Brothels in johannesburg

Added: Herson Broyles - Date: 14.10.2021 01:50 - Views: 47863 - Clicks: 3465

Metrics details. The sexual and reproductive health SRH status of female sex workers is influenced by a wide range of demographic, behavioural and structural factors. These factors vary considerably across and even within settings. Adopting an overly standardised approach to sex worker programmes may compromise its impact on some sub-groups in local areas. Johannesburg women were also more likely to access health services at a hotel In both cities, risk of HIV rose rapidly with age Sex worker populations are heterogeneous.

Local health programmes must prioritise services that reflect the variety and complexity of sex worker needs and behaviours, and should be deed in consultation with sex workers. Segmenting sex worker populations according to age, country of origin and place of service delivery, and training healthcare providers accordingly, could help prevent new HIV infections, improve adherence to antiretroviral treatment and increase uptake of SRH services. Female sex workers face many barriers to accessing sexual and reproductive health SRH care because of stigma and discrimination [ 1 , 2 ], which increase their vulnerability and impede their right to access health services [ 3 , 4 ].

Other factors contributing to poor SRH outcomes include high sexually transmitted infections STI prevalence [ 1 ], HPV infection and thus risk for cervical cancer [ 5 ], unintended pregnancies [ 6 , 7 ], repeated physical and emotional abuse [ 8 ], high mobility and frequently an illegal immigrant status [ 2 , 9 ]. In most countries the prevalence of HIV is 10 to 20 times higher among female sex workers than it is among women in the general population [ 10 , 11 , 12 ].

Overcoming these barriers through improved service delivery to link sex workers to early antiretroviral treatment is essential if the ambitious global goal of ending the HIV epidemic by is to be reached [ 13 ]. Most sex work programmes in Africa are not linked with broader HIV care and treatment networks [ 2 ]. The South African government recently adopted a comprehensive national HIV plan for sex workers [ 14 ]. This plan combines the rollout of pre-exposure prophylaxis PrEP for those that are HIV negative, and immediate antiretroviral treatment for HIV-positive sex workers, in addition to six integrated support packages of care encompassing the multi-faceted lives of sex workers.

The plan targets SRH and HIV, and includes a minimum package of health services, peer-led service delivery, psychosocial and human rights support, building sex worker organisations, and promoting career paths and economic opportunities. SRH services included in the plan are periodic presumptive treatment for STIs, contraception including dual protection and emergency contraception , referral for termination of pregnancy, and annual PAP smears for screening for cervical cancer [ 14 ]. In a resource-limited setting like South Africa it is important to implement evidence-based care at sufficient scale and tailored to the needs of sex workers in different settings [ 15 ].

The objective of this study was to describe the socio-demographic and behavioural characteristics of sex workers in two cities, and to identify risk factors for adverse SRH outcomes. These findings may guide the formulation of more focused and locally-relevant health and social responses in the rollout of the South African HIV plan for sex workers.

Then, in , the Wits RHI set up sex worker services and outreach programmes in Pretoria, the capital city of South Africa, about 50 km from Hillbrow. In both places, peer educators recruit sex workers who can then access a comprehensive package of health education, HIV and SRH services. These services are provided through stand-alone sex worker clinics, mobile vans that deliver clinical services to street-based sex workers within the community, and clinical teams that provide health services in brothels and hotels where sex workers operate.

We conducted a retrospective analysis of routinely collected data from the female sex worker programs from to in Johannesburg and Pretoria. In both sites, data were collected using standardised forms that were completed when sex workers accessed services for the first time at the clinic, mobile van, hotels or brothels.

Data were collected on demographics and sex work history, as well as sexual behaviours with different types of partners and substance use. Data were included for all female sex workers who attended the services during the study periods. Demographic variables included age, country of birth, education level, of adult dependents, of children living with the sex worker and whether they have a main partner. Behavioural variables included, of sexual encounters in the last seven days, of years in sex work, whether they used condoms consistently with their main partners and clients, alcohol and marijuana use, of times the woman moved house in the last 12 months, and the site of service delivery.

Chi-square tests were used to test relationships between categorical variables and Student t -tests were performed on continuous variables. We used multivariate logistic regression to assess associations between the independent and outcome variables. are consistently reported for Johannesburg first and then Pretoria. The Johannesburg database recorded first visits and the Pretoria site Table 1. A third Women in Johannesburg were more likely than those in Pretoria to have finished secondary education In both sites, around half of the women had a main partner Almost half of the sex workers in Johannesburg were from Zimbabwe Alcohol use was twice as high among women in Johannesburg as in Pretoria Johannesburg women moved house markedly more often in the past year mean 3.

Women in Johannesburg reported higher condom use with commercial clients In both sites, consistent condom use with main partners was three to seven-fold lower than condom use with commercial clients. For SRH outcomes at the first visit, a lower proportion of women in Johannesburg than in Pretoria In both sites, odds of HIV infection rose stepwise with each increase in age category. Women over 35 were 2-times more likely to be HIV positive than those under 25 Table 2. The association was, however, only detected in the multivariate model of the Johannesburg site.

In Pretoria, sex workers from Zimbabwe and other countries were more likely to have reported a prior STI. Also in that city, inconsistent condom use with clients was associated with a lower odds of an STI. In Johannesburg, those with Grade 11—12 education had higher STI levels than women with only primary schooling. In both sites, the majority of women reported using condoms as their preferred method of contraception In Johannesburg, modern contraceptive use was highest among those with no adult dependents Of the 65 1.

Sex workers in Johannesburg were more likely to have no child dependents than Pretoria women There was no association between contraceptive use and of child dependents. This study, conducted in two urban sites in Gauteng Province, shows that female sex workers are a very heterogeneous group, and have quite disparate needs [ 6 , 17 ], both within and between sites. Sex workers might have varied motivations for entering the profession [ 18 ]; with many women supporting themselves and their dependants through sex work [ 19 ].

Poverty, large s of dependents, lack of other employment options might increase the risk taking behaviours of these women [ 18 ]. Screening for STIs is also a key part of sex worker services. They were younger, better educated, and were more likely to come from outside South Africa than those in Pretoria. They were also twice as likely to drink alcohol, had been in sex work for longer than their colleagues in Pretoria, but had fewer sex encounters in the last seven days.

On the domestic front, women in Johannesburg were less likely to have a main partner, less likely to have child dependents and more likely to have moved house in the last year. These differences were associated with SRH outcomes and require differentiated sex work-specific preventive health care [ 1 , 16 , 20 ]. As in other studies [ 1 ], younger age was linked with lower HIV positivity and less child dependents.

To prevent new HIV infections and unintended pregnancy, young sex workers constitute a key group to be targeted with HIV interventions such as PrEP and condom negotiation skills, especially with main partners as well as modern contraception services.

In contrast, the emphasis of services for women older than 25, those who have been in sex work for some time and those who are already HIV-positive must be on psychosocial support and motivation to stay adherent to treatment regimens [ 4 ]. Given their experience in the trade and to complement age-matched peer educators, older sex workers might be trained to provide mentoring for younger sex workers, assisting them to lower the risks inherent in the industry [ 22 ]. The finding that sex workers in Johannesburg are younger, yet have been in sex work longer than their counterparts in Pretoria could be ascribed to several factors and was observed in other settings where groups of sex workers were compared [ 9 ].

Firstly, the city centre in Johannesburg is renowned for commercial sex work and women who exchange sex for money may more readily adopt a sex worker identity than those in Pretoria [ 23 ]. Secondly, the majority of women in Johannesburg migrated from Zimbabwe or other countries, often at a young age. These women might enter sex work early as they lack official documentation and experience xenophobic-related stigma that diminishes their employment opportunities in other sectors [ 16 , 25 ]. Migrancy and mobility are an inherent part of sex work in most settings [ 8 , 16 , 26 ], which limits their contact with health providers [ 4 , 26 ].

The reasons for women having to relocate, especially those in Johannesburg, and the impact this may have on income and the welfare of their children are important factors to consider in programming. Support groups and sex worker networks can play a valuable role in advising their fellow sex workers about stable accommodation [ 20 , 23 ]. Reducing levels of mobility will promote retention in programmes, continuity of care within services such as ART and improve access to familiar health providers.

Sex workers are more open to accessing healthcare if services are delivered at their place of work [ 2 , 23 ]. This is clearly seen from the several fold higher of visits held through outreach to hotels and street-based venues, than at the clinics. Site of service delivery has important implications. Firstly, sex workers often only report to the clinic when they have disease symptoms or are already suffering from advanced disease HIV prevalence was highest among women at the clinic, for example.

We propose that sex work programmes use outreach peer educators and peer networks to encourage sex workers to seek preventative services or health care early when symptoms arise. Secondly, sex workers served by the mobile vans are usually street-based and might be more susceptible to violence from clients, police arrest, and have less access to condoms and healthcare than their colleagues in hotels and brothels [ 6 ]. Also, homeless women might not have a place to store their medication, even if they were to access treatment. The increased vulnerability of street-based sex workers is reflected in their higher HIV prevalence than hotel-based women.

Routine enquiry about violence-related trauma and violation of human rights is important in outreach, but also in other service sites [ 17 ]. Health programming often only caters for occupational hazards, like unprotected sex with commercial clients [ 8 ] and substance use [ 27 ], omitting the compounding exposures sex workers might face in their domestic lives.

Brothels in johannesburg

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Trafficked girls, women rescued from Joburg brothel allegedly owned by Nigerian nationals