Perception of Risk in the Context of sex Work among Venezuelan Immigrant Women and Men in Colombia

Introduction

The perception of risk is a complex process based on subjective experience and rooted in the context of daily life. The theory of social representations explains that responses to risk are based on symbolic constructions that emerge and are modified in social interactions ¹. In this sense, the protective practices that people assume depend on what they perceive as a risk-a subjective perception shaped by their interests and the social and cultural value system in which they are immersed- ².

Therefore, the perception of risk in the context of sex work among Venezuelan men and women in Colombia is a complex issue, as it must not only consider the social and cultural context in which this work is carried out in the country of destination; but must also take into account the same aspects in the country of origin, since the ability of individuals to manage risk in the practice of sex work depends on these factors. Additionally, individual aspects such as age, gender identity, sexual orientation, migratory trajectories, and migratory status, among others, contribute elements that will determine this ability.

Consequently, risk perception is mediated by social interaction, whose meanings are intersubjective and are constructed through the responses that individuals have to certain actions, which give rise to behaviors. This is part of the process that Blumer ³ called symbolic interactionism. Therefore, the meanings given in the context of sex work by Venezuelan immigrant men and women determine the behaviors they assume and, therefore, the perception and responses to risks, which are not only directed at clients who access sexual services but also at sex workers themselves, as well as affective partners. This is because meanings act as determinants of the way in which human beings behave with themselves, with other people, and in establishing their relationship with their context.

In the case of the sex workers who participated in this study, the perception of risk is a constant in their lives and is manifested in different ways. Thus, risk is valued and faced based on their personal experiences and interests, which allow them to understand the extent of this risk. For example, in relation to condom use, it acquires a distinct symbolic meaning depending on the client or the affective partner, modifying the interactions established between them ⁴.

Some studies have identified the risks perceived by sex workers, which include the fear of acquiring a sexually transmitted infection (STI), especially HIV, the risk of being assaulted by clients, the possibility that the client may report the irregular situation of the immigrant, or the consumption of psychoactive substances, among others ^5-8. However, it is not only necessary to identify risks, but also to prioritize them, as the priorities for immigrant sex workers may not focus on STIS when they are in contexts of various types of violence, or when legal aspects such as migratory irregularity, social factors like stigma and prejudice, or poverty limit their ability to respond to risks, with decision-making being subordinated to these issues.

Consequently, understanding the risk perception of male and female sex workers, considering their particularities, will allow for the identification of their priorities so that they can be considered in the design of sexual and reproductive health (SRH) programs that respond to a complex and dynamic reality, recognizing both the structural and individual aspects in which sex work is practiced.

Methods

A mixed methodology was used, combining the collection and analysis of qualitative data, which focus on quality and meaning, with quantitative data, which focus on quantity and measurement. The study was conducted in the regions of Bogotá D.C., the Metropolitan Area of Valle de Aburrá, and the Colombian coffee-growing region. The research that led to this article aimed to understand the perceptions, behaviors, and unmet needs in terms of SRH among the population of Venezuelan immigrant sex workers residing in the aforementioned regions.

Results

Discussion

Our study showed that the perception of biological risk decreases as it enters the personal, affective, and emotional level of individuals, increasing the level of exposure to them. Thus, there is a separation between the work and personal contexts for sex workers, which divides the perception of risk. Consequently, the use of condoms and their negotiation in the context of sex work is permanently established, while in the affective context, such negotiation is almost nonexistent, which corroborates what was stated by Torres ¹⁴.

Biological risk is linked to the use or non-use of condoms during sexual encounters between sex workers. This depends not only on knowledge about sus and condom use, but also on factors such as subjectivity, gender, sexual orientation, migratory status, and precarious quality of life, among others. In other words, biological risk is determined by multicausal and intersectional factors that must be analyzed precisely in order to establish strategies to reduce it.

Therefore, condom use can be considered a protective practice associated with sex work, serving as a boundary between women and their clients. However, this perception regarding condom use in transactional sex contrasts with its non-use in affective-sexual relationships ⁴. This situation highlights the symbolic use of condoms: as a barrier or physical and emotional limit with clients, and as a sign of trust and love with affective partners.

In the case of men engaged in sex work, it was observed that they accept unprotected intercourse, which increases the biological risk and proportionally decreases their ability to manage it. This situation is determined in part by the precariousness of their quality of life, a situation similar to that of Salmerón, who argues that "it is true that the economic motivation for sex work seems to be more common among immigrant male sex workers, a fact that can lead them to maintain unprotected sexual practices when the client offers them a higher amount of money" ⁶.

Thus, it is evident that men have easier access to risky practices than women. This situation stems from the beliefs, imaginaries, perceptions, and experiences that individuals have about their sexuality, where gender as a social construct reveals different normative patterns for men and women, significantly influencing the vulnerability underlying the practice of sex work. For example, some of the heterosexual and homosexual men engaged in sex work consider that as long as they do not engage in receptive sexual practices, they are not at risk of HIV infection, while most of the women interviewed consider that any sexual practice they engage in carries a biological risk.

Consequently, for authors such as Martínez-Pizarro and Reboiras-Finardi ¹⁵, the traditional epidemiological and human rights perspective on biological risks, and especially sus and HIV, should be broadened to include contextual dynamics that broaden the perspective on inequity, discrimination, and poverty among groups susceptible to the spread of HIV and the evolution of the disease. In other words, it should be recognized that "the vulnerability of migrants is not innate; therefore, their management should consider them in a continuous relationship with the context of the destination country and the situations they face" ¹⁶, understanding that these factors determine the vulnerability of migrants and how they respond to risks, as migration paves the way for changes in knowledge, perceptions, and sexual practices, which may increase the biological risk of HIV and other sus.

As for psychological risks, the lack or weakness of social and family support networks, the concealment of sexual orientation and sex work, and the limited access to social, material, economic, and cognitive resources directly influence the psychosocial health of Venezuelan immigrants engaged in sex work, becoming a psychological risk factor that leads to depression, anxiety, and other mental health disorders. In the case of men, this is particularly evident because they lack social and family support networks to cope with any situation that may arise from the exercise of this work. Although women also suffer from anxiety and depression, they have a broader and more consolidated support network than men, since female sex work is socially recognized and, although there is a high level of stigma and prejudice surrounding it, social, institutional, and personal support networks have also been consolidated around it.

It should also be noted that the cisgender and transgender women interviewed decided to tell their families about the work they do, as they consider this support network to be important in their lives. Meanwhile, in the case of men, due to the social stigma that male sex work carries and the prejudices that exist about this activity, they turn to their friends as a support network. However, this situation does not necessarily represent a strong social support network, since in most cases, these men find themselves in the same situations of individual and social vulnerability as their peers, as they sometimes have little contact with other social contexts outside of sex work. This situation prevents the interaction or exchange of accurate and real information, the creation of emotional ties, and the development of sufficient trust, which are fundamental factors for the psychosocial adjustment of male sex workers.

As for social risks, these are directly linked to psychological risks. In the case of the support networks of male sex workers, it is evident that because they constantly travel between cities in Colombia in order to get new clients and increase their economic income, there is a lack of knowledge of the social and health resources available in each city, weakening the support networks and access to sexual health services ⁴. This could explain why the interviewees did not know the sites for accessing HIV and other STI tests, nor the SRH care routes. On the contrary, female sex workers have less internal mobility, and this could be explained because they provide their sexual services in physical establishments where they stay for long periods of time, such as bars, discos, nightclubs, among others, where they have the infrastructure to develop their work. In contrast, male sex workers offer their services almost exclusively through social networks, applications for mobile devices, and websites, which gives them greater freedom to move between cities.

The same situation is seen in the socio-family support networks. It must be said that the absence or weakness of these networks directly influences psychosocial risk as they dissipate the capacity to achieve resilient management, generating measures of emotional distancing. Therefore, the weakening of the family support network stems not only from the physical distancing caused by migration but also from the fears arising from prejudice, social stigma, and discrimination that have historically criminalized female sex work and promoted the concealment of male sex work. In this sense, authors such as Ruiz and Rodríguez ¹⁷ affirmed that the support derived from social networks constitutes a primary protective factor for the migrant population.

Another social risk factor that appears in the context of migrant sex work is the consumption of psychoactive substances. However, the consumption of these substances is not directly related to the coping strategies associated with migration, but with the practice of sex work, where psychoactive substances serve different purposes. One of them has been the fact that they become a bargaining tool that brings economic benefits for sex workers. In addition, the consumption of these substances helps sex workers cope with their activity, because at times "they feel the need to consume a substance to help them cope with the stress and, sometimes, the rejection of their work" ⁶.

The use of psychoactive substances temporarily isolates the conscious state and thus reduces decision-making ability, limiting risk management and increasing the possibility of contracting sexually transmitted infections. In addition, their consumption and sexualized use are linked to the change of geographical and socio-cultural context as a result of migration, where "these elements give a new meaning to the perceptions of men and women about their bodies and sexuality, which are redefined and reconstructed under new and different parameters in migratory contexts" ¹⁸.

Within the social risks in the context of sex work, there is the risk associated with violence, including gender-based violence, which affects both cisgender and transgender women. In this regard, for "the year 2018 in Colombia, 666 femicides and 232 attempted femicides were recorded in the press for a total of 898 cases of femicide violence" ¹⁹, of which 16 femicides and 1 attempted femicide (1.9 %) correspond to Venezuelan women ¹⁹. Although these data do not link women to the practice of sex work, they do highlight the gender-based violence they face in different contexts.

However, male sex workers have also been exposed to sexual violence and, in the case of this study's participants, to a greater extent than women. This is because "clients believe that when a guy engages in sex work, he has to be willing and available for any sexual act that the client craves, as long as he is paid" ⁶.

In general, the testimonies of the research participants corroborate the fact that "in the case of women who sell sex, violence tends to be unidirectional against them, while men who sell sex are rarely attacked by their clients, and the violence they suffer almost always has to do with pressuring them to engage in unwanted or unsafe practices" ²⁰. Nevertheless, the research shows that the men interviewed are also affected by aggression, harassment, sexual abuse, and rape. These situations are determined by the places where they provide sexual services, which often place them in a position of vulnerability, compounded by the unequal relationship that is established between the client and the sex worker due to their migrant status, especially when they are in an irregular situation in the host country.

Our interviews allowed us to identify that gender-based violence comes from the partners of both male and female sex workers. The violence was justified by the participants as a response to situations of jealousy sometimes associated with sex work or linked to conflicts in the couple's relationship. The violence exercised by the partners of the interviewees has not only been physical but also verbal, psychological, and economic, which, added to the sexual violence exercised by the clients, makes sex workers more prone to the consumption of psychoactive substances and mental health problems ²¹.

Consequently, the violence to which women and men engaged in sex work may be subjected comes from different spheres and is of various types, which increases vulnerability and generates processes of systematic violence for this population. In the case of male sex workers, due to their social concealment and the stigmas and prejudices that apply to them, it is possible that acts of violence are not reported and, therefore, are omitted from public health surveillance systems.

Consequently, it is necessary to identify the priorities in the risk perception of female and male sex workers, since it is possible that the priority is not related to biological risks such as HIV or sus, when these people are suffering from various types of violence or when legal aspects such as migratory irregularity or social aspects such as the stigma associated with sex work and sexual practices among men are involved. These aspects should be considered in the design of SRH programs that respond to the priorities identified by sex workers and the stereotypes they have regarding risk.

The acts of discrimination reported by the interviewees are mostly related to their nationality, i.e., they are acts of xenophobia, while in a smaller proportion, there are acts of discrimination related to the gender identities and sexual orientation of the participants. It should be borne in mind that, unlike sex workers, men engaged in this work are socially hidden due to feelings of rejection and acts of discrimination that may arise from this activity, which are linked not only to the practice of sex work itself but also to the sexual practices they engage in with other men. This occurs because there are no social norms and stereotypes that allow them to be identified, as is the case with female sex work. In addition, social stigmas and prejudices lead to the fact that "the concealment of prostitution becomes a totally assumed and maintained characteristic, sometimes creating real traumas due to the lies and deceptions that a double life can entail" ⁴.

This allows us to affirm that sex workers dedicated to this work live in social contexts where prejudice, stigma, discrimination, and social exclusion influence their psychosocial health, in addition to becoming barriers to access to health services, and specifically to sexual and reproductive health services. In this sense, "the relationship between migration and poverty has given rise to contexts of sexual violence and discrimination that favor the spread of HIV/STI among people whose dignity is less respected" ²².

Conclusions

The risk perception among Venezuelan sex workers of both sexes in Colombia is related to biological risks referred to the possibility of acquiring an STI, including HIV, where certain personal factors are involved that will determine the exposure to this risk. These factors include the separation that sex workers make between work and personal contexts, where, during the provision of sexual services, the condom is used as a barrier or limit with the client, as this is considered a potential danger due to the client being an unknown person. The opposite occurs with the affective partners of sex workers, who, due to the emotional relationship, relax condom use based on feelings of trust and fidelity. This situation can increase the degree of vulnerability to sexually transmitted infections and HIV. It can be concluded, then, that there is a symbolic use of condoms, as with clients it functions as a barrier, while with affective partners it symbolizes trust in the relationship. It is necessary to consider this aspect when designing SRH promotion and prevention programs for this population.

The second type of risks identified by male and female sex workers were psychological risks, which lead to depression and anxiety that affect this population. These are generally caused by feelings of loss of life purpose linked to the practice of sex work or by the realization that the economic objectives that led to the migratory process have not been achieved. However, it was found that female sex workers have social resources that allow them to better face these types of risks, since female sex work is socially recognized and, although there is a high level of stigma and prejudice about it, social, personal, and family support networks have also been consolidated around it. The opposite is true for male sex work, which has been socially hidden due to the stigma and prejudice surrounding this activity. Therefore, these men do not have consolidated social or family support networks.

In third place are the social factors, among which is internal mobility, i.e., the fact that male sex workers constantly travel between cities in Colombia to find new clients and increase their economic income. This can lead to a lack of knowledge of the social and health resources available in each city, which is why many of them are unaware of places to access HIV and other STI tests, nor the SRH care routes. On the contrary, the female sex workers interviewed have less internal mobility, since they generally provide their sexual services in physical establishments.

Both men and women who engage in sex work have been exposed to different types of violence, including gender-based, physical, psychological, and economic violence, both from their clients and from their intimate partners. In addition, contextual aspects such as the places where sexual services are provided can place them in a position of vulnerability, added to the fact of the unequal relationship established between the client and the sex worker due to their migrant status, especially for those who are in the country illegally. This situation can favor subjugation and sexual violence based on their migratory status. In addition, it is necessary to include gender violence suffered by men as an existing phenomenon, but not recognized in public health surveillance systems, which would allow the generation of differential intervention actions that respond to the needs of these men.

Finally, it is essential to identify the priorities in the perception of risk that male and female sex workers have, so they can be considered in the design of SRH programs that respond to the priorities they have identified and their perception of risk. The priority for them is not necessarily biological risks, especially when they are suffering from various types of violence or when legal aspects, such as migration irregularity, or social aspects, such as stigma and prejudice related to sex work and sexual practices among men, are involved.