Promise Project

Female sex workers (FSWs) face heightened health risks, particularly from HIV, which accounts for 8% of FSW deaths in low- and middle-income countries. Adherence to antiretroviral therapy (ART) remains suboptimal and few studies have explored drivers of ART non-adherence among FSWs who died from HIV in sub-Saharan Africa. Using a community knowledge approach methodology, data on HIV-related deaths among FSWs were collected from a convenience sample across Kenya, Nigeria, and the Democratic Republic of the Congo between 1 February 2022, and 28 February 2023. Participants were recruited through local sex worker organizations and non-governmental organizations. A structured questionnaire was used to collect demographic data, HIV treatment history, and reasons for ART non-adherence from participants about the deaths of FSWs they knew of personally. A qualitative descriptive analysis was used to code the interviews for reasons for ART non-adherence. A total of 853 FSWs reported the deaths of 445 peers who had died from HIV/AIDS. The mean age at death was 27 years; 70.6% were mothers. Among the deceased, 95.1% were not taking antiretrovirals at the time of their death, and 90% had stopped using ART, rather than never initiating treatment. The most cited reasons for ART non-adherence were food insecurity (97; 22.9%), alcohol and drug use (44; 10.4%), depression (57; 13.5%), and stigma (24; 5.7%). HIV-related deaths among FSWs in these three sub-Saharan African countries are associated with food insecurity, mental health issues, substance use, and stigma. Improving access to ART alone is insufficient to reduce mortality.

Individuals with a criminal record often face significant barriers to opportunities, including those related to employment, housing, and education. Although options for criminal record clearing exist, few eligible individuals take advantage of these pathways to relief, as relevant information can be difficult to access, and the processes can be considerably costly. Aiming to expand the pursuit of record relief in Philadelphia, a local nonprofit, in partnership with City Council, has been sponsoring neighborhood events where individuals can meet with legal organizations, for free, in their own communities to learn about their records and the forms of relief for which they may be eligible. Then, eligible individuals can choose to partner with the participating legal organization to pursue record clearing in the forms of sealing, expungement, and/or pardon. Researchers attended the initial three clinic events to evaluate operations—through interviews with attendees, feedback from community-based organizations and legal staff, and structured observations—and provided rapid qualitative feedback. Lessons learned from these clinics, including those related to event advertising and access, event experience, and legal clinic experience were shared and leveraged to maximize ongoing clinic programming.

Previous studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraception, safe abortion, and post-abortion care.

ABSTRACTThe goal of this exploratory study was to identify health problems experienced by children whose mothers are trafficked or in sex work in the U.S. and the proportion of the children who experience these health problems. Participants were adult survivors of sex trafficking and adult women in sex work. They were asked about the health of children whose mothers were trafficked or in sex work but not about their own children. This approach allows participants to discuss sensitive issues but without having to share potentially negative information about their own children. Participants were asked to identify the common and serious health problems among the children based on their observations, to rank the problems in order of seriousness, to estimate the percentages of the children who experience certain health problems, and to identify the causes of death among the children. There were numerous reports of birth defects, fetal alcohol syndrome, blindness, neonatal abstinence syndrome, and physical and sexual abuse. Nearly a third of respondents (31%) knew of the death of a child whose mother was trafficked or in sex work, and 11% reported they knew of the death of a child due to physical abuse. The majority of respondents (89%) reported that some daughters are trafficked into prostitution. The median estimate of the percentage of daughters who are trafficked was 50%. Children born to trafficked adolescents and adult female sex workers in the U.S. are potentially at high risk for many serious and fatal health problems. The magnitude of these health problems is poorly understood but warrant urgent attention.