RESUMO
OBJECTIVES: People involved in commercial sex work during the COVID-19 pandemic, particularly those compelled to sell sex, faced multiple challenges to their safety and well-being. We explored, in real time, the impact of the COVID-19 pandemic on people involved in commercial sex work and the broader commercial sex industry. METHODS: Using a participatory action research approach, we interviewed 159 English- and Spanish-speaking adults who had engaged in commercial sex work under the direction of a third party in Sacramento County, California, within the past 5 years (approximately 2017-2022). As part of a larger study, our interview protocol included 1 question about the COVID-19 pandemic: "Has COVID-19 changed anything about your experience with sex work?" We transcribed and analyzed interviews using QSR-NVivo, a qualitative coding software. RESULTS: Participants described the effects of increased isolation, decreased demand, difficulty accessing social services, fear of contracting COVID-19, difficulty in following public health guidance on social distancing and wearing face masks, and how the pandemic resulted in some people entering or exiting commercial sex work. Most participants were familiar with recommended public health safety measures, but lack of agency and financial need limited their ability to comply with all recommendations. A lack of access to social services added stress to those most in need of emergency housing or substance use treatment and left them vulnerable to continued abuse. CONCLUSIONS: Stress and financial insecurity generally increased among people involved in commercial sex work during the pandemic, and no efforts were made to understand and mitigate the hardships that this population faced. Future research should address how to maintain social service availability during times of public health emergencies and other crises.
RESUMO
BACKGROUND: Little is known about the impact of trauma-informed primary healthcare on recovery from human trafficking, or individual characteristics associated with successful participation in community services. OBJECTIVE: To evaluate the efficacy of a trauma-informed family medicine clinic, the Medical Safe Haven ("MSH"), in facilitating success in a community-based anti-trafficking victim service program, Community Against Sexual Harm ("CASH"), and to identify participant characteristics associated with successful CASH completion. METHODS: Retrospective analysis of data from 57 adult females participating in the CASH program, 37 of whom received care at MSH. We examined differences in descriptive statistics between those who completed the CASH program and those who did not; then conducted logistic and linear regressions testing the association between MSH care and CASH program outcomes. Survival analysis models examined the time to CASH program drop-out (program incompletion). RESULTS: Odds of successful CASH completion increased by a factor of 5.37 for MSH patients compared to other participants. This association strengthened with increases in the duration of MSH care and degree of patient engagement. The positive association of MSH care on program completion was mediated by the length of program participation. The extended length of participation among MSH patients was even stronger when those patients were in a stable and independent housing situation. The risk of program incompletion was 68% lower for MSH patients compared to other participants. CONCLUSIONS: Adults who experience human trafficking and receive healthcare at MSH are significantly more likely to successfully complete the CASH program than those who do not receive healthcare or who use alternative health systems. Study findings argue for the importance of consistent, trauma-informed longitudinal healthcare for trafficked persons.