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BMC Public Health
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Human Immunodeficiency Virus | Research

Beaten but not down! Exploring resilience among female sex workers (FSWs) in Nairobi, Kenya

Authors: Rhoda Wanjiru, Emily Nyariki, Hellen Babu, Ibrahim Lwingi, Jennifer Liku, Zaina Jama, Mary Kung’u, Polly Ngurukiri, Chrispo Nyamweya, Pooja Shah, Monica Okumu, Helen Weiss, Rupert Kaul, Tara S. Beattie, Joshua Kimani, Janet Seeley, The Maisha Fiti Study Champions

Published in: BMC Public Health | Issue 1/2022

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Abstract

Background

In Kenya sex work is illegal and those engaged in the trade are stigmatized and marginalized.
We explored how female sex workers in Nairobi, Kenya, utilize different resources to navigate the negative consequences of the work they do.

Methods

Qualitative data were collected in October 2019 from 40 FSWs who were randomly sampled from 1003 women enrolled in the Maisha Fiti study, a 3-year longitudinal mixed-methods study exploring the relationship between HIV risk and violence and mental health. All interviews were audio-recorded, transcribed and translated. Data were thematically coded and analyzed using Nvivo 12.

Results

Participants’ age range was 18–45 years. Before entry into sex work, all but one had at least one child. Providing for the children was expressed as the main reason the women joined sex work. All the women grew up in adverse circumstances such as poor financial backgrounds and some reported sexual and physical abuse as children. They also continued to experience adversity in their adulthood including intimate partner violence as well as violence at the workplace. All the participants were noted to have utilised the resources they have to build resilience and cope with these adversities while remaining hopeful for the future. Motherhood was mentioned by most as the reason they have remained resilient. Coming together in groups and engaging with HIV prevention and treatment services were noted as important factors too in building resilience.

Conclusion

Despite the adverse experiences throughout the lives of FSWs, resilience was a key theme that emerged from this study. A holistic approach is needed in addressing the health needs of female sex workers. Encouraging FSWs to come together and advocating together for their needs is a key resource from which resilience and forbearance can grow. Upstream prevention through strengthening of education systems and supporting girls to stay in school and complete their secondary and/or tertiary education would help them gain training and skills, providing them with options for income generation during their adult lives.
Literature
1.
Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo Y-R. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan africa: a systematic review. AIDS Behav. 2012;16(4):920–33.PubMedCrossRef
2.
Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among illegal female sex workers in Israel. Sex Health. 2006;3(4):301–3.PubMedCrossRef
3.
Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.PubMedCrossRef
4.
5.
Platt L, Grenfell P, Meiksin R, Elmes J, Sherman SG, Sanders T, et al. Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med. 2018;15(12):e1002680.PubMedPubMedCentralCrossRef
6.
Beyrer C, Pizer H. Public Health and Human Rights: evidence-based approaches. Baltimore: Johns Hopkins University Press; 2007.
7.
8.
Mbote DK, Nyblade L, Kemunto C, Giger K, Kimani J, Mingkwan P, et al. Police discrimination, misconduct, and stigmatization of female sex workers in Kenya: associations with delayed and avoided health care utilization and lower consistent condom use. Health Hum Rights. 2020;22(2):199–212.PubMedPubMedCentral
9.
Ma H, Loke AY. A qualitative study into female sex workers’ experience of stigma in the health care setting in Hong Kong. Int J Equity Health. 2019;18(1):1–14.CrossRef
10.
Kalemi G, Gkioka S, Tsapatsari P, Tzeferakos G, Kandri T, Psarra ML, et al. Stigma and self-esteem: a case of HIV-positive sex-workers. Psychiatriki. 2017;28(1):67–74.PubMedCrossRef
11.
Peitzmeier S, Mason K, Ceesay N, Diouf D, Drame F, Loum J, et al. A cross-sectional evaluation of the prevalence and associations of HIV among female sex workers in the Gambia. Int J STD AIDS. 2014;25(4):244–52.PubMedCrossRef
12.
Monroe J. Women in street prostitution: the result of poverty and the brunt of inequity. J Poverty. 2005;9(3):69–88.CrossRef
13.
Bronfenbrenner U. Ecological systems theory. In: Vasta R, editor. Six theories of child development: Revised formulations and current issues. London: Jessica Kingsley Publishers; 1992. p. 187–249.
14.
Yates TM, Tyrell FA, Masten AS. Resilience theory and the practice of positive psychology from individuals to societies. In: Joseph S, editor. Positive Psychology in Practice. New Jersey: Wiley; 2015. p. 773–88.CrossRef
15.
Fergus S, Zimmerman MA. Adolescent resilience: a framework for understanding healthy development in the face of risk. Annu Rev Public Health. 2005;26(1):399–419.PubMedCrossRef
16.
McCaghy CH, Hou C. Family affiliation and prostitution in a cultural context: Career onsets of Taiwanese prostitutes. Arch Sex Behav. 1994;23(3):251–65.PubMedCrossRef
17.
Ulibarri MD, Strathdee SA, Lozada R, Magis-Rodriguez C, Amaro H, O'Campo P, et al. Intimate partner violence among female sex workers in two Mexico–U.S. Border cities: Partner characteristics and HIV risk behaviors as correlates of abuse. Psychol Trauma Theory Res Pract Policy. 2010;2(4):318–25.CrossRef
18.
Baker LM, Dalla RL, Williamson C. Exiting Prostitution: An Integrated Model. Violence Against Women. 2010;16(5):579–600.PubMedCrossRef
19.
Bernstein E. Temporarily Yours: intimacy, authenticity and the commerce of sex. Chicago: University of Chicago Press; 2021.
20.
Potter K, Martin J, Romans S. Early developmental experiences of female sex workers: a comparative study. Aust N Z J Psychiatry. 1999;33(6):935–40.PubMedCrossRef
21.
Parillo KM, Freeman RC, Collier K, Young P. Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women☆. Child Abuse Negl. 2001;25(3):335–46.PubMedCrossRef
22.
Swanston HY, Plunkett AM, O’Toole BI, Shrimpton S, Parkinson PN, Oates RK. Nine years after child sexual abuse. Child Abuse Negl. 2003;27(8):967–84.PubMedCrossRef
23.
Ferraro KF, Shippee TP, Schafer MH. Cumulative inequality theory for research on aging and the life course. In: Bengston VL, Gans D, Pulney NM, Silverstein M, editors. Handbook of Theories of Aging. 2nd ed. New York: Springer Publishing Company; 2009. p. 413–33.
24.
Decker MR, Pearson E, Illangasekare SL, Clark E, Sherman SG. Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator. BMC Public Health. 2013;13(1):876.PubMedPubMedCentralCrossRef
25.
Bhattacharjee P, Campbell L, Thalinja R, Nair S, Doddamane M, Ramanaik S, et al. Understanding the Relationship Between Female Sex Workers and Their Intimate Partners: Lessons and Initial Findings From Participatory Research in North Karnataka, South India. Health Educ Behav. 2018;45(5):824–35.PubMedPubMedCentralCrossRef
26.
el Bassel N, Schilling RF, Irwin KL, Faruque S, Gilbert L, Von Bargen J, et al. Sex trading and psychological distress among women recruited from the streets of Harlem. Am J Public Health. 1997;87(1):66–70.PubMedPubMedCentralCrossRef
27.
Scorgie F, Vasey K, Harper E, Richter M, Nare P, Maseko S, et al. Human rights abuses and collective resilience among sex workers in four African countries: a qualitative study. Glob Health. 2013;9(1):33.CrossRef
28.
Fletcher D, Sarkar M. Psychological Resilience. Eur Psychol. 2013;18(1):12–23.CrossRef
29.
30.
Ledesma J. Conceptual frameworks and research models on resilience in leadership. SAGE Open. 2014;4(3):2158244014545464.CrossRef
31.
National AIDS and STI Control Programme (NASCOP). Key population mapping and size estimation in selected counties in Kenya. Phase 1. Nairobi: NASCOP; 2019.
32.
Odek WO, Bhattacharjee P, Kimani J, Kimani G, Musyoki H, Githuka GN, et al. Assessment of female sex workers' operational characteristics and programme exposure in Nairobi. Nairobi: NASCOP; 2014.
33.
Alliance ASW. ‘Every sex workers has got a story to tell about violence’. Violence Against Sex Workers. Nairobi: Africa Sex Worker Alliance; 2012.
34.
Ngugi EN, Roth E, Mastin T, Nderitu MG, Yasmin S. Female sex workers in Africa: Epidemiology overview, data gaps, ways forward. SAHARA-J. 2012;9(3):148–53.PubMedCrossRef
35.
Widom CS, Kuhns JB. Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: a prospective study. Am J Public Health. 1996;86(11):1607–12.PubMedPubMedCentralCrossRef
36.
Stoltz J-AM, Shannon K, Kerr T, Zhang R, Montaner JS, Wood E. Associations between childhood maltreatment and sex work in a cohort of drug-using youth. Soc Sci Med. 2007;65(6):1214–21.PubMedPubMedCentralCrossRef
37.
Beattie TS, Smilenova B, Krishnaratne S, Mazzuca A. Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med. 2020;17(9):e1003297.PubMedPubMedCentralCrossRef
38.
Ross MW, Crisp BR, Månsson S-A, Hawkes S. Occupational health and safety among commercial sex workers. Scand J Work Environ Health. 2012;2:105–19.CrossRef
39.
Beattie TSH, Mohan HL, Bhattacharjee P, Chandrashekar S, Isac S, Wheeler T, et al. Community mobilization and empowerment of female sex workers in Karnataka State, South India: associations with HIV and sexually transmitted infection risk. Am J Public Health. 2014;104(8):1516–25.PubMedPubMedCentralCrossRef
40.
Yuen WW-Y, Wong WC-W, Tang CS-K, Holroyd E, Tiwari AF-Y, Fong DY-T, et al. Evaluating the effectiveness of personal resilience and enrichment programme (PREP) for HIV prevention among female sex workers: a randomised controlled trial. BMC Public Health. 2013;13(1):683.PubMedPubMedCentralCrossRef
41.
Wen J, Yeh T-P, Xie H, Yu X, Tang J, Chen Y. Resilience, self-esteem, self-efficacy, social support, depression and ART adherence among people living with HIV in Sichuan, China. AIDS Care 2021;33(11):1414–21.
42.
Blanchard AK, Mohan HL, Shahmanesh M, Prakash R, Isac S, Ramesh BM, et al. Community mobilization, empowerment and HIV prevention among female sex workers in south India. BMC Public Health. 2013;13(1):234.PubMedPubMedCentralCrossRef
43.
Anthony J, Hugar V, Munjattu JF, Pal A, Gyarappagari S, Ghosh S, Murugan S, Fahim S. Nothing for us without us: community led approaches towards successful implementation of HIV prevention programs: experiences from southern India. J Int AIDS Soc. 2012;15:264–5.
44.
Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, et al. Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Glob Health. 2014;10(1):47.CrossRef
45.
Benoit C, Roth E, Hallgrimsdottir H, Jansson M, Ngugi E, Sharpe K. Benefits and constraints of intimate partnerships for HIV positive sex workers in Kibera, Kenya. Int J Equity Health. 2013;12(1):76.PubMedPubMedCentralCrossRef
46.
Aggleton P, O'Reilly K, Slutkin G, Davies P. Risking everything? Risk behavior, behavior change, and AIDS. Science. 1994;265(5170):341–5.PubMedCrossRef
47.
Hickle KE. Resiliency and women exiting sex trade industry work. J Soc Work. 2017;17(3):302–23.CrossRef
48.
Odek WO, Githuka GN, Avery L, Njoroge PK, Kasonde L, Gorgens M, et al. Estimating the Size of the Female Sex Worker Population in Kenya to Inform HIV Prevention Programming. PLoS One. 2014;9(3):e89180.PubMedPubMedCentralCrossRef
49.
Metadata
Title
Beaten but not down! Exploring resilience among female sex workers (FSWs) in Nairobi, Kenya
Authors
Rhoda Wanjiru
Emily Nyariki
Hellen Babu
Ibrahim Lwingi
Jennifer Liku
Zaina Jama
Mary Kung’u
Polly Ngurukiri
Chrispo Nyamweya
Pooja Shah
Monica Okumu
Helen Weiss
Rupert Kaul
Tara S. Beattie
Joshua Kimani
Janet Seeley
The Maisha Fiti Study Champions
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-13387-3

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