Female Sex Workers
A more comprehensive version of this profile can be downloaded using the “PDF Download” button.
In a snapshot: she is enduring varying degrees of agency loss.
Broadly, sex work is defined as the exchange of money (or other items of value) for sexual services—importantly, consensual sexual services. Most female sex workers (FSW) in sub-Saharan Africa begin sex work between the ages of 16 and 35, often as a way to support themselves and their families in the face of limited job opportunities. Some gain not only financial security but also a sense of economic liberation through their work. However, it comes at a significant cost, as sex work is criminalized and sex workers face stigma, abuse, and violence—in some cases life-threatening.
FSW priorities are survival, stability, and community.
Whether or not they identify as sex workers, FSW are well aware of the steep physical and financial risks they face. According to quantitative market research conducted in 2017 in Kenya (OPTIONS research), FSW value “survival” more than any other group at risk of HIV acquisition. The research also found that FSW want to support themselves and their families financially. 1 In terms of community, FSW seek emotional support and want to learn how to collectively protect themselves. 2
In communicating about PrEP, it is important to recognize that FSW don’t necessarily identify as sex workers; other identities, priorities, and goals are more important. 3
FSW are not a homogenous group, as one landscape assessment of recent research explained: Marital status, number of children, and level of education are widely varied. Further, sex work is not necessarily performed year-round, as some people engage in sex work only seasonally or during times of need. 4
Importantly, per a UNAIDS consultation meeting in October 2014, FSW don’t always see themselves as “sex workers,” but rather as women. Many consider themselves temporarily engaged in an advantageous but stigmatized way to generate income. 5
These situations may contribute to some FSW perceived low risk of HIV: “You’re not talking about me when you say sex worker.” Similarly, reports have found that members of this group do not always perceive themselves as “victims. 6 In any context, messages speaking to “sex workers” specifically not only are stigmatizing but also may not resonate; research and messaging in collaboration with local FSW is necessary!
FSW are widely concerned about their health and practice preventative care — when they can.
The 2017 OPTIONS research in Kenya found that a strong majority of FSW respondents—94 percent—are concerned about their health, and the risk of HIV was generally their highest concern. Respondents in the OPTIONS research placed a high priority on HIV prevention, specifically by “using condoms.” In practice, however, use can be inconsistent. 1 Refusal by clients is the most important reason; clients will sometimes offer more money for sex without a condom, or demand it through threat or violence. 7
The criminalization of condoms also thwarts FSW agency to insist on protected sex. 5 In Zimbabwe, for example, sex workers report being arrested for carrying condoms. This discourages sex workers from doing so, hampering their ability to negotiate condom use with clients. 8
Awareness of PrEP is high among FSW, and there is definite interest in trying it.
According to the OPTIONS research, roughly half of FSW were aware of PrEP, and a majority were interested in trying it. 1 However, awareness doesn’t equate to understanding of what PrEP is or does. Interestingly, FSW perceive other benefits to PrEP apart from HIV prevention. In a 2016 study in Kenya, respondents described the benefit of PrEP as one of “added protection” when other forms of protection are not on hand, especially in the case of forced sexual assault. Respondents also said it would be useful to have added protection in dealing with older partners, when drugs/alcohol are involved, when condoms break, or with multiple partners. Notwithstanding this, the stigma that accompanies HIV cannot be underestimated 9 For many FSW surveyed in the 2017 OPTIONS research in Kenya, the potential risk for being mislabeled as HIV positive overshadowed the lower risk of HIV transmission. 1
A more detailed, comprehensive version of this audience profile, including the relationship between FSW and high-risk activities and sexual and reproductive health, can be downloaded here.
For a sample demand creation strategy, including the best media and tactics to reach FSW, check out the Communications Fast Tracker.
OPTIONS. OPTIONS Market Intelligence Report: Kenya. Source. Published July 31, 2018. Accessed December 23, 2018.
Africa Sex Worker Alliance. “I expect to be abused and I have fear”: Sex workers’ experiences of human rights violations and barriers to accessing healthcare in four African countries. Source. Published April 2011. Accessed December 26, 2018.
Wits Reproductive Health and HIV Institute. Sex workers’ hopes and fears for HIV pre-exposure prophylaxis: recommendations from a UNAIDS consultation meeting. Published October 2014. Source. Accessed January 3, 2018.
PrEP Communications Advocacy Taskforce. Summary presentation on rapid community insights assessment.
UNAIDS. The Gap Report. Source. Published 2014. Accessed December 22, 2018.
World Health Organization. Global AIDS Response Progress Report 2015. Source. Published 2015. Accessed January 3, 2018.
South African National AIDS Council. National Strategic Plan for HIV Prevention, Care and Treatment for Sex Workers. Source. Published 2013. Accessed January 3, 2018.
Maseko S, Ndlovu L. Condoms as evidence: police, sex workers and condom confiscation in Zimbabwe. Presentation at: The 19th International AIDS Conference; July 22–27, 2012; Washington, D.C.
Ngure K, Heffron R, Curran K, et al. I knew I would be safer. Experiences of Kenyan HIV serodiscordant couples soon after pre-exposure Prophylaxis (PrEP) initiation. AIDS Patient Care STDS. 2016;30(2):78-83. doi:10.1089/apc.2015.0259.