Are Pregnancies Saving Lives Among Sex Workers in Sub-Saharan Africa?

A new paper examines the relationship between motherhood, sex work, and access to healthcare. Female Sex Workers (FSWs) in sub-Saharan Africa are at great risk of acquiring and spreading HIV; in fact, they are 12 times more likely to have HIV than other women of childbearing age in sub-Saharan Africa. This area has the highest incidence of HIV-related deaths among FSWs, with an estimated 98,000 of 106,000 worldwide, HIV-related deaths each year. Approximately 65 percent of FSWs in sub-Saharan Africa have at least one biological child, and most continue to work while pregnant. Thus, examining the dynamics of motherhood and sex work could provide valuable insight for policy efforts aimed at reducing HIV transmission.

A recent study by Erin Papworth et al., examines the effects of motherhood on FSWs’ access to healthcare, as well as subsequent HIV detection and treatment rates. The researchers conducted a survey of FSWs in two major cities in Burkina Faso: Ouagadougou, the capital, and Bobo-Dioulasso. Respondents were asked about socio-demographic characteristics, human rights violations they had experienced, their sexual behaviors, sexual/reproductive health, and access to health services. The researchers were most interested in determining whether mothers differed substantially on these characteristics than those who did not report having a child.

Across the two study locations, nearly 75 percent of survey respondents had at least one biological child. Mothers tended to be older than non-mothers, and were more likely to be married or cohabiting with a partner. However, mothers also tended to be less educated than non-mothers. Furthermore, they were more likely to be living with HIV.

Overall, the study finds that motherhood tends to drive women to engage in sex work, mostly as a source of additional income. Mothers who engage in sex work are also less likely to have additional sources of income outside of this sex work. Though this study does not expand upon this finding, the researchers believe that, once sex workers become mothers, they retain their status in order to provide for their children. After accounting for age, mothers were more likely than non-mothers to participate in sex work for more than two years.

The study also examined the correlation between motherhood and FSWs’ reproductive practices. Mothers reported engaging in fewer risk-taking behaviors in their work. For instance, mothers were less likely than non-mothers to have unprotected sex with a new client. They were also more likely to be tested for HIV, and four times more likely to use hormonal contraception than non-mothers. These findings indicate that motherhood may enhance a FSW’s engagement in safe sexual practices. Since pregnancy increases the likelihood of mother-to-child HIV transmission, a nuanced understanding of the relationship between motherhood and sex work is key to developing future health programs for FSWs.

However, the study shows that FSWs, both mothers and non-mothers, are fearful of obtaining health services. Sex workers often face threats of physical and sexual violence, should their profession be exposed, which can deter FSWs from seeking healthcare. FSWs who were also mothers reported easier access to health services, despite this fear. The results of this study indicate that motherhood potentially mitigates the stigma associated with accessing sexual healthcare because the focus of care is on the fetus and the mother’s well being. This focus can help decrease the fear of stigmatization, while also increasing the likelihood that a mother continues care.

As the surveyed population of this study may not be representative of all FSWs, it remains important to examine reasons why sex workers in other locations are reluctant to seek health services, in order to overcome barriers to healthcare. Ensuring that HIV testing is repeated at antenatal care visits will be a critical factor in ensuring that FSWs continue to receive HIV testing, especially given evidence that sex workers do not cease sex work during pregnancy. On a larger scale, future policy efforts aimed at HIV prevention in sub-Saharan Africa must take into account both the cultural and economic barriers that FSWs face in accessing healthcare.

Article Source: Papworth, Erin, et al. “Mothers Who Sell Sex: A Potential Paradigm for Integrated HIV, Sexual, and Reproductive Health Interventions Among Women at High Risk of HIV in Burkina Faso.” J Acquir Immune Defic Syndr 68, 2015.

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