1. Sex work and the city: a comparison of female sex workers in two South Cross-sectional African cities
Mopo Radebe and Mariette Slabbert
In South Africa, at least one-third of female sex workers (FSW) are HIV positive by the age of 24 years, and levels of infection reach 80% among those 25 and older (1,2). Once infected, SW can transmit HIV to a large number of clients who transmit HIV onward to the general population. To achieve the target set by UNAIDS, this population must be understood, accessed and linked to effective HIV programmes.
The study was conducted to characterise socio-demographic, behavioural and health factors of female sex workers which may affect uptake and use of health services in order to inform more targeted and efficient HIV programming.
This was a cross-sectional study conducted in two sex worker populations in Gauteng, South Africa. Study participants were sex workers aged 18 years and older, working in inner city brothels in Johannesburg and Tshwane. A standardised questionnaire was administered in face-to-face interviews. We used Chi square and the independent t–test to compare the characteristics of FSW from the two sites.
Of the 174 participants enrolled into the study, 124 worked in the inner city Johannesburg and 50 in inner city Tshwane (Table 1). The majority of participants had an average of 10 years of formal education. Our data also show that there were significantly more FSW of Zimbabwean origin working in Johannesburg than in Tshwane (p=0.015), and FSW working in Johannesburg were more likely to stay at the brothel where they worked than their counterparts in Tshwane (p<0.001).
Findings show that FSW in Tshwane experienced more condom failure than women in Johannesburg and also reported more STIs. This suggests that efforts in Tshwane should focus on promoting consistent and correct condom use and use of lubricants to prevent condom failure and STIs.
FSW in Tshwane reported more episodes of both vaginal and oral sex per day compared with those in Johannesburg (p=0.008 and p=0.016, respectively). FSW in Johannesburg reported fewer STI cases than FSW in Tshwane (p=0.037) and there were also fewer cases of condom failure reported in Johannesburg than in Tshwane (p=0.019). No significant difference in 39.5HIV status between the two sites was observed (Johannesburg 40%, Tshwane 43%, p=0.44).
REFERENCES:
Richter M, Chersich M, Vearey J, Sartorius B, Temmerman M, Luchters S. Migration Status, Work Conditions and Health Utilization of Female Sex Workers in Three South African Cities. J Immigr Minor Health ;16:7–17.
Although the FSW at these sites share similar characteristics, there are important differences which could affect the mode of service delivery and the type of services that should be offered.
FSW in Johannesburg were more likely to come from Zimbabwe and were likely to stay at brothels where they worked. These women were also less likely to have had an HIV test in the last 6 months or to have received health education on HIV. This suggests that it is imperative to use mobile outreach services to access brothels in Johannesburg to track and retain clients in the programme. This is also evident from the lower percentage of HIV-positive sex workers on ART: 65% in Johannesburg versus 80% in Tshwane.
Lane T. The South Africa National Health Monitoring Study with Female Sex Workers. IAS, July, 2015
Introduction:
Table 1. Characteristics of female sex workers working in inner city brothels in Johannesburg and Tshwane, Gauteng, South Africa.
Variable
Johannesburg (n=124)
Tshwane (n=50)
p value
Socio-demographic characteristics
Mean age (SD)
32.08 (6.56)
31.52 (5.21)
0.201
Marital status (single)
76%
85%
0.126
From Zimbabwe
63%
42%
0.015
Bread winner
84%
80%
0.500
Stay at brothel
82%
48%
0.000
Mean # school years completed (SD)
10.3 (1.67)
10.02 (1.74)
0.368
Mean # of children (SD)
1.9 (1.02)
1.7 (1.16)
0.910
Staying without children
90%
46%
0.001
Without adult independents
47%
Sexual behaviour
Mean #episodes of vaginal sex per day
9.5 (5.89)
13 (8.5)
0.008
Mean #episodes of oral sex per day
1.5 (3.43)
3.2 (5.2)
0.016
Condom failure in past week
37%
56%
0.019
Use of condom with main partner
25%
35%
0.219
Sexually transmitted infections
Ever had an STI test
87%
0.110
Last STI test <6mths
0.161
Ever had an STI
55%
73%
0.037
Last HIV test <6mths ago
54%
0.038
HIV+
0.409
On ART
65%
0.294
Risky behaviours
Use drugs/alcohol for confidence
50%
36%
0.265
Objective:
Methods:
Results:
The study highlights the importance to consider the uniqueness in composition, behaviours and health profile of individual sites when implementing services for sex workers.
Conclusions: