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Socio-demographic, Behavioral and Health Characteristics of Underage Female Sex Workers in Mozambique: The Need to Protect a Generation from HIV Risk

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Abstract

Characteristics, HIV risk, and program coverage for underage female sex workers (FSW) are rarely systematically described worldwide. We compared characteristics of underage (15–17 years old) and adult (≥18 years old) FSW in three main urban areas of Mozambique (Maputo, Beira and Nampula) using data from three respondent-driven sampling surveys implemented in 2011–2012. Among survey participants, 9.8 % (39/400) in Maputo, 17.0 % (70/411) in Beira and 25.6 % (110/429) in Nampula were underage. Over half reported performing sex work to afford daily living, and 29.7–50.0 % had unprotected sex with their last client. The proportion of underage FSW having accessed care and prevention services was lower compared to adult FSW. While HIV prevalence among underage FSW was lower than in adults, it increased markedly with age. Our results point to the urgency of expanding prevention and care programs geared towards underage FSW.

Resumen

Las características, riesgos de VIH y cobertura programática de las mujeres trabajadoras de sexo (MTS) menores de edad raramente están descritas en el mundo. Soliamos datos de tres encuestas hechas por Respondent-Driven Sampling en 2011-2012 para comparar las características de MTS menores de edad (15-17 años) y adultas (≥18 años) en tres principales áreas urbanas (Maputo, Beira y Nampula) de Mozambique. El 9.8% (39/400) de MTS en Maputo, 17.0% (70/411) en Beira y 25.6% (110/429) en Nampula tenían menos de 17 años de edad. Más de la mitad reportó que tenía sexo por dinero para cubrir gastos diarios y 29.7-50.0% había tenido sexo sin preservativo con el último cliente. La proporción de MTS menores de edad que usaron servicios de prevención y cuidado de salud diminuyo en comparación con las adultas. Mientras que la prevalencia del VIH era más baja entre las MTS menores de edad, hubo un aumento marcado con la edad. Nuestros resultados indican la urgencia de expandir programas de prevención y cuidado de salud para las MTS menores de edad.

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Notes

  1. Comprehensive knowledge about HIV meant correctly responding to questions about the means of transmission and prevention of HIV and rejecting the major misconceptions about HIV transmission. Questions about HIV transmission and prevention where (a) people can reduce their risk of HIV by having only one sexual partner who does not have other sexual partners; (b) people can protect themselves from HIV by using a condom in each sexual intercourse; and (c) an apparently healthy looking person can have HIV. The major misconceptions about HIV transmission used for the indicator were (a) people can become infected with HIV by a mosquito bite; and (b) people can become infected with HIV by sharing a meal with a person infected with HIV. This is the first Global AIDS Response Progress Reporting (GARPR) indicator [26].

References

  1. Joint United Nations Programme on HIV/AIDS, United Nations. Global Report: UNAIDS Report on the Global AIDS epidemic: 2012 [Internet]. [Geneva]: UNAIDS; 2012 [cited 2013 Jun 26]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_en.pdf.

  2. 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. 2011;16(4):920–33.

    Article  Google Scholar 

  3. Silverman JG. Adolescent female sex workers: invisibility, violence and HIV. Arch Dis Child. 2011;96(5):478–81.

    Article  PubMed  Google Scholar 

  4. Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P, et al. A systematic review of the correlates of violence against sex workers. Am J Public Health. 2014;104(5):e42–54.

    Article  PubMed  Google Scholar 

  5. Urada LA, Malow RM, Santos NC, Morisky DE. Age differences among female sex workers in the Philippines: sexual risk negotiations and perceived manager advice. AIDS Res Treat. 2012;2012:1–7.

    Article  Google Scholar 

  6. Willis BM, Levy BS. Child prostitution: global health burden, research needs, and interventions. Lancet. 2002;359(9315):1417–22.

    Article  PubMed  Google Scholar 

  7. Instituto Nacional de Saúde, Instituto Nacional de Estatística, ICF Macro. Inquérito Nacional de Prevalência, Riscos Comportamentais e Informação sobre o HIV e SIDA em Moçambique 2009. Calverton; 2010.

  8. Mozambican Council of Ministers (Conselho de Ministros de Moçambique). Strategic Plan for the National Response towards HIV and Aids, 2010–2014 (Plano Estratégico Nacional de Resposta ao HIV e SIDA, 2010–2014). 2010 [cited 2013 Jun 26]; Available from: http://cms.nam.org.uk/site/v634849572084170000/file/1053097/Plano_Estrat_c3_a9gico_Nacional_de_Resposta_ao_HIV_e_SIDA__2010___2014.pdf.

  9. Whitman D, Horth R, Gonçalves S. Analysis of HIV Prevention Response and Modes of Transmission: Mozambique Country Synthesis. Analysis of HIV prevention response and modes of HIV transmission. 2008.

  10. Groes-Green C. “To put men in a bottle”: Eroticism, kinship, female power, and transactional sex in Maputo, Mozambique. Am Ethnol. 2013;40(1):102–17.

    Article  Google Scholar 

  11. Machel JZ. Unsafe sexual behaviour among schoolgirls in Mozambique: a matter of gender and class. Reprod Health Matters. 2001;9(17):82–90.

    Article  CAS  PubMed  Google Scholar 

  12. Hawkins K, Price N, Mussá F. Milking the cow: Young women’s construction of identity and risk in age-disparate transactional sexual relationships in Maputo, Mozambique. Glob Public Health. 2009;4(2):169–82.

    Article  CAS  PubMed  Google Scholar 

  13. De Barros JG, Taju G. Prostituição, Abuso Sexual e Trabalho Infantil em Moçambique: o caso específico das províncias de Maputo, Nampula e Tete. Maputo City: Terre des Hommes; 1999. p. 62.

    Google Scholar 

  14. Osório C, Mussa E. Violação sexual de menores: estudo de caso na cidade de Maputo : relatório de pesquisa. Maputo: WLSA Moçambique; 2011.

    Google Scholar 

  15. Selvester K, Tinga C, Marcelino C, Mahache D, Zandamela I. Vulnerability to HIV and AIDS. Sex Workers in Ressano Garcia and Namaacha Border Posts, and the Southern Transport Corridor in Inhambane Province, Mozambique. Maputo: UNFPA; 2009 Apr.

  16. INS, CDC, UCSF, Pathfinder, I-TECH. Final Report: The Integrated Biological and Behavioral Survey among Female Sex Workers, Mozambique 2011–2012 [Internet]. San Francisco: UCSF; 2013 p. 92. Available from: http://globalhealthsciences.ucsf.edu/gsi/IBBS-FSW-Final-Report.pdf.

  17. UN General Assembly. Convention on the Rights of the Child, 20 November 1989, United Nations, Treaty Series, vol. 1577.

  18. Schenk K, Williamson J. Ethical approaches to gathering information from children and adolescents in international settings [Internet]. Family Health International; 2009 [cited 2013 Nov 25]. Available from: http://dspace.cigilibrary.org/jspui/handle/123456789/8210.

  19. Kajubi P, Kamya MR, Raymond HF, Chen S, Rutherford GW, Mandel JS, et al. Gay and bisexual men in Kampala, Uganda. AIDS Behav. 2008;12(3):492–504.

    Article  PubMed  Google Scholar 

  20. Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, et al. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto men’s study. AIDS Behav. 2011;15(3):626–34.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–99.

    Article  Google Scholar 

  22. Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49(1):11–34.

    Article  Google Scholar 

  23. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.

    Article  PubMed  Google Scholar 

  24. Bagnol B, Ernesto C. Titios e Catorzinhas. Pesquisa Exploratoria sobre “Sugar Daddies” Na Zambézia Quelimane E Pebane DFIDPMG Maputo [Internet]. 2003 [cited 2013 Aug 14]; Available from: http://www.wlsa.org.mz/lib/publicacoes/SugarDaddies.pdf.

  25. Handcock MS, Fellows IE, Gile KJ. Software for the analysis of respondent-driven sampling data, Version 0.42, http://hpmrg.org (2014).

  26. UNAIDS, UNICEF, World Health Organization. Global AIDS response progress reporting 2013: construction of core indicators for monitoring 2011 political declaration on HIV/AIDS. 2013 [cited 2015 Mar 14]; Available from: http://apps.who.int/iris/handle/10665/78126.

  27. Instituto Nacional de Estatística, Ministério da Saúde Moçambique, MEASURE DHS/ICF Interational. Moçambique Inquérito Demográfico e de Saúde 2011: Relatório Preliminar (Mozambique National Demographic Health Survey 2011: Preliminary Report) [Internet]. Maputo; 2012 Mar [cited 2014 Sep 18]. Available from: http://dhsprogram.com/pubs/pdf/PR14/PR14.pdf.

  28. Gopalappa C, Stover J, Pretorius C. HIV prevalence patterns by age and sex: exploring differences among 19 countries. Calverton: ICF International; 2013.

    Google Scholar 

  29. Ribeiro C. Educational decentralization in Mozambique: a case study in the Region of Nampula. In: Daun H, editor. School decentralization in the context of globalizing governance [Internet]. Springer, Dordrecht; 2007 [cited 2014 Sep 18]. pp. 159–74. Available from: http://link.springer.com/chapter/10.1007/978-1-4020-4700-8_8.

  30. Baird SJ, Garfein RS, McIntosh CT, Özler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379(9823):1320–9.

    Article  PubMed  Google Scholar 

  31. Baird S, Chirwa E, McIntosh C, Özler B. The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Health Econ. 2010;19(S1):55–68.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. Finger C. Brazil pledges to eliminate sexual exploitation of children. Lancet. 2003;361(9364):1196.

    Article  PubMed  Google Scholar 

  34. Rekart ML. Sex-work harm reduction. Lancet. 2006;366(9503):2123–34.

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank research participants for their courage in accepting to be part of these surveys; the surveys’ field staff and members of the Mozambique IBBS technical working group for their dedication in planning and implementing the surveys; and all implementing institutions for their support at all stages of the surveys. This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) Mozambique Country Office under the terms of Cooperative Agreement Number U2GPS001468. The views expressed in this report do not necessarily reflect the views of the CDC or the U.S. Government.

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Authors and Affiliations

  1. Department of Anthropology, University of Washington, Box 353100, Seattle, WA, 98195-3100, USA

    Celso Inguane

  2. International Training and Education Center for Health (I-TECH), Maputo, Mozambique

    Celso Inguane & Isabel Sathane

  3. Global Health Sciences Department, University of California, San Francisco (UCSF), San Francisco, CA, USA

    Roberta Z. Horth, Henry F. Raymond & Willi Mcfarland

  4. Universidade Federal do Espírito Santo (UFES), Vitória, Espirito Santo, Brazil

    Angélica E. Miranda

  5. Strategic Information, Centers for Disease Control and Prevention (CDC), Maputo, Mozambique

    Peter W. Young & Beverley E. Cummings

  6. Department of Laboratory Platforms, Instituto Nacional de Saúde (INS), Maputo, Mozambique

    Ângelo Augusto

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  1. Celso Inguane
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Correspondence to Celso Inguane.

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Inguane, C., Horth, R.Z., Miranda, A.E. et al. Socio-demographic, Behavioral and Health Characteristics of Underage Female Sex Workers in Mozambique: The Need to Protect a Generation from HIV Risk. AIDS Behav 19, 2184–2193 (2015). https://doi.org/10.1007/s10461-015-1068-0

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