Abstract
BackgroundFemale sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence.MethodsA cross-sectional survey was administered among 251 FSW accrued through a combination of chain referral and venue-based sampling in The Gambia. Eligibility criteria included being over 16 years old and having exchanged sex for money, goods, or favors in the past 12 months.ResultsThere is a high prevalence of sexual violence against FSW in The Gambia, with 29% (n = 70) of participants reporting a client forced them to have sex in their lifetime. Women who reported forced sex by a client were more likely to report symptoms of depression (aOR 2.15, CI: 1.10 – 4.16 p < 0.05), unwanted pregnancy (aOR: 2.69, CI: 1.12 – 6.49 p < 0.05) and report “no”, “difficult” or “somewhat difficult” access to condoms (aOR: 3.31, CI: 1.76 – 6.26 p < .01) compared to women who did not report forced sex. Client-perpetrated forced sex was also negatively associated with receiving any sexually transmitted infection (STI) test in the past 12 months (aOR: 0.49, CI: .26 – .91 p < .05).ConclusionFSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strategy to improve the health and safety of FSW as well as impact the spread of HIV/STIs in The Gambia.
Highlights
Female sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes
More research is needed in The Gambia to examine the prevalence and correlates of forced sex against FSW by non-clients as well as sexual violence in the general population
A response to sexual violence victimization that includes the availability of emergency contraceptives, post-exposure prophylaxis, and mental health crisis services, could better meet the post-assault health needs of Gambian FSW as well as women in the general population
Summary
Female sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence. Female sex workers (FSW) are among the most vulnerable populations for the acquisition and transmission of both HIV and STIs. In many parts of sub-Saharan Africa such as Guinea, Benin, and Senegal the national HIV prevalence is reported as 1.7% (2010), 1.5% (2007) and 1.0% (2010) compared to 36.7%, 40.9%, and 19.9% among FSW (OR 33.1, 44.2 and 23.7 respectively) [1,2,3,4,5,6]. Data from African contexts, for instance, Kenya (43%) [18], Namibia (72%) [17], and Rwanda (37%), [19] report a high prevalence of victimization
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