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Exposure to work place and war time violence among female sex workers living in conflict-affected northern Uganda Muldoon, Katherine Anne

Abstract

Background and objectives: Sex workers in sub-Saharan Africa are dually affected by HIV/STIs and violence. It is estimated that over one-third of commercial sex workers in sub-Saharan Africa are living with HIV; within Uganda, the site of the current study, 37.2% of female sex workers are reportedly living with HIV compared to 8.5% among the general Ugandan female population. There is limited information on the health and safety of sex workers living in environments affected by conflict despite the structural conditions that heighten risk of HIV infection and exposure to violence. This dissertation explores the prevalence and factors associated with exposure to violence among women currently involved in sex work in conflict-affected northern Uganda. Methods: This dissertation drew on data from a community-based cross-sectional study of HIV prevention, treatment, and care among 400 sex workers living in northern Uganda. Analyses investigated exposure to violence from commercial sources (e.g., clients) and non-commercial sources (e.g., conflict-related violence, including abduction). Descriptive statistics were used to display the individual-level, sex work environment, and conflict related characteristics of study participants. Bivariable and multivariable logistic regression methods were used to examine demographic, conflict-related, and sex work-related factors associated with exposure to violence. Results: 49.0% of sex workers had experienced sexual and physical violence in the previous six months, including physical assault, rape, and gang rape. Police harassment, inconsistent condom use, and managers/pimps that controlled sex workers’ negotiations were factors independently associated with increased odds of violence from clients. Exposure to historical conflict-related violence was common, as 32.3% of sex workers had been abducted into the Lord’s Resistance Army. From this sample, less than half reported accessing post-abduction reintegration programming. Conclusion: Sex workers in this study were exposed to extreme levels of commercial and non-commercial violence while concurrently facing substantial barriers to care. Rights-based policies, programming, and protective services for sex workers are needed to improve access to care and social services to reduce the burden of violence and improve health and well-being outcomes.

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Attribution-NonCommercial-NoDerivs 2.5 Canada

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