LAUSR

The COVID-19 pandemic has disproportionately impacted people of color as well as those affected by systemic poverty (Gross et al., 2020; Human Rights Campaign, 2020). Urbanbased sex workers are another subpopulation at increased risk for contracting COVID-19. Unstable housing, IV drug use, increased criminalization, and limited access to care put sex workers at greater risk of contracting COVID-19 (Human Rights Campaign, 2020; Platt et al., 2020) Although the term sex worker can be defined in multiple ways, for the purpose of this Letter, sex workers are adults who trade oral, anal, and/or vaginal sex for something of value. Although largely neglected in current COVID-19 risk reduction efforts, it is well established that the health and well-being of sex workers is inextricably linked to the health and wellbeing of their clients and to the broader public (Patterson et al., 2009). As such, tailored harm reduction interventions aimed at increasing the use of personal protective equipment among sex workers and their clients may help to reduce the overall burden of COVID-19 infections, hospitalizations, and resulting deaths in urban settings. The social response, isolation, experience of stigma and the health disparities of COVID-19 are, in many ways, comparable to that of the HIV/AIDS pandemic, especially as it applies to those engaged in sex work. Similar to HIV, complex structural and social factors create unique challenges to targeting COVID-19 health promotion and disease prevention efforts for sex workers (Shannon et al., 2018). Those who exchange sex may regularly experience the social repercussions of stigmatized and criminalized work (Benoit, Jansson, Smith, & Flagg, 2018; Lutnick, 2019), including a lack of access to health care (Krüsi et al., 2014; Shannon et al., 2018). Research has shown that some sex workers also report increased experiences of homelessness, unemployment, incarceration, mental illness, drug use, and various forms of personal and structural/systemic violence and abuse (Benoit et al., 2019; Human Rights Campaign, 2020; Krüsi et al., 2014; Platt et al., 2020). All of these intersecting experiences impact sex workers’ ability to access health care and limit their ability to adhere to COVID-19 prevention practices. Furthermore, criminalization, targeted policing, and environments that limit worker agency impact sex workers’ abilities to practice harm reduction and health promotion behaviors (Benoit et al., 2019; Herek 2004; Shahmanesh, Patel, Mabey, & Cowan, 2008; World Health Organization 2014). As with successful HIV prevention initiatives with sex workers, targeted COVID-19 prevention efforts must also take into account structural barriers to virus prevention and health promotion. Sex workers would benefit from COVID-19 interventions informed by evidence-based, community-empowered HIV prevention initiatives. For example, Getting to Zero (GTZ) new HIV infections by 2030 is an important public health plan that recognizes the significance of increasing HIV prevention, and the role of self-management and harm reduction for marginalized populations. Similar to community-empowered HIV responses, targeted COVID-19 prevention efforts are needed for people engaged in sex work (World Health Organization et al., 2013). In this Letter, we draw on preliminary analysis from our study, Centering and Empowerment: The Road to Reducing HIV and STIs in Chicago’s Sex Worker Community, to inform public health researchers, clinicians, and health educators about the current status of sex work during the * Randi Singer [email protected]