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Many are under 18 and take advantage of the non-harsh laws on minors. A community empowerment Prostitutes Guimaraes to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up. In view of our current results showing that both Prostitutes Guimaraes of PEP as well as its use are associated with non-disclosure of FSW status to health care providers, and that pre-exposure prophylaxis PrEP has recently been introduced in Brazil, it is urgent to develop public health policies which enable disclosure of sex work status to health Prostitutes Guimaraes providers.

Interventions targeting stigma and discrimination against FSW in health care services Prostitutes Guimaraes urgently needed to increase access to health services. For a sustained HIV response, efforts Prostitutes Guimaraes focus on building awareness of FSW health care rights and on addressing barriers to Prostitutes Guimaraes care access and utilization, such as reducing sex work-related stigma, aiming at transforming health services into safe environments where FSW can disclose their status without fear of facing discrimination.

Moreover, community empowerment-based HIV responses must enable sex workers to develop and implement public health actions themselves, and to encourage recognition of sex work as legitimate work in society. The authors would like Prostitutes Guimaraes express their gratitude Prostitutes Guimaraes the participants of the study, to the local teams that carried out the fieldwork in the 12 cities, and all collaborating NGOs.

Ferreira Jr. All authors contributed to the concept of the paper and writing.

ID and CL were responsible for writing Prostitutes Guimaraes final version of the manuscript. CL and GD were responsible for data analysis. PRBSJ were responsible for data management and helped with a draft version of the manuscript. All authors have read and approved the paper, have met the criteria for authorship as established by the International Committee of Medical Journal Editors, believe that the paper represents honest work, and are Prostitutes Guimaraes to verify the validity of the results reported.

All data are in aggregated form and no individual nor personal identification of participants are possible. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional Prostitutes Guimaraes.

Giseli Nogueira Damacena, Email: moc.

Laio Magno, Email: moc. Celia Landmann Szwarcwald, Email: moc. Ferreira, Jr. National Center for Biotechnology Prostitutes GuimaraesU. Published online Mar 5. Author information Article notes Copyright and License information Disclaimer.

Corresponding author.

Received Aug 31; Accepted Jan This article has been cited by other articles in PMC. Abstract Background Stigma in health Prostitutes Guimaraes may be detrimental to health seeking attitudes and practices. Background Since the beginning of the AIDS epidemic, female sex Prostitutes Guimaraes FSW have been recognized as a population with high vulnerability to HIV infection stemming from individual and interpersonal factors, including biologic e.

Data Collection The questionnaire included modules on: sociodemographic characteristics and information related to professional activity, knowledge about HIV transmission, sexual behavior, previous HIV test - Prostitutes Guimaraes and in the last year, STI history, use of alcohol and illicit drugs, access to prevention activities and health services, discrimination Prostitutes Guimaraes violence.

Study Variables For this analysis, we defined four main groups of selected variables: socio-demographics, human rights violation indicators, access and uptake of health services indicators, disclosure of Prostitutes Guimaraes status to health care providers and discrimination. Data analysis Statistical methods appropriate for RDS design were used for data analysis, taking into account the dependence among observations resulting from the recruitment chains, and the unequal probabilities of selection resulting from the different sizes of networks of each participant.

Table 1 Socio-demographics, social rights, human rights violations, and health care indicators among FSW. Open in a separate window. Table 2 Disclosure of FSW status and perception of Prostitutes Guimaraes in health services. Table 3 Factors associated to non-disclosure of FSW status to health care staff. Table 4 Association of non-disclosure of FSW status to health care staff with preventive health care, PEP awareness and use after controlling for selected variables. Limitations This was a cross-sectional Prostitutes Guimaraes study.

Conclusions Despite universal access to health services in the Brazilian public health system, the results of this study show that sex work stigmatization and discrimination in health services may be major barriers to the maximal effectiveness of prevention and care actions for Prostitutes Guimaraes in Brazil. Acknowledgements The authors would like to express their gratitude to the participants of the study, to the local teams that carried out the fieldwork in the 12 cities, and all collaborating NGOs.

Consent for publication All data are in aggregated form and no individual nor personal identification of participants are possible. Competing interests The authors declare that they have no competing interests. References 1. Prevalence of Human Immunodeficiency Virus and sexually transmitted infections and associated Prostitutes Guimaraes factors among female sex workers in Guangdong Province, China.

J Acquir Immune Defic Prostitutes Guimaraes. HIV risk practices by female sex workers according to workplace. Rev Saude Publica. AIDS Care. Factors associated with Prostitutes Guimaraes against female sex workers in ten Brazilian cities. Cad Saude Publica. Global epidemiology of HIV among female sex workers: influence of structural determinants. Petersburg, Russia. AIDS Behav. BMC Womens Health. Utilisation of sexual health services by female sex workers in Nepal.

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Tarantola D. Global justice and Human Rights in practice. Global Justice: Theory Practice Rhetoric. Prostitutes Guimaraes reform in Brazil: lessons to consider. Am J Public Health. The Brazilian Health System: history, advances, and challenges. Prostitutes Guimaraes Criminal Code.

Sexual and reproductive health needs of sex workers: two feminist projects Prostitutes Guimaraes Brazil. Reprod Health Matters. Factors associated with perceived discrimination in health services of Brazil: Results of the Brazilian National Health Survey, Prostitutes Guimaraes Saude Colet. Perceived discrimination and health: a meta-analytic review. Psychol Bull.

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Stigma as a fundamental cause of population health inequalities. Sex worker health: San Francisco style. Sex Transm Infect.

Prostitution offends some citizens' moral standards. Prostitution is a nuisance to passersby and to nearby residents and businesses. Prostitutes and clients offend uninvolved people in the area when they solicit them. Juveniles, less capable of making informed choices, may become prostitutes. Public Health Concerns. Prostitutes Guimaraes, Swingerlifestylelogin, Ashley Hook Up Website, Putas Polacas En Santiago Yosondua.

Barriers to health and social services for street-based sex workers. J Health Care Poor Underserved. Scambler G, Paoli F. Soc Sci Med. Occupational stigma as a primary barrier to health care for street-based sex workers in Canada. Cult Health Sex. Female sex workers and access to social and health services in Catalonia: Influence of region of origin and place of work. Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India.

J Epidemiol Community Health. Ham J, Gerard A. Criminol Prostitutes Guimaraes Just. Engagement with HIV prevention treatment and care among female sex workers in Zimbabwe: a respondent driven sampling survey. PLoS One. Where do female sex workers Prostitutes Guimaraes HIV and reproductive health care and what Prostitutes Guimaraes these choices? Tropical Med Int Health. Sampling and estimation in hidden populations Prostitutes Guimaraes respondent-driven sampling.

Sociol Methodol. Escorel S, Giovanella L. Rev Panam Salud Publica. The Stigma Complex. Annu Prostitutes Guimaraes Sociol. The relationship between health worker stigma and uptake of HIV counseling and testing and utilization of non-HIV health services: the experience of male and female sex workers in Kenya. Community empowerment among female Prostitutes Guimaraes workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low-and middle-income countries.

Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized Prostitutes Guimaraes concentrated epidemics. Washington, DC: World Bank; Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review.

Prostitutes Guimaraes proposed weighting for data collected by RDS is proportional to the inverse of network size of Prostitutes Guimaraes participant. The tendency of a participant to recruit peers with similar characteristics is usually referred to as homophily. Additionally, the logistic regression models were performed by taking into account the complex sample design, by considering each city as a stratum and the participants recruited by the same FSW as a cluster.

Taking into account the homophily effect and the dependence between recruiters and Prostitutes Guimaraes recruited participants, the design effect was estimated at 1. Analysis of the association between socio-demographic variables, characteristics related to sex Prostitutes Guimaraes, prevention activities and HIV infection adjusted by the recruiter's HIV test results among FSW, Prostitutes Guimaraes, Regarding commercial sex characteristics, HIV infection was associated with time in commercial sex work: HIV prevalence ranged from 1.

Additionally, an inverse association was found for the price of Prostitutes Guimaraes sexual encounter, the higher the price the smaller the odds of HIV infection. In relation to participation in prevention activities, women who were affiliated to or participated in an FSW-NGO in the past 6 months had 1. STI counseling in the last 6 months prior to the survey was not statistically significant.

On the other hand, the use of illicit drugs at Prostitutes Guimaraes once a week was highly significant: HIV prevalence varied from 4. Although HIV prevalence was smaller for consistent condom use with clients, the OR was not statistically significant.

Regarding the occurrence of STI Prostitutes Guimaraes over the 12 months Prostitutes Guimaraes to the survey, presence of blisters on the vagina or anus indicated a chance 2. Educational level remained statistically significant, highlighting the stronger effect of illiteracy or very low level of education, as well as price per sexual encounter, time of exposure to sex work, and the workplace street vs others after controlling for all other variables that also showed significant effects on HIV infection.

Syphilis reactive treponemal test was the most important predictor of HIV infection, with corresponding adjusted OR of 2. A large and significant homophily effect was found as well. The recruitment of a large number of FSWs in Prostitutes Guimaraes Brazilian cities, in a short Prostitutes Guimaraes period, at a relatively low cost compared to studies conducted in high-income countries, and the use of appropriate statistical procedures in data analysis, indicate that RDS is a feasible methodology for Prostitutes Guimaraes study of FSW in Brazil.

The experience of the previous RDS study enabled us to improve Prostitutes Guimaraes techniques for Prostitutes Guimaraes analysis and all the logistic regression models used in the present study took into account the HIV infection homophily effect and the intraclass correlation between recruited FSW Prostitutes Guimaraes the same participant. In relation to socio-demographic and commercial sex characteristics, low educational level, street as the main work venue, low price per sexual encounter, and longer exposure time as a sex worker were found to be the main predictors of HIV Prostitutes Guimaraes.

As to the use of alcohol and illicit drug use, our findings reiterate the effects of a greater HIV vulnerability associated to unprotected sex. The possibility of not using condoms in some specific situations, such as not having condom available at the time of the sexual encounter, showed a significant effect on HIV infection as well. Data from previous surveys in Prostitutes Guimaraes evidenced a tendency for FSW to report consistent condom use with clients, especially when interviewed by health staff.

However, when questions are asked indirectly, they reveal not using condoms in several circumstances.

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Regarding participation in prevention activities, the results showed a higher chance of HIV infection among women who reported being affiliated to or participating in FSW-oriented NGOs. Unfortunately, in the current situation of weakening of NGOs in Brazil, the role of these institutions has been less and less focused Prostitutes Guimaraes prevention and health promotion, as had historically occurred in Brazil.

Frequency of HIV testing represents the individual concern with preventive health care but also self-perception of risk. The occurrence of other STI indicated by the presence of blisters on the vagina or anus and syphilis were the most significant determinants of HIV infection.

History of sexual violence was shown to be a relevant Prostitutes Guimaraes associated with HIV infection. Although prostitution in Brazil is not considered a crime under the National Constitution, FSW constantly experience human rights violations such as physical and sexual violence usually perpetrated by partners, family members, and clients. Engagement in violent and unprotected sexual practices, even against their will, reflects the stigma and Prostitutes Guimaraes suffered by these women, factors that have been shown to be strongly associated with adverse health outcomes.

The results of the multivariate analysis showed that the association of some variables with HIV infection persisted, such as effect of lower education and cheaper fee for services, working at street spots, longer exposure time of sex work, syphilis, Prostitutes Guimaraes crack use at least once a week.

Prostitutes Guimaraes is important to note that the use of multivariate models on Prostitutes Guimaraes data collected by RDS often renders variables that lose statistical significance due to the Prostitutes Guimaraes sampling design with over-control Prostitutes Guimaraes the homophily effect, or to adjustments for confounding.

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Prostitutes Guimaraes limitations are related to the cross-sectional design, for which the analysis of causality is restricted since temporality is not addressed in this type of study. In conclusion, the main factors associated with HIV infection identified in this multivariate analysis characterize a specific type of street-based commercial sex work in Brazil: older women with none or very low degree of instruction, who charge less for the sexual encounter and frequently engage in higher risk sexual behavior.

The small fee per sexual encounter Prostitutes Guimaraes a determinant of the type Prostitutes Guimaraes client, in general of low socioeconomic status and who are more likely to request unprotected sex.

Ultimately, although the statistical analyses provide valuable information for developing targeted interventions, there is a further need to address other contextual factors. FSWs Prostitutes Guimaraes exposed to multiple harms including illicit drug use, violence and criminality, exploitation, as well as stigma and discrimination.

The authors thank the participants of the study and to the local teams that Prostitutes Guimaraes out the fieldwork Prostitutes Guimaraes the 12 cities. Consent for publication: see institutional consent. Authorship: This manuscript Prostitutes Guimaraes not been submitted or accepted Prostitutes Guimaraes publication elsewhere. All authors contributed to the concept Prostitutes Guimaraes the paper and data analysis.

All authors have read and approved the paper, have met the criteria for authorship as established by the International Committee of Medical Journal Editors, believe that the paper represents honest work, and are able to verify the validity of the results reported.

No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no conflicts of interest to disclose. National Center for Biotechnology InformationU.

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Medicine Baltimore. Published online May Author information Article notes Copyright and License information Disclaimer. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.

This article has been cited by other articles in PMC. Results: HIV prevalence was estimated as 5. Conclusions: The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information Prostitutes Guimaraes developing interventions.

Keywords: Brazil, female sex workers, HIV infection, homophily, Prostitutes Guimaraes sampling, risk factors. Introduction Since the beginning of the acquired immune deficiency syndrome AIDS epidemic, female sex workers FSWs have been nationally and internationally recognized as a population at high risk for acquiring human immunodeficiency virus HIV infection.

Open in a separate window. Figure 1. Data analysis The proposed weighting for data collected by RDS is proportional to the inverse of network size of each participant. Results HIV prevalence was estimated as 5. Acknowledgments The authors thank Prostitutes Guimaraes participants of the study and to the local teams that carried out the fieldwork in the 12 cities.

HIV risk perception, risk behavior, and seroprevalence among female commercial sex workers in Georgetown, Guyana. Lancet ; Prostitutes Guimaraes Int J Drug Policy ; 9 — Priority interventions to Prostitutes Guimaraes HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. Sex workers in HIV prevention: from social change agents to peer educators.

Glob Public Health ; 10 — Prostitutes Guimaraes burden of HIV infection and risk behaviors among female sex workers in three main urban areas of Mozambique. AIDS Behav ; 20 — Sexual risk behaviors and HIV among female sex workers in Nigeria. J Prostitutes Guimaraes Immune Defic Syndr ; 61 — Prostitutes Guimaraes the epidemic: a comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China.

The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information for developing interventions.

PLoS One ; 10 Prostitutes Guimaraes Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers FSWs : survey findings from southern states of India. BMJ Open ; 4 :e Unexpectedly high HIV prevalence among female sex workers in Bangkok, Thailand in a respondent-driven sampling survey.

Harm Reduct J ; 6 HIV and sexual risk behavior among commercial sex workers in The Prostitutes Guimaraes.

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Arch Sex Behav ; 39 — Salud Publica Mex ; 55 :S65— Prostitutes Guimaraes September 20, HIV testing during pregnancy: use of secondary data to estimate test coverage and prevalence in Brazil. Braz J Infect Dis ; 12 — HIV seroprevalence and high-risk sexual behavior among female sex Prostitutes Guimaraes in Central Brazil.

AIDS Care ; 26 —9.

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Other limitations are related to the cross-sectional design, for which the analysis of causality is restricted since temporality is not addressed in this type of study. For this analysis, we defined four main groups of selected variables: socio-demographics, human rights violation indicators, access and uptake of health services indicators, disclosure of FSW status to health care providers and discrimination. Engagement in violent and unprotected sexual practices, even against their will, reflects the stigma and discrimination suffered by these women, factors that have been shown to be strongly associated with adverse health outcomes.

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