21 April, 2024

A word from our Director: The HPRU is proud to support the MSc module on Disaster Response: Mental Health, Communication and Behaviour, as part of the MSc Mental Health Studies at King’s College London. Each year, students on the module are given the chance to write blogs about papers produced by the Unit. We are delighted to present this recent submission by Yu Li that is based on this paper: Brooks, S. K., Patel, S. S., & Greenberg, N. (2023). Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic. Archives of Sexual Behavior, 52, 1969–2010. 

 

Struggling in the forgotten corner: A scoping review of sex workers’ COVID-19 pandemic experiences.

Background

In March 2020, the World Health Organization declared COVID-19 to be a global pandemic. Soon after, social distancing measures were introduced in most countries. However, sex workers faced structural disparities and disproportionately suffered during the pandemic. There are 40-42 million sex workers across the world. Their livelihood and wellbeing suffered during the pandemic because they were stigmatised, and their work remained illegal or limitedly legal in most countries. They were often systematically excluded from the support system during the pandemic despite most countries providing financial and health support for their citizens. Given sex workers’ unique and difficult situations, it is essential to understand their experiences and difficulties to effectively support them in case of another pandemic in the future.

This blog summarises a scoping review of the sex workers' experiences under the impacts of the COVID-19 pandemic.

Methods

This study followed the 5-step scoping framework.

The authors asked a broad question “What is known about the impact of the COVID-19 pandemic on sex workers?”

They searched in 6 databases and the studies met the following criteria.

• Published between December 2019 to December 2022.
• Reported primary data on COVID-19 experiences in English.
• Published in academic journals.
• Participants were sex workers, clients, or staff who support sex workers.

Through thematic analysis, data was coded based on the summary of its content. The identified themes were summarised narratively with a description of the theme and a discussion of the evidence.

Results

63 international studies were reviewed and several factors relating to wellbeing identified.

Financial issues

Reduced work and income were extremely common, increasing food and housing insecurities, and the pressure to return to work. These difficulties were attributed to physical distancing measures, the fear of law enforcement, and reduced demand for sexual services. To survive, people reported having to borrow money, find alternative work, or move to cheaper neighbourhoods.

Exposure to harm

Harms can come from both clients and police. Sex workers reported reduced negotiation power against clients, and increased violence and aggression from clients and the police.

Alternative working approaches

Sex workers made efforts to increase their work by changing the working venue or moving it online. However, the limitations of online sex work, such as technological barriers, low prices, and privacy issues made it less sustainable or accessible for some.

COVID knowledge, feelings, and protective behaviours

Sex workers were afraid of being infected but had limited information about community infections and many had to continue working. Their knowledge of COVID-19 was mixed, and language barriers to the information available were reported. Nonetheless, the knowledge of COVID did not guarantee protective behaviours as clients may refuse to wear masks.

Mental health, wellbeing, and coping

The pandemic posed a negative impact on sex workers’ wellbeing. They reported feeling distressed and exacerbated mental health problems. They used humour, positive thinking, religion, and support from loved ones to cope.

Access to support

Sex workers often felt abandoned. Most government financial support was not accessible due to migrant status and other barriers. Support from family and friends was also limited due to distance and stigma. Previously accessible support from nonprofit organisations was reduced due to lockdown and unstable funding. Support organisations were unable to reach all the sex workers and worried that remote service may create new barriers or threaten therapeutic relationships.

Access to healthcare

The impact on healthcare was overall negative. Sex workers reported different levels of accessibility to general healthcare and HIV care. The barriers to general healthcare included stigma, language, and financial issues. Difficulties accessing COVID-19 care and sexual and reproductive care were also reported.

Impact on research

The pandemic made research more difficult because phone calls used for research may not be accessible for sex workers or make them feel a lack of privacy.

Conclusions

The COVID-19 pandemic had substantial negative impacts on sex workers across the world, who were already an extremely vulnerable population. The financial difficulties, social isolation, stigmatisation, and health concerns together threatened the health and wellbeing of sex workers.

Strengths and limitations

This study reviewed sex workers’ COVID-19 pandemic experience globally, enabling the understanding of more phenomena in multiple aspects and building a foundation for both research and policies to support sex workers.

However, there may be additional relevant studies not reviewed, which could be captured with a broader search strategy, and thus leaving open questions in the experience of some sex workers.

Implications for practice

Sex workers struggled a lot during the COVID-19 pandemic. Nevertheless, they were often the blind spot of pandemic-related supportive policies. Brooks and colleagues identified some difficulties and related barriers that are shared across countries, which can contribute to the practice of supporting sex workers. This information can provide evidence and guidance for policymakers and nonprofit organisations to support sex workers more effectively during disasters and emergencies by targeting the barriers.

For example, the barriers and challenges identified in this study were also reported in other pandemics (e.g., HIV), suggesting that these common issues can be targeted in reducing the spread of communicable disease and improving the quality of life of sex workers. Specifically, given that sex workers from marginalised/socially isolated groups faced disproportionately more challenges, community engagement can be vital. It can reduce the spread of diseases and support sex workers better as it can provide more accessible information, promote community contact, and reduce stigma and loneliness.

About the author: Yu Li is a MSc Mental Health Studies student at King’s College London. Her research interest includes memory biases, trauma, and the experience of neurodiverse people.