Prevention in context: HIV risk behaviour among Zambian sex workers

Patterns of risk behaviour and condom use among commercial sex workers (CSWs) have been heavily investigated in recent years. But what is known about the social context of these women's lives? What factors prevent them from having safer sex? Researchers from Population Services International investigate the lives of CSWs in Lusaka, Zambia.

The researchers interviewed 14 nightclub-based and six street-based CSWs. There are relatively few employment opportunities for women in Zambia and marriage is still key to economic survival. Inability to form a long-term partnership or the collapse of a marriage can have disastrous financial consequences for women and some may be pushed into sex work. This is illegal and highly stigmatised. CSWs are subject to frequent police raids and the risk of violence from clients or members of the public. The lack of a supportive social environment for these women may reduce their ability to adopt effective safe behaviours.

Eight of the women have been married at some point and one is still married. Eleven have dependent children. Several of the nightclub-based workers are motivated by a desire to find a husband, whereas street-based CSWs see their activities purely as work. Other findings include:

• Low educational level and limited employment opportunities are common reasons for taking up sex work.
• Street-based CSWs regard harassment by clients and police as part of their daily routine.
• Sex workers feel stigmatised by their work and several have been rejected by their families.
• The women are aware of HIV and sexually transmitted infections (STIs). Street-based CSWs and those with children are more likely to insist on condom use than childless or nightclub-based workers.
• Fear of being stigmatised as having HIV or of losing a regular client by refusing to have unsafe sex are both barriers to condom use. Women generally expect more money for sex without a condom.
• CSWs rely mainly on herbal remedies to prevent or cure STIs.

The results of this study suggest that HIV-prevention programmes may have more success in encouraging CSWs and their clients to adopt healthy practices if they:

• challenge the negative stereotypes concerning commercial sex in Zambian society
• encourage public acknowledgement of the role of CSWs and the associated risks of infection
• strengthen peer support networks among nightclub-based CSWs to assist the development of a professional identity more conducive to implementing safer sexual behaviours
• provide voluntary counselling and affordable testing for HIV to encourage participation in peer education interventions and induce behaviour change.

Source(s):
‘HIV risk among street and nightclub- based sex workers in Lusaka, Zambia: implications for HIV prevention interventions’ by S. Agha and M. C. Nchima, PSI Research Division Working Paper 38, Population Services International, Washington DC (2001)

Funded by: USAID; UK Department for International Development

id21 Research Highlight: 08 May 2002

Further Information:
Sohail Agha or Mwaba Chulu Nchima
Population Services International
1120 19th Street, NW, Suite 600
Washington
DC 20036
USA

Tel: +1 202 785 0072
Fax: +1 202 785 0120
Contact the contributor: generalinfo@psiwash.org

Population Services International

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