Female Sex Workers Reveal Risks and Motivations

GABORONE - They sell sex for money or other goods. It's a risky practice – and illegal in Botswana – but it's a reality that female sex workers are still out there, and so are the clients who keep them in business.

However, not much is understood about sex workers in Botswana, what risks they take and what motivates them. But a recently released assessment by the International Training and Education Center on HIV (I-TECH) and Matshelo Community Development Association (Francistown), with support from BOTUSA (CDC) through the President's Emergency Plan for AIDS Relief (PEPFAR), is one of the first to take a comprehensive look at how the world's oldest profession is practiced here.

"I was never interested in this job and never thought I can do it," says one woman in the assessment, explaining her motivation for taking up sex work. "A man came up to me and offered to have sex and give me something. I thought life is good. I was given P600 (Botswana Pula)."

The authors of the assessment, released during official launches in Gaborone and Francistown in July 2007, sought specifically to understand the risks of HIV infection and transmission, as well as access to prevention and treatment services among female sex workers (or FSWs) and their clients, and suitable interventions to reduce HIV/AIDS transmission in both groups.

One of the most significant findings of the assessment was that few organizations target sex workers for HIV/AIDS prevention interventions, yet FSWs represent a high risk group for HIV infection.

The assessment was conducted in Ghanzi, Gaborone, Selebi-Phikwe, Francistown, Letlhakane and Kasane in 2006. Researchers found that sex work existed in all 6 sites.

Anjali Sharma, a researcher with I-TECH, is the lead author of the report entitled "HIV Needs Assessment of Female Sex Workers in Major Towns, Mining Towns, and Along Major Roads in Botswana."

"It was not difficult to get FSW or men to talk to us and yes, they were frank," Sharma said. "It was more the NGOs (non-government organizations) and HCPs (health care providers) who were guarded – maybe because the illegality of sex work plays more on their minds."

Motivation for Sex Work
Some common threads that ran through interviews with the women, Sharma said, including motivations for entry into sex work. Gender roles, poor education, limited work opportunities and low wages also created the path to sex work for women in Botswana. Participants commonly attributed entry into sex work as a failure of male partners to provide for them adequately and lack of female earning power.

As for the motivation of male clients, several believed that their manliness "was determined by the number of women" with whom they were seen. One man explained that: "In culture past, to realize that this is a man, he had a number of wives. A rich man had seven wives. It still exists today. To recognize that this is a dangerous guy, he must have all of these women around him and we should be able to see that he can take anyone."

Alternative work was not always possible for the FSWs. All of the women but one said that they did not do well in school. About a third of the women interviewed had income-producing work in addition to sex work such as, nanny/maid, hawking vegetables, sales girl, managing a car wash, security guard, hairdressing, and musician; but these jobs did not give the women an income that was adequate to buy the basic necessities.

"It's not easy in jobs," explained by one woman. "I was working in a shop. At month-end the owner accused us of stealing and we each got P30-P50. Can you imagine working everyday and getting P50 at month end? In this job [sex work], I can get P50 in one day!"

Women reported earning an average of P700 per month in sex work. Many of these women supported the welfare and survival of their entire family as mothers, daughters, sisters, nieces and granddaughters. Most said they did not enjoy sex with clients; it was motivated by money, not desire.

Condom Negotiation, Health Care and Support
Both men and women said the use of condoms depended on client agreement, on the price that was negotiated and individual ability to insist on condom use. Of the 24 women with regular customers, 12 always used condoms, nine sometimes and three never used them. About half of the 30 women in the assessment reported always using condoms with casual customers and the other half reported intermittent use.

"The men are strangers. They can kill and throw you in the bush. And no-one will even know what happened. He does not want to use condoms just to enjoy sex. For 250BWP spreading AIDS to me. But if he offers, 500BWP I will do it," said one woman.

The women thought health care in Botswana was equitable but did not specifically target vulnerable or priority populations, such as FSW. Women feared taunts from health care providers if they took many condoms.

The women thought health promotion on HIV, VCT and social support should reach them as groups through peers.

Service Providers
Very few organizations target sex workers in Botswana. One organisation that does is Matshelo Community Development Association (MCDA), a network organization that teaches women how to reduce the number of clients and negotiate for consistent condom use. But the organization has had little support from government and non-government partners due to lack of interpretation of laws on prostitution, Sharma said.

"People fear that helping sex workers is tantamount to illegal activity," Sharma said.

Needs of FSWs include condom negotiation skills and accessing public assistance such as housing, child welfare, job training and education. Also, there is need for a discrete public, or non-governmental, clinic that caters to all these needs for sex workers. Targeting FSW to reduce harm in sex work is necessary, but the researchers concluded that interventions must also target men.