Violence against substance-abusing South African sex workers: intersection with culture and HIV risk

Abstract

The Republic of South Africa has become an epicentre of heterosexual HIV transmission among Black women, and the interface between violence against women, substance abuse, and HIV risk is becoming evident. This paper describes the characteristics of Black South African women who engage in sex work in Pretoria and examines their intersecting experiences of high-risk sexual behaviour, substance abuse, and victimization. Ninety-three women were recruited into the study. Field staff collected biological measures of drug use and administered a structured, self-report interview. Findings indicate that young South African women who engage in sex work and use drugs rely on this activity as their main source of income and are supporting other family members. The majority of sample women reported experiencing some victimization at the hand of men, either clients or boyfriends, with many reporting childhood abuse histories; young women also report great fear of future victimization. Findings also suggest that as a result of their decreased likelihood of using protection, women who reported any sexual or physical victimization are at increased risk for HIV and other STIs. Results support the critical need for targeted, comprehensive interventions that address substance abuse, sexual risk, and violence as interrelated phenomena.

Acknowledgments

We wish to acknowledge the financial support provided by the National Institute on Drug Abuse (NIDA) grant R01 DA11609. The interpretations and conclusions do not represent the position of NIDA or the U.S. Department of Health and Human Services. We wish to thank Jeff Novey and Antonio Morgan-Lopez of RTI for their helpful comments and suggestions on this manuscript. We also wish to thank all the women participants, field staff, and community advisory board members for their involvement in this study.