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Breaking the Chains: Unveiling the Global Impact of HIV on Female Sex Workers in Sub-Saharan Africa.

Author: Chidumebi Judith Idemili is a PhD student of Health Systems Research with emphasis on Health Technology Assessment and Global Health Specialization at the Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health (DLSPH), University of Toronto, Canada.

This article focused on amplifying attention and call for action on the overlooked challenges of HIV among female sex workers in Sub-Saharan Africa (SSA) in plain language form that serves broader no technical audience.


Across many sectors in human development and global health, “leave no one behind“, a cross- cutting theme of the SDGs, has become a central vision to reduce inequalities and end discrimination. Therefore, it becomes crucial to spotlight the issues that affect marginalized communities and key populations such as Female Sex Workers (FSW). The World Health Organization (WHO) recognizes FSW as a group of individuals who have an unfair combination of stigma, vulnerability, and systemic neglect that subject them to a disproportionate risk of HIV1. Consequently, sex work amplifies the risk of HIV for young women in SSA, where age-discordant sex is a crucial driver of the HIV epidemic2. Age- discordant sex is when older men purchase sex or provide gifts in exchange for sex from young women. The average age of sex workers in Africa is between 25 and 30 years, and adolescent women living near areas with high demand for sex work such as in Nairobi, Kenya, South Africa3, and prevailing poverty, may have a high likelihood of entering sex work.

The WHO’s Global Programme on AIDS spotlighted the high rate of HIV among FSWs and their clients in sub-Saharan Africa in the early 1980s4. Sex workers were not just disproportionately affected compared to the rest of the general population by HIV alone but also by other sexually transmitted infections (STIs). HIV prevalence among sex workers and their clients is 10-20 times higher than the general population5. The high rates of partner change make the potential for onward transmission of HIV from an infected sex worker to their partners more than 100 times greater than from other people infected with HIV6. Sex workers who have other STIs, particularly ulcerative STIs, are more likely to transmit HIV, especially in countries where circumcision among men is not prevalent7.

Political and moralistic tensions surrounding sex work in sub-Saharan Africa have resulted in the neglect of sex workers who incidental hold a stake in breaking the HIV transmission chain within the general population. In SSA, sex work widely lacks legal recognition by political institutions, and it is morally unacceptable in many cultures. Currently, only about one in three sex workers receives adequate HIV prevention services in sub-Saharan Africa8. Fewer have access to HIV treatment, care, and support.

The confrontations with stigma

The narratives of female sex workers depict a universal struggle often overlooked or underrated. Amplifying these stories is crucial in addressing the complex challenges they face. Utilizing science and storytelling, we can dispel myths and prejudices that perpetuate stigmatization. Society tends to blame victims but learning about FSWs’ lived experiences guides attention to crucial priorities. Recognizing the multiple marginalized identities linked to stigma is vital for both health and human dignity. Unveiling layers of stigma foster empathy, compassion, and a collective acknowledgement of our shared responsibility to break chains hindering FSWs’ equitable healthcare access.

Bridging the gap with empowerment

Standing in the way between FSW and access to healthcare are daunting obstacles that must be overcome. Discrimination and a lack of culturally competent services are some of the salient obstacles. The 2022 Amnesty International report clearly expressed the urgent need to remove legal barriers and enhance healthcare access for female sex workers9. Undoubtedly, empowering FSWs through community-focused programs, evidence-driven research and robust policy recommendations as exemplified by organizations like the Global Fund, is crucial. Nevertheless, breaking systemic barriers is pivotal for equitable healthcare that ensures a future where every woman, irrespective of her profession, can be guaranteed to safeguard her health and well-being, particularly in the context of HIV prevention.


The global impact of HIV on female sex workers is a pressing issue that requires the collective efforts of communities, healthcare providers, legislators, and researchers. Society worldwide must be its ally and not the enemy, committing to eliminating stigma, empowering individuals, and ensuring access to healthcare for all. The shared responsibility of breaking the chains, ensuring equitable access to healthcare, and creating a world where HIV or sex work is not a barrier to the aspirations of female sex workers is crucial.


  1. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021: accountability for the international health sector strategies 2016–2021: actions for impact.
  2. Glynn JR, Caraël M, Auvert B, Kahindo M, Chege J, Musonda R, Kaona F, Buve A, Study Group on the Heterogeneity of HIV Epidemics in African Cities. Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia. Aids. 2001 Aug 1;15:S51-60.
  3. Aklilu M, Messele T, Tsegaye A, Biru T, Mariam DH, Van Benthem B, Coutinho R, de Wit TR, Fontanet A. Factors associated with HIV-1 infection among sex workers of Addis Ababa, Ethiopia. Aids. 2001 Jan 5;15(1):87-96.
  4. Ryan KA, Roddy RE, Zekeng L, Weir SS, Tamoufé U. Characteristics associated with prevalent HIV infection among a cohort of sex workers in Cameroon. Sexually transmitted infections. 1998 Apr 1;74(2):131-5.
  5. Nadol P, Hoang TV, Le LV, Nguyen TA, Kaldor J, Law M. High HIV prevalence and risk among male clients of female sex workers in Hanoi and Ho Chi Minh City, Vietnam. AIDS and Behavior. 2017 Aug;21:2381-93.
  6. WHO. Preventing HIV in Sex Work Settings in Sub–Saharan Africa.
  7. Mabey D. Epidemiology of sexually transmitted infections: worldwide. Medicine. 2014 Jun 1;42(6):287-90.
  8. Chersich MF, Luchters S, Ntaganira I, Gerbase A, Lo YR, Scorgie F, Steen R. Priority interventions to reduce HIV transmission in sex work settings in sub‐Saharan Africa and delivery of these services. Journal of the International AIDS Society. 2013 Jan;16(1):17980.
  9. Fox JA. International law after dark: How legalized sex work can comport with international and human rights law. Chi. J. Int’l L.. 2021;22:185.
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