The need for improved services for minors who sell sex in West Africa

Structural determinants of health among women who started selling sex as minors in Burkina Faso.

Grosso AL, Ketende S, Dam K, Papworth E, Ouedraogo HG, Ky-Zerbo O, Baral S. J Acquir Immune Defic Syndr. 2015 Mar 1;68 Suppl 2:S162-70. doi: 10.1097/QAI.0000000000000447.

Objectives: To explore the prevalence of and factors associated with initiation of selling sex as a minor.

Design: Data were drawn from cross-sectional studies of adult female sex workers (FSW) recruited through respondent-driven sampling in Ouagadougou and Bobo-Dioulasso, Burkina Faso.

Methods: FSW completed a questionnaire that included a retrospective question regarding the age at which they started selling sex. Separate multivariate logistic regression analyses were conducted for each city to examine associations with initiation of selling sex as a minor (<18 year old), controlling for current age.

Results: Of study participants, 27.8% (194/698) reported selling sex as a minor, ranging from 24.4% (85/349) in Bobo-Dioulasso to 31.2% (85/349) in Ouagadougou. In Ouagadougou, early initiates were more than twice as likely to report someone ever forced them to have sex [age-adjusted odds ratio (aaOR): 2.54, 95% confidence interval (CI): 1.53 to 4.23]. In Bobo-Dioulasso, those who started as minors were more likely to report someone ever tortured them (aaOR: 2.29, 95% CI: 1.28 to 4.10). In both cities, early initiates were more likely to not use a condom with a client if offered more money (Ouagadougou aaOR: 2.34, 95% CI: 1.23 to 4.47; Bobo-Dioulasso aaOR: 2.37, 95% CI: 1.29 to 4.36). In Ouagadougou, women who had started selling sex at a young age were half as likely to have been tested for HIV more than once ever (aaOR: 0.50, 95% CI: 0.26 to 0.94). In Bobo-Dioulasso, early initiates were less likely to attend HIV-related talks or meetings (aaOR: 0.56, 95% CI: 0.33 to 0.97).

Conclusions: A substantial proportion of FSW in Burkina Faso started selling sex as minors. The findings show that there are heightened vulnerabilities associated with selling sex below age 18 years, including physical and sexual violence, client-related barriers to condom use, and lower access to HIV-related services.

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Editor’s notes: Young girls in sub-Saharan Africa are at increased risk of acquiring HIV compared with their male peers. Studies have identified both individual-level and structural-level risks for HIV infection among young girls, including inconsistent condom use and violence. Female sex workers who start selling sex as minors are particularly vulnerable to these risks. In West and central Africa, HIV infection is concentrated among key populations, such as female sex workers, with pooled HIV prevalence estimated to be 34.9%. Despite this, there have been relatively few studies of girls who sell sex in sub-Saharan Africa compared to multiple studies that have been conducted in Asia and the Americas. This is one of the first studies comparing early and later initiation of selling sex in West Africa. This study, using data from cross-sectional studies, investigated the structural determinants of health associated with the start of selling sex as a minor among female sex workers in Burkina Faso. The investigators found that almost a third of female sex workers had started selling sex as minors, and early initiation of selling sex was associated with a range of behavioural risk factors. In addition these women were more likely to experience social and structural vulnerabilities including limited access to health services, and violence. The study highlights the need to provide HIV services for minors who sell sex in sub-Saharan Africa, and to prevent sexual exploitation of children.

Burkina Faso
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