AIDS, mobility and commercial sex in Ethiopia: Implications for policy

Abstract

Since the emergence of the AIDS pandemic in sub-Saharan Africa, male mobility has been highlighted as one of the reasons for the spread of the disease with men employing the services of commercial sex workers while away from home. However, sex workers' mobility and the implications of this for their access to prevention services, has largely been ignored. This paper, based on multi-method qualitative research with 60 young sex workers in two Ethiopian towns, reveals that sex workers are highly mobile, moving in order to attract a wider or different client base, for adventure and to conceal illnesses which might be associated with AIDS. In addition, sex workers are affected by restrictions on their movements, with girls working in bars and red-light areas having little free time to access projects. This paper advocates that policy approaches need to take account of this mobility in three ways: first, by exploring ways for girls to access information and maintain contact with support structures while moving between places of work; second, by building the capacity of sex workers to take greater control over decision-making in their day-to-day lives and third, by developing outreach strategies for taking services into bars and red-light areas.

Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India

“…While mobility for sex work per se may not be directly associated with HIV, as seen in prior research, mobility may increase FSWs’ vulnerability to exploitation and abuse as a result of operating in new environments with unknown clients and the lack of community ties for social support [11]. Empirical research suggests that mobility for sex work among FSWs is common in India and around the world [4,5,10,11,23,31], and our study further suggests that some sub-groups of FSWs were more likely to be mobile than others. For example, mobility was higher among FSWs who were currently or previously married or who had a regular non-paying partner than others; reasons for higher mobility among this sub-group could be to work in an environment of anonymity and to keep their sex worker identity separate from their private life [25].…”

“…For example, mobility was higher among FSWs who were currently or previously married or who had a regular non-paying partner than others; reasons for higher mobility among this sub-group could be to work in an environment of anonymity and to keep their sex worker identity separate from their private life [25]. Following their relocation to new areas, FSWs face several kinds of vulnerabilities including physical and sexual violence [11,14], a finding also observed in our study, which indicates that a greater proportion of mobile FSWs were abused as compared to those who were not mobile.…”

“…Violence and mobility are increasingly being recognized as important risk factors contributing to the spread of HIV and sexually transmitted infection (STI) worldwide [1-11]. High rates of violence perpetrated against female sex workers (FSWs) have been consistently documented in developing countries [12-14].…”

“…In India, as is the case globally, FSWs are highly mobile for sex work [5] due to police harassment [24]; to escape stigma and discrimination [4,25]; and to attract a different or wider client base [11]. Research suggests that FSWs who were mobile for sex work had higher rates of HIV as compared to non-mobile FSWs [5,10], possible reasons being their experience of violence [11,14,17], sexual risk behaviors such as unprotected sex [4,5,25], lack of access to condoms [25], inability to negotiate safe sexual practices [26], and limited access to health care services [11,27] and HIV prevention programs [11,26] in new locations.…”

Labor migration, externalities and ethics: Theorizing the meso-level determinants of HIV vulnerability

“…Calls for understanding migrants’ social and cultural context (e.g., Parrado, Flippen, and McQuiston 2004) underline the importance of considering environmental determinants of migration-related risk as amenable to intervention rather than assuming that migration inevitably produces HIV vulnerability. A limited number of community-level interventions have followed this latter approach, seeking to increase access to health care services, including STI testing and treatment; to protect human rights and increase access to education and credit (Campbell & Williams, 1999; Mooney & Sarangi, 2005; Van Blerk, 2007; Williams et al, 2000); and even to change transport schedules (Lurie, Hintzen and Lowe, 1995). …”