Exploring the protective role of sex work social cohesion in contexts of violence and criminalisation: A case study with gender-diverse sex workers in Jamaica

Abstract

Background: Sex work social cohesion (SWSC) is associated with reduced HIV vulnerabilities, yet little is known of its associations with mental health or violence. This is particularly salient to understand among gender-diverse sex workers who may experience criminalisation of sex work and same-gender sexual practices. This chapter explores SWSC and its associations with mental health and violence among sex workers in Jamaica. Methods: In collaboration with the Sex Work Association of Jamaica (SWAJ) and Jamaica AIDS Support for Life, we implemented a cross-sectional survey with a peer-driven sample of sex workers in Kingston, Montego Bay, and Ocho Rios. Structural equation modelling (SEM) was conducted to examine direct and indirect effects of SWSC on depressive symptoms and violence (from clients, intimate partners, and police), testing the mediating roles of sex work stigma and binge drinking. SWAJ developed an in-depth narrative of the lived experiences of a sex worker germane to understanding SWSC. Results: Participants (N = 340; mean age: 25.77, SD = 5.71) included 36.5% cisgender men, 29.7% transgender women, and 33.8% cisgender women. SEM results revealed that SWSC had significant direct and indirect effects on depressive symptoms. Sex work stigma partially mediated the relationship between SWSC and depressive symptoms. The direct path from SWSC to reduced violence was significant; sex work stigma partially mediated this relationship. Implications: Strengths-focused strategies can consider the multidimensional role that social cohesion plays in promoting health and safety among sex workers to further support the ways in which sex workers build community and advocate for rights.