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Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice
  1. Michele R Decker1,2,
  2. Carrie Lyons2,3,
  3. Serge Clotaire Billong4,
  4. Iliassou Mfochive Njindam2,3,
  5. Ashley Grosso2,3,
  6. Gnilane Turpin Nunez2,3,
  7. Florence Tumasang5,
  8. Matthew LeBreton6,7,
  9. Ubald Tamoufe6,
  10. Stefan Baral2,3
  1. 1Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Comité national de lutte contre le sida (CNLS), Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon
  5. 5PEPFAR DSF Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon
  6. 6Global Viral, Yaoundé, Cameroon
  7. 7Mosaic, Yaoundé, Cameroon
  1. Correspondence to Dr Michele R. Decker, Department of Population, Family & Reproductive Health, Women's Health & Rights Program, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E4142, Baltimore, MD 21205, USA; mdecker{at}jhu.edu

Abstract

Background/objectives Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon.

Methods FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models.

Results Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78).

Discussion Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice.

  • AFRICA
  • COMMERCIAL SEX
  • SEXUAL ABUSE
  • WOMEN
  • HIV

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors Study concept: MRD, IMN, CL, GTN, AG and SB. Acquisition of data: SB, UT, ML, AG and SCB. Analysis and interpretation of data: CL, AG, MRD, SB and GTN. Drafting of manuscript: MRD, CL, GTN, SB and IMN. Critical revision of manuscript for important intellectual content: SCB, GTN, FT, ML, UT and AG.

  • Funding National Institute of Allergy and Infectious Diseases (P30AI094189). The USAID and Project SEARCH, Task Order No. 2, is funded by the United States Agency for International Development under Contract No. GHH-I-00-07-00,032-00, beginning 30 September 2008, and supported by the President’s Emergency Plan for AIDS Relief.

  • Competing interests None declared.

  • Ethics approval Johns Hopkins Bloomberg School of Public Health, FWA#0000287.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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