SOCIAL THOUGHTS OF FEMALE SEX WORKERS REGARDING VULNERABILITY AND COPING STRATEGIES: A STUDY OF SOCIAL REPRESENTATIONS

Couto, Pablo Luiz Santos; Vilela, Alba Benemérita Alves; Suto, Cleuma Sueli Santos; Porcino, Carle; Nogueira, Virgínia Paiva Figueiredo; Gomes, Antônio Marcos Tosoli; Silva, Dejeane de Oliveira; Rodrigues, Vanda Palmarella

doi:10.1590/1980-265X-TCE-2024-0292en

ABSTRACT

Objective: To understand the process of constructing social thought on vulnerability and coping mechanisms among female sex workers.

Method: This descriptive and qualitative study, based on the Theory of Social Representations (TSR), was conducted with 43 female sex workers in the Southwest region of Bahia, Brazil, between November 2022 and January 2023. The responses were analyzed with the aid of software IRAMUTEQ for Descending Hierarchical Classification.

Results: Six thematic categories were identified, revealing how these groups construct social representations of vulnerability, based on everyday problems found through the words: unemployment, needs, poverty, violence, and fear of the streets; lack of rights, citizenship, and absence of the State. In turn, coping is based on understanding preventive practices against illness and body care, as well as the benefits gained from the money derived from sex work: sustenance, autonomy, freedom, and independence.

Conclusion: Social thought, present in social representations of vulnerability, refers to the difficulties faced by women in the context of sex work. Coping strategies are rooted in attitudes and behaviors aimed at protecting and maintaining health. These findings may contribute to professionals and services rethinking the promotion of care, with a congruent and intersectional perspective, focused on the needs of vulnerable population groups.

DESCRIPTORS:
Female Sex Workers; Women's Health; Social vulnerability; Psychological Adaptation; Social Representation; Nursing; Social stigma

RESUMO

Objetivo: Compreender o processo de construção do pensamento social sobre vulnerabilidade e enfrentamento por trabalhadoras sexuais.

Método: Estudo descritivo e qualitativo, apoiado na Teoria das Representações Sociais, desenvolvido com 43 trabalhadoras sexuais, na região Sudoeste da Bahia, Brasil, entre os meses de novembro de 2022 e janeiro de 2023. As respostas foram analisadas com o auxílio do software IRAMUTEQ para Classificação Hierárquica Descendente.

Resultados: Foram evidenciadas seis classes temáticas que revelaram como elas constroem as representações sociais acerca da vulnerabilidade, a partir de problemas cotidianos verificado nas palavras: desemprego, necessidades, pobreza, violência e medo da rua; falta de direitos, cidadania e ausência do Estado. Por sua vez, o enfrentamento se baseia no entendimento sobre práticas preventivas de adoecimento e cuidados com o corpo, assim como nos benefícios adquiridos com o dinheiro oriundo do serviço sexual: sustento, autonomia, liberdade e independência.

Conclusão: O pensamento social, presente nas representações sociais da vulnerabilidade, remete às dificuldades enfrentadas pelas mulheres no contexto do serviço sexual. As formas de enfrentamento estão ancoradas nas atitudes e comportamentos que visam a proteção e manutenção da saúde. Tais achados poderão contribuir para que profissionais e serviços repensem a promoção do cuidado, com um olhar congruente e interseccional, focado nas demandas de grupos populacionais vulneráveis.

DESCRITORES:
Profissionais do Sexo; Saúde da Mulher; Vulnerabilidade social; Adaptação Psicológica; Representação Social; Enfermagem; Estigma Social

RESUMEN

Objetivo: Comprender el proceso de construcción del pensamiento social sobre la vulnerabilidad y los mecanismos de afrontamiento entre las trabajadoras sexuales.

Método: Se trata de un estudio descriptivo y cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 43 trabajadoras sexuales de la región Suroeste de Bahía, Brasil, entre noviembre de 2022 y enero de 2023. Las respuestas fueron analizadas con la ayuda de software IRAMUTEQ para Clasificación Jerárquica Descendente.

Resultados: Se identificaron seis categorías temáticas, que revelan cómo estos grupos construyen representaciones sociales de la vulnerabilidad, a partir de problemáticas cotidianas identificadas a través de las palabras: desempleo, carencias, pobreza, violencia y miedo a las calles; falta de derechos, ciudadanía y ausencia del Estado. A su vez, el enfoque se basa en comprender las prácticas preventivas ante la enfermedad y el cuidado del cuerpo, así como los beneficios que se obtienen del dinero derivado del trabajo sexual: sustento, autonomía, libertad e independencia.

Conclusión: El pensamiento social, presente en las representaciones sociales de la vulnerabilidad, refiere a las dificultades que enfrentan las mujeres en el contexto del trabajo sexual. Las estrategias de afrontamiento se basan en actitudes y comportamientos destinados a proteger y mantener la salud. Estos hallazgos pueden contribuir a que los profesionales y servicios repiensen la promoción del cuidado, con una perspectiva congruente e interseccional, centrada en las necesidades de los grupos poblacionales vulnerables.

DESCRIPTORES:
Trabajadores sexuales; Salud de la mujer; Vulnerabilidad social; Adaptación psicológica; Representación social; Enfermería; Estigma social

INTRODUCTION

Sexual services, as performed by cisgender women, have historically developed in parallel with the shaping of society and traditional family structures, but have been marginalized and rendered invisible due to sexuality and sexual practices being geared towards marriage and procreation, as well as men’s satisfaction¹^-³. Sex work is marked by stigmas because, in addition to involving female sexuality and evoking female pleasure, sexual practices are seen as a means of work for women who break with the sociocultural determinism of what it means to be a woman³^-⁴.

When negotiating their services in a wide variety of environments, but especially on the street and in public spaces, these women find themselves exposed to various situations of vulnerability maintained by States and Governments, such as different forms of gender-based violence, the lack of regulation of the profession, the absence of social safety, difficulties in accessing health services, and the maintenance of institutional stigma and prejudice in the most diverse sectors, transversalized with intersectionalities that amplify social inequities (gender, race/color, and social class)⁵^-⁷.

Developing countries, such as Asian (India)⁸_, African⁹ ones_, Latin American countries like Colombia¹⁰ and, in this specific study, Brazil (with its marked social inequalities)¹¹_, have adopted, through their governments, dubious and discordant strategies for protection and the formulation of public policies, different from those regulated by the World Health Organization, for reducing ills and situations that create vulnerabilities⁶^,¹².

Paid sex work in Brazil and other countries such as Italy, France, and Finland has been conceptualized as a continuum about the relationships established through economic-pleasure/sexual exchange¹^,⁴^,¹³. The delimitation of time, type of service, and the negotiation of remuneration lead them to a breakdown of status quo, because, although many women are exploited, just as many are directly responsible for the sexual services they offer, based on an economic-sexual exchange.¹¹^,¹⁴^-¹⁵.

As an alternative to the lack of State protection, female sex workers need to establish coping mechanisms to overcome adversity: exploitation, abuse, violence, fear, and the anxiety of not being able to earn money².

It is important to highlight that vulnerability has a broad concept that moves beyond the characteristics of risk groups and is seen as a set of biological, epidemiological, social, and cultural factors that can increase or decrease the exposure or protection of a given group in the face of a disease, condition, or harm⁵.

Coping has been understood from the notion of cognitive and behavioral mechanisms or strategies (psychological adaptations) that are used by individuals or social groups to deal with exposure to harm or situations that are potentially damaging. Thus, they are subjective (or perhaps not so subjective) resources that become evident when people lack routine or automatic means at their disposal, made possible primarily by the presence of the State, to overcome situations that make them vulnerable¹⁶^-¹⁷.

Further study becomes relevant, from the point of view of deepening scientific knowledge, because there is a theoretical gap that cuts across the theoretical framework of vulnerability with sexual services from the perspective of social representations. This would also strengthen efforts to achieve some of the Sustainable Development Goals established by the United Nations (UN), with a view to the social impact on vulnerable social groups, such as health and well-being, poverty eradication, gender equality, decent work and economic growth, and reduction of inequalities⁷.

Thus, this study has the potential to point out ways for professionals and services (not just nursing services) to rethink the care provided to female sex workers, focusing on their needs, demands, and understandings, to contribute to a professional practice congruent with the promotion of care, self-care, and coping, beyond the treatment and prevention of STIs, enabling effective, individualized care based on encouraging well-being, quality of life, and overcoming of vulnerabilities.

Furthermore, the guiding question posed was: what social thought has been constructed by female sex workers regarding vulnerability and coping in the exercise of sexual services? Therefore, the objective of the study was to understand the process of construction of the social thought on vulnerability and coping mechanisms among female sex workers.

METHOD

This is a descriptive and qualitative study, grounded in the Theory of Social Representations from a procedural perspective¹⁸^-¹⁹. The procedural approach brings with its construct the understanding that social representations are knowledge based on daily practice, and therefore on common sense, in which the object and the subject that represent it are connected and constructed through mental processes that develop with ideas and meanings stored in the unconscious, in memory, and in social thought¹⁹^-²⁰. These processes are called objectification and anchoring, which give form, realism, concepts, and classifications, transforming the unfamiliar into familiar, the unknown into known, common sense into science¹⁸^-²¹.

The study was conducted in the Southwest Region of Bahia, in the five largest and most populous cities, which encompass a large part of the semi-arid region of Bahia, along the BR-116 highway and the Sertão Produtivo Baiano: Vitória da Conquista, Jequié, Guanambi, Bom Jesus da Lapa and Brumado. To reach the social group under investigation, the research started with information from an Extension project developed by the principal investigator in the Municipality of Guanambi-BA, together with the Testing and Counseling Center (CTA) for STIs/AIDS with female sex workers, and from there, the women indicated the others. In this sense, the research was conducted in the various establishments that the workers used to negotiate their services with clients: open-air markets, bars, restaurants, boarding houses, inns, and gas stations along the BR-116 highway in the cities of Vitória da Conquista and Jequié.

The inclusion criteria adopted were being over 18 years of age and having been involved in sex work for at least 1 year (since experience allows for a broader view of sex work). It should be noted that there was no prior determination of how many women from the five cities that comprised the research universe should participate, as it was based on acceptance of the invitation and one woman indicating another according to the selection and recruitment criteria called Snowball, which is a participant recruitment technique¹⁶.

Despite snowball does not require the use of exclusion criteria, it was agreed that the participants who did not answer the questions completely and refused to continue the interview would be excluded, resulting in 9 interviewees being dismissed. A priori, 52 women who provided paid sex work participated, and a final sample consisted of 43 women. The number of female sex workers from each of the five cities that responded to the survey was similar: Guanambi (09), Bom Jesus da Lapa (08), Brumado (06), Vitória da Conquista (11), and Jequié (09).

Data collection was carried out by two of the researchers responsible for the study (one male and one female, both with experience in qualitative and quantitative research, extension projects, and publications in the field of sexual services); it took place individually (without other people around, to avoid noise and interference or contamination of the responses) between November 2022 and January 2023, in spaces indicated by the workers themselves, considered comfortable and suitable for them.

A questionnaire was used to conduct a sociodemographic characterization of the participants, and a script consisting of four questions guided the in-depth interview. “I would like you to speak freely about what you consider vulnerability and being vulnerable in sex work to be”; “In your opinion, what factors might increase your exposure in sex work, making you more vulnerable?”; “In your opinion, what factors could facilitate the safe and protected practice of sex work?”; “Tell me about the actions and strategies you use regarding the norms and conduct you follow to cope with adversity and take care of yourself and your colleagues.”

The interviews conducted with the participants lasted an average of about 25 minutes each. The responses were recorded on a cell phone, then transcribed in full on software Microsoft Word 2016. The transcripts of the conversations were made by the authors on the same day the interviews were completed.

Following transcription and organization of the information in the database (text corpus), the responses were processed in the software Interface de R pour lês Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), which performs semantic-lexical content analysis, according to the following steps: decoding of signs; identification of semantic-lexical convergences and divergences in the content present in the speech; classification of codes and text units; decoding of elements that had lexical and semantic similarity to delimit the classes, whose most important words present the highest chi-square (x²) values²².

Then, with the classification of the classes, the analysis was carried out using the Descending Hierarchical Classification (DHC) method, based on the Class Dendrogram²². Subsequently, two synoptic charts were developed summarizing the themes of the classes present in the DHC and their respective text segments (TS), that is, excerpts from the speeches, which give characteristics to the classes and meaning to the words/lexicons.

Semantic-lexical analysis techniques provide critical understanding of communications, of the respective meanings that each word has within the context of a sentence or narrative, whether explicit or hidden, but which favor DHC²¹.

Throughout all stages of the research process, the authors adhered to rigorous quality standards and criteria, directed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The study was linked to the results of a thesis, originating from an umbrella project, and was submitted to and approved by the Research Ethics Committee of the Universidade Estadual do Sudoeste da Bahia, through platform Brasil,. The free informed consent form was obtained before the interviews. It should be noted that artificial intelligence tools were not used for this study.

To ensure the participants’ anonymity and preserve each one’s identities, codes were adopted to name them: the letters 'TS', followed by a number (example: TS. 01).

RESULTS

Regarding the characterization of the 43 interviewees, according to the variables used for processing the narratives, which, after being transcribed in full, constituted a textual corpus for processing in software IRAMUTEQ, we have: regarding self-declared race/color, 58% were brown or black; concerning religion, 79% of women reported having a Christian faith (Catholic or Evangelical); however, it is noteworthy that only 21% admitted following Spiritism, Umbanda, or Candomblé. The level of education showed that 35% had only completed elementary school and 32% had only completed high school, totaling 67% of them with a low level of education.

Regarding the length of time working in the sex industry, the majority had at least one year of experience: 46.5% between one and five years, and 42% had been working for more than five years. A large percentage of these women revealed that they attend 3 to 4 programs per week (53.4%), and have an average daily frequency of 5 programs (49%). Regarding adherence to condom use in relationships with clients, it was observed that 79% always used them; however, this percentage drops when it comes to regular partners or men with whom they develop some affection, with sometimes presenting 43% or rarely 38%, and always, 14%.

For the composition and final presentation of the Dendrogram (Figure 1), a text corpus was developed, which included 43 texts from interviews or Initial Context Units (ICUs), comprising 1734 text segments (TSs) or elementary context units (ECUs), with a retention rate of 74.14% for TS utilization, exceeding the minimum required rate for utilization (70%)²¹.

Figure 1 -
Dendrogram of Classes for Descending Hierarchical Classification that make up the 'Social thinking of female sex workers on vulnerability and coping strategies'. Southwest Region, BA, Brazil, 2022-2023. (n= 43).

The initial lexical content analysis, provided by DHC, showed the categorization of 06 classes, arranged in two large axes in the final design of the Dendrogram (figure 1): the first axis has two branches in which there is class 01 (16.3%), separated from classes 05 (18.6%) and 02 (13.9%) which are arranged together; in turn, the second axis, also with two more branches, is composed of class 06 (16.3%), which is isolated from classes 04 (16.3%) and 03 (18.6%), which were linked.

It is noted that the classes content (Figure 1) does not oppose each other, but demonstrates complementarity, which allows inferring a consonance of the group to which they belong that contributed to the formation of Social Representations. Therefore, the local/city of residence/origin factor does not reveal itself as a bias, but reinforces the ideas present in the female sex workers’ social thinking.

The Dendrogram shows the graphic composition of the DHC, in which the six Classes are presented divided into two branches of whole corpus analyzed. While the two major divisions were named according to the meaning that the syntax and semantics of the lexicons had in the classes composing them, the classes received titles with excerpts from the narratives, that is, from the ECUs that translated the meanings of the words to form the social representations.

By dissecting the schematic formation of the Dendrogram, we see the first division, in figure 1, named according to the thematic context as 'Vulnerabilities marked by exposure to problems and the need to have forms of (self) care to maintain a healthy body', which comprises three classes, organized with their respective TSs in a synoptic Chart 1: class 1 (“We have several problems: both we have to take care of ourselves and politicians have to look out for us”), class 5 (“We are vulnerable because our rights are denied and because work puts us at risk”) and class 2 (“We take care of ourselves so that we don't lack clients, because we need money for our needs”).

Thumbnail

Chart 1 -
Synoptic chart, summarizing the classes that make up the first section of the Dendrogram and their respective text segments characterizing it. Southwest Region, BA, Brazil, 2022-2023. (n=43)

The second major class, also observed in figure 1, was titled “Being vulnerable as a consequence of the life context, society, and the State's lack of support in the face of personal coping mechanisms adopted,” following the naming criteria, which aimed to express the meanings present in the semantic content of the lexicons in their respective ECUs and classes, also organized in synoptic Chart 2. It had its formation based on three classes: 6 (“There are many situations that make us vulnerable, but the street and society scare me”), 4 (“We all face the risks of this job, protecting ourselves, because nobody looks out for us”) and 3 (“I’m on the street and in this job because I need to, even with the dangers and prejudice”).

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Chart 2 -
Synoptic chart, summarizing the classes that make up the second section of the Dendrogram and their respective text segments characterizing it. Southwest Region, BA, Brazil, 2022-2023. (n=43)

DISCUSSION

Regarding the profile, there is a predominance of Black women, followers of some Christian religion (predominant in Brazil and with a persuasive discourse). In other words, it is suggested that the social inequalities that mark all women in Brazil, Latin America, and the world in general, are the same that plague female sex workers and place them at the base of the social pyramid, since the intersectional inequalities of class, race, and gender directly interfere with their vulnerable conditions²^,⁸^,¹⁰^-¹¹.

The SRT aims for homogeneity within the group to form social representations, even if there are some disagreements about a particular phenomenon, due to the context. However, its alignment with concrete reality reveals a representational content with uniform social thought, which refers to the subjective, affective, cultural, and behavioral dimensions of human beings, constructed in an interindividual and intergroup manner³^,¹⁸.

Considering that the social group studied here shows consonance in their social representations, regardless of location or origin, it is suggested that the situations to which they are exposed daily in the sex work environment influence representational consensus. Furthermore, social representations function as thoughts or ideas originating from common sense and the experiences of people belonging to a social group¹⁹^-²⁰.

The results presented regarding the profile of female sex workers in this study are consistent with previous studies³^,¹⁰^-¹². Research conducted with female sex workers in India, Colombia, and southern Brazil has shown that they occupy the bottom of the social pyramid and have low levels of education⁸^,¹⁰^-¹¹. Other studies corroborate the results presented here, showing that although these women comprise a group vulnerable to STIs/AIDS, through decades of focus from public policies, it is noticeable that the educational strategies for promoting sexual health and preventing STIs are effective, leading many of these women to adhere to the use of condoms and hormonal contraceptives⁸^,²³^-²⁴, as is the case with female sex workers in the Alto Sertão Produtivo region of Bahia, Brazil³^,²³.

Still within the first division of the DHC, it is noted that social thought is anchored in life context situations that lead them to engage in sex work (problems, unemployment, despair, need, poverty, and family), issues involving the daily routine of sex work and the lack of state protection that makes them exposed and consequently vulnerable (lack of rights, citizenship, and access to benefits), (self-)care actions to cope with health problems that put them at risk of illness (rapid testing, not kissing on the mouth, body care, safe sex, CTAs, taking care of their health, tests, knowledge, and lack of trust), and the 'benefits' they believe come from sex work (autonomy, freedom, independence, future, and quality of life).

It has been argued that the meanings of vulnerability presented by female sex workers are consistent with the results of previous studies, as they are hallmarks present in the daily life of the service: fear of violence, poverty, difficulty accessing public services, and lack of State support). These issues are further intensified by the intersectionalities of class, race, and gender¹^,³^,⁶^,¹¹.

The protective practices they develop and the positive aspects they see in engaging in sex work may be linked to the money they earn and the fact that they are their ‘own bosses’ and determine how the service will be provided, negotiating directly with clients¹^,³^,¹³. Furthermore, the need to face the insecurity of the streets alone, with little or no support network, suggests that some feel free and in control of their own lives¹^,⁶^,¹¹^,¹⁴.

Despite the marginalization imposed on sex work by society, many female sex workers find in this work a viable employment opportunity, as it is a means to achieve financial independence, support themselves and their families, autonomy, and personal fulfillment, as is the case in France, Finland, India, and Brazil¹^,⁴^,⁸^,¹¹^,²³. In this context, many of them face difficulties obtaining government support to meet their demands and needs, requiring subsidies and protection from other sectors of society, or even from female sex workers' unions and other support networks¹¹^,¹⁶.

Conversely, by including the expression “do not trust” in the narratives, connecting it to the fact that they have no friends at work, distrust their colleagues and clients, as well as they refer to knowledge as a coping mechanism, it is suggested that self-care, from the ethical perspective of caring for others or not causing harm to others, is minimal due to the competitive environment for clients and money. It is also considered that the individual struggle for survival that each of them carries leads to reflection on the lack of self-care, not due to selfishness, but because of the marks of social inequities so present in their lives¹⁴.

As pointed out by Michel Foucault¹⁴, in a philosophical context, self-care refers to ethical issues in relationships between people, even more so when it comes to female sex workers, who are embedded in a context of multiple relationships (colleagues, clients, bar and room owners, and even family members), within which they need to have sovereignty over themselves, provided that it is developed ethically.

Because they are in a profession that requires them to compete for clients daily, this ethical issue is called into question, since they need to fight hard for their own survival as well as for their families (children and relatives) and, often, go against the rules and principles they themselves have established to access more clients and guarantee income. Therefore, it is a dubious form of self-care, as they disrespect their colleague's space but prioritize their own (basic) personal needs¹⁴^-¹⁵.

It can be inferred that the composition of the second division of the DHC aligns with the first, insofar as it reinforces the anchoring process by demonstrating how consensual and complementary they are¹⁸^-¹⁹. Although the situations that make them vulnerable in the context of sex work are reinforced by insecurity (STIs, dangerous encounters, crimes, fear, risk of death, violence and dangerous work), lack of rights and manifestations of prejudice (discrimination, being called lazy, being considered a bad woman, religion), as well as the lack of recognition by society and the state as a 'normal job', these women find in sex work ways to take care of themselves and be well in order to attract clients, as well as to protect themselves and minimize exposure to harm (clothing, personal hygiene, condoms, client hygiene, contraception, maturity, self-esteem, and childcare).

Religion becomes a subterfuge for people from disadvantaged economic classes, as it fills a social vacuum left by the State and offers benevolence through faith in exchange for tithes, forgiveness of sins, and eternal life (even though sex work is considered a sin by Christian religions)¹¹^,¹⁶^,²³.

This coping mechanism, referred to as religious/spiritual coping, arises when individuals or social groups utilize faith, spirituality, or religiosity to manage and overcome adversities and stressful life situations when support from societal and/or state institutions is unavailable²⁵^-²⁶. This form of coping refers to the spiritual, behavioral, cognitive, and interpersonal domains developed by human beings, therefore inherent to the holistic being²⁵^-²⁶. Furthermore, it exhibits diversity in its use, as it changes according to the experiences, meanings, and representations of each person and social group²⁶.

Holistic care, focused on human dimensions, provided by nursing to individuals, especially vulnerable groups, is fundamental for the adoption and implementation of coping and self-care practices, since the guidance conveyed in a simple, clear, and objective manner must be congruent with reality¹⁷_. In this specific case, for several reasons, including working hours, respect for autonomy and decisions made about their bodies, and psycho-emotional and social demands³^,¹¹^,¹³.

These issues are relevant to SRT and the meanings emerging from daily practice of the profession. They are linked to aspects of human emotions and psyche, which, when impaired, lead to interference with basic human needs and, consequently, with self-care and care for others, directly impacting well-being and quality of life¹⁴^,¹⁶^-¹⁷^,²⁶^-²⁷.

In this sense, female sex workers showed that the notion of coping points to a direct relationship with the adoption of healthy lifestyle habits for achieving independence, well-being, and a positive assessment of quality of life¹⁶^-¹⁷. Studies conducted in France and Kenya have indicated that groups of female sex workers adopt alternative strategies to address the lack of state support and assistance, using money to meet their needs¹^,²⁴.

Coping relates to well-being and goes beyond issues involving the health-disease process, encompassing distinct factors such as psychosocial well-being, mental health, self-esteem, health status, and, with regard to this group of women, there should be a reduction in stigma, acceptance by society, as well as other aspects that complement the human being, especially the acquisition of income¹⁶^-¹⁷^,²⁸.

Another association highlighted in the narratives of the female sex workers presented here was between income/money and self-care. The money earned from sex work is essential for subsistence, meeting basic needs, overcoming vulnerabilities to which they are exposed, and acquiring the means and actions to ensure a healthy life, as well as caring for physical, emotional, and spiritual well-being to the fullest extent¹^,³^,¹³^,¹⁶^,²⁸.

It is through this income that they are able to access private healthcare services without necessarily revealing their profession, ensuring care free from rejection and strangeness, since many professionals who provide assistance in the Brazilian Public Health System not always treat them universally, comprehensively, and equitably, perpetuating stigmas through institutional prejudice because, at times, the professionals (nurses, community health workers, technicians, among others) know the people who make up the assigned area, for example, of a Family Health Strategy unit³^,¹¹.

These care practices, when promoted by nurses in primary care, free from prejudice and stigma, attract marginalized and state-invisible populations to the health service and contribute to adherence to the care provided³^,¹². The female sex workers in this study differ from others, since recent research has shown that vulnerable social groups are increasingly less likely to seek health services as a consequence of institutional prejudice⁶^,⁸^,²⁴^,²⁷.

Leading a healthy life, having good health, and acquiring money are paramount factors for a segment of these women and are closely related to their self-care, respect for their privacy, and self-love¹^,³^,¹¹^,²³. Results from previous studies have shown that adopting preventive measures is only possible with income¹^,⁶^,¹³^,²⁸, such as female sex workers from the African continent⁷^,⁹.

Finally, social representations, as elements that exhibit processes as varied as the diffusion and assimilation of knowledge, both at the individual level and, above all, at the collective level, in the definition of personal and social identities, in the expression of segmented population groups, and in social transformations¹⁸^,²¹_, are essential for elucidating health demands (resulting from vulnerabilities) and the need for coping strategies, as they have the elements to reconstruct and reframe them, in order to allow progress²⁵^-²⁸.

The limitations arise, a priori, in its conduction in an impoverished region of northeastern Brazil, far from major urban centers, which hinders the application of these results to other settings, both in Brazil and in other countries. There are also difficulties in obtaining studies that point to the relationship between SRT, female sex workers, and vulnerability, imposing limits and hindering discussion and comparisons with other cultures, realities, and contexts. Since this work is an offshoot of a larger study, data collection was excessively lengthy, with the interview being the third stage, and those who contributed appeared tired and anxious for the interviews to end.

By presenting the results of this study within the context of paid and consensual sexual services, based on the SRT, it becomes relevant and unprecedented. Thus, it can contribute to nurses and other professionals rethinking their praxis by providing care tailored to the needs of vulnerable population groups, such as female sex workers, in a way that is equitable, comprehensive, universal, individualized, and free from discrimination.

In this way, it will be possible to minimize stigmas and prejudices, welcoming them in a way that fosters trust in the professional, with instructions and guidance on self-care actions and coping strategies, especially ways to minimize and overcome vulnerabilities. It should be noted that knowing the social representations (SRs) of stigmatized groups, who require attention and care within a holistic context, will allow the nurse to pay attention to the biopsychosocial aspects that interfere in the health-disease process.

It is suggested that this framework be used to conduct further research in the field of sexual services in different contexts and realities, especially as it relates to the health of vulnerable women, with the aim of expanding the care network in professional practice. For that reason, we hope that other results and outcomes, such as cause and effect relationships, can be obtained, and, a posteriori, publicized to continue promoting health, dignity, and well-being of female sex workers.

CONCLUSION

It is concluded that the narratives giving rise to the classes were responsible for constructing the representational meanings that translate the social thought female sex workers attributed to vulnerability and the ways of coping in the exercise of paid sexual services. The social representations of vulnerability were anchored in the problems present in the daily life of sex work, manifested in the fear of the streets, various forms of violence, poverty, personal needs, competition for clients, insecurity, and lack of protection imposed by state negligence. The confrontation was anchored in behaviors, habits, and attitudes adopted in the day-to-day work of female sex workers, perceived in the objectifications associated with money (which provides independence, in addition to their autonomy in negotiations), personal hygiene, health care for maintaining a healthy body, such as preventive practices against STIs/HIV/AIDS (at least with clients).

It is suggested that this framework be used to conduct further research in the field of sexual services in different contexts and realities, especially as it relates to the health of vulnerable women, with the aim of expanding the care network in professional practice. For that reason, we hope that other results and outcomes, such as cause and effect relationships, can be obtained, and, a posteriori, publicized to continue promoting health, dignity, and well-being of female sex workers.

ACKNOWLEDGMENT

To the sex workers participating in the study, as well as Santuzza Alves and Monique Prada, for providing less stigmatizing and more humanized perspectives on this social group.

REFERENCES

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» https://doi.org/10.4000/jda.7996
2. Olivar JMN. Banquete de homens: sexualidade, parentesco e predação na prática da prostituição feminina. Rev Bras Cienc Soc [Internet]. 2021 [cited 2023 May 15];26(75):89-189. Available from: https://doi.org/10.1590/S0102-69092011000100005
» https://doi.org/10.1590/S0102-69092011000100005
3. Couto PLS, Montalvao BPC, Vieira ARS, Vilela ABA, Marques SC, Gomes AMT et al. Social representations of female sex workers about their sexuality. Invest Educ Enferm [Internet]. 2020 [cited 2023 May 15];38(1):e03. Available from: https://doi.org/10.17533/udea.iee.v38n1e03
» https://doi.org/10.17533/udea.iee.v38n1e03
4. Gunst A, Uusitalo M, Pölönen P, Petrík Š, Antfolk J. Sex workers’ professional agency, quality of life, and problematic substance use in Finland. Scand J Psychol [Internet]. 2025 [cited 2025 Oct 21];66(1):131-40. Available from: https://doi.org/10.1111/sjop.13070
» https://doi.org/10.1111/sjop.13070
5. Couto PLS, Gomes AMT, Pereira SSC, Vilela ABA, Flores TS, Porcino C. Situations of health vulnerabilities experienced by sex workers in times of COVID-19 pandemic. Rev Baiana Enferm [Internet]. 2021 [cited 2023 May 15];35:e37327. Available from: https:// doi.org/10.18471/rbe.v35.37325
» https:// doi.org/10.18471/rbe.v35.37325
6. Howard S. Covid-19: Health needs of sex workers are being sidelined, warn agencies. BMJ [Internet]. 2020 [cited 2023 May 15];369:m1867. Available from: https://doi.org/10.1136/bmj.m1867
» https://doi.org/10.1136/bmj.m1867
7. Shah P, Beattie TS, Kabuti R, Liku J, Kung’u M, Babu H et al. Syndemic of factors that shape the early lives of women who enter into sex work: A qualitative methods study from Nairobi, Kenya. BMJ Open [Internet]. 2023 [cited 2024 Sep 02];13(4):e068886. Available from: https://doi.org/10.1136/bmjopen-2022-068886
» https://doi.org/10.1136/bmjopen-2022-068886
8. Sherwood-Martin H. The dignity of Indian female sex workers. Lancet Infect Dis [Internet]. 2025 [cited 2025 Oct 21];26:S1473-3099(25)00540-7. Available from: https://doi.org/10.1016/S1473-3099(25)0
» https://doi.org/10.1016/S1473-3099(25)0
9. Gilbert M, Pullano G, Pinotti F, Valdano E, Poletto C, Boëlle PY et al. Preparedness and vulnerability of African countries against importations of COVID-19: A modelling study. Lancet [Internet]. 2020 [cited 2023 May 15];395(10227):871-77. Available from: https://doi.org/10.1016/S0140-6736(20)30411-6
» https://doi.org/10.1016/S0140-6736(20)30411-6
10. Vasquez JMC. La prostitución en Colombia, un camino hacia la formalización. Rev Ágora USB [Internet]. 2021 [cited 2023 May 15];21(2):748-59. Available from: https://doi.org/10.21500/16578031.5101
» https://doi.org/10.21500/16578031.5101
11. Costa MO, Coimbra VCC, Oliveira MM, Cardoso CS, Cruz VD, Guedes ADC, Moreira JDC, Gentilini LS. Narratives of sex workers: Intimate partner violence and coping strategies. Rev Bras Enferm [Internet]. 2024 [cited 2025 Oct 21]16;77(6):e20240180. Available from: https:// doi.org/10.1590/0034-7167-2024-0180
» https:// doi.org/10.1590/0034-7167-2024-0180
12. Gois ARS, Santos CNS, S Filho JC, Garcia EGC, Oliveira RC, Abrão FMS. Social representations of homosexual sex workers, transvestites and transgender women about acquired immunodeficiency síndrome. Rev Enfer Actual Costa Rica [Internet]. 2020 [cited 2023 May 15];38:121-35. Available from: https://doi.org/10.15517/revenf.v0i38.38533
» https://doi.org/10.15517/revenf.v0i38.38533
13. Broqua C, Deschamps C. Transactions sexuelles et imbrication des rapports de pouvoir. In: Broqua C, Deschamps C, editors. L’échange economico-sexuel. Paris (FR): Éditions EHESS; 2014 [cited 2023 May 15]. pp. 45-66. Available from: https://doi.org/10.4000/books.editionsehess.7376
» https://doi.org/10.4000/books.editionsehess.7376
14. Foucault M. História da Sexualidade 3: O Cuidado de Si. 5th ed. Rio de Janeiro (BR): Edições Paz e Terra, 2014.
15. Foucault M. Microfísica do poder. 12th ed. Rio de Janeiro (BR): Edições Paz e Terra , 2021.
16. Couto PLS, Porcino C, Pereira SS da C, Gomes AMT, França LCM, Vilela ABA. Mental health of female sex workers in the COVID-19 pandemic: Stressors and coping strategies. Ciênc Saúde Coletiva [Internet]. 2022 [cited 2023 May 15];27(9):3571-82. Available from: https://doi.org/10.1590/1413-81232022279.16462021
» https://doi.org/10.1590/1413-81232022279.16462021
17. Sousa AR, Santana TS, Moreira WC, Sousa AFL, Carvalho ESS, Craveiro I. Motions and coping strategies of men to the COVID-19 pandemic in Brazil. Texto Contexto Enferm [Internet]. 2020 [cited 2023 May 15];29:e20200248. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0248
» https://doi.org/10.1590/1980-265X-TCE-2020-0248
18. Jodelet D. A representação do corpo e suas transformações. In: Jodelet D. Representações sociais e mundos de vida. São Paulo (BR): Fundação Carlos Chagas; 2017. pp. 271-292.
19. Moscovici S. Representações Sociais: Investigações em Psicologia Social. Rio de Janeiro (BR): Vozes, 2015.
20. Nogueira VPF, Gomes AMT, Mercês MC, Couto PLS, Yarid SD, Andrade PCST. Spirituality, religiosity, and their representations for people living with HIV: daily life and its experiences. Rev Esc Enferm USP [Internet]. 2023 [cited 2024 Sep 02];57:e20220394. Available from: https://doi.org/10.1590/1980-220X-REEUSP-2022-0394en
» https://doi.org/10.1590/1980-220X-REEUSP-2022-0394en
21. Sabeh ACB, Cecilio HPM, Campos CJG, Reis HFT, Wysocki AD, Santos EM dos. Social representations of nurses of the Emergency Care Unit towards people with mental disorder. Rev Esc Enferm USP [Internet]. 2023 [cited 2024 Sep 02];57:e20220298. Available from: https://doi.org/10.1590/1980-220X-REEUSP-2022-0298en
» https://doi.org/10.1590/1980-220X-REEUSP-2022-0298en
22. Brandão BMGM, Angelim RCM, Marques SC, Oliveira RC, Abrão FMS. Living with HIV: Coping strategies of seropositive older adults. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 May 15];54:e03576. Available from: https://doi.org/10.1590/S1980-220X2018027603576
» https://doi.org/10.1590/S1980-220X2018027603576
23. Couto PLS, Ferreira LC, Gomes AMT, Oliveira DC, Pereira SSC, Vilela ABA, et al. Meanings of quality of life for sex workers: Structure of social representations. Acta Paul Enferm [Internet]. 2022 [cited 2025 Oct 21];35:eAPE00986. Available from: https://doi.org/10.37689/acta-ape/2022AO0098666
» https://doi.org/10.37689/acta-ape/2022AO0098666
24. Gichuna S, Hassan R, Sanders T, Campbell R, Mutonyi M, Mwangi P. Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi, Kenya. Glob Public Health [Internet]. 2020 [cited 2023 May 15];20:1430-1442. Available from: https://doi.org/10.1080/17441692.2020.1810298
» https://doi.org/10.1080/17441692.2020.1810298
25. Souza AV, Anunciação L, Landeira-Fernandez J. Spirituality, religiosity and mental health during the COVID-19 pandemic. Estud Psicol [Internet]. 2023 [cited 2024 Sep 02];40:e210206. Available from: https://doi.org/10.1590/1982-0275202340e210206
» https://doi.org/10.1590/1982-0275202340e210206
26. Marcelo EMG, Huarcaya SSL, Ferreira M de A. Social representations of loneliness in people aged at least seventy years old. Texto Contexto Enferm [Internet]. 2024 [cited 2024 Sep 02];33:e20230143. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0143en
» https://doi.org/10.1590/1980-265X-TCE-2023-0143en
27. Kluge HHP, Jakab Z, Bartovic J, D’Anna V, Severoni S. Refugee and migrant health in the COVID-19 response. Lancet [Internet]. 2020 [cited 2024 Sep 02];395(10232):1237-9. Available from: https://doi.org/10.1016/S0140-6736(20)30791-1
» https://doi.org/10.1016/S0140-6736(20)30791-1
28. Couto PLS, Pereira SSC, Vilela ABA, Gomes AMT, Merces MC. Covid-19 coping-prevention strategies for female sexual workers in the context of various countries. Texto Contexto Enferm [Internet]. 2021 [cited 2024 Sep 02];30:e20200560. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0560
» https://doi.org/10.1590/1980-265X-TCE-2020-0560

NOTES

ORIGIN OF THE ARTICLE
Extracted from the thesis - “I FACE THE STREET TO MEET MY NEEDS”: meanings of vulnerability and forms of coping/self-care attributed by sex workers - presented to the Postgraduate Program in Nursing and Health, at the Universidade Estadual do Sudoeste da Bahia, 2023.
FUNDING INFORMATION
Self-financing
APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Research Ethics Committee of the da Universidade Estadual do Sudoeste da Bahia, opinion no. 5.735.368 /2022, Certificate of Presentation for Ethical Review 60984022.9.0000.0055.
TRANSLATED BY
Denise Costa Rodrigues.
DATA AVAILABILITY
The data supporting the results of this study are available upon request from the correspondent. The dataset is not publicly accessible because it contains sensitive information that could compromise the privacy and anonymity of the participants. The research involved women in vulnerable situations, mostly sex workers, whose life stories contained confidential information, primarily regarding their involvement with illicit psychoactive substances and practices considered deviant from the law. Therefore, it requires additional confidentiality precautions in accordance with ethical guidelines for research with human subjects. Sharing of information, when requested, will be evaluated according to ethical criteria and, if necessary, subject to the signing of a confidentiality agreement.

Edited by

EDITORS
Associated Editors: Sandra Maria Cezar Leal.

Editor-in-chief: Gisele Cristina Manfrini.

Data availability

The data supporting the results of this study are available upon request from the correspondent. The dataset is not publicly accessible because it contains sensitive information that could compromise the privacy and anonymity of the participants. The research involved women in vulnerable situations, mostly sex workers, whose life stories contained confidential information, primarily regarding their involvement with illicit psychoactive substances and practices considered deviant from the law. Therefore, it requires additional confidentiality precautions in accordance with ethical guidelines for research with human subjects. Sharing of information, when requested, will be evaluated according to ethical criteria and, if necessary, subject to the signing of a confidentiality agreement.

Publication Dates

Publication in this collection
21 Aug 2026
Date of issue
2026

History

Received
02 Aug 2025
Accepted
28 Oct 2025

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] 1. Broqua C, Combessie P, Deschamps C, Rubio V. La sexualité au cœur des échanges intimes. J. Anthropologues [Internet]. 2019 [cited 2023 May 15];156-157:21-35. Available from: https://doi.org/10.4000/jda.7996
» https://doi.org/10.4000/jda.7996

[2] 2. Olivar JMN. Banquete de homens: sexualidade, parentesco e predação na prática da prostituição feminina. Rev Bras Cienc Soc [Internet]. 2021 [cited 2023 May 15];26(75):89-189. Available from: https://doi.org/10.1590/S0102-69092011000100005
» https://doi.org/10.1590/S0102-69092011000100005

[3] 3. Couto PLS, Montalvao BPC, Vieira ARS, Vilela ABA, Marques SC, Gomes AMT et al. Social representations of female sex workers about their sexuality. Invest Educ Enferm [Internet]. 2020 [cited 2023 May 15];38(1):e03. Available from: https://doi.org/10.17533/udea.iee.v38n1e03
» https://doi.org/10.17533/udea.iee.v38n1e03

[4] 4. Gunst A, Uusitalo M, Pölönen P, Petrík Š, Antfolk J. Sex workers’ professional agency, quality of life, and problematic substance use in Finland. Scand J Psychol [Internet]. 2025 [cited 2025 Oct 21];66(1):131-40. Available from: https://doi.org/10.1111/sjop.13070
» https://doi.org/10.1111/sjop.13070

[5] 5. Couto PLS, Gomes AMT, Pereira SSC, Vilela ABA, Flores TS, Porcino C. Situations of health vulnerabilities experienced by sex workers in times of COVID-19 pandemic. Rev Baiana Enferm [Internet]. 2021 [cited 2023 May 15];35:e37327. Available from: https:// doi.org/10.18471/rbe.v35.37325
» https:// doi.org/10.18471/rbe.v35.37325

[6] 6. Howard S. Covid-19: Health needs of sex workers are being sidelined, warn agencies. BMJ [Internet]. 2020 [cited 2023 May 15];369:m1867. Available from: https://doi.org/10.1136/bmj.m1867
» https://doi.org/10.1136/bmj.m1867

[7] 7. Shah P, Beattie TS, Kabuti R, Liku J, Kung’u M, Babu H et al. Syndemic of factors that shape the early lives of women who enter into sex work: A qualitative methods study from Nairobi, Kenya. BMJ Open [Internet]. 2023 [cited 2024 Sep 02];13(4):e068886. Available from: https://doi.org/10.1136/bmjopen-2022-068886
» https://doi.org/10.1136/bmjopen-2022-068886

[8] 8. Sherwood-Martin H. The dignity of Indian female sex workers. Lancet Infect Dis [Internet]. 2025 [cited 2025 Oct 21];26:S1473-3099(25)00540-7. Available from: https://doi.org/10.1016/S1473-3099(25)0
» https://doi.org/10.1016/S1473-3099(25)0

[9] 9. Gilbert M, Pullano G, Pinotti F, Valdano E, Poletto C, Boëlle PY et al. Preparedness and vulnerability of African countries against importations of COVID-19: A modelling study. Lancet [Internet]. 2020 [cited 2023 May 15];395(10227):871-77. Available from: https://doi.org/10.1016/S0140-6736(20)30411-6
» https://doi.org/10.1016/S0140-6736(20)30411-6

[10] 10. Vasquez JMC. La prostitución en Colombia, un camino hacia la formalización. Rev Ágora USB [Internet]. 2021 [cited 2023 May 15];21(2):748-59. Available from: https://doi.org/10.21500/16578031.5101
» https://doi.org/10.21500/16578031.5101

[11] 11. Costa MO, Coimbra VCC, Oliveira MM, Cardoso CS, Cruz VD, Guedes ADC, Moreira JDC, Gentilini LS. Narratives of sex workers: Intimate partner violence and coping strategies. Rev Bras Enferm [Internet]. 2024 [cited 2025 Oct 21]16;77(6):e20240180. Available from: https:// doi.org/10.1590/0034-7167-2024-0180
» https:// doi.org/10.1590/0034-7167-2024-0180

[12] 12. Gois ARS, Santos CNS, S Filho JC, Garcia EGC, Oliveira RC, Abrão FMS. Social representations of homosexual sex workers, transvestites and transgender women about acquired immunodeficiency síndrome. Rev Enfer Actual Costa Rica [Internet]. 2020 [cited 2023 May 15];38:121-35. Available from: https://doi.org/10.15517/revenf.v0i38.38533
» https://doi.org/10.15517/revenf.v0i38.38533

[13] 13. Broqua C, Deschamps C. Transactions sexuelles et imbrication des rapports de pouvoir. In: Broqua C, Deschamps C, editors. L’échange economico-sexuel. Paris (FR): Éditions EHESS; 2014 [cited 2023 May 15]. pp. 45-66. Available from: https://doi.org/10.4000/books.editionsehess.7376
» https://doi.org/10.4000/books.editionsehess.7376

[14] 14. Foucault M. História da Sexualidade 3: O Cuidado de Si. 5th ed. Rio de Janeiro (BR): Edições Paz e Terra, 2014.

[15] 15. Foucault M. Microfísica do poder. 12th ed. Rio de Janeiro (BR): Edições Paz e Terra , 2021.

[16] 16. Couto PLS, Porcino C, Pereira SS da C, Gomes AMT, França LCM, Vilela ABA. Mental health of female sex workers in the COVID-19 pandemic: Stressors and coping strategies. Ciênc Saúde Coletiva [Internet]. 2022 [cited 2023 May 15];27(9):3571-82. Available from: https://doi.org/10.1590/1413-81232022279.16462021
» https://doi.org/10.1590/1413-81232022279.16462021

[17] 17. Sousa AR, Santana TS, Moreira WC, Sousa AFL, Carvalho ESS, Craveiro I. Motions and coping strategies of men to the COVID-19 pandemic in Brazil. Texto Contexto Enferm [Internet]. 2020 [cited 2023 May 15];29:e20200248. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0248
» https://doi.org/10.1590/1980-265X-TCE-2020-0248

[18] 18. Jodelet D. A representação do corpo e suas transformações. In: Jodelet D. Representações sociais e mundos de vida. São Paulo (BR): Fundação Carlos Chagas; 2017. pp. 271-292.

[19] 19. Moscovici S. Representações Sociais: Investigações em Psicologia Social. Rio de Janeiro (BR): Vozes, 2015.

[20] 20. Nogueira VPF, Gomes AMT, Mercês MC, Couto PLS, Yarid SD, Andrade PCST. Spirituality, religiosity, and their representations for people living with HIV: daily life and its experiences. Rev Esc Enferm USP [Internet]. 2023 [cited 2024 Sep 02];57:e20220394. Available from: https://doi.org/10.1590/1980-220X-REEUSP-2022-0394en
» https://doi.org/10.1590/1980-220X-REEUSP-2022-0394en

[21] 21. Sabeh ACB, Cecilio HPM, Campos CJG, Reis HFT, Wysocki AD, Santos EM dos. Social representations of nurses of the Emergency Care Unit towards people with mental disorder. Rev Esc Enferm USP [Internet]. 2023 [cited 2024 Sep 02];57:e20220298. Available from: https://doi.org/10.1590/1980-220X-REEUSP-2022-0298en
» https://doi.org/10.1590/1980-220X-REEUSP-2022-0298en

[22] 22. Brandão BMGM, Angelim RCM, Marques SC, Oliveira RC, Abrão FMS. Living with HIV: Coping strategies of seropositive older adults. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 May 15];54:e03576. Available from: https://doi.org/10.1590/S1980-220X2018027603576
» https://doi.org/10.1590/S1980-220X2018027603576

[23] 23. Couto PLS, Ferreira LC, Gomes AMT, Oliveira DC, Pereira SSC, Vilela ABA, et al. Meanings of quality of life for sex workers: Structure of social representations. Acta Paul Enferm [Internet]. 2022 [cited 2025 Oct 21];35:eAPE00986. Available from: https://doi.org/10.37689/acta-ape/2022AO0098666
» https://doi.org/10.37689/acta-ape/2022AO0098666

[24] 24. Gichuna S, Hassan R, Sanders T, Campbell R, Mutonyi M, Mwangi P. Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi, Kenya. Glob Public Health [Internet]. 2020 [cited 2023 May 15];20:1430-1442. Available from: https://doi.org/10.1080/17441692.2020.1810298
» https://doi.org/10.1080/17441692.2020.1810298

[25] 25. Souza AV, Anunciação L, Landeira-Fernandez J. Spirituality, religiosity and mental health during the COVID-19 pandemic. Estud Psicol [Internet]. 2023 [cited 2024 Sep 02];40:e210206. Available from: https://doi.org/10.1590/1982-0275202340e210206
» https://doi.org/10.1590/1982-0275202340e210206

[26] 26. Marcelo EMG, Huarcaya SSL, Ferreira M de A. Social representations of loneliness in people aged at least seventy years old. Texto Contexto Enferm [Internet]. 2024 [cited 2024 Sep 02];33:e20230143. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0143en
» https://doi.org/10.1590/1980-265X-TCE-2023-0143en

[27] 27. Kluge HHP, Jakab Z, Bartovic J, D’Anna V, Severoni S. Refugee and migrant health in the COVID-19 response. Lancet [Internet]. 2020 [cited 2024 Sep 02];395(10232):1237-9. Available from: https://doi.org/10.1016/S0140-6736(20)30791-1
» https://doi.org/10.1016/S0140-6736(20)30791-1

[28] 28. Couto PLS, Pereira SSC, Vilela ABA, Gomes AMT, Merces MC. Covid-19 coping-prevention strategies for female sexual workers in the context of various countries. Texto Contexto Enferm [Internet]. 2021 [cited 2024 Sep 02];30:e20200560. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0560
» https://doi.org/10.1590/1980-265X-TCE-2020-0560

Thematic class	Text Segments
Class I: “We have several problems: both we have to take care of ourselves and politicians have to look out for us.”	Wow, there are so many problems that we have to face. Actually, it stemmed from family problems, which is why I entered prostitution early on. With my parents unemployed, despair arose of not having anything to eat [TS 06]. Daily life on the street is complicated. The fear of being raped, of disrespectful men, lack of safety. Here it's you on your own, because any slip-up here and it's all over [TS 09].
Class 05: “We are vulnerable because our rights are denied and because our work puts us at risk.”	Here I am exposed to violence and the risk of being raped by drunk and drugged men, but nothing can compensate for the fact that I am free and not in some madam's house being humiliated and harassed by her husband, and receiving nothing more for it [TS 11]. We have no guarantee of labor rights, we have no right to safety. Many men, politicians, seek us out, but will they defend us? How? The fear they have of being discovered by their wives [TS 22].
Class 02: “We take care to ensure we don't lack customers, because we need money for our necessities.”	The CTA is there to help us take care of our health and is very important because it does rapid testing, distributes condoms, talks about PrEP (Pre-Exposure Prophylaxis), conducts educational activities, and guides us [TS 03] Of course, there's always one girl or another who'll do anything for a little extra money. But I and others of us don't accept no for an answer. It's either with a condom or it's not happening. My health and my body protected first [TS 26].

Thematic class	Text Segments
Class 06: “There are many situations that make us vulnerable, but the streets and society scare me.”	We are at risk of contracting a disease all the time. Some men remove condoms without us noticing, and others don't put them on properly. It's awful, because I, for example, get tense having to pay attention to these details [TS 29]. The insecurity we face in our work isn't just about violence, but also about contracting an infectious disease. I feel anxious just thinking about getting HIV, hepatitis (...) [TS 43].
Class 04: “We all face the risks of this job, protecting ourselves, because nobody looks out for us.”	We can't trust anyone here. If I slip up, the other one comes along and brazenly takes my client, undercutting my fee [TS 08]. I think it should be recognized as work, as a profession. We charge the fee, and the customer pays. We do business [TS 16]. Man, can you believe I was sharing a house with some girl and I had a regular client? When I saw, he had disappeared and I found out, by chance, with her, passing by in the car [TS 28].
Class 03: “I'm on the streets and doing this job because I need to, even with the dangers and prejudice.”	(...) I don't have to be at my boss's house suffering all kinds of humiliation in exchange for peanuts. Here I have the autonomy and freedom to work when I want and negotiate the price with the client [TS 37]. I'm not going to tell you that I enjoy turning tricks, but it's not bad. I earn good; I can pay my bills and support myself. And of course, just by being in control of yourself, you can negotiate directly with the client [TS 42].