COVID-19: pregnancy, childbirth and breastfeeding – statements & guidance

Various sources, March 2020

Sex Work & COVID-19: Guidelines for Sex Workers, Clients, Third Parties, and Allies

Butterfly Asian and Migrant Sex Workers Support Network and Maggie’s Toronto Sex Workers Action Project, 2020

The COVID-19 outbreak has created a lot of stress and panic, but sex workers are and always have been resourceful and resilient.  We are experts in keeping ourselves and our communities safe. We’ve been doing it for decades! We would like to share our wisdom and learn from each other on how to overcome this current challenge.

The COVID-19 pandemic has placed many sex workers in a particularly difficult situation. While social distancing is strongly advised, it is particularly challenging for contact sex workers (full service workers, strippers, massage workers, professional dominants, etc), queer and trans sex workers, Black and Indigenous People of Colour (BIPOC) workers at the margins, and otherwise low-income workers to adhere to these
recommendations. We recognize that many sex workers will need to go about their
business as usual. That is the reality of surviving in a capitalist society while enduring
criminalization and stigmatization.

This document follows a harm reduction approach, offering guidelines from various sources to help lower the risk of contact and transmission to those who must continue in-person sex working.

Knowing that each sex worker’s work is unique, we encourage each of our community members to know how transmission occurs, how that fits with your individual work, and what decisions can be made for your specific situation to reduce as many risks as possible for yourself and others.

We have also included guidelines for clients, third parties, allies, and healthcare providers on how to best support sex workers during this time.

Coronavirus disease (COVID-19), HIV & hepatitis C: What you need to know

CATIE (Canada), 17 March 2020

  • An HIV-positive person on effective treatment is not expected to be at higher risk of becoming seriously ill with COVID-19
  • A person with untreated HIV or a low CD4+ cell count may be at higher risk of becoming seriously ill with COVID-19
  • People with HIV or hepatitis C are more likely to have other conditions that carry a greater risk of becoming seriously ill with COVID-19

 

 

Delayed linkage to HIV care among asylum seekers

Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, CanadaBMC Public Health 191683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

Are We Blinded by Desire? Relationship Motivation and Sexual Risk-Taking Intentions during Condom Negotiation

The Journal of Sex Research, Shayna Skakoon-Sparling & Kenneth M. Cramer (2019) DOI: 10.1080/00224499.2019.1579888

ABSTRACT

Effective condom negotiation skills support better sexual health for both men and women. The current study explored relationship motivation (motivation to establish and maintain long-term romantic relationships), gender, and sexual orientation as factors influencing the condom negotiation process.

Participants (177 heterosexual women, 157 heterosexual men, and 106 men who have sex with men) read a vignette describing an encounter with a hypothetical new sexual/romantic partner and responded to embedded items and scales.

Stronger relationship motivation predicted increased willingness to have condomless sex among women who perceived greater familiarity with the hypothetical partner. Gender and sexual orientation predicted different preferences for condom insistence strategies.

The findings suggest that there are a number of conditions that make it more difficult to recognize risk during a sexual encounter and demonstrate how the process of condom negotiation can be impacted by gender, sexual orientation, and relationship motivation.

Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care

Identifying and Plugging the Leaks: Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care

CTAC (Canadian Treatment Action Council), 2018

This project explored what issues impact engagement by people living with HIV with healthcare in Ontario. The goal was to identify policy issues that impact treatment access for people living with HIV, and to identify opportunities to make the healthcare system more accessible.

The HIV Cascade of Care is a useful description of the different steps that a person living with HIV will need to take in order to achieve an undetectable viral load and optimal health outcomes, from infection and diagnosis through to Antiretroviral Therapy (ART) initiation and viral suppression.

We know people drop out of the HIV Cascade of Care – e.g. why those starting treatment don’t stay on it. By seeking out policy barriers and developing solutions we can enable people to live long, healthy, and happy lives.

The project has five recommendations around barriers to engagement in the HIV Cascade of Care.

Download report here