Abstract
Young women (aged 15–24) who exchange sex for money or other support are among the highest risk groups for HIV acquisition, particularly in high prevalence settings. To prepare for introduction and evaluation of the DREAMS programme in Zimbabwe, which provides biomedical and social interventions to reduce adolescent girls’ and young women’s HIV vulnerability, we conducted a rapid needs assessment in 6 towns using a “social mapping” approach. In each site, we talked to adult sex workers and other key informants to identify locations where young women sell sex, followed by direct observation, group discussions and interviews. We collected data on socio-demographic characteristics of young women who sell sex, the structure and organisation of their sexual exchanges, interactions with each other and adult sex workers, and engagement with health services. Over a two-week period, we developed a “social map” for each study site, identifying similarities and differences across contexts and their implications for programming and research. Similarities include the concentration of younger women in street-based venues in town centres, their conflict with older sex workers due to competition for clients and acceptance of lower payments, and reluctance to attend existing services. Key differences were found in the 4 university towns included in our sample, where female students participate in diverse forms of sexual exchange but do not identify themselves as selling sex. In smaller towns where illegal gold panning or trucking routes were found, young women migrated in from surrounding rural areas specifically to sell sex. Young women who sell sex are different from each other, and do not work with or attend the same services as adult sex workers. Our findings are being used to inform appropriate intervention activities targeting these vulnerable young women, and to identify effective strategies for recruiting them into the DREAMS process and impact evaluations.
Highlights
Adolescent girls and young women (AGYW) aged 15–24 are at disproportionately high risk of acquiring HIV in sub-Saharan Africa; they accounted for 25% of new adult HIV infections in 2015 [1]
Survey and programme data collected from female sex workers across Zimbabwe since 2009 suggest that that Young women who sell sex (YWSS) exist in sizeable numbers, and around 20% of female sex workers (FSW) report initiating sex work before age 20 [4,5,6]
We defined YWSS as women aged between 18–24 who exchanged sex for money or material goods, including those who self-identify as FSW as well as those who do not consider themselves as sex workers but report sex with men that would not occur in the absence of receiving financial or other resources
Summary
Adolescent girls and young women (AGYW) aged 15–24 are at disproportionately high risk of acquiring HIV in sub-Saharan Africa; they accounted for 25% of new adult HIV infections in 2015 [1]. Young women who sell sex (YWSS) face high risks due to high numbers of sexual partners, inability to negotiate condom use, and limited access to health services[2, 3]. To reduce HIV among AGYW, the DREAMS initiative (Determined Resilient Empowered AIDS-free Mentored and Safe), targets biological, behavioural, and socio- economic determinants of risk through a comprehensive package of HIV prevention interventions in 10 African countries. In Zimbabwe, DREAMS is being implemented across six districts, delivered through local implementing partners that provide access to condoms, contraception, and HIV testing, and offer educational opportunities, vocational training, and work experience to address AGYW’s socio-economic vulnerabilities. DREAMS is making oral pre-exposure prophylaxis (PrEP) available to YWSS aged 18–24 in four of its programme districts in Zimbabwe to ameliorate their heightened risk
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