Exploring Associations between Sex Work Social Cohesion, Sex Work Stigma, Mental Health and Violence Among Gender Diverse Sex Workers in Jamaica: Implications for Strengths-Focused Interventions

Background: Empowerment and social support among sex workers is health promoting. Sex work social cohesion, an indicator of community empowerment, is multifaceted and includes mutual aid and support. Prior research has demonstrated that sex work social cohesion is associated with reduced HIV vulnerabilities, yet there is less knowledge of the ways that sex work social cohesion may be associated with improved mental health and reduced violence exposure. This is particularly true among gender diverse sex workers in Jamaica, who experience community level stigma, sex work criminalization, and criminalization of same sex sexual practices. The objective of this paper is to explore sex work social cohesion and its associations with sex work stigma, mental health and violence exposure among gender diverse sex workers in Jamaica. We will also discuss implications for practice, intervention and future research.

 

Methods: We conducted a community-based research project in collaboration with Sex Work Association of Jamaica and Jamaica AIDS Support for Life with a peer driven chain recruitment sample of sex workers (inclusive of cisgender men, transgender women, and cisgender women) in Kingston, Montego Bay, Ocho Rios and surrounding areas. Peer research assistants conducted a tablet-based cross-sectional survey to explore social and structural factors associated with health and wellbeing. Sex work social cohesion was measured on a 14-item scale. Structural equation modelling (SEM) using maximum likelihood estimation method was conducted to examine the direct and indirect effect of sex work social cohesion on types of violence experienced from clients, intimate partners, and community members and depressive symptoms, with the potential mediating effects of sex work occupational stigma and binge drinking

Results: Among 340 sex workers in Jamaica, 124 (36.47%) were cisgender men, 101 (29.71%) were transgender women, and 115 (33.82%) were cisgender women. The mean age was 25.77 (SD=5.71, range 17-57). Multivariate linear regression results indicated that higher depressive symptoms were associated with lower levels of sex work social cohesion (Acoef: -0.04, 95% CI: -0.07 to -0.02). More violence experiences were associated with lower levels of sex work social cohesion (Acoef: -0.02, 95% CI: -0.04 to -0.01), and sex work stigma (Acoef: 0.17, 95% CI: 0.12 to 0.22), controlling for socio-demographic factors. SEM results revealed that sex work social cohesion has both significant direct and indirect effects on depressive symptoms (β=-0.046 for direct effect, p<0.001; -0.009 for indirect effect, p<0.001). Sex work stigma partially mediated the relationship between sex work social cohesion and depressive symptoms. The direct path from sex work social cohesion to violence experiences was significant (β=-0.028 for direct effect, p<0.001; -0.020 for indirect effect, p<0.001) and sex work stigma and binge drinking partially mediated this relationship.

 

Implications:Findings suggest the promise of interventions focused on community empowerment strategies, such as fostering sex work social cohesion, for lowering sex work stigma, fo rpromoting mental health, and violence reduction with gender diverse sex workers in Jamaica. Strengths-focused and harm reduction strategies can consider the multi-dimensional nature of social cohesion among sex workers, to further support the ways in which sex workers build community and solidarity.