Sex work and young women: a cross sectional study to understand the overlap of age and sex work as a central tenet to epidemic control in South Africa

ABSTRACT

Adolescent girls and young women (AGYW) engaging in sex-for-money transactions are at risk of HIV infection. A better understanding of the demographic, socio-economic factors and risks of HIV acquisition is required to guide appropriate public health interventions targeting young sex workers in South Africa. A cross-sectional survey of Female Sex Workers (FSWs), using a chain referral sampling method, was conducted across 12 sites in South Africa in 2019. Three thousand and five participants were enrolled and interviewed assessing demographic characteristics, sexual behaviour, substance use and HIV testing and treatment. Of 3005 women, 13.3% were ≤24 years old (young FSWs); of these, 60.0% entered sex work aged ≤19 years. Economic factors were the primary drivers of entry into sex work. HIV prevalence amongst young FSWs was 40.4%, with 12.4% recently infected. Younger FSWs were significantly less likely to know they were HIV positive (87.6% versus 92.1%), to report any ART exposure (75.2% versus 87.6%) and to be virally suppressed (58.1% versus 75.2%) compared to older FSWs. Our findings highlight that many FSWs enter sex work at a young age. It is essential to develop tailored services and interventions that improve access to HIV prevention and treatment services addressing specific needs.

KEYWORDS:

• Adolescent girls and young women
• key population
• sex work
• HIV

Acknowledgement

We would like to acknowledge all the study participants and the staff that ensured the successful conduct of this multi-site study. MM facilitated the design, and oversaw the implementation and scientific aspects of the study and led the writing of the paper; RJ assisted with data analysis and interpretation and manuscript preparation and review; MM assisted with study oversight and manuscript preparation; KD assisted with data analysis and interpretation and manuscript preparation and review; KH monitored and analyse the data and contributed to writing; LV technical input and manuscript review; NS technical input and manuscript review; MJ oversaw the clinical aspects of the study and provided technical review; VM assisted with study oversight and manuscript preparation; FA provided technical and scientific oversight and manuscript review; KO monitored and analyse the data and contributed to writing; GG provided technical and scientific oversight and manuscript review; JC, oversaw the design, implementation and scientific aspects of the study and led the writing of the paper. All co-authors have provided their consent for publication

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work herein was supported by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the Research Capacity Development Initiative programme. Funding was also received through a Social Impact Bond under the South African Medical Research Council’s Office of AIDS and TB Research, The Global Fund and the Department of Science and Technology [grant number 46523]. This research was funded in part, by the Wellcome Trust [grant number 214204/A/18/Z]. For the purpose of open access, the author has applied for a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.