Prevention and treatment needs of women who started selling sex as minors

Ashley L. Grosso1, Sosthenes Ketende1, Kim Dam1, Erin Papworth1, Gautier Ouedraogo2, Odette Ky-Zerbo3, Simplice Anato4,

Felicity Nadedjo5, Nuha Ceesay6, Daouda Diouf7, Zandile Mnisi8, Xolile Mabuza9, Stefan Baral1.1 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, USA; 2 IRSS,

Ouagadougou, Burkina Faso; 3 PAMAC, Ouagadougou, Burkina Faso; 4 Arc-en-ciel, Lome, Togo; 5 FAMME, Kara, Togo; 6 UNAIDS, Banjul, The Gambia; 7 Enda Sante, Dakar, Senegal; 8 Swaziland National AIDS Program (SNAP), Ministry of Health

and Social Welfare, Mbabane, Swaziland; 9 Rock of Hope, Mbabane, Swaziland

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Methods• Female sex workers (FSW) ≥18 years old recruited through

respondent-driven sampling in Burkina Faso, Togo, and Swaziland; FSW ≥ 16 years old in The Gambia recruited through snowball sampling

• Were administered a questionnaire including a retrospective question on the age at which they started selling sex

• Separate multivariate logistic regressions for each country/ city to examine correlates of start of selling sex under age 18, controlling for current age.

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ResultsProportion of female sex worker study participants who started selling sex as minors Setting Ouagadougou,

Burkina FasoBobo-Dioulasso, Burkina Faso

Lomé, Togo

Kara, Togo

Gambia Swaziland

Started selling sex <age 18

31.2% (109/349)

24.4% (85/349)

21.6% (76/352)

46.2% (150/325)

12.6% (27/214)

25.9% (83/321)

Among those who started selling sex <age 18Mean age of start of selling sex (min.-max.)

15.9 (12-17)

15.7 (12-17)

15.5(12-17)

15.6 (12-17)

15.8 (13-17)

16.0 (14-17)

Forced, coerced, pressured or talked into selling sex

12.8% (14/109)

29.4% (25/85)

1.3% (1/76)

8.7% (13/150)

Not available

Not available

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ResultsCompared to FSW who started selling sex as adults, those who started as minors were more likely to report:• Behavioral risks

– using drugs, having anal sex in the last year, clients removed or paid more not to use condoms

• Violence– torture, rape, being beaten up

• Poor service access– less likely attend HIV-related prevention talks or test for HIV > once

ever • Poor health outcomes

– unwanted pregnancy, previous HIV diagnosis

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Acknowledgements• The women who participated in these studies. Without the leadership of

these communities, these studies would not have been possible. • The study staff• Partner organizations and supporters:

– Burkina Faso: PAMAC, IRSS– Togo: Espoir-Vie Togo, Arc-en-ciel, FAMME– Swaziland: Swaziland National AIDS Program at the Ministry of Health, National

Emergency Response Council on HIV/AIDS– The Gambia: National AIDS Secretariat, Action Aid International, UNAIDS, Network

of AIDS Service Organizations – The Gambia, Jobot Laboratories, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and Enda Sante

– The studies in Burkina Faso, Togo and Swaziland were implemented by USAID | Project SEARCH, Task Order No. 2: Research to Prevention (R2P). R2P is based at the Johns Hopkins University (JHU) in Baltimore, Maryland, USA. This work was supported by USAID | Project SEARCH, Task Order No. 2, funded by the US Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning 30 September 2008, and by the President’s Emergency Plan for AIDS Relief.