Background
Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. To address this important issue, it is expedient to understand the prevalence and the associated factors of multiple indicators of violence against FSWs to inform evidence-based and urgent targeted public health policy and intervention strategies.
Method
The study utilised a cross-sectional secondary data from the 2015 Integrated Bio-Behavioural Surveillance Survey (IBBSS) conducted among FSWs and their non-paying partners by Ghana AIDS Commission (GAC). We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15.
Results
The study found the prevalence of physical and sexual violence as 10.1% and 24.8% respectively. Physical violence was perpetrated mainly by first-time paying clients (50.6%) and regular paying clients (31.0%) with similar trend observed for sexual violence. The predictors of physical violence are being a seater (aOR=0.53, 95%CI: 0.36-0.74), aged ≥40 (aOR=0.23, 95%CI: 0.08-0.64), non-use of drugs (aOR=0.56, 95%CI: 0.44-0.70), and not using alcohol before sex (aOR=0.69, 95%CI: 0.56-0.86). Sexual violence was predicted by those aged age 31-40 (aOR=0.68, 95%CI: 0.49-0.94) and age≥40 (aOR=0.38, 95%CI: 0.22-0.66), currently married (aOR=0.42, 95%CI: 0.27-0.67), having no living children (aOR=0.69, 95%CI: 0.51-0.94), non-use of drugs (aOR=0.80, 95%CI: 0.68-0.94), and not using alcohol before sex (aOR=0.74, 95%CI: 0.63-0.86). Region and other source of income were associated with both physical and sexual violence. Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs.
Conclusion
Physical and sexual violence against FSWs is pervasive, and a critical public health issue in Ghana. The identified associated factors could be considered as part of an overall strategy aimed at addressing the menace. Further studies are warranted to devise multisectoral approaches for appropriate policy and intervention strategies aimed at regulating the practice.