Women's Voices: Attitudes and Behaviors of Female Ghanaian Sex Workers Regarding HIV Prevention and AIDS-Related Stigma

Raingruber, Bonnie; Uwazie, Ernest; Bowie, Sylvester

doi:10.3109/01612841003646999

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…Condom use was also found to be influenced by sex workers' perceived control over their own sexual decision-making processes [22], which is tied to economic and socio-cultural constraints. This finding is consistent with studies of female sex workers in urban environments in Namibia [17], in other LMIC, Nigeria [13], Ghana [12], the Caribbean [23] as well as in high income countries, the USA [24] and Canada [25] but may, arguably, be even more heightened in rural, traditional environments like northern Namibia. As such safer sex for females engaging in transactional sexual practices-and Namibian women, in general-may be more accurately viewed as a product of the '3 Es' of education, empowerment, and economic independence.…”

Section: Discussionsupporting

confidence: 90%

“…The increasing importance of the cash economy in Namibia and reduced access for many females further marginalizes them, pushing them towards unstable livelihoods in the informal economy, and carrying dangerous implications for women's ability to protect their own health [10,11]. Previous research has examined the attitudes and experiences of sex workers in Ghana [12], the various forms and determinants of transactional sex in sub-Saharan Africa [1,13], and the types and efficacy of HIV transmission strategies targeting sex workers in South Africa and India [6], Mozambique [14], and elsewhere in the world [15,16]. The two studies conducted on sex work in Namibia are not in the peer-reviewed literature and have focused on the legalities of sex work in urban environments [17,18].…”

Section: Introductionmentioning

confidence: 99%

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"I do what I have to do to survive": An investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia

et al. 2011

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BackgroundThere is little published research investigating sex work in Namibia, particularly in rural areas. Therefore, the aim of this paper was to determine the views of women engaged in sex work in the Oshakati area of Namibia concerning the main factors influencing their use, or non-use, of male condoms during transactional sexual exchanges.MethodsQualitative interviews were used to better understand the perceptions, experiences and economic considerations of female sex workers in Namibia who were involved in a Behavior Change Communication Program encouraging safer sex practices among high-risk populations in 2006 and 2007.ResultsWhile the Behavior Change Communication Program has made significant strides in educating and empowering young women to negotiate more consistent condom use with sexual partners, the gendered economic inequalities and power imbalances within rural and semi-urban Namibian society that favor men hinder further advancement towards positive behavioral change for HIV prevention and also hinder the development of the loving relationships sought by some sex workers.ConclusionThis study found that sex workers and transactional sex encounters are heterogeneous entities dependent upon the characteristics of the man (known, stranger, wealthy, attractive to the woman) and the woman (in financial need, desiring love). These features all influence condom use. The 3 E's 'education, empowerment and economic independence' are critical factors needed to encourage and facilitate consistent condom use to prevent HIV transmission. Without financial independence and occupational alternatives building on their health education and empowerment, women who engage in sex work-and transactional sex more generally-will remain largely marginalized from Namibian society, and will continue engaging in risky sexual practices that facilitate HIV acquisition and transmission throughout the community.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

"I do what I have to do to survive": An investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia

et al. 2011

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“…Based on our literature review, PrEP stigma may intersect with stigma related to sexual health, such as pregnancy, contraceptive use and sexually transmitted infections (STIs) and stigma related to other marginalized identities based on gender (both female and transgender), age, race, sexual orientation and occupation (especially sex work) [ 20 , 31 , 42 , 43 , 44 , 55 , 56 ]. Identity‐based stigma is known to intersect with HIV stigma [ 50 , 52 , 57 ] because of elevated HIV prevalence among MSM, transgender women and people who sell sex.…”

Section: Resultsmentioning

confidence: 99%

“…At the community and interpersonal level, literature noted that PrEP users are blamed and called names [ 14 , 49 ], distrusted by partners [ 44 ] and judged as being HIV positive [ 42 ]. Drawing from HIV and sexuality stigma, additional practices could include social isolation/rejection [ 54 , 56 , 57 , 60 ], and exposure to verbal violence [ 64 ]. FGDs with PrEP users and key influencers agreed with these findings, providing greater nuance to practices such as social isolation and rejection, such as parents warning their children not to associate with PrEP users.…”

Section: Resultsmentioning

confidence: 99%

The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub‐Saharan Africa

Hartmann,

Nyblade,

Otticha

et al. 2024

J Int AIDS Soc.

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IntroductionStigma is a well‐known barrier to HIV testing and treatment and is an emerging barrier to pre‐exposure prophylaxis (PrEP) use. To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub‐Saharan Africa, a priority population for PrEP.MethodsA literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio‐ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; n = 20) and key influencers (14 FGDs; n = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023.ResultsThe conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high‐risk populations), health systems (e.g. youth‐friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency.ConclusionsOur PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.

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“…Both Sudan and Yemen are considered low income countries with high rates of poverty. An inevitable consequence is the widespread expansion of the sex trade, which has led many women, and often men, into this vicious cycle as in many neighbouring countries in MENA and in sub-Saharan Africa (SSA) [32]. Participants identified sex workers as one of the major target groups that is notoriously difficult to engage with.…”

Section: Challenges Facing Hiv Responsesmentioning

confidence: 99%

The realities of HIV prevention. A closer look at facilitators and challenges faced by HIV prevention programmes in Sudan and Yemen

Bashir

Wazir

Schumann

et al. 2019

Global Health Action

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Background: HIV/AIDS prevention has historically encountered many obstacles. Understanding the factors affecting HIV/AIDS prevention is central to designing and implementing suitable context-specific interventions. Research relating to HIV prevention in the Middle East and North African region is required to address the gradually increasing HIV epidemic.Objective: This study aimed to explore the perspectives of employees/health care professionals who are working or have worked within HIV prevention in Sudan and Yemen on the challenges and facilitating factors facing HIV prevention.Methods: A qualitative approach was employed using an open-ended questionnaire. Sixteen stakeholders from governmental and non-governmental agencies participated in the study. The questionnaire focused on the various challenges and facilitating factors facing HIV prevention as well as proposed possible solutions from the perspectives of the participants. The data were analysed using thematic analysis.Results: The study illustrated the similarities in context and HIV prevention systems between Sudan and Yemen. Thematic analysis resulted in three main themes: I) much is achieved despite difficulties; II) a programme left to be paralysed; this theme addressed the main obstacles facing HIV prevention in Sudan and Yemen generating a total of six sub-themes; III) comprehensive change is needed. The participants drew focus and attention to vital changes required to improve the delivery of HIV prevention services.Conclusion: Increased financial support for HIV prevention in Sudan and Yemen is urgently needed. De-stigmatisation and increased political support, advocacy and improved legislation for people living with HIV (PLHIV) are required for the sustainability and effectiveness of HIV prevention programmes in Sudan and Yemen. Civil society organisations must be aided and supported in their role in engaging key populations.

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Women's Voices: Attitudes and Behaviors of Female Ghanaian Sex Workers Regarding HIV Prevention and AIDS-Related Stigma

Cited by 7 publications

References 13 publications

"I do what I have to do to survive": An investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia

"I do what I have to do to survive": An investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia

The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub‐Saharan Africa

The realities of HIV prevention. A closer look at facilitators and challenges faced by HIV prevention programmes in Sudan and Yemen

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