Strong1 Trisha Arnold3 Siena C. Chan 1, 2, 4. Sabrina H. Siena C. Philip A. Author information Article notes Copyright and License information Disclaimer.

Rogers, Email: ude. Corresponding author. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means Prostitutes Annaka acknowledgement of the original source.

This article has been cited by other articles in PMC. Introduction Severe acute respiratory syndrome 2 SARS-CoV-2which is the Prostitutes Annaka responsible for coronavirus disease COVIDis a public health issue of the highest magnitude, Prostitutes Annaka diverse populations around the globe.

Prostitutes Annaka Participants These data were collected as part of a needs assessment conducted in collaboration with a local community-based organization CBO in New England that provides harm reduction services to individuals who use substances and engage in sex work.

Data Analysis Plan Quantitative data analysis. Open in a separate window. Conclusions In conclusion, our study documents the impact of COVID on sex work, substance use, and other areas of life among a group of street-based sex workers utilizing survey data Prostitutes Annaka open-ended qualitative sections. Supplementary Information Prostitutes Annaka is the link to the electronic supplementary material.

Compliance with Ethical Standards Conflict of interest There is no potential conflict of interest to report.

Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Global Public Health. Participants were incredibly diverse and ranged in age from 18 to over 55 and represented multiple racial groups