‘There is fear but there is no other work’: a preliminary qualitative exploration of the experience of sex workers in eastern Democratic Republic of Congo

Abstract

Two decades of conflict and insecurity have had a devastating impact on many in the Democratic Republic of Congo (DRC), including marginalised groups such as sex workers. In the province of North Kivu, many residents face desperate conditions that render them vulnerable to exploitation and abuse. As a result, many turn to the sex trade in what can often be described as 'survival sex'. This small-scale qualitative study explores the experience of urban sex workers in the eastern region of the DRC. Sex workers were recruited at their place of business and asked to participate in a semi-structured interview. Eight participants were recruited, including seven women and one man. Our analysis identified several themes: (1) economic hardship as a catalyst for joining the sex trade, (2) significant work-related violence and (3) a paucity of available resources or assistance. Responses to specific prompts indicated that sex workers do not trust law enforcement and there are significant barriers to both medical care and local resources. Further studies of this vulnerable population and its needs are encouraged in order to develop programmes that provide the means to manage the hazards of their work and obtain an alternative source of income.

Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies

“…Violence and abuses of power by police were reported across all genders and diverse political and economic contexts, including Cambodia, Canada, the Democratic Republic of the Congo, India, Kenya, Nepal, Nigeria, Pakistan, Serbia, South Africa, Sri Lanka, Thailand, Uganda, the US, and Zimbabwe [49,97,99,104,106,111,112,118,119,122,125,127,128]. This took the form of arbitrary arrest and detention, verbal harassment, intimidation, humiliating and derogatory treatment, extortion, forcible displacement, physical violence, gang rape, and other forms of sexual violence during raids and in police custody [49,97,99,103,104,106,111,112,118,122,127,128].…”

“…Violence and abuses of power by police were reported across all genders and diverse political and economic contexts, including Cambodia, Canada, the Democratic Republic of the Congo, India, Kenya, Nepal, Nigeria, Pakistan, Serbia, South Africa, Sri Lanka, Thailand, Uganda, the US, and Zimbabwe [49,97,99,104,106,111,112,118,119,122,125,127,128]. This took the form of arbitrary arrest and detention, verbal harassment, intimidation, humiliating and derogatory treatment, extortion, forcible displacement, physical violence, gang rape, and other forms of sexual violence during raids and in police custody [49,97,99,103,104,106,111,112,118,122,127,128]. In Kenya, Mexico, Nepal, Pakistan, Serbia, Sri Lanka, and the US, sex workers experienced extortion (unofficial ‘fines’, payments, or bribes) or provided sexual services enforced through physical or sexual violence or under threat of detention, arrest, transfer to rehabilitation centres, or forced registration (Quotes 10 and 11) [49,101,103,110,119,122,128–130], with limited or no opportunity to negotiate condom use [128].…”

“…Reporting violence could result in sex workers’ being further criminalised [49,97,120–122,127,128]. Sex workers were reluctant to report violence and theft to the police [98,125] for fear of the following: arrest for prostitution-related activities, unrelated petty offences, or non-payment of previous fines [97,98,116,120,124,131]; being accused of crimes they had not committed [49,103]; harsh treatment or moral judgement [97,120]; further extortion or violence [35,101,112]; disclosure in court [97]; prohibitive costs [112]; or because no action would be taken to address the crime [97,111,112,114,116]. Long-standing discrimination, and the sense that police viewed them as criminals, made sex workers doubt the police would take complaints seriously [114,115,128].…”

Understanding the financial lives of female sex workers in Abidjan, Côte d’Ivoire: implications for economic strengthening interventions for HIV prevention

“…However, contextual, social, and structural factors such as stigma, criminalization, discriminatory policies, gender-based violence, and poverty further exacerbate sex workers' vulnerability to HIV (Baral et al, 2012;Papworth et al, 2013;WHO, 2015) by reducing opportunities for or disincentivizing HIV risk-reduction practices. For example, underlying economic determinants of HIV risk affect women's decisions about whether and how they will take part in sex work (Baleta, 2015;Bamba et al, 2014;Karamouzian et al, 2016;Kiernan, Mishori, & Masoda, 2016;Scorgie et al, 2012;Strathdee, Crago, Butler, Bekker, & Beyrer, 2015), and many economic strengthening programs for FSWs are premised on observations that economic vulnerability and food insecurity can lead to riskier sexual transactions, including condomless and anal sex (Beckham, Shembilu, Winch, Beyrer, & Kerrigan, 2015;Cange et al, 2017;Elmes et al, 2014;Scorgie et al, 2012;Tsai et al, 2013;Tucker, Krishna, Prabhakar, Panyam, & Anand, 2012;Veldhuijzen et al, 2011;Weiser et al, 2007). Rather than attempting to directly change proximal-level sexual risk behaviors, these economic strengthening-focused HIV prevention programs attempt to change distal economic factors, by stabilizing income and/or increasing economic resilience, as a means of empowering women to reduce financially-driven decisions about sex partners or practices (Ndoye, 2010;Odek et al, 2009) (see Figure 1).…”

Pediatric Infectious Diseases Encountered During Wartime—Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era

“…The ensuing extreme poverty and infrastructure breakdown has contributed to HIV rates that are among the highest in Africa. Multiple social studies reveal that young women are forced into transactional sex work to survive, with little access to health care to protect them from STIs in general, and HIV in particular [ 50 , 51 ]. Although the association of HIV with combat has been studied in detail, a linear relationship with conflict may not be easily delineated.…”