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Sex workers represent a diverse population including Prostitutes Borne women, cis men, and trans individuals. The organization of sex worker populations varies considerably by work setting [ 26 ], with sex workers operating out of more formal in-call Prostitutes Borne e.

Sex workers solicit clients in equally diverse settings: independent self-advertising e. The majority of sex workers are cis female with cis male clients; however, cis male and trans sex worker populations exist in many settings, including with cis female patrons [ 78 ]. Of note, data are especially sparse among trans men; therefore the available data among trans Prostitutes Borne workers is limited to Prostitutes Borne women [ 8 ].

In recent years, research and evidence demonstrate that behavioural and biomedical interventions alone are only moderately successful in reducing STBBIs and increasing condom use, emphasizing the urgent need to scale-up structural interventions and community-led programs [ 1211 ], which focus on reducing social and economic inequalities by addressing larger social, legal, and policy barriers.

Numerous research and medical experts, international bodies, and sex work Prostitutes Borne around the globe have formally Prostitutes Borne decriminalization of sex work, given the well-established evidence that criminalized and enforcement-based approaches to sex work have harmful impacts.

Despite efforts to consider Prostitutes Borne determinants in STBBI prevention interventions, such as community empowerment approaches in many settings in the global north, and Canada in particular [ 17 ], stigma, criminalization, and a lack of funding continue to impede large-scale implementation. A series of papers in the Lancet systematically reviewed the evidence and determinants of vulnerability and interventions to prevent HIV among sex Prostitutes Borne and released an urgent call to Prostitutes Borne to address the disparities and drivers of high burden and Prostitutes Borne HIV prevention, treatment, and care among sex workers globally [ 2 ].

Prostitutes Borne on a structural determinants framework — one that aims to elucidate the role Prostitutes Borne intersecting social, structural, and environmental factors in shaping individual-level health outcomes [ 21819 ] — this aim of this critical review is to Prostitutes Borne a comprehensive synthesis of the global literature and evidence on HIV and other STBBI vulnerability and promising prevention practices for sex workers of all genders in high-income settings.

A literature search was conducted of publications over the last decade January — March on STBBIs among sex workers cis women, cis men, and trans individuals in the 27 high-income countries classified by the World Bank OECD members in [ 20 ]. Publications were assessed for the extent to which they reported on STBBIs and Prostitutes Borne use outcomes, as well as structural, individual, and biomedical determinants and interventions in the mitigation or potentiation of STBBI acquisition and transmission risk.

The search was supplemented with additional sources, including publicly available reports e. Non-primary research e. Qualitative studies and publicly available reports were included to provide further context around quantitative work.

Despite reports on the high prevalence of STBBIs among both cis men and trans sex workers [ 21222324 ], little data exist on the determinants of STBBIs unique to these populations. Current evidence suggests the determinants of STBBIs for sex workers of any gender are highly multifaceted. Individual and interpersonal determinants including substance use and sexual risk practices, mental health, and partner-level variables, among others were examined Prostitutes Borne 12 studies focusing on female sex workers Table 13 studies focusing on cis male sex workers Table 2and 3 studies focusing on trans sex workers Table 3.

Among female sex workers in Europe, injecting drugs is the primary individual-level determinant of HIV [ 26 ].

Dual drug and sexual risk behaviours significantly enhance risks for STBBI transmission among sex workers and their partners. For example, condoms are less likely to be used in transactions with regular clients Prostitutes Borne compared to one-time clients, and similar to estimates in the general Canadian population, nearly three-quarters of female trans inclusive sex workers in Canada report recent inconsistent condom use with intimate partners [ 29 ]. In Canada, Indigenous sex workers i. While the vast majority of sex workers initiate sex work in adulthood, duration of time in sex work has Prostitutes Borne shown to shape risk pathways for STBBIs, including increased risk for HIV infection among women sex workers in Vancouver and Miami [ 31Prostitutes Borne ].

Among cis female sex workers in Korea, younger age and higher inconsistency of condom use were associated with chlamydia infection [ 36 ]. In the Netherlands, younger men were more than twice as likely to test positive for STBBIs, and identifying as gay or bisexual significantly increased risk [ 22 ]. Despite dual drug and sexual risks, little is known about the burden of HCV among sex workers. The HCV incidence density was 4. HCV prevalence among cis female sex workers who do not inject drugs in Korea was positively associated with history of acupuncture and diabetes [ 39 ].

Globally, trans women sex workers can have up to six times increased odds of HIV infection than cis male or cis female sex workers, with injection drug use being highly prevalent among those living with HIV [ 4041 ]. The primary risks for STBBIs identified among MSWs include unprotected anal intercourse, having a high number of sexual partners and large sexual Prostitutes Borne, and stigma [ Prostitutes Borne44 Prostitutes Borne, 454647 ].

Among the limited available data among MSWs, research from the UK found that rates of both unprotected sex and gonorrhoea both increased steadily over the Prostitutes Borne period Prostitutes Borne [ 21 ].

Sex workers in Canada and the USA Prostitutes Borne high levels of childhood trauma and violence, and among those with histories of violence and abuse, mental illness may be mediating the association between trauma and unprotected sex [ 2949 ].

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Prostitutes Borne suggests historical experiences of violence and indirect violence i. Comorbid substance use Prostitutes Borne mental health Prostitutes Borne among sex workers may elevate risk for violence and risk of STBBIs from partners to sex workers [ 454651 ]. A recent study identified depression as significant predictor of unprotected anal sex Prostitutes Borne the most recent male client among MSWs who work online [ 52 ]. Epidemic rates of physical, sexual, and verbal violence against sex workers continue to be reported globally and have among the strongest links to elevated STBBI burden among sex workers [ 56 ].

Cities across Canada are sadly home to epidemics of Prostitutes Borne against sex workers, with Indigenous and street-involved sex workers facing the highest burden, and yet there continues to be a lack of coordinated response.

A systematic failure to protect women sex workers from violence over decades has led to deeply-rooted mistrust of health and service providers [ 6263 ]. Research has shown that avoidance of health services in Vancouver, Canada due to violence, fear of violence, and negative interactions with police displaces marginalized sex workers to more isolated spaces — particularly youth and Indigenous women Prostitutes Borne 64Prostitutes Borne ].

The Prostitutes Borne is unequivocal that in criminalized settings, sex workers are forced into adversarial relationships with police officers and are unable to access essential social, health, and legal Prostitutes Borne [ 268 ]. Police have used possession of condoms as evidence of sex work to justify arrest, which creates a substantial disincentive among sex workers to use protection with clients [ 576669 ], and is a gross violation Prostitutes Borne human rights.

Condoms have also been used as evidence to target third parties and sex work businesses, which directly Prostitutes Borne access to condoms. For sex workers in Sweden, structural stigma and the law have led to increased violence and social exclusion, including housing instability [ 69 ].

Police surveillance and harassment e. Fear of disclosure of Prostitutes Borne work status or drug use to family, friends, and service providers has been both quantitatively and qualitatively linked to increased barriers to health care for sex workers of all genders [ 7374 ] and increased risk of HIV and HCV [ 75 ].

Punitive policies that perpetuate stigma and discrimination against sex workers have been associated with an increase in economic and social insecurity e. Stigma and discrimination are major barriers to reporting violence to authorities, and result in increased violence and victimization Prostitutes Borne sex workers [ 687778 ]. Social stigma, homophobia and transphobia create environments Prostitutes Borne are Prostitutes Borne hostile for trans sex workers and greatly undermine health and safety.

Stigma is associated with poverty, refugee or migrant status, ethnicity, substance use, and healthcare avoidance among trans individuals globally [ 879 ]. Legal restrictions and confusion of gender-appropriate identification create further barriers to accessing social and health care services in some settings, thus potentiating the economic reliance on sex work and risks for STBBIs.

Qualitative Prostitutes Borne from Vancouver and San Francisco shed light on the ways in which different trajectories of risk and violence are shaped by socio-structural factors, such Prostitutes Borne transphobia and criminalization, with trans sex workers experiencing complex and multilayered vulnerability to STBBIs based on their identity, ethnicity, class, and appearance [ 7880 ].

Despite dual drug and sexual risks, little is known about the burden of HCV among sex workers.

Qualitative work Prostitutes Borne MSWs in New York exemplifies how experiencing discrimination and medical distrust can impede access to biomedical HIV prevention strategies such as PrEP pre-exposure prophylaxis [ 74 ].

In high-income settings, short-term internal mobility or migration Prostitutes Borne. Internal mobility and Prostitutes Borne for sex work in Canada has been linked to gaps in health services, including disruptions in ART [ 87 ]. Among MSWs in England, being a migrant worker vs. UK-born was positively associated with a two-fold increased odds of chlamydia [ 88 ].

Sex workers continue to experience suboptimal access and barriers to STBBI testing and care, and consistently experience structural barriers to safe, non-judgemental health care. There are extremely limited data on ART use and care experiences among sex workers living with HIV in high-income settings, despite being a key population affected by the epidemic [ 90 ].

Structural barriers to scaling up and retention in ART remain a major challenge among sex workers globally [ Prostitutes Borne11 ]. Studies describing context of promising structural-level intervention and prevention practices to reduce STBBIs among sex workers in high-income countries and policy implications Prostitutes Borne outlined in Table 4.

Community empowerment, Prostitutes Borne process by which sex workers take collective ownership of programs to achieve the most effective outcomes and Prostitutes Borne social and structural barriers to health and human rights [ 13 ], can be a powerful Prostitutes Borne in mitigating STBBI among sex workers. However, despite decades of grassroots organizing among sex workers in Canada, there Prostitutes Borne an astonishing dearth of data on community empowerment in high-income countries, with available global data largely restricted to low and middle-income settings, namely India and Brazil.

Criminalization, stigma and a lack of funding to scale up efforts continue to impede progress in many settings to implement large-scale community empowerment efforts to prevent STBBIs [ 13 ]. Sex worker-led Prostitutes Borne community empowerment-based approaches in LMICs place emphasis on organization at the community level e.

The defining features of community empowerment among sex workers are that they are community-led, committed to ensuring health and human rights, recognize sex work as work, and driven by the needs and priorities of sex workers themselves [ 13 ].

The sex worker-led Sonagachi project in Kolkata, India [ 93 ], is perhaps the most well renowned community-based structural approach to HIV prevention.

The Prostitutes Borne led to substantial increases in condom use between sex Prostitutes Borne and their clients and significantly decreased STI transmission through community awareness and empowerment.

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Sex worker engagement with police, public, and other community stakeholders e. In San Francisco, the St James Infirmary was established as a peer-based occupational health and safety clinic for sex workers of all genders and operates within a harm reduction framework of sex worker-led programming one-third to one-half of staff are experiential Prostitutes Borne 95 ].

The St James Infirmary provides integrated care to sex workers across sexual and reproductive health, mental and physical health, and includes a number Prostitutes Borne support services and advocacy efforts. In Canada, grassroots sex worker organizing led to one of the largest charter challenge cases Prostitutes Borne the Supreme Court Bedford that ultimately struck down criminalized sex work laws [ 72 ].

Research has demonstrated that sex worker-led outreach and peer support are critical interventions, increasing access to HIV and other STTBI testing and care. Sex worker-led and mobile outreach have been independently linked with increased access to HIV testing and addiction treatment, while sex worker-only drop-in spaces have been linked to greater uptake of sexual and reproductive health care [ 9798 ].

A pilot Prostitutes Borne of peer-mediated support has also shown increased engagement and retention in care for sex workers Prostitutes Borne with HIV [ 99 ]. Among street and off-street sex workers in Vancouver, higher levels of social cohesion i. Collectively, research highlights the critical need to increase investment and support in community organization and Prostitutes Borne work-led programming in Prostitutes Borne response Prostitutes Borne prevent STBBIs.

In the Lancet, the decriminalization of sex work i. A number of regions, most notably New Zealand and in some states in Australia, have decriminalized all aspects of sex work, and research by governments and academics have shown increased access to occupational health and safety standards, and better Prostitutes Borne of health services [], with no evidence of unintended harms.

Low access to STBBI testing and cervical screening [ 91] underscores the need for novel structural and sex worker-led approaches to remove barriers to safe, non-judgemental testing and care along the Prostitutes Borne. As noted, sex worker-led and mobile outreach have been evidenced to be critical strategies to reaching hidden street and off-street sex workers and building linkages to STBBI prevention and care [ 8497].

Low-threshold sex worker drop-in spaces have been shown to increase access and referral Prostitutes Borne sexual and reproductive health [ 98 ]. The potential to integrate sex work-tailored health care within existing spaces e. The work environment refers to physical, social, political and economic features of spaces where sex workers operate. As described previously, Prostitutes Borne to unsafe working conditions, including isolated street and indoor spaces, have been consistently linked to elevated violence, client condom refusal, and Prostitutes Borne risks for STBBIs [ 27 ].

Longitudinal research in Vancouver, Canada demonstrates that access to safer indoor work spaces e. Evaluation of a novel supportive and women-only housing model for sex workers demonstrates the potential of structural and community interventions to prevent violence and increase safety, including prevention of STBBIs, for the most marginalized sex workers [ 768698 ].

Qualitative studies and narratives of sex workers demonstrate that access to safer indoor work venues enables sex workers to move away from street-based settings and Prostitutes Borne control the conditions of work, including connecting with social and legal supports and increasing capacity to refuse unwanted service requests and avoid violent perpetrators [ 7686 ].

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Prostitutes Borne licensing that allow access to safer indoor work spaces e. The rise of social media and online platforms has transformed the structure and organization of the sex industry [ ]. Recent qualitative research conducted with cis men Prostitutes Borne trans sex workers and clients in Vancouver highlights how the shift to online solicitation has increased safety and control over the work environment by enhancing screening of prospective clients e.

Alongside increased efforts to Prostitutes Borne sexual health education and referral Prostitutes Borne self-testing for some STBBIs across the general population and among gay and other MSM, there represents a critical opportunity for safe, non-judgmental health and support services and peer-led interventions for sex workers through online means. Unfortunately, in the context of new legislation in Canada PCEPA that criminalizes buying and advertising of sex, including in online venues and third parties [ ], these policies have serious implications for the health and safety of sex workers, many of whom have transitioned to Prostitutes Borne advertisement and Prostitutes Borne.

Interventions must recognize the heterogeneity of MSWs [ 745]. Risk reduction is impeded by criminalization of sex work and stigma. While brief risk reduction interventions have been demonstrated to be efficacious in reducing unprotected anal sex with clients Prostitutes Borne street-based MSWs in the USA, further research is warranted given the heterogeneity of MSW populations [ ].

Qualitative research with MSWs has elicited the needs of MSWs who identified important interventions and areas of interest beyond safer sex, such as Prostitutes Borne with businesses and legal advice [ ]. Addressing the specific needs of MSWs requires laws and public health policies that facilitate accessible STBBI prevention and treatment for men, further research to understand context-specific risks, and comprehensive care programs e.

Increasing access to Prostitutes Borne is a necessary but insufficient method on its own [ 1]. There is a paucity of literature and evidence-based interventions among trans sex worker populations, globally. Behavioural change and biomedical interventions for trans sex workers are promising for preventing HIV in certain settings e. Access to STBBI prevention and other health care services are severely hampered by challenges related Prostitutes Borne sexual and legal identities, transphobia, and human rights violations.

No interventions thus far have Prostitutes Borne been developed specifically for trans sex workers. This critical review of the research over the last ten years demonstrates consistent evidence of the direct and indirect impacts of structural factors e. Structural factors play a driving role in Prostitutes Borne and mitigating risk for STBBIs, affecting individual Prostitutes Borne interpersonal determinants e.

Sub-optimal access to STBBI prevention and care remains detrimental to sex workers across diverse settings worldwide, and evidence suggests this can only be addressed through Prostitutes Borne, structural and community-led interventions in tandem with biomedical interventions.

Similar to findings in LMICs, the global evidence among high-income countries suggests that multipronged structural and community-led interventions are urgently needed to increase access to STBBI prevention and care for sex workers [ 11145767, ]. Meanwhile, evidence indicates Prostitutes Borne criminalized approaches to sex work reduces access to critical social and health support services, and entrenches individuals in cycles of social exclusion, violence, incarceration, substance use, and poor mental health, infringing upon the human rights of sex workers [ 166869 ].

At local and regional levels, important evidence has demonstrated the role of safer work environments in reducing risks for STBBIs among Prostitutes Borne workers through supportive managerial and venue-based practices, access to harm reduction and prevention resources, and referrals to health and support services [ 2686 ].

Supportive women-only housing models in Vancouver, Canada have provided a novel intervention approach to ensure the most marginalized sex workers have access to safer indoor work spaces and were linked to increase control over Prostitutes Borne of sexual risk reduction [ 76 ]. As Prostitutes Borne currently, many of Prostitutes Borne interventions are small, operate in a legal limbo, and resources to scale-up Prostitutes Borne further evaluate are urgently needed. Evidence from both LMICs and high-income settings identified in this review highlight that community and sex worker-led interventions e.

Community and sex worker-led strategies that Prostitutes Borne to reduce social stigma and health provider discrimination towards sex Prostitutes Borne have been shown to have substantial promise elsewhere e. While a number of municipalities in Canada and the USA have made some progress through city-wide taskforces towards addressing stigma and violence against sex workers e.

Despite Prostitutes Borne community-led programs, large gaps remain in resources, funding, and coverage to scale-up services. This review uniquely builds upon the literature and contributes to our understanding of Prostitutes Borne factors that potentiate and mitigate STBBI Prostitutes Borne among cis women, cis men, and trans sex worker populations.

To the best of Prostitutes Borne knowledge, this is the first comprehensive synthesis of determinants and intervention and prevention strategies to reduce Prostitutes Borne burden among sex workers of all genders, specific to high-income countries. The majority of research and data on STBBIs among sex workers are largely confined to LMICs, with a dearth of research focusing on the experiences of cis men and trans sex workers.

Studies seldom disaggregate data by sex work involvement [ ], which limited our ability to understand the determinants of, and interventions for, STBBIs in these populations.

Prostitutes Borne 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 for all sex workers. This review highlights promising strategies that need to be scaled up and evaluated to prevent STBBIs among sex workers. An Prostitutes Borne agenda for HIV and sex workers.

PubMed Google Scholar. Global epidemiology of HIV among female sex workers: influence of structural determinants. Burden of HIV among female sex workers in low-income and middle-income Prostitutes Borne a systematic review and meta-analysis. Lancet Infect Dis. The Prostitutes Borne supplementary appendix.

As so little is known about male CSWs, there was no readily identifiable group with which to compare them and it was unclear which variables it was appropriate to match for.

Google Scholar. The global north: HIV epidemiology in high-income countries. Article PubMed Google Scholar. Work Prostitutes Borne and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives.

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BMC Public Health. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. HIV risk and preventive interventions in transgender women sex workers. Determinants of health among two-spirit American Indians and Alaska natives. In: Meyer I, Northridge M, editors. The health of sexual minorities.

New York: Springer; Winnipeg, MB; World Health Organization. Geneva; Accssed Prostitutes Borne July Confronting structural violence in sex work: lessons from a community-led HIV prevention project in Mysore, India. AIDS Care. A community empowerment approach to the HIV response among sex Prostitutes Borne effectiveness, challenges, and considerations for implementation and scale-up. Accessed 24 July New York; Amnesty International.

Ferris S. Street sex work and Canadian cities: resisting a dangerous order. Edmonton: University of Alberta Press; HIV infection among female sex workers in concentrated and high Prostitutes Borne epidemics: why a structural determinants framework is needed. Rhodes T. Risk environments and drug harms: Prostitutes Borne social science for harm reduction approach.

Washington, DC; Accessed 03 Aug HIV, Prostitutes Borne transmitted infections, and risk behaviours in male sex workers in London over a 10 year period. Sex Transm Infect. Young male sex workers are at high risk for sexually transmitted infections, a cross-sectional study from Dutch STI clinics, the Netherlands, — BMC Infect Dis. Sex trade in a male-to-female transgender Prostitutes Borne psychosocial correlates of Prostitutes Borne condom use.

Sex Health. Practices of receptive and insertive Prostitutes Borne sex among transgender women in relation to partner types, sociocultural factors, and background variables. Sexual and drug-related vulnerabilities for HIV infection among women engaged in sex work in Vancouver, Canada. Can J Public Heal. Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis.

BMJ Open. AIDS Behav. Sex work and HIV incidence among people who inject drugs. High prevalence and partner correlates of physical and sexual violence by intimate partners among street and off-street sex workers.

Kids with Cameras continues to work toward improving the lives of children from the Calcutta red light district with the Prostitutes Borne to build a Hope House. The Durbar Mahila Samanwaya Committeea prostitutes' organization active in Sonagachi, has criticized the film for presenting the children's parents as abusive and for ignoring the prostitutes' efforts to provide education programs and career building activities for their Prostitutes Borne.

IF Born Into Brothels were remade as an adventure-thriller in the tradition of Indiana Jones and the Last Crusadeits Prostitutes Borne might read: "New York film-maker Zana Briski sallies forth among the natives to save souls. Some critics joined the Sonagachi prostitute-advocacy groups in condemning the film for Prostitutes Borne of the plight of the prostitutes Prostitutes Borne profit.

The website's critical consensus states, "A powerful and uplifting documentary".

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Box Office Mojo. Retrieved 12 July The New York Times. Archived from the Prostitutes Borne on 28 December Retrieved 23 November Archived from the original on 22 September Kids with Cameras. July Archived from the original on 7 October April Archived from the original on 23 April Archived from the Prostitutes Borne on 26 April Retrieved 17 February Archived from the original on 3 September Retrieved 18 August Retrieved 21 January Archived from the original on 3 March