Policing the epidemic: High burden of workplace violence among female sex workers in conflict-affected northern Uganda

Abstract

Sex workers in sub-Saharan Africa experience a high burden of HIV with a paucity of data on violence and links to HIV risk among sex workers, and even less within conflict-affected environments. Data are from a cross-sectional survey of female sex workers in Gulu, northern Uganda (n = 400). Logistic regression was used to determine the specific association between policing and recent physical/sexual violence from clients. A total of 196 (49.0%) sex workers experienced physical/sexual violence by a client. From those who experienced client violence the most common forms included physical assault (58.7%), rape (38.3%), and gang rape (15.8%) Police harassment was very common, a total of 149 (37.3%) reported rushing negotiations with clients because of police presence, a practice that was significantly associated with increased odds of client violence (adjusted odds ratio: 1.61, 95% confidence intervals: 1.03-2.52). Inconsistent condom use with clients, servicing clients in a bar, and working for a manager/pimp were also independently associated with recent client violence. Structural and community-led responses, including decriminalisation, and engagement with police and policy stakeholders, remain critical to addressing violence, both a human rights and public health imperative.

Adapting the Risk Environment Framework to Understand Substance Use, Gender-Based Violence, and HIV Risk Behaviors Among Female Sex Workers in Tanzania

“…This is contrary to prior research, which suggests that GBV is associated with inconsistent condom use among FSWs and their sexual partners (12, 15). Importantly, some of this work has yielded partner-specific results related to violence and condom use (13, 56, 57). Unfortunately, our data lacked specificity regarding perpetrator type (e.g.…”

Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India

“…Moreover, over two-thirds of participants reported being offered more money to not use a condom with a client. Previous studies have documented sex workers accepting additional financial incentives in exchange for unprotected sex, leading to an increased risk for HIV acquisition (Ballester-Arnal et al, 2014; Ballester, Salmeron, Gil, & Gomez, 2012; Muldoon et al, 2015; Nemoto et al, 2012; Patterson et al, 2012). A study of female sex workers in India conducted by Erausquin et al between 2006 and 2010 identified accepting additional financial incentives for unprotected sex as a risk factor for HIV and STIs (Erausquin, Reed, & Blankenship, 2014).…”

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use

“…As in other regions in Uganda, ongoing poverty and deprivation have contributed to the presence of an informal economic sex work sector 2 . This is despite the fact that sex work is criminalized in Uganda and sex workers face widespread harassment, discrimination and other human rights violations, including from the police and community members 3 .…”