Abstract
Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR] = 2.25, 95% confidence interval [CI]: 1.30–3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36–4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13–3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33–0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland.
Highlights
In sub-Saharan Africa, female sex workers have a 12-fold increase in odds of being HIV infected as compared to all women of reproductive age [1]
Marital status was associated with social cohesion in that participants who had ever cohabitated with a sexual partner experienced lower levels of social cohesion compared to participants who were single/never married (p = 0.05)
Associations between social capital constructs and HIV-related risk factors found in this study demonstrate that including social capital enhancement in HIV prevention interventions for sex workers in Swaziland could be beneficial
Summary
In sub-Saharan Africa, female sex workers have a 12-fold increase in odds of being HIV infected as compared to all women of reproductive age [1]. Sex workers face heightened behavioral risk for HIV infection due to high numbers of sex partners and frequent sexual encounters. This risk is exacerbated by social and structural factors, including stigma, poverty, sexual and physical violence [2,3,4], as well as inequitable laws and policies, police brutality, and lack of non-discriminatory healthcare services [5,6]. Evidence from HIV prevention interventions among sex workers in India [8,9,10,11,12,13,14,15], Brazil [16,17], and the Dominican Republic [18] suggests that community empowerment can be an effective tool for reducing HIV-related risk and enacting social- and structural-level changes that alter HIV-related risk environments [19].
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