RESUMO
Most research on sex workers globally has focused on cis women sex workers vulnerabilities including violence, risk for HIV/AIDS, and stigma. Despite the plethora of studies on the topic, older sex workers are significantly underrepresented in research. We used a phenomenological approach to highlight street and home-based sex workers' experiences. Using a purposive sampling strategy, 39 cis women sex workers were recruited from Karnataka, India and data were collected using in-depth interviews and focus group discussions. Findings revealed a range of changes in sex workers' lives as they aged, financial instability, lack of alternate livelihood options, and limited access to governmental benefits and social security. Participant narratives challenged the notion of anticipated traditional familial support especially from their grown children. Findings were replete with instances of sex workers' personal agency to confront personal and professional challenges. Peer networks formed the biggest forms of support as were sex workers' connections with local community-based groups. There is an urgent need for helping professionals to recognize the ongoing marginalization faced by older sex workers. It is critical to address concerns broadly along with inequities in terms of access and power as experienced by older sex workers. Finally, examining the differential impact of ageism, structural barriers including neglect by the State, violence, and stigma that follow sex workers is vital.
RESUMO
In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice.
RESUMO
Public health crises alter political landscapes. This article investigates social movement strategies during and between the HIV and COVID-19 pandemics. We conducted a set of eighteen in-depth interviews with eleven leaders of organisations working with sex workers, sexual minorities, and transgender people around India, all of whom had been actively involved in HIV prevention programs, before and after the arrival of COVID-19 in India. First HIV, and then COVID-19, altered the political landscape for these groups in relation to three types of institutions: (1) donors (by creating dramatic increases and decreases in the amount, type, and conditions of global funding and deepening inequalities among organisations) (2) the state (by shifting the balance of advocacy and human rights work toward immediate relief); and (3) other social movements (by expanding solidarities across groups but also placing them in competition for limited resources). We argue that, to weather these dramatic shifts, organisations relied on internal alliances and resources built in and after periods of crisis. In this way, despite the differences between the two pandemics, the legacies of HIV shaped the response to COVID-19. Though responses to COVID-19 seem improvised and temporary, they build on a longer-term social movement infrastructure.