Barriers to Accessing Sexual Health Services for Transgender and Male Sex Workers: A Systematic Qualitative Meta-summary

Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research

“…Applying specifically to sexual health, it builds on Nutbeam's three-part model of functional, interactive and critical health literacy (Nutbeam 2000), and the broader definitions of health literacy that recognise dynamic and societal influences (Sørensen et al 2012;Nutbeam 2000;Rootman and Gordon-El-Bihbety 2008;Zarcadoolas, Pleasant, and Greer 2005;Nutbeam 2008). It extends the existing and limited field of sexual health literacy research (Freeman et al 2018;Vamos et al 2018;Lin, Zhang, and Cao 2018;Haruna et al 2019;Kaczkowski and Swartout 2019), particularly among gay, bisexual and other men who have sex with men (Rosenberger et al 2011;Eliason, Robinson, and Balsam 2018;Oliffe et al 2019;Manduley et al 2018;Gilbert et al 2019;Brookfield et al 2019;Rucker et al 2018), by advocating a multi-level approach to enable men to attain sexual health literacy in the context of social and cultural practices and forces that shape it. There is a challenge for communities to manage sexual health within the wider context of social stigma and shrinking healthcare services, while increasingly being asked to become (bio)medical experts in their own sexual healthcare.…”

“…Some studies have applied (existing and tailored) health literacy measures to our understanding of treatment adherence and health outcomes among people living with HIV (Perazzo, Reyes, and Webel 2017;Reynolds et al 2019). Much of this research has focused on young people and/or the individual-level (Haruna et al 2019;Freeman et al 2018;Vamos et al 2018;Lin, Zhang, and Cao 2018;Kaczkowski and Swartout 2019) and while a few studies have begun to examine health literacy inequities among gay, bisexual and other men who have sex with men (Rosenberger et al 2011;Manduley et al 2018;Gilbert et al 2019;Brookfield et al 2019;Rucker et al 2018;Eliason, Robinson, and Balsam 2018;Oliffe et al 2019), sexual health literacy as a concept remains under-developed.…”

“…All of this takes place within the context of profound systemic factors that affect the health of gay, bisexual and other men who have sex with men, including stigma and discrimination on the basis of sexual orientation and HIV, as well as inadequate access to appropriate healthcare services (Beyrer et al 2012). Fully realising the benefits of and implementing biomedical HIV prevention at scale requires that the communities most affected are made aware, educated and empowered to access it, while at the same time challenging the many entrenched forms of stigma preventing this (Young et al 2019;Young, Flowers, and McDaid 2016;Brookfield et al 2019). It is for this reason that we argue that gay, bisexual and other men who have sex with men's sexual health literacy should capture the individual as always embedded within multiple, intersectional social contexts.…”

Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US

“…Indeed, people involved in the sex trades-including those with trafficking experiences-continue to struggle accessing quality, non-judgmental care. In a systematic review of 22 qualitative papers addressing barriers to accessing sexual health care for trans and male sex workers, for example, Brookfield et al (2019) found that intersectional forms of stigma around sex worker status, sexuality, gender identity, HIV status, and internalized stigma were predominant barriers. Scambler and Paoli (2008) found that within female sex work in London, Bangkok, and Kolkata, norms of blame, shame, and labelling sex work as deviant created barriers to accessing effective health care.…”

High HIV prevalence among transgender women in Paraguay

“…[5][6][7][8] Other studies document the relationship between sex work and HIV risk among trans women who may be vulnerable to engaging in unsafe sex due to violence and high pay offered for not using condoms. 9,10 Trans women with cisgender male partners face a high HIV transmission probability via condomless anal sex with serodiscordant and viremic partners. 11 Social marginalization also contributes to the high burden of HIV by limiting the provision and uptake of services for trans women, and by forcing them into risky environments including sex work for economic survival.…”