Sex Worker Community Empowerment-Based HIV Interventions: An Integrative Literature Review

Sex Worker Community Empowerment-Based HIV Interventions: An Integrative Literature Review Julia Gelbort Faculty sponsors: Elizabeth Anderson RN, PhD & Randi Singer PhD, MSN Background: Evidence suggests that community empowerment-based interventions addressing structural factors are the most effective approach to HIV prevention in global sex worker populations. Recent policy changes in the U.S. are expected to increase sex worker HIV risk, necessitating more qualitative information to guide effective HIV prevention programs. Objectives: To gain a qualitative understanding of how community empowerment-based sex worker interventions address structural determinants of HIV transmission. Methods: An integrative literature review was conducted utilizing the methods described by Torraco (2005). Ten qualitative articles were selected and critically appraised. Information from the studies was extracted into a data matrix and organized based on an expanded version of the socio-ecological model. Results: The ten selected articles studied programsin Canada (2), U.S. (1), Cambodia (1), China (1), and India (5). Community empowerment interventions addressed determinants of HIV transmission among sex workers at each level of the socio-ecological model: 1) the intrapersonal level by increasing sexual health knowledge, condom use, and self-efficacy; 2) the interpersonal level by improving social support systems and reducing violence; 3) the institutional level by improving the accessibility of clinical services; 4) the community level by building relationships between sex worker community organizations, healthcare professionals, and other non-governmental organizations; 5) the environmental level by improving control and safety in workplaces; 6) the policy level by engaging sex workers in political advocacy. Interventions also faced barriers at each of these levels including financial instability, violence, reduced access to health care, social stigma, poor control of work environments, and the criminalization of sex work. The current state of the literature is limited in geographic location (one of ten studies in the U.S.) and theoretical rigor. Conclusion: While sex workers continue to face structural barriers to HIV prevention, community empowerment interventions show promise as an innovative response to HIV epidemics. The results of this review indicate that community empowerment interventions must be highly contextual and responsive to local sex worker needs. Additional support is required to achieve public policy enabling sex worker health and to improve the sustainability of sex worker community organizing. The socio-ecological model was found capable of addressing multi-level structural impacts on sex worker HIV vulnerability. While the environmental level has been neglected in previous research, findings suggest that future studies should include an analysis of environment-level influences on sex worker health. Qualitative methodology should be considered as a way to center marginalized voices in the production of knowledge that serves sex worker community interests. Furthermore, researchers might be most effective by leveraging their skills and resources to support sex workers who wish to research their own communities, thereby extending the benefits of community empowerment to the realm of research. Keywords:HIV/AIDS, sex work, socio-ecological model, community empowermen