Conditions and consequences of geographic mobility among female sex workers in Peru: implications for STI/HIV prevention
C. Mejia1,2, V. Paz Soldan3, M. Nuñez4, A. Paca4, P. Campos4, P.J. Garcia4, K.K. Holmes5
1University of Washington, Health Services, Seattle, United States, 2Battelle, Centers for Public Health Research and Evaluation, Seattle, United States, 3Tulane University, School of Public Health and Tropical Medicine, New Orleans, United States, 4Universidad Peruana Cayetano Heredia (UPCH)., School of Public Health and Administration, Lima, Peru, 5University of Washigton, Departments of Global Health and Medicine, Seattle, United States
Background: Mobility and sex work have been associated with the spread of STIs/HIV. Mobility of female sex workers (FSWs) traveling within their country for short-term periods occurs frequently in developing countries. We aimed to provide a contextual understanding of conditions influencing mobility and explore how these conditions may contribute to women's STI/HIV vulnerability.
Methods: Qualitative interviews were conducted with 107 FSWs (53 mobile, 54 non-mobile) selected from six Peruvian cities. Mobile FSWs were defined as women performing sex work in >1 city away from their city of residence in the previous 12 months. Analyses reported here represent an iterative process of reviewing the narratives coded as: mobility process, entry into sex work, perceived risks, and consequences of mobility to identify central themes and relationships among themes.
Results: Higher proportions of mobile than non-mobile FSWs were < 24 years old, had completed high school, and had no children. Non-mobile FSWs' need to stay close to family was the primary reason for not traveling to other cities. Among mobile FSWs, common reasons for traveling were increasing earnings by attracting more clients in a new city (“fresh-face”), avoiding police harassment, concealing STI/HIV status, and being persuaded or forced to enter sex work. Debt and violence from police and clients were major barriers to condom use. Brothel-based FSWs diagnosed with STIs faced harsh discrimination in the workplace. Employers often prohibited mobile FSW to leave workplaces during non-work hours thus preventing FSW from seeking STI treatment/prevention services.
Conclusions: Financial constraints, police harassment, employer discrimination, and forced entry into sex work create conditions of STI/HIV vulnerability for mobile FSWs in Peru. FSWs may benefit from rapid and confidential workplace STI/HIV services. Interventions must consider contextual realities faced by mobile populations, and incorporate comprehensive processes which consider their human rights and socioeconomic and health status.
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