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As of mid-June 2020, the COVID-19 pandemic has afflicted over 8 million people.1 Sex workers, in particular, have not been given due attention during the COVID-19 pandemic; rapidly emerging data show that many sex workers are experiencing extreme hardship due to a total loss of income and increased discrimination and harassment.2 Since COVID-19 was first reported in Singapore, its spread has been characterised by a sharp rise in cases among migrant workers, which led to public health concerns around the transmission risk that this population might have had with other individuals in the community, including sex workers.3 In Singapore, there exists ‘formal’ sex workers who operate out of strictly regulated brothels, alongside ‘informal’ sex workers who operate out of entertainment establishments and those who solicit clients on the streets at the red-light districts or through online channels.4
To address these growing concerns, we conducted a qualitative stakeholder analysis on the impact of COVID-19 and its concomitant control measures on the sex work industry in Singapore. This study was completed in 9 days. As researchers who have drawn on the lessons learnt and partnerships built from the local HIV response, we identified four key areas that led to the success of this study in gathering pertinent data to inform policy. First, by identifying key issues through the expertise and on-the-ground knowledge of Project X, a community-based organisation (CBO) that supports sex workers in Singapore. Second, by leveraging our pre-existing relationships with researchers, policymakers and CBOs involved in the delivery of sexual health services, we were able to identify participants with important perspectives on this issue. Third, by using online teleconferencing software to conduct interviews, expanded field notes and the analysis of secondary field notes data in lieu of verbatim transcripts,5 and applying a deductive social ecological framework to generate policy-relevant findings.6 Finally, we propose recommendations for the current context that take into consideration the country’s existing laws around sex work, ongoing policies and schemes available to individuals residing in Singapore, as well as the diverse networks, existing support structures available to sex workers, as well as the dynamics and relationships among stakeholders.
Overall, we conducted 17 in-depth interviews, alongside cyberethnographic observations on 10 virtual spaces. We found that sex workers have continued to work in spite of the movement control measures as a means of survival. We concluded that addressing the exacerbated financial and social vulnerabilities of sex workers in the context of COVID-19 would also address the public health concerns of community transmission. We eventually developed a set of pragmatic solutions that were relevant to sex workers affected by the spread of COVID-19 and its accompanying control measures. In sum, we hope that sharing our experience would highlight how community-based participatory research and engaging stakeholders in identifying key issues may further the aims of achieving equitable outcomes for those who are vulnerable to HIV, other STIs and to COVID-19 as well.
We thank Professor Teo Yik Ying, Associate Professor Hsu Li Yang and the staff at the Saw Swee Hock School of Public Health for their support of this study. We also thank all participants for their contributions to this study.
Handling editor Anna Maria Geretti
Contributors RKJT, VH and MLW conceptualised and designed the study. RKJT, JML, JJML, AKJT and MLW conducted the interviews and analysed the data. RKJT wrote the first draft of the paper. All authors contributed to final revisions to the text and read and approved the final manuscript.
Funding This study was funded by the Saw Swee Hock School of Public Health, National University of Singapore.
Disclaimer The authors' work was independent of the funders, who had no role in the design, collection, analysis or interpretation of the data or the decision to submit for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethics approval was granted by the Saw Swee Hock School of Public Health Department Ethics Review Committee (Reference: SSHSPH-028).
Provenance and peer review Not commissioned; internally peer reviewed.
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