“Right now we are scared of each other, we fear everyone, the whole world has COVID”: The impact of COVID-19 on young female sex workers in Kampala, Uganda, during national lockdowns in 2020–2021

Abstract

In 2020–2021 the COVID-19 pandemic led to multiple and diverse global public health response strategies globally and in Uganda to slow the spread of the virus by promoting wearing face coverings in public, frequent hand washing, physical distancing, restricting travel, and imposing home lockdowns. We conducted 146 interviews over four rounds of phone-follow up calls over 15 months with 125 young female sex workers coinciding in time with four different government-imposed lockdown periods in Kampala, Uganda, to assess the impact of these measures on young sex workers, their families and their communities as well as to gauge their resilience. Our findings revealed how COVID-19 fears and public health restrictions over time pushed an already marginalized population to the brink and how that pressure drove some participants into a new way of life.

The Impact of COVID-19 Restrictions on the Health and Well-being of Women Living in Informal Settlements in Uganda.

“…This combination of factors has signi cant consequences for a population with a large burden of HIV and higher rates among women (37). Similarly, the current study underscores the vulnerability of women in these transactional relationships, shedding light on unequal power dynamics and compromised ability to negotiate safer sex practices (22,34,38). This nding is consistent with literature on gender-based violence that indicates that exploitation within intimate relationships further undermines women's ability to remain healthy in adverse conditions (39)(40)(41).…”

“…In our context, we found that many women experienced abandonment by men (partners), which increased the burden of work and compounded the toll of economic hardships on women's mental and physical well-being. Some women, grappling with severe nancial di culties and food insecurity, turned to short-term sexual survival strategies (22,33). Long before the pandemic, several studies have highlighted the complex and intersectional relationship between socioeconomic status and sexual health outcomes, including HIV and unwanted pregnancies, within informal settlements in Uganda and other sub-Saharan African countries (22,(33)(34)(35).…”

“…Some women, grappling with severe nancial di culties and food insecurity, turned to short-term sexual survival strategies (22,33). Long before the pandemic, several studies have highlighted the complex and intersectional relationship between socioeconomic status and sexual health outcomes, including HIV and unwanted pregnancies, within informal settlements in Uganda and other sub-Saharan African countries (22,(33)(34)(35). Engagement in transactional sex and longer-term relationships for economic support illuminates the compromises impoverished women must make, even as it places them at heightened risk of HIV infection.…”

“…These changes, exacerbated by isolation, also increased the risk of gender-based violence and family abandonment (19)(20)(21). Given these challenges, many women were left particularly vulnerable and had to make di cult decisions about how to support themselves and their families, turning to various strategies including unprotected transactional sex (22,23). Experiences of gender-based violence and participation in transactional sex activities are associated with higher risk of acquiring HIV and poor sexual and reproductive health outcomes (24).…”

“…Experiences of gender-based violence and participation in transactional sex activities are associated with higher risk of acquiring HIV and poor sexual and reproductive health outcomes (24). These risks are suggested to have increased during the pandemic when health services became more di cult to access (22).…”