Benefits and constraints of intimate partnerships for HIV positive sex workers in Kibera, Kenya

Abstract

IntroductionResearch on the intimate partnerships of female sex workers (FSWs) tends to focus on the risks associated with these relationships. This paper takes as its starting point that the situation of FSWs is better understood by including knowledge of the benefits of their intimate partnerships. Specifically, we employ the conceptual framework provided by emergent research examining intimacy as a complex fusion of affective and instrumental dimensions among sex workers. This perspective allows us to frame information about FSWs’ intimate partnerships within a behaviour-structural approach that is helpful for identifying how intimate partnerships can be a source of both benefit as well as increased risk to FSWs.MethodsOur results are based on a mixed-methods study carried out in the summer of 2011 in Kibera, Kenya. We conducted face-to-face interviews (n=30) with a non-probability sample of FSWs stratified by age who self-identified as Human Immune Virus positive (HIV+). We asked about participants’ involvement in current and past intimate partnerships, and whether these relationships had a positive or negative impact on their health and well‒being.ResultsParticipants currently in intimate partnerships had fewer clients and thus lower incomes than those without intimate partnerships. Participants presently with partners were also more likely to receive some financial support from partners, to report lower intimate partner violence, and to narrate higher partner emotional support and greater assistance with medications. These participants were also more likely to have disclosed their sex work and HIV+ statuses to their partners. Intimate partnerships, on the other hand, showed increased risk of economic vulnerability and emotional dependence for FSWs. This became especially problematic for those participants in fragile relationships. Despite these variations, none of the differences between the two groups were statistically significant.ConclusionsIntimacy and transactional relations are bound up with one another and intersect with the structural realities and vulnerabilities; this is the case for sex workers in well-resourced and resourced-constrained countries alike. Rather than treating intimate partnerships as distinct from transactional relationships, FSWs’ relationships should be viewed on a continuum of risk and support.

Prevalence and correlates of intimate partner violence in HIV-positive women engaged in transactional sex in Mombasa, Kenya

“…31 Fourth, we did not conduct a partner-level analysis to evaluate the frequency of IPV with different partners, including more than one index partner. 16,23 Asking about IPV committed by the current or most recent emotional partner is consistent with use of the WHO VAW tool, but could underestimate the true prevalence of IPV in the past year if women have more than one emotional partner. While our results may not be generalisable to all other populations, our findings are likely applicable to other women engaged in transactional sex.…”

“…16,22,23 FSWs may also experience a high frequency of IPV, which may affect their overall health and ongoing risk of unintended pregnancy and HIV transmission. 16,22,24 One cohort study of HIV-negative FSWs in Kenya reported that 55.0% of women had experienced any physical or sexual violence by an ‘emotional’ partner in the past year. 24 Limitations to the existing literature in African FSWs include a focus on violence by clients and police rather than IPV, lack of standard definitions of IPV in this population and lack of studies on the correlates of IPV in HIV-positive FSWs.…”

HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: A systematic review

“…ART adherence and viral suppression was assessed in six articles (Braunstein et al, 2011; Konate et al, 2011; Benoit et al, 2013; Fielding-Miller, Mnisi, Adams, Baral, & Kennedy, 2014; Mbonye, Rutakumwa, Weiss, & Seeley, 2014; Goldenberg et al, 2016). Lack of adequate food was often linked to the difficulty of adhering to ART (Braunstein et al, 2011; Fielding-Miller et al, 2014).…”

“…Additionally, substance use was strongly associated with gaps in ART treatment and likelihood of a detectable viral load (Mbonye et al, 2014). One article highlighted the importance of intimate partner support for ART adherence (Benoit et al, 2013). …”

A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

“…A third possible explanation is that reporting IPV may be a marker for certain positive features of long-term partnerships (69). Our qualitative findings revealed that many women wanted to stay with their mzees , despite episodes of IPV, because of love, companionship, and financial stability.…”