Violence, Condom Breakage, and HIV Infection Among Female Sex Workers in Benin, West Africa

Abstract

The results show that violence is associated with a higher HIV prevalence among FSWs and that condom breakage is a potential mediator for this association. Longitudinal studies designed to analyze this relationship and specific interventions integrated to current HIV prevention strategies are needed to reduce the burden of violence among FSWs.

Sexual Violence, Condom Negotiation, and Condom Use in the Context of Sex Work

“…Consistent with violence research in other low-and middle-income settings, these findings highlight the potential implications of violence exposures among sex workers on successful negotiation of condom use. 1,[7][8][9] Mathematical models have gone further to highlight the impact of sexual violence against sex workers, demonstrating that reductions in violence against FSWs in Kenya may avert 17%-25% of new HIV infections among FSWs within 5-10 years and may avert new infections among the general adult population, by improving levels of condomprotected sex acts during sex work. 1,33 The study presented here further supports the relationship between single and multiple experiences of sexual violence affecting FSW, sustained effects on condom negotiation self-efficacy, and ultimately condom use or nonuse with clients.…”

“…5,6 Taken together, violence against sex workers may offer several potential mechanisms for HIV transmission, including condom breakage, exposure to sexually transmitted infections (STIs), and/or immediate or sustained condom nonuse or misuse. 1,[7][8][9] The heightened burden of HIV among FSW across HIV epidemic settings has been well described. 10,11 Globally, but particularly in sub-Saharan African (SSA) settings, the prevalence of HIV among FSWs seems to be a magnification of the prevalence that exists among the general adult population.…”

“…23,24 In neighboring Benin, increasing types of violence (defined as any combination of physical, sexual, and/or psychological violence) has been associated with increasing trends in HIV prevalence among FSWs (N = 981). 8 Condom use remains a cornerstone of HIV prevention for FSWs, as a means to protect against HIV transmission or acquisition, but also serves as the only method to simultaneously prevent STI transmission or acquisition and unintended or unplanned pregnancy. 25,26 Changing the trajectory of HIV incidence through condom distribution and use in the context of sex work thus warrants understanding the various pathways related to condom use or nonuse with clients.…”

Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice

“…Physical and sexual gender-based violence (GBV), that is, violence perpetrated based on sex, gender identity or perceived adherence to socially defined gender norms,3 is an important structural driver of FSWs' HIV risk behaviour and infection in sub-Saharan Africa and elsewhere 4–7. While regional data are limited, GBV appears to be a persistent and significant threat to FSWs,4 7 8 affecting approximately 50% of FSWs in the past 6 months alone in Kampala, Uganda 9. Gender-based power differentials and criminalisation of sex work fuel GBV against FSWs and the concomitant HIV risk,10 often against a backdrop of endemic GBV.…”

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries

“…20 This may lead individuals to feel unable to reject pressure to engage in unprotected sex, and, for those who are trafficked, rape may occur without condoms if acquiescence is not forthcoming. This has been observed in such diverse settings as South Africa mining communities, 24,25,[29][30][31][32] and Armenian female sex workers who had histories of physical abuse. 30 Female sex workers in Moscow, for example, were three times more likely to test HIV positive if they reported experiencing violence or the threat of violence in the last year.…”