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      Strengthening participation by young women sex workers in HIV programs: reflections on a study from Bangkok, Thailand

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          Abstract

          Background

          Participation is an accepted means of increasing the effectiveness of public health programs, and as such, it is considered an important component of HIV interventions targeting at-risk youth. The situation of young women sex workers in Thailand is alarming on many fronts, including that of HIV risk. As a result, HIV programs in Thailand are the key interventions undertaken in relation to young women sex workers’ health. A small-scale study used semistructured interviews to explore the participation reports of five young women sex workers, as well as the related views of two community support workers, who lived and worked in Bangkok, Thailand.

          Discussion

          This study is considered in the light of current research on – as well as new opportunities and challenges offered for – participation by vulnerable groups in the context of digital society. Thematic analysis of the interview data identified barriers to participation, including the illegality of sex work, fear, and lack of trust of the authorities, as well as widespread social stigma. Such barriers resulted in young women seeking anonymity. Yet, promisingly, young women positioned themselves as experts; they are involved in peer education and are supportive of greater involvement in HIV programs, such as further educational initiatives and collective actions.

          Conclusion

          There is a need for a more empowerment-oriented participation practice positioning young women sex workers as expert educators and codecision makers within a model of participation that is also accountable, such as including young women as members of program boards. Beyond current norms, there are new opportunities emerging because of the increasing availability of smartphone/Internet technology. These can support activist and codesign participation by young women sex workers in HIV programs. However, any developments in participation must maximize opportunities carefully, taking into consideration the difficult social environment faced by young women sex workers as well as the need for strategies to address illegality and stigma.

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          Most cited references 23

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          World Development Report 2016: Digital Dividends

          (2016)
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            Using thematic analysis in psychology

             V Braun,  V. CLARKE,  V Clarke (2006)
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              Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand.

              Commercial sex work is a primary context for heterosexual HIV/AIDS transmission. Violence victimisation is considered to compromise women's ability to protect against HIV and other sexually transmitted infections (STI); little research has investigated violence as it relates to sexual risk and STI among female sex workers (FSW). This study sought to compare sexual risk and STI symptoms among FSW based on recent violence exposure. Data from 815 FSW in Thailand were used to assess the prevalence of physical or sexual violence within the context of sex work, and associations of victimisation with sexual risk and STI symptoms. Approximately one in seven FSW (14.6%) had experienced violence in the week before the survey. Compared with their unexposed counterparts, FSW exposed to violence demonstrated a greater risk of condom failure (19.6% vs 12.3%, ARR 1.92, 95% CI 1.24 to 2.95) and client condom refusal (85.7% vs 69.0%, ARR 1.24, 95% CI 1.14 to 1.35). In analyses adjusted for sexual risk, violence related to STI symptoms collectively (ARR 1.11, 95% CI 1.02 to 1.21) and genital lesions as an individual STI symptom (ARR 1.78, 95% CI 1.20 to 2.66). Physical and sexual violence against FSW in Thailand appears to be common, with women experiencing such violence demonstrating diminished capacity for STI/HIV harm reduction and greater prevalence of STI symptoms. Efforts to reduce violence towards this vulnerable population must be prioritised, as a means of protecting the health and wellbeing of FSW, and as a key component of STI/HIV prevention and control.
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                Author and article information

                Journal
                Int J Womens Health
                Int J Womens Health
                International Journal of Women’s Health
                International Journal of Women's Health
                Dove Medical Press
                1179-1411
                2017
                05 September 2017
                : 9
                : 619-623
                Affiliations
                School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
                Author notes
                Correspondence: Cath Conn, School of Public Health and Psychosocial Studies, Auckland University of Technology (AUT), AUT South Campus, 640 Great South Road, Manukau, Auckland, New Zealand, Tel +64 9 921 9999, Email cath.conn@ 123456aut.ac.nz
                Article
                ijwh-9-619
                10.2147/IJWH.S141996
                5592913
                © 2017 Conn et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Obstetrics & Gynecology

                community participation, prosumer, epublic health, peer educator, stigma

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