Navigating sexual and reproductive health among Venezuelan women sex workers in Peru: Qualitative explorations of structural vulnerability and resistance.

内容摘要

Migration to Peru from Venezuela has reshaped engagement in informal labour for many women who turn to sex work as a survival strategy amid legal precarity and systemic exclusion. Yet little is known about how migrant sex workers navigate sexual and reproductive health (SRH) in this context. In 2023, we conducted 34 semi-structured interviews with Venezuelan migrant cisgender women sex workers living in Lima, Peru. Interviews explored migration trajectories, working conditions, SRH needs, and experiences seeking care. Analysis was guided by the Structural Vulnerability Framework, contextualizing how institutional framings and public health logics structure SRH access, exclusion, and women's adaptive strategies. Participants described access to SRH services in Peru as narrowly restricted to HIV and sexually transmitted infection (STI) testing and condom distribution, with accessibility to those services often contingent upon disclosing involvement in sex work, thereby reinforcing surveillance, stigma, and experiences of mistreatment in healthcare settings. Comprehensive SRH needs-including contraception, cervical and breast cancer screening, management of menstrual disorders, and responses to condom breakage or occupational injuries-were frequently unaffordable, unavailable, or dismissed, even as these conditions directly affected women's capacity to work. Responding to structural gaps in care, participants exercised agency within constrained landscapes, organizing peer networks and relying on community-based organizations to access SRH information, emotional support, and care. The normalization of out-of-pocket payments further illustrated how health decisions were made within constrained economic and bureaucratic contexts. Urgent and structural action is needed to close bureaucratic barriers to access to health insurance for migrants, implement non-stigmatizing models of care, and support partnerships with peer networks and community organizations.