Structural determinants of health: a qualitative study on female sex workers in Benin

ABSTRACT

The objective of this paper is to expose those socio-structural contexts revealing the social injustice and human rights violations that sub-Saharan women face every day when forced into sex work by unemployment or sickness. Results of a qualitative study highlighting some key structural determinants of sex work and HIV infection among FSWs will be presented and examined through the lens of the WHO conceptual framework for action on the social determinants of health. The results showed that most FSWs had lacked the necessary financial support at some point in their lives. Also, both the socioeconomic and political context failed to provide proper support to prevent involvement in sex work and the consequent risks of HIV. The cultural and societal values placed on the health and well-being of FSWs in Benin appear to depend on the degree to which sexual violence and adultery are perceived as a collective social concern. This portrait of FSWs calls for both long-term interventions through a structural determinant approach to HIV prevention, targeting all the women who could face such a financial situation well before their entry into sex work, while maintaining short and medium-term interventions on the intermediary determinants.

KEYWORDS:

• Structural determinants
• Health
• Female sex workers
• gender
• Migration
• HIV
• Benin

Acknowledgements

This study was funded by the Canadian Institutes of Health Research (grant # ROH-115205). The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or in writing the report. The authors are indebted to interviewers, community workers and collaborators whose dedication made this study possible. Above all, they wish to thank all the participants in this study for their time and openness to share their experiences.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval and consent to participate

The study was approved by the ethics committee of the CHU de Québec (Canada) and by the National Committee on Ethics in Health Research in Benin. Every participant consented to participate.

Authors’ contributions

MD; conceptualization, methodology, qualitative analysis and writing original draft, EB; conceptualization, methodology and manuscript review, AK; writing up of the protocol, methodology and manuscript review; FAG supervision, and manuscript review. LB manuscript review, MA funding acquisition, writing up of the protocol, conceptualization, methodology, supervision, and manuscript review. All authors read and approved the final manuscript.

Additional information

Funding

This study was funded by the Canadian Institutes of Health Research (grant # ROH-115205).