Structural determinants of HIV/STI prevalence, HIV/STI/sexual and reproductive health access, and condom use among immigrant sex workers globally

Abstract

Objective: 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.Methods: Systematic search of peer-reviewed studies published in English (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(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.Results: 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. Conclusion: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.

Sexual risk and STI testing behaviour among Dutch female and male self-employed sex workers; a cross-sectional study using an Internet based survey

“…Inconsistent condom use is one of the factors leading to high STI positivity rates among sex workers worldwide [10][11][12]. However, STI positivity rates are lower in Western countries than in other countries.…”

HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis

“…For example, a recent review by McBride and colleagues suggests that precarious immigration status was associated with poorer HIV outcomes. 53 This data will be helpful in advocacy and policymaking to ensure migrant populations have equal access to healthcare overall, including HIV prevention and treatment, as their native-born counterparts.…”

Sexually Transmitted Infections Prevalence and Cascade of Care among Undocumented Sex Workers: A Twenty-Year-Long Experience

“…Many studies in the field provide information regarding STI prevalence among migrant SWs. However, most studies focus on bloodborne infections and syphilis and do not report other STIs [ 10 , 11 , 12 ].…”