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Table 1 Emergent themes on work environment influences on HIV prevention from sex worker narratives, 2008–2014 (n = 24 studies)

From: Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives

Theme Features that support HIV prevention Features that undermine HIV prevention
Occupational health & safety standards in indoor venues • Where occupational health & safety are provided in formal indoor spaces, SWs experience enhanced power to negotiate condom use, less violence, access to care, sharing of information and advice [37, 39, 40, 49, 53, 57] • Operating in isolated, informal spaces often linked to greater susceptibility to violence, barriers to sexual risk negotiation [39, 10]
• Enhanced vulnerability in isolated, informal settings can impede sexual health and enhance vulnerability to violence [38, 40, 10, 4547]
Influence of third parties • Manager support/policies for HIV prevention promotes condom norms, access to information [38, 49]
• Protection against client violence by third parties in some indoor venues (e.g., security guards, manager policies on violence) can assist in preventing violence and enables sexual negotiation [37, 41, 42]
• Close relationships between managers and workers in managed indoor spaces facilitate condom promotion and access to HIV/STI and health information [56].
• Support from managers/supportive establishment policies available in some informal indoor venues, but often depended on type of relationship [50]
• Lack of manager supports, particularly within criminalized environments results in limited support and a lack of access to condoms, HIV/STI prevention [46, 51, 52]
• Manager pressure to service clients quickly/satisfy clients’ needs leads to pressure for unprotected sex. [39, 53]
• Concern of manager exploitation or restriction of autonomy relates to reduced control over HIV prevention, extortion for sex [46, 53]
• In more informal settings, health protection often left to the individual worker, with a lack of managerial support [50]
Sex worker/peer support • Peer support within the workplace linked to positive outcomes including role modeling, sharing of HIV/STI information, condom negotiation strategies, and support for dealing with difficult clients [49, 56, 57]
• Workplaces that promote cooperation, rather than competition, between workers enhanced workers’ power to negotiate condom use and strengthened condom use norms at a venue level [37, 39]
• Peers support for HIV prevention also included facilitating access to HIV/STI testing and condoms (e.g., by purchasing in bulk to have available in the venue, lending condoms) [56]
• Lack of social support at work or ability to work with peers related to social isolation, less exposure to advice or information on condom negotiation and sexual health, violence, and enhanced susceptibility to exploitation at work promoted workers’ vulnerability [41, 46, 58]
Interactions with police • Access to police protections and the ability to work without criminalization fostered the creation of trusting relationships with police, ability to report violence, and ability to negotiate sexual transactions without fear of negative consequences [39] • Harassment, raids, arrest, or detention by police linked to displacement and undermines sexual negotiation [57, 59]
• Fear of police harassment, abuse, and arrest and confiscation of harm reduction equipment posed critical barriers to accessing/carrying condoms and other HIV prevention supplies [10, 44]
• Direct impacts of police harassment, abuse, and arrest included HIV/STI risks as a result of sexual violence, rape, and sexual abuse by police [45, 46]