Violence and sex work in Uganda

Policing the epidemic: high burden of workplace violence among female sex workers in conflict-affected northern Uganda.

Muldoon KA, Akello M, Muzaaya G, Simo A, Shoveller J, Shannon K. Glob Public Health. 2017 Jan;12(1):84-97. Epub 2015 Oct 27.

Sex workers in sub-Saharan Africa experience a high burden of HIV with a paucity of data on violence and links to HIV risk among sex workers, and even less within conflict-affected environments. Data are from a cross-sectional survey of female sex workers in Gulu, northern Uganda (n = 400). Logistic regression was used to determine the specific association between policing and recent physical/sexual violence from clients. A total of 196 (49.0%) sex workers experienced physical/sexual violence by a client. From those who experienced client violence the most common forms included physical assault (58.7%), rape (38.3%), and gang rape (15.8%) Police harassment was very common, a total of 149 (37.3%) reported rushing negotiations with clients because of police presence, a practice that was significantly associated with increased odds of client violence (adjusted odds ratio: 1.61, 95% confidence intervals: 1.03-2.52). Inconsistent condom use with clients, servicing clients in a bar, and working for a manager/pimp were also independently associated with recent client violence. Structural and community-led responses, including decriminalisation, and engagement with police and policy stakeholders, remain critical to addressing violence, both a human rights and public health imperative.

Abstract access   [1]

Editor’s notes: Sex workers are at increased risk of HIV and of violence from multiple perpetrators. There is a paucity of research examining violence among sex workers in conflict-affected areas. Sex work in Uganda is illegal. A police presence can reduce sex workers ability to screen for dangerous clients, negotiate sex acts, price and condom use. This study is from northern Uganda. The site, now at peace, has experienced 20 years of war. A quarter of sex workers are living with HIV. The paper examines the prevalence of client violence, police arrest and other factors, and how they interrelate.

Participants in the study were usually young (median age 21 years), poorly educated and had ≥1 child. One third had been abducted into the Lord’s Resistance Army and two thirds had lived in an Internal Displacement Camp. Some 49% had experienced recent physical or sexual violence from clients.  Eight percent had been gang raped in the past six months. Policing, inconsistent condom use, having sex in a bar and working for a manager or pimp were significantly associated with client violence. Sex workers in this survey face a high prevalence of violence and HIV. Decriminalisation of sex work is vital if sex workers are to access labour and human rights protection and to reduce the high prevalence of violence and HIV

Gender [3], Key populations [4], Sexual transmission [5]
Africa [6]
Uganda [7]
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