Some of these countries reported the first case of HIV infection early in the epidemic Ethiopia ; Kenya These findings point to the need to further understand the social, behavioural, biological and structural factors that place African FSWs at high risk of HIV infection and establish strategies to reduce HIV transmission in this population Stefan, Beyrer, Muessig, Poteat, Wirtz, Decker, et al.
To understand these histories, it is necessary to first recognize that there are two distinct legal frameworks in Africa in relation to sex work. In the first, sex work itself, the exchange of sexual services in kind or for monetary payment and sex work-related activities i. In the second legal framework, sex work is not criminalized, but the procurement and solicitation of sex in public places are illegal.
Senegal is the only African country in which prostitution is both legal and regulated. Currently, there is no African country in which sex work is entirely decriminalized. The lack of data and the continuing stigma surrounding women who engage in sex work make the provision of comprehensive HIV prevention, care, treatment and support for this vulnerable population particularly challenging furthermore. Currently, 28 African countries lack data on national FSW population estimates.
With very few structural interventions and a paucity of peer-led grass roots organizations, African FSWs remain highly vulnerable to HIV infection. This population is further characterized by extreme poverty and a concomitant lack of familial and social support. The lack of familial and social support and its impact on the lives of FSWs were recently demonstrated in research conducted in the large, informal settlement of Kibera in Nairobi.
Here, FSWs were compared with women of the same age also residing in Kibera who reported having never engaged in commercial sex work. As shown in Table 1 and Fig. At their current age, the FSWs surveyed reported significantly fewer male and female guardians and a significantly earlier age at last contact with guardians.
