Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review

Abstract

Sex work remains an important contributor to HIV transmission within early, advanced and regressing epidemics in sub-Saharan Africa, but its social and behavioral underpinnings remain poorly understood, limiting the impact of HIV prevention initiatives. This article systematically reviews the socio-demographics of female sex workers (FSW) in this region, their occupational contexts and key behavioral risk factors for HIV. In total 128 relevant articles were reviewed following a search of Medline, Web of Science and Anthropological Index. FSW commonly have limited economic options, many dependents, marital disruption, and low education. Their vulnerability to HIV, heightened among young women, is inextricably linked to the occupational contexts of their work, characterized most commonly by poverty, endemic violence, criminalization, high mobility and hazardous alcohol use. These, in turn, predict behaviors such as low condom use, anal sex and co-infection with other sexually transmitted infections. Sex work in Africa cannot be viewed in isolation from other HIV-risk behaviors such as multiple concurrent partnerships-there is often much overlap between sexual networks. High turn-over of FSW, with sex work duration typically around 3 years, further heightens risk of HIV acquisition and transmission. Targeted services at sufficiently high coverage, taking into account the behavioral and social vulnerabilities described here, are urgently required to address the disproportionate burden of HIV carried by FSW on the continent.

Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

“…However, consistent condom use among FSWs and truckers is low 14 , and this is largely explained by economic and relationship factors including poverty, refusal by male partners to use condoms, alcohol use before sex and beliefs that condoms kill the mood for sex. These barriers continue to hamper effective use of condoms for HIV prevention, and explain why, despite high levels of knowledge of condom use as an HIV prevention strategy, both FSWs and truckers continue to engage in unprotected sex 21 . Previous studies have identified a number of factors that affect condom use among female sex workers.…”

Test and treat: the early experiences in a clinic serving women at high risk of HIV infection in Kampala

“…In Kampala, recent research has noted high HIV prevalence among women in the general population (Nakku-Joloba et al, 2015), and specifically among women engaged in sex work and their clients (Lindan et al, 2015;Vandepitte et al, 2011). Female sex workers are vulnerable to infection because many have multiple concurrent partners, may not always be able to negotiate condom use, and may also be at risk of violence from clients and regular partners, among other factors (Rutakumwa, Mbonye, Kiwanuka, Bagiire, & Seeley, 2015;Schulkind, Mbonye, Watts, & Seeley, in press;Scorgie et al, 2012).…”

Relationship dynamics and sexual risk behaviour of male partners of female sex workers in Kampala, Uganda

“…In such settings female sex workers (FSW) and their clients are at greater risk of HIV and other sexually transmitted infections than the general population (Baral et al, 2012;Scorgie et al, 2012), due largely to inconsistent condom use with multiple sexual partners, including with the regular partners (Rekart, 2006;Vanwesenbeeck, 2001;Wojcicki & Malala, 2001). Reaching sex workers and their clients can therefore significantly contribute to global efforts to fast track HIV prevention and treatment (UNAIDS, 2014).…”