Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda

Abstract

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011-January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31-5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46-4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20-3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86-5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.

Client-Initiated Violence Against Zambian Female Sex Workers: Prevalence and Associations With Behavior, Environment, and Sexual History

“…This is in line with previous studies in sub-Saharan Africa, where the prevalence of forced sexual initiation among women varies between 5.3% and 46% (Stockman, Lucea, & Campbell, 2013). Similar to our findings, others have demonstrated an association between forced sexual debut and violence against FSW (Argento et al, 2014;Erickson et al, 2018). Being sexually abused as a child can result in "re-victimization" in adulthood (Roodman & Clum, 2001).…”

Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis

“…Childhood maltreatment was a strong predictor of IPV perpetration in adulthood among men in Burundi 129. Across many countries, forced sexual debut was a risk factor for IPV in later life among female sex workers,88 126 130 131 and among adolescent girls and young women 111 116 132…”

High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda

“…This study adds to the limited body of evidence describing the health and social inequities faced by conflict-affected women engaged in sex work and to our knowledge remains one of few studies reporting on the HIV ‘cascade of care’ among conflict-affected SWs in sub-Saharan Africa. 30–32,34 Over one-third of SWs living with HIV were newly diagnosed infections, which is higher than a recent study in Malawi (20%) 35 and lower than a study in Zimbabwe in which half of SWs with confirmed HIV infection were unaware of their status, with the majority not on ART. 8 Women reporting unstable housing and substance use were more likely to be newly diagnosed, whereas accessing condom demonstrations and greater number of lifetime pregnancies were protective, likely reflecting linkage to HIV testing and care services through accessing SRH and condom promotion services.…”