Female sex workers in Cote d’Ivoire experience high levels of physical and sexual violence alongside intimidation from the police

Physical and sexual violence affecting female sex workers in Abidjan, Cote d'Ivoire: Prevalence, and the relationship between violence, the work environment, HIV and access to health services.

Lyons C, Ketende S, Drame F, Grosso A, Diouf D, Ba I, Shannon K, Ezouatchi R, Bamba A, Kouame A, Baral S. J Acquir Immune Defic Syndr. 2017 Feb 6. doi: 10.1097/QAI.0000000000001310. [Epub ahead of print]

Background: Violence is a human rights violation, and an important measure in understanding HIV among female sex workers (FSW). However, limited data exist regarding correlates of violence among FSW in Cote d'Ivoire. Characterizing prevalence and determinants of violence and the relationship with structural risks for HIV can inform development and implementation of comprehensive HIV prevention and treatment programs.

Methods: FSW > 18 years were recruited through respondent driven sampling (RDS) in Abidjan, Cote d'Ivoire. In total, 466 participants completed a socio-behavioral questionnaire and HIV testing. Prevalence estimates of violence were calculated using crude and RDS adjusted estimates. Relationships between structural risk factors and violence were analyzed using chi squared tests, and multivariable logistic regression.

Results: RDS Police refusal of protection was associated with physical (adjusted Odds Ratio [aOR]:2.6; 95%CI: 1.7,4.4) and sexual violence (aOR: 3.0; 95%CI: 1.9,4.8). Blackmail was associated with physical (aOR: 2.5; 95%CI: 1.5,4.2) and sexual violence (aOR: 2.4; 95%CI: 1.5,4.0). Physical violence was associated with fear (aOR: 2.2; 95%CI: 1.3,3.1) and avoidance of seeking health services (aOR:1.7; 95%CI:1.1-2.6).

Conclusions: Violence is prevalent among FSW in Abidjan and associated with features of the work environment. These relationships highlight layers of rights violations affecting FSW, underscoring the need for structural interventions and policy reforms to improve work environments; and to address police harassment, stigma, and rights violations to reduce violence and improve access to HIV interventions.

Abstract access   [1]

Editor’s notes: The authors report the findings of a study with female sex workers in Cote d’Ivoire.  They explored prevalence and determinants of violence and the relationship with structural risks for HIV. Of the women interviewed, 60% had experienced physical violence and, for these women, 85% had experienced physical violence in the last 12 months. Of these women around 70% reported violence after starting sex work. Almost half of the women surveyed had experienced sexual violence. The main perpetrators were clients. There were associations between being HIV positive and physical violence. Around 11% of the women were HIV positive but a quarter feared seeking health services due to their engagement in sex work.

A quarter of the women reported that police had refused them protection. Around a third had been intimidated or harassed by the police, and there were associations between experiences of physical or sexual violence and arrest, blackmail or condom refusal. The authors conclude that these findings illustrate an urgent need for improving the work environments for female sex workers in Cote d’Ivoire.  There is also a need to address police harassment and violence. The authors argue for the need for policy reforms to address legal barriers focussing on sex work.

Africa [4]
Côte d'Ivoire [5]
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